This I Believe - You Can Do It!

The TV was on as I was getting ready for work this morning.  One of the updates was about Robin Roberts, co-anchor of Good Morning America, who is going through a bone marrow transplant.  Talk about dignity and grace under pressure!  You do know the whole bone marrow transplant is still experimental, don't you?

I was struck by Ms Roberts' thoughts, prayers - for certainly some of her words are prayers for others, as well as herself, and belief.  Paraphrasing her words: It starts with belief.  Believe you can do it.  Believe you will be better.  Believe that you can make the necessary changes... 

She might as well have been talking to diabetics.  I won't belabor the point, but your control of diabetes, beating diabetes, starts with believing you can.  Believing you can overcome.  Believing you can beat it.  I was lucky when I was diagnosed.  My doctor told me that, "Phil, you have diabetes and there is a good chance you will be on meds for the rest of your life.  You need to lose a little weight.  And, we need to get your A1c down as soon as possible.  You are going to need to see a dietician to learn new ways to eat.  And, you are going to have to track your blood sugar.  Sugar is the enemy."

He went on to explain what diabetes was and the effect it could have on my body if I did not control it.  But, he also went on to explain that he had one patient who beat it; who is no longer taking medication of any kind and he told me how she did it.  Well, I am still pressing on toward that goal.  But, the important issue is that he made me believe that I could control the disease.  I listened, and because I am incredibly afraid of how diabetes can effect me, I took the necessary steps.

The BIG point?  I BELIEVED.  And I believe you can control diabetes, too.  I truly believe it from the bottom of my heart.  I believe you can make the necessary changes in your life - the food you eat, taking your meds all of the time, and doing a bit of exercise.  You can do it.

And, if you don't believe it, let me know, because my belief in you; my belief that you can manage the beast called diabetes is strong and deep.

You can follow Robin Roberts' progress here.

Diabetes Survival Guide!

You've been told you have Type 2 Diabetes.  Your A1c is something higher that 6.5.  So, now what?  You have three basic tools to control Type 2 Diabetes: medication, exercise and diet.  Using all three, you can control and manage the disease.  But, what in the world is diabetes?

(I have used survival guides most of my professional life.  A survival guide gives you just enough information to 'get your work done' if everything is normal and is a reference resource until you gain experience.  And, I probably should have written this a while back, but it just occurred to me that it might be needed.  Plus, it also helps that I have a number of the pieces in place to which to refer.  Could it be seredipity?)

Your doctor has told you that you will probably have to take some medication to lower your A1c.  No surprise.  The doctor wants to get your A1c down ASAP - think of it as getting the poison out of your system.  So, meds are a very normal route.  In fact, they might start you on metformin, one of the most widely prescribed drugs fo diabetics.

Dr. K has written about metformin, and you should read it to understand the drug and  how it works.

But, what if you don't want to take a medication?  Well, there are those who decide they want to control diabetes through diet and exercise - and some are successful!  Some control and beat back the disease through the diet and exercise route.  But, the number who are successful is limited - very limited.

The first goal is to get your A1c down as soon as you can.  You can always stop taking meds if you see your numbers dropping and getting an A1c under 5.5; there is no rule that states you have to take them forever.  This is a decision you should make after talking with your doctor.  So, think about taking the medication.

For me, it was a no brainer.  I knew diabetes could cause serious damage and could lead to death.  I chose to take the meds to get myself back to 'normal.'  Diabetes normal is not good enough for me.  Normal is normal is normal, even if it's done with the aid of medication!

Regardless if you are taking medication, or not, you should start to exercise.  Read about my post on exercise to get a beginning point.  I still just walk, but a lot faster than I did at the beginning.  If you are going depend on exercise to gain more control, you will need to use cardio exercise and resistance training (aka weightlifting).  And, plan to spend about an hour a day, five or six days a week of exercise time if you have the weights at home.  If you go to a gym during a busy period, figure at least two hours a day.

You are going to have to start glucose testing at least twice per day.  Most of the instruction I have seen is either incomplete, or really cause pain.  For complete instructions on how to get a good reading without pain, read this.

And, you are going to examine your diet. Chances are it will change.  Mine did - a lot.  I started a lower carb diet and over the course of nine months I lost about 60 pounds between diet and exercise.  Diet is so very, very important as you work to control diabetes.

And, to bring it all together, I have strongly recommeded a food diary.  Keeping one was so helpful in the beginning as I was lowering my A1c - it told me what I could and could not eat if I paid attention to my meter readings.  The food diary continues to be a tool for success and something I go back to when I see my numbers creeping up.  You can read about it here and then download it by following the instructions in the post.

Just so you know, I started my diabetes journey with an A1c of 13 - that's pretty high.  My most recent test gave me a 6.1.  Blood pressure 114/80.  Weight seven pounds up over a year's time, which I am losing - I got a bit cocky when I had a test result of 5.9!  I lose the weight, keep up with my diet and meds, and I should be at about a 5.8 or lower when tested again.  I mention all of that just so you know I have first hand knowledge of what you are facing - and KNOW you can be successful!

As always, thank you for reading.  God Bless and know you can beat the enemy; you CAN control diabetes.

Please feel free to send me your comments.

What is Diabetes?

I assumed anyone reading this blog would know what a diabetic is, but I could be wrong.  So, just what is diabetes?

Diabetes is a disease that is caused by too much glucose (sugar) in the blood.  You see, for all of the different types of abuse our bodies survive, they are really pretty delicate chemical factories where thousands of reactions are going on every moment of our lives.  If they get out of balance, there can be problems.  One of them is diabetes.

Diabetes occurs when there is too much sugar floating around in your blood and not enough in your blood cells.  This happens because insulin, which the pancreas produces, is  not working like it should, or is in pretty short supply.  Think of it this way, insulin is a key to a door in the cell wall.  If everything is working right, insulin comes along, opens the cell door and sugar enters the cell and leaves the blood.  All pretty simple, right?

But, in diabetics there is either not enough insulin, or the insulin is not working correctly.  If sugar can't get into your blood cells, then it's floating around in your blood causing all kinds of havoc on your organs - not good at all!  Which is why it's really important for a diabetic to control the disease - because it can to lead to so many other problems.

So, now you have a basic idea of what diabetes is.  And, you know that it's caused by an insulin shortage of some kind.  Which will all make even more sense as you read Dr. K's description of the various diabetes drugs being used today and what they seek to do.  Go back and read her post on Metformin - it will make more sense.

This article provides a decent overview of diabetes and how to deal with it in general terms.  Remember, as you battle to control diabetes, not everything will work the way researchers say it will because they deal with large numbers of folks and do not know you or your body.  Your body chemistry might be different, so you will find a lot of guidelines, but fewer hard and fast rules.  The car manufacturers have a phrase for this kind of difference: "Your mileage may vary."

Your fight with diabetes is a personal fight - one that you must win...and CAN win.  I know you can do it.  I know you can beat back and beat down the disease and have a wonderful life.  I know it. My goal is to help you find the tools you need to win the battle.

You can read more about what makes a diabetic here, on a previous post.

As always, I welcome your comments.

What is a Diabetec?

During the last few days I have noticed questions coming in about what defines being a diabetic and thought I should take a moment and provide a definition.  Keep in mind that this is not my definition, but based on the definition provided by the Center for Disease Control (CDC)

Also, I offer my apology. I probably should have started with this.

The CDC describes diabetes as:

Diabetes is the condition in which the body does not properly process food for use as energy.  Most of the food we eat is turned into glucose, or sugar, for our bodies to use for energy. The pancreas, an organ that lies near the stomach, makes a hormone called insulin to help glucose get into the cells of our bodies. When you have diabetes, your body either doesn't make enough insulin or can't use its own insulin as well as it should. This causes sugars to build up in your blood. This is why many people refer to diabetes as “sugar.”

Diabetes can cause serious health complications including heart disease, blindness, kidney failure, and lower-extremity amputations. Diabetes is the seventh leading cause of death in the United States.

That's a good description of diabetes, but to make it even more simple when you have diabetes there is too much glucose (sugar) in your blood.  That, folks, can lead to some serious problems if left untreated. You can read the complete article here.

The amount of sugar in your blood is measured through an A1c test which measures the average amount of glucose in your blood over the last approximately three months.  If you are interested, take a look at what the ADA has written about A1c tests.

What do those readings mean?  Well, normal (for those who do not have diabetes) is between 4.5 and 6.0.  Prediabetes is defined as having an A1c between 5.7 and 6.4.  If you test 6.5, or higher, on two tests, you probably have diabetes.  Just so you know I am not making this up,  take a look at what the Mayo Clinic writes about A1c test results.

To put this in perspective, when I was diagnosed with diabetes, I had an A1c of 13 - kind of high.  Okay, very high and in every 'red' zone I have ever seen.  Three years later my A1c results are routinely between 5.9 and 6.1.  So, I know diabetes can be fought and controlled first hand.  And, I know you can do it.

So, if your A1c test results are between 5.7 and 6.4, you are probably being told by your doctor you have prediabetes, so take action and beat it!  Beat it before you are told you have diabetes.  If above 6.5, your doctor is probably telling you that you are a diabetic - now, you really have to take action.

What action do you take? Change your diet. Take your meds. Exercise 30 minutes a day.

You can beat diabetes.  You can control and manage it.  Do not let diabetes manage you!

As always, thank you for reading.  I wish the very best life for you.

Let's Start at the Very Beginning: Classes of T2 Diabetes Medications

For my first post, I'm going to give a brief overview of the various classes of medications used to treat type 2 diabetes.  Within our bodies, blood sugar levels are controlled by various mechanisms.  This is a good thing, because it allows us to "attack" diabetes from various angles. 

For any of you footbal fans out there, you could compare this to what your favorite coach does.  In order to gain yards and score touchdowns, do they always use the same plays for every team they encounter?  Of course not!  Some plays are more effective against different defensive lines, and all circumstances can change from one snap of the football to the next.

This is the same when it comes to treating diabetes.  Every person is unique and has their own body chemistry.  This is the same reason why an allergy medication might work well for one person, but not another.  Pharmaceutical scientists have studied these differences and have developed a wide variety of drugs to treat the causes of high blood sugar (glucose) at every stage.  In future posts I will breakdown each of the currently available type 2 diabetes medications and give you the "need to know" information.  But for now, let's start with the basics.

Biguanides

Don't let this name intimidate you.  Biguanides, like most other classes of medications, are simply named for the molecule that is part of their chemical structure.  In fact, to make things even simpler for you, the biguanide "class" of medications only contains one diabetic medication.  One!  Metformin, a drug that most type 2 diabetics are very familiar with, is the only biguanide currently available in the US that is used for diabetes. 

Biguanides use a few methods for lowering blood glucose levels.  The first method is by making the cells of your body more sensitive to insulin.  If you are unfamiliar with it, insulin is the hormone made by your pancreas that is responsible for "pushing" glucose into your cells.  More glucose in your liver, muscle, and fat tissue = less glucose floating around in the blood.  Too much glucose in your blood, and not in your cells, is what causes diabetes.  In type 2 diabetics, the body starts to not respond to insulin as well as it should, so metformin helps the cells "recognize" insulin again.

The other way that metformin lowers blood glucose levels is by decreasing the amount of glucose produced by the body.  One of my pharmacy professors liked to use the phrase "the liver is a giver."  Your liver is responsible for a wide variety of functions, among which is production of glucose.  During times of fasting or starvation, the liver does this to prevent dangerous drops in blood glucose.  But in diabetics, the extra glucose is not necessary, so metformin stops this.

Another exciting thing about metformin is its ability to produce small decreases in cholesterol.  This is something that I will discuss in future posts.  As you will see, this is uncommon and part of the reason why metformin is the go-to medication for new diabetics.

Sulfonylureas

Another long name based on a chemical structure.  Glyburide, glipizide, and glimepiride are the most well-known students in this class.  Compared to the two different mechanisms of action of the biguanides, sulfonylureas do not provide as much "bang for the buck."  Their main action comes from the ability to stimulate the pancreas to release more insulin.  This causes glucose to enter the cells, decreasing the amount of glucose in the blood. 

Meglitinides

This is a category of medications that we see used much less commonly than the two previously mentioned.  The two meds in this group are Prandin and Starlix, which are currently only available in their brand name form.  Meglitinides are essentially the same as sulfonylureas, except they don't contain a sulfa molecule.  This is important for our patients with sulfa allergies.  They work the same way as the sulfonylureas (increasing insulin release from the pancreas).

Thiazolidinediones

Sometimes you wonder if we are making these names up, don't you?  It's pretty obvious why we abbreviate this class to the term "TZD".  The two current TZDs available in the US are Avandia and Actos.  The main effect of these medications comes from the ability to sensitize the muscles, liver, and fat tissue to insulin.  This allows more glucose to enter the cells and leave the blood stream.  They also show some effectiveness in decreasing the amount of glucose that is released by the liver.

Alpha-Glucosidase Inhibitors

This is a newer class of medications that contains the drugs Precose and Glyset.  Maybe this shows my "nerdy" side a bit, but I find the mechanism of this class to be quite exciting.  Alpha-glucosidase inhibitors work in the small intestine by delaying and preventing complex carbohydrates from being absorbed from what you eat.  This means that the carbohydrates don't enter the bloodstream, and your after-meal (postprandial) glucose readings are much lower.

DPP-4 Inhibitors

Januvia, Onglyza, and Trajenta are the current US available medications in this category.  These medications cause insulin to be produced and released by the pancreas as blood glucose levels rise.  They also decrease the production of glucagon, a hormone that causes the body to break down glucose storage units and dump glucose back into the blood when blood glucose is too low (during periods of fasting or between meals).  Finally, DPP-4 inhibitors improve the function of beta cells in the pancreas, which allows them to better produce the insulin that is needed to keep blood glucose levels at normal levels.

Insulin

Most people are familiar with the use of insulin in type 1 diabetics.  They require insulin because their bodies are no longer able to produce it.  However, insulin is also used as a very effective treatment in type 2 diabetics when oral medications and lifestyle changes are not effective enough at lowering blood glucose. 

I have already discussed insulin a bit within the other drug categories, but let's cover it as its own category, to be thorough.  At low levels, insulin causes the liver to stop producing glucose.  As you increase the insulin dose, that causes the muscles in your body to start taking glucose out of the blood.

Insulin is categorized based on how fast it starts working in the body, and for how long it works (rapid, intermediate, or long acting).  In a future post I will discuss the different types of insulins and injection regimens, but for now this is a good place to start.

Incretin Mimetics

The injectible drugs Byetta and Victoza are the two drugs currently within this category.  These medications work to lower blood glucose by increasing insulin production in response to high blood glucose levels.  They also are unique because they stop glucagon (mentioned earlier) from being released after you eat. 

Other ways that incretin mimetics work to lower blood glucose are by improving the function of beta cells in the pancreas (responsible for making insulin) and causing a feeling of fullness (making the patient eat less and lose weight).

Amylin Analogs

Currently the injectible drug Symlin is the only amylin analog.  Amylin is a hormone that is released by the body, with insulin, to control glucose levels after you eat.  In diabetics, amylin levels are too low.  Symlin acts like amylin in the body; it causes glucose to be absorbed into the body more slowly from the food you eat and also makes you feel fuller faster, leading to less calories eaten and more weight loss.


---So there we have it, a basic overview of the many classes of medications available for treating type 2 diabetes.  In my next series of posts, I will discuss each medication individually, and give you the most important "need to know" information.  As a reminder, every diabetic is different.  I will continue to present information in a general format, but always consult with your personal physician and pharmacist before making any changes in your medications.  I invite you to feel free to ask me any questions you might have regarding diabetes and medications.  Eventually we might have a section of "frequently asked pharmacy questions" in which I answer your questions or address things that I've read about or been asked within my practice recently.  I'm here for you, as a part of your virtual care "team."  Feel free to help me customize my posts to help your needs. 

Dr. K, PharmD

Some Days I Just Don't Want to Do It!

I got up this morning and I just did not want to deal with diabetes.  I did not want to take any meds.  I wanted to eat waffles, pancakes, bacon, sausage, muffins...well, just about anything I shouldn't eat.  Oh, and I wanted syrup; real maple syrup.  Ever have a day like that?

So, what did I do?  I opened the cabinet where my meds are all laid out for a week in a pill box (so I am sure if I take them, or not - more on that at some later date), and I closed it again without ever taking the meds out.  

I looked around in the kitchen for breakfast food.  Thought about going out for a minute.  I could just taste donuts!  I did not want deal with diabetes...just did not want to.  

Then, I leaned against the counter.  Gave it a little thought.  Took a deep breath.  And, went about making and eating my breakfast, and then taking my meds.  You see, I am more committed to my health and being around for grand-children and (God willing) great-grand-children than I am to maple syrup, waffles, french fries or donuts.

I know it's not easy.  I know it's not easy to never have (or have very, very small portions of) the foods you really love.  Of course, I don't know about you, but between not exercising and having way too much of the foods I love is what got me in this position of having diabetes.  

My point is that sometimes it's an act of will to do what's right for you and your body.  Why do you think I refer to the fight against diabetes as a battle; a fight; gaining control? Because that's exactly what it is and for some of us it's a daily fight meal-by-meal.

You can fight and win.  You can control diabetes.  It's a tricky opponent, but the alternative of not fighting is possibly a loss of a foot, dialysis, and perhaps even death.  When I think about it in those terms, the fight becomes a bit easier.  And, there are others who would be effected if I didn't do the things I have to do to keep diabetes controlled.

You can win this fight.  Day-by-day and meal-by-meal.  Don't give up. Don't give in.  Be victorious!

As always, thank you for reading.

You Can Win the War...You Can Be In Control!

I have found there is so much in life I really can't control.  If you work, there are aspects about your job you don't control.  If you are married, do you think you can control your spouse?  Can you control how much homework a teacher might assign?  Heck, I can't even control how long it takes me to drive somewhere due to traffic.  Think about it.

There are so many health related concerns you can't control.  Cancer.  A failing back.  Even getting a cold is something we can't seem to control.

But, there is some good news - YOU can control diabetes.  I know I have hammered this home before, but it's worth doing again and again.  You can control and manage diabetes.  What does it take?  A few simple steps.

Form you team.  The best way to fight diabetes and win the war is to have an engaged team.  Your team should include your doctor, pharmacist and you.

Take your medication.  This is so simple.  Do not miss a dose.  Take what your doctor prescribes, when he prescribes it to be taken, how it's prescribed to be taken.  This is such an easy step.  But, in order to take your meds, you have to have them.  My pharmacist tells me about 30% or prescriptions that are filled don't get picked-up.  30%!  Please, be part of the 70% and pick-up your medication so you can take it.

Diet.  And, by diet I mean what you eat.  This probably has to change.  My big diet change was to limit the carbs I would have during a meal to 55 to 60 carbs.  This means eating different foods and less of them.  As I look back, I must have been having 150 to 200 carbs per meal.  No wonder I am a diabetic. Now, I normally have about 50, and sometimes less.

Let me tell you that a lower carb diet helped me to lose about 60 pounds and dropped my sugar levels.  I went from an AIc of about 13.0 to 6.1.  My lowest A1c was 5.9 - so I know it's attainable and it my next goal.  That will probably require a change in my diet to both low carb and low fat (basically it means I will have to start counting calories).

Exercise.  I can't stress this enough.  There is something about exercise that makes it easier for your blood cells to receive sugar - glucose.  And, what will that do?  Lower your daily glucose reading!  And, you will lose more weight if you exercise than if you just try to do it by reducing what you eat.

Form your team.  Take your medication. Change your diet and realize it will be a way of life. And, exercise.  You will be on your way to controlling diabetes instead of it controlling you.  You really can do this.

A great way to get started is by downloading and using the Food Diary Plus to act as a reminder and keep track of your progress.

I know, that was a shameless plug, but it's your Food Diary that will form the basis for your fight.  You will gain so much information and will know how your body is responding.  And, it's a great way to keep track of what you eat and the effect it has on your blood sugar.

Are you ready?  You can battle the disease and win your war with diabetes.

Fight on!

A Test You Can't Fail - Part Four - What Does it Mean?

You have done your tests and have your results.  What in the world do they mean?

First, understand that while your numbers will fluctuate, the ADA refers to ranges.  The American Diabetes Association has a good article on glucose levels.  Again, because I love simple, think in terms of the following ranges as goals to achieve:

Fasting Glucose Test - This is your first test of the day: 70 to 120 is the target range.  This range is the goal.  The Goal.  You may not be seing these numbers.  I remember my first test in the middle of the day about 30 minutes after I had lunch.  My number was over 300.  I had no clue what that meant.  Now I know it was way, way, way too high.  My first morning reading was 297.  Again, very, very, very high.  Now my morning readings are 85 - 95.  Rarely do they go above or below.

As I started my way to gaining control over diabetes, my morning readings started to come down 10 and 20 points a day.  Sometimes they went up from one day to another, but I was learning what I could eat and not eat.  But, when you look over a week's or month's time period, there was a downward trend.  These morning readings are a great indicator of where you are in your battle to control the disease.  If you are only going to test once a day, this is the one to do.

Evening/Night Test - This one was a challenge for me.  Think in terms of a range of 110 to 140.  I, again, want to stress I am not a doctor, this is just what I found to be about right when I test at night as I was gaining control.

Diabetes control is a journey - remember that.  When I first started testing at night after I started medication, I was happy to see anything around 160.  Due to eating changes, exercise and medication, that number came down pretty quickly to around 130.

I just did a test and found that I was at 91.  I ate about 2.5 hours ago - so it was low even for me.  Most of the time I my tests show 95 to 125 - there are a lot of variables such as what did I have for dinner, how long ago it was, and have I had anything to eat since dinner.

After Eating - This test is done two hours after you start eating a meal.  This is important enough to repeat - two hours after you START a meal.  For me, start means when I take my first bite.  The goal here is less than 180 for a Type 2 Diabetic.

You can control diabetes.  You really can.  I know in the beginning it might not seem so easy, but it's all about a series of choices.  The better choices lead to control and lower test numbers.  Other choices lead to higher results.  But sometimes you don't know how certain foods will effect you.  sure, there are guidelines, but we are all different.  You only learn how a food will effect your body after you eat it - and you learn through testing.  If you get a higher number, it's a food to avoid.

I started with very high numbers - VERY high.  Through diet, exercise and medication I am controlling the disease.  Do I miss apple pie, french fries and cheese cake?  Well, yeah.  But, I want control of the disease because I have respect (fear) of what it can do to me - the complications can be severe.

Remember, you cannot fail this test; you can only fail to test.  Even getting a high number provides a lesson.  If you are just starting treatment, you want your readings to trend down.  If you have been under treatment for awhile, you want fairly level readings near or in the normal range - at least that's the goal and it's one that is attainable!

Here is a good article from Diabetes Self-Management on glucose levels.

Don't let diabetes win. Battle and control it!  You can do it...I know you can.  Keep your food diary and learn from it.  If needed, lose weight.  Take your medication.  And, TEST.

Helpful Folks - Diabetes Writers - Part Two

I read other blogs several times a week to learn what others are writing about and I ame across another blog that is helpful: http://www.diabetesselfmanagement.com/. Rather than having a single author, there are multiple authors providing several points of view on different topics with the one goal of helping you manage diabetes.

So many tips and great information.  I especially like Amy Campbell's series on how to prevent diabetes.  You know, not only are they great steps to take to prevent diabetes, they are a good guide for treating diabetes: Eat less and exercise.  There are direct links to her other diabetes prevention articles at the bottom of her entry.  But, to keep it simple, and you know I love simple, here are the other posts:

Preventing Diabetes: A Window of Opportunity
Preventing Diabetes: Steps You Can Take
Preventing Diabetes: More Steps You Can Take

Continue to fight diabetes.  Remember, your life is not defined by the disease; it's only a part of your life.

The Ultimate Diabetes Book

When I was first diagnosed with diabetes I tried to find one book that would tell me how to manage and control the disease.  In order for me to save you time, let me tell you, there isn't one.  Why not?

I really wanted to find that ultimate guide.  That one book I could refer to over and over and over that would guide me through the pitfalls and dangers of diabetes.  Oh, I looked.  At my local bookstore.  On Amazon.  Google Books.  Just about any where I could think of to look, I looked.  I reviewed a lot of books to find out none of them offered solid guaranteed-to-work steps.

Don't misunderstand me, there are some great books for understanding diabetes and they offer guidelines on what you can do.  And, in some future blog, I will list some of the ones I found helpful.  But, there is no one-size-fits-all book.

I even toyed with the idea of writing one, but did not know enough.  I mean how hard could it be?  You have diabetes?  This is what you do.  Wrong.  And, now, I know I can't write a guide for you.

I was wrong because we are all different.  Blame it on our body's chemistry.  What works for me may not work for you; or will be less effective.  There is no single diet - for which cookbook writers and publishers are thankful.  No single medication - do you think drug companies are happy about that?  Of course they are!

There can be strategies for victory.  There can be guides.  But no one way works for everyone.  It's just a fact of life.  And, why this blog is called Solutions for Type 2 Diabetes.

I have told you about my food diary.  In it I wrote down everything I ate or drank, exercise and glucose readings.  Not only do you become more aware of what you are putting in your body, you are charting your body's response.  Morning glucose reading goes up - not so good.  Morning reading goes down or is where it should be - good, keep doing what you are doing.

What you are really doing is creating The Ultimate Diabetes Book for yourself.   So, it seems as though I was wrong.  There is one Ultimate Diabetes Book and you create it for yourself.  It doesn't get any more custom that that!

I learned very quickly what I could eat and what I couldn't eat.  It's right there - in 'black and white.' How long does it take each day?  If you really stretch it out - five minutes, maybe.  Even now if I see a higher glucose reading than I think should exist, I re-start my food diary immediately.  Within a day, and sometimes sooner, I can see what the problem is and fix it.

Notice, this is my diary I complete - nobody else can complete it.  You have to take responsibility for your care and this is probably one of the single best things you can possibly do.

You are creating your own reference piece that will guide you, the owner and operator of your body, to control of diabetes!  You can do this.  You can keep a food diary and by doing that simple step, you will be working to manage and control your diabetes.

This is really, really important to do.  It will take less than five minutes a day - that's all.  Five minutes a day to create The Ultimate Diabetes Book for yourself.  In 30 or 60 days you will have your own book completed.

What do you list?

1. Your morning reading.
2. Your morning weight (I had to lose weight, so I listed it.)
3. Everything you eat or drink by meal or snack.
4. Exercise - length and what you did.
5. Evening reading.
6. Medication
7. Repeat for 30 or 60 days.

It really is easy and incredibly useful. 

You are going to win your battle with diabetes.  You will control and manage it.  Start by writing your own Ultimate Guide.

As always, thanks for reading!

A Test You Can't Fail - Part Three - How to Test

During the last few days I have been reading instructions on various sites about how to test using a glucose meter.  Most of them are pretty good and get the high points really well.  However, there are a few things they miss, which can make all of the difference in the world when testing.  So, here is the process I follow for testing.

When do I test? I test when I first get up in the morning before I eat or drink anything except water, and then at night before going to bed.

The steps I always follow are:

1. I wash my hands carefully using plain soap; soap without any fragrance.  I found scented soaps would effect my readings - make them higher.  The last thing I ever need is a fasle higher reading.
2. Dry your hands using either a clean hand towel or paper towels.  I use paper towels because I know they are not putting anything on my fingers.  If you paper towels are scented, do not use them.  (Heck, I don't even know if scented paper towels are made, but I thought I'd hammer the un-scented thing one more time.)
3. Give the hand you are going to test on a few shakes to get blood into the tips of your fingers.  This might be more important for you to do in the morning than the evening.
4. Get the lancet ready.  Do whatever you need to do like inserting it, or cocking the lancing device.  Just make sure it's ready to go.
5. Insert a test strip into the meter.  For me, the insertion of a strip turns the meter on, so I have never had to physically turn a meter on with an extra step.
6. Lance the side...the side of your finger.  It's less sensitive than your finger tip.  I have no clue why every picture I have ever seen of someone lancing their finger shows them using their finger tip.  It hurts far more than using the side of your finger.  In fact, I don't even feel the lance about 50% of the time on the side of my finger.  By the way, I have used one of two fingers on the same hand for the last few years - I don't vary it.  Do what's best for you, though.
7. Squeeze your finger a bit so a drop of blood appears.  It doesn't take much to test - far less than a drop.
8. Apply the testing strip to the drop of blood.  It will pick up the blood it needs through capillary action.  Be careful not to touch your skin with the strip - it could pick-up contaminants that will effect the reading.
9. Rinse the blood off of your finger as your meter gives you results.
10. Dispose of the lancet properly - in a medical sharps container.  DO NOT put it in the trash.
11. Dispose of the testing strip in the same manner.
12. Record your reading on your log.
13. Put your meter and supplies away.

I know supplies can be a bit pricey, but use lancets and strips only once.  That's important so I will repeat it - use lancets and strips once and then discard properly.

You have done it!  You have taken the test you cannot fail.  But, will fail in your battle on diabetes if you do not test!

There are so many meters on the market, that I won't get into any one brand right now.  If you do not know what your meter is capable of, or the information you can gain from it - learn.  Read the directions that came with the meter, or find them on the internet at the manufacturer's site.

As always, thank you for reading.  Fight the good fight and you will win your war with diabetes.

"Victory is always possible for the person who refuses to stop fighting." ~Napoleon Hill

"Be kind, for everyone you meet is fighting a hard battle." ~Philo

A Test You Can't Fail, Part Two - The Dawn Phenomenon

Remember, you cannot fail your daily glucose test; you can only fail to test!  There is so much more to testing than we are sometimes told, I am going to have to make this a three-parter.  This entry is about the Dawn Phenomenon - a topic every testing diabetic should know about.

You are doing your twice daily tests - maybe even more often.  One of your tests should be in the morning after you get up and before you eat or drink anything.  This morning test theoretically provides a fasting glucose reading - provided you have not had a midnight snack.  If you have a midnight snack, it will likely elevate your glucose, and it will show up in your morning reading. Common sense, huh?

And, you are keeping a record of your test readings, or they are being kept in your meter.  Over a few weeks you see them go up anywhere from 10 to 20 points.  Why?  Welcome to the Dawn Phenomenon (DP because it's easier for me to type).

 The DP happens sometime in the early morning.  For me it's sometime after 6:00 am - others might find it happening earlier or later.  What does it do?  Well, it's your body's response in getting ready to get up and moving - it releases some sugar to get you going.  Why does that matter?  Your blood sugar reading goes up and does not provide an accurate morning reading.  So, if you test before it happens, you get a lower score; if you test after, your reading will be higher.  There's not a whole lot you can do about it, either.  It just happens.  I will tell you that I try to test in the morning before 6:00 so I see my lowest reading.  Want to know more about DP - read it here.

I learned about the DP because my late night readings were suddenly higher than my morning readings.  I couldn't figure it out.  I thought it was my meter.  I was wrong.  It seemed that I was testing a bit later in the morning AFTER the DP had taken effect.

All you can do is to just be aware of the DP and how it might effect your readings.

That you are testing at least twice a day is great - good job!

A Test You Can't Fail, Part One

The whole idea of having to test my blood twice everyday was a huge challenge to me...just the idea of lancing my finger to get a drop of blood kind of made me a bit scared.  Looking back on it, I don't know why it was like that, but it was.  I just did not want to prick my finger.  Why make yourself bleed?

Why indeed?  Well, first, I have to tell you that pricking my finger was no big deal.  Yes, there is a bit of pain, but if you read the directions on how to use your glucose meter (which I strongly suggest you do), you will learn where to use the lancet so it really isn't painful.  I won't kid you, there is just the tiniest bit of discomfort once in awhile.  But, if you prick the side of your finger - yes, the side, and not the tip, you may not feel a thing.

Wait, that's important enough to repeat - prick the side of your finger!  Somewhere between no pain and very, very, very little pain.  Got it?

And, while I am at it - you only need a little drop of blood.  The scientists have figured out how much you need to give up and it varies from meter to meter.  For me, it's just a bit bigger than the head of a pin.  I'm serious.

Meanwhile back at glucose testing - which is what you do at home with your meter - it's suggested that most Type 2 Diabetics test twice a day.  Once in the morning just after you get up and then once at night before bed.  That's it.  Twice a day.  Now, when I was just figuring things out in the beginning, I was fortunate because my doctor prescribed enough strips and lances so I could test three times a day.  The truth is sometimes I tested three times, other days two times and sometimes even four times a day as I was learning how to manage diabetes.  I got so much good information from doing this.

I tested in the morning, before lunch, two hours after lunch or dinner began, and at night.  I knew what my body was doing when; I knew about what my glucose reading would be within 10 points after a few months even as it was going down and stabilizing.

What did I do with this information?  I wrote it down in my food log.  Learning what I ate and seeing my reading gave me invaluable information and immediate feedback.  I very quickly learned what I could and could not eat.

For example, some folks can eat wild brown rice.  Not me.  Any rice no matter the color or type causes my readings to go up.  And, I loved rice!  But, I learned that if I wanted to control diabetes, rice did not love me and became a 'has been' in my diet.

then, again, I learned that a basic (stressing the word BASIC) hamburger really didn't hurt me.  You know the kind - a basic hamburger from In N' Out.  Not a lot of dressing and the bun is not huge.  Although, I found that any number of french fires - any number - were off my menu.

How did I learn this?  By frequent testing and comparing the results to what I ate.  Recording everything - food and test results in the food diary helped me so very, very much to begin to gain some sense of control.

The message here is clear, I hope.  Test.  Test often  Keep a food diary.  And, use the results to learn how to best manage diabetes.  That is the first step to gaining control.

Remember, to manage diabetes you have to give yourself a glucose test at least twice a day; more often during the first few months if possible.  It's a test you cannot fail, but you will fail to manage diabetes if you don't test.

RAKs, You and Diabetes

You know it's so easy to become self-absorbed in how you are dealing with diabetes.  Just a reminder - diabetes is not your life.  It's a part of your life that you must manage, but it does not define you.  Look, chances are pretty good that your grave stone will not read, "Here Lies A Diabetic," right?

So, how do you insure you keep your life in perspective?  Look outward.  See what you might be able to do for others.  There are so many folks who just need a bit of help - and you can give it to them if you watch for opportunities.

Think about doing a weekly random act of kindness (RAK).  A RAK can be spontaneous and is almost always an easy thing to do by it's very nature.  The great thing is that it is totally unexpected by the receiving party.

What qualifies as a RAK?  Well, the list is endless, but a few ideas might include:

1. Helping someone carry a box.
2. Offering to do a simple errand.
3. Buying the next person in line's coffee or even lunch.
4. Getting someone a simple gift just because - just make sure it's something small that they will use. (Example: I know someone who loves pink.  I happened to see a pink pencil, got it for them and put it on their desk.)
5. Reaching for a product in a store for a person who is too short to get it.

What do most of these have in common?  You have to be watching and be observant.  You would be surprised at how many opportunities you have to do little things for others everyday.  And, if you are looking outward, you will be too busy to be centered on your diabetes.  As a result, you will be happier and probably more successful in your war on diabetes.

Helping others and helping yourself - does it get any better than that?  I don't think so.

A RAK a day will keep diabetes at bay.  Okay, that might not be 100% right, but it rhymes. I know it won't hurt you to brighten another's day.  There is a power in a RAK that is incredible and life changing - discover it for yourself.

I'd sure like to hear about any RAK you do.  Remember, it's not the size of the act, but the fact you acted that will transform.  

You can read about RAKs here...it's uplifting and inspiring.

New Numbers!

I just came back from dinner with my in-laws.  Okay, is that blog worthy?  Probably not.  But I never, ever thought I would spend a meal talking about doctors, lab tests and other medical odds and ends.  Never in my wildest imagination (and I can imagine a lot!) did  I ever see myself talking about medical issues during dinner.  But, we did and it seemed okay to do so.  In fact, there were several times when we laughed pretty hard. 

Did you notice my great segue into lab work and medical stuff, there?  Should I repeat it so you can enjoy it again?  Don't worry, I won't do it.

I have just gone through my semi-annual lab work and my report card came back.  I won't bore you with cholesterol numbers, because you don't really care about those.  But, in the spirit of transparency I will tell you two numbers.

Blood pressure is 114/81.  And, A1c is 6.1.  That A1c is not great by a lot of diabetic's standards, but it means I am managing the disease pretty well.  Can I get a bit lower?  Yes - my goal during the next six months is 5.8.  I am developing a plan to meet it and will share it with you when I have the plan finished. 

I mention this because I consistently see room for improvement in what I do and how I do it.  And, if I can do it, I know you can, too.   It's a matter of setting a goal and making a plan to achieve that goal.  The steps are pretty simple.  In fact, you probably already know what to do.

1. Set a realistic goal.  
2. Develop a plan to achieve that goal. 
3. Then, follow your plan. 
4. Monitor your progress.

Simple, huh?  It really is and can lead to your triumph over diabetes.  You can, and will, win the war.  Does it get any better than that?  Not in my little world.  I want everyone to know they can win the war and control diabetes.

In the next blog I will take a look at these steps.  Tune in tomorrow for the exciting conclusion to New Numbers!

And, as always, thank you for reading.

A Smile Can Help Win The War

As you know I take diabetes very seriously; I have a "take no prisoners" attitude.  But, I have found a little laughter once in a while can go a long way in winning the war.  Hope you enjoy.

Diabetes Week Two

I made it through the first week of diabetes.  My life changed in the same way you turn a light on - within a moment.  Was I still scared?  Oh, yeah.  In fact today, almost three years later I am still scared of diabetes if I was being completely honest.  I have a deep and abiding respect for what the disease can do if not managed and controlled.

The good news is that it can be controlled with a bit of effort which was my big "AHA!" during Week Two.

Anyway, back at Week Two.  I had begun to take my meds - Metformin twice a day 1.000 mg each time.  Pretty standard starting treatment.  And, it was just the Metformin.  I know many may have two pills to take, which for some proves to be very effective.  It's kind of like a one-two punch and when you are in a war with diabetes, you want to throw as many punches as possible to get your glucose, and subsequently your A1c, down somewhere in normal range.  If you need to see the a chart for A1c values and how they compare to your blood glucose readings, look here for a pretty easy to read chart.

Remember not to use one reading, but look at your average reading.  Even then, it depends on when you take it.  More on that at some point in the near future.

Again I got a bit side tracked.  Week Two - I had begun my walking.  Every evening for 30 minutes.  I know I have written here before I don't like exercise, but we were talking about my life here.  So, that walk became one of my best friends.  I didn't try to walk fast or go very far at first.  I used shoes that were about five or six years old and just walked.  One foot in front of another.  For 30 minutes - which seemed like forever the frist few days, but by the time Week Two started, the time seemed to go a little faster, but not much.

And, I was getting more ideas of what I could and could not eat.  Think about it, we get near immediate feedback with our glucose readings.  If it's not the right food, up it goes.  If it is the right food, it dips a little bit.  Take your readings twice a day, more often if your doctor will authorize it, so you will know what your blood sugar (glucose) is doing.  You should be on a steady downward trend.  And, keep a record of your readings as well as diet (everything you eat and when) in a food diary.  You will really learn what is working and will be able to spot trends faster.  If you spot the trend, you can make adjustments.

Me?  I just liked seeing the numbers go down.  I started with seeing glucose numbers of 300+.  It was an exciting morning when I hit 297.  During the second week I saw it get down to 275.  I was making progress!  Fear was gone because I was taking action.  I knew the meds would not make me go too low - fat chance when you are in the high 200's.  Things were beginning to work and I felt empowered; that I could get this disease under control. Hey, I even found I lost my first couple of pounds during Week Two,

What was I doing?

Meds.  Diet.  Walking.  Testing.  Recording.  If I was really bright, I'd come up with some sort of catchy acronym, but alas and alack, I am not that bright.  I am open to ideas, though.  You know what my meds were.  I was on a low carb diet.  I was walking 30 minutes a day, six days per week.  And, I kept records.  All of this really began to come together during the second week.

You can do this.  It's all about little steps that collectively make a journey.  You can take the small steps without fear - a lot of folks have gone before you.

Your Best Friends in the Kitchen

If you are at all like me, after being diagnosed with diabetes, you are kind of afraid of the ktichen.  Afterall, that is where it might have all happened.  there is no need to be afraid of the ktichen - it's one of the best rooms in the house to win the war on diabetes. 

I remember before I heard those words, "You have diabetes." I loved kitchen tools.  Why?  I had to make sure I was putting enough sugar in the cookies...and butter.  Can't forget the butter, can I?  I am not kidding.  Measuring cups were used most of the time to measure sugar.  In just about everything.  I even found out a little bit of sugar made pasta sauce better!

Well, now I have new uses for the measuring cups, spoons and even a scale - to make sure I am getting the right portions.  I know, you can eyeball what three or four ounces of meat look like without a scale (kind like a deck of cards), but if you have a scale you will know exactly.  Okay, I am going on about a scale, but to tell you the truth, I learned the visual clues on some items, which can be found here.  I am actually a bit too lazy to weigh my food.

However, I have used measuring cups from Day One for a lot of foods like berries and cereals.  Look at cereal boxes to determine what a real portion size is - or at least what they use to base the nutrition information.  I have found it to be somewhere between 1/2 and 3/4 of a cup.  Measure it out and put it in a bowl - and that's it besides a bit of milk.  You don't get to add more cereal.  Add a piece of whole wheat toast (I never, ever thought I'd be advocating whole wheat anything!), if you need to add food, or add a 1/4 cup of berries.

Whatever you do read labels, know what you are getting nutritionally and get in the habit of measuring everything until you can eyeball it.  But, beware of CREEP.  What is creep, you ask?  It's when you subconsciously make the portion sizes bigger as you eyeball portion sizes.  I found I need to check the portion sizes every couple of weeks just to make sure I am still adhering to the portion guide lines.  It's way too easy to make them bigger than they should be if you aren't using a measuring cup.

I can hear you now, "I don't have a measuring cup."  Go out and get one either at a Target or Walmart, or you can even go to your local thrift store.  Wherever you get your measuring cups and spoons, make sure you wash and sterilize them prior to using.  Yes, you will need the spoons, too.

Learn the portion sizes.  Use measuring tools in the kitchen - they will become your new best friends.  Learn visual clues to portion sizes.  Learn carb counts of the foods you eat.  Lots of learning going on, but it will pay-off very quickly as your glucose levels and weight drop.

You are in a war - make you sure have the right weapons.  Your fight starts in your kitchen.

And, if you eat out often, learn what you can eat at the places you enjoy by looking at nutritional guides that most places have easily available.

This is such an exciting time for you as you start your battle in earnest.  You can win the war and control diabetes.



Measuring cups. Measuring spoons. Maybe a scale.

Steady As She Goes...

Do you remember watching all of those movies about WW II naval battles - especially the ones about submarines?  In every movie - EVERY movie, I heard the phrase, "Steady as he goes."  Now, I am not sure what it means in Navy-speak, but to me it means stay straight and true.  Do you think there is a lesson somewhere in there for diabetics?  Especially Type 2 Diabetics?

This all comes to mind because I was reading posts in a couple of diabetes forums.  I literally hurt for the person who was writing that she walked for 30 minutes one night and tried to eat right, but found she had gained  a little weight and her glucose reading was a bit up the next morning.  That's not to be totally unexpected, really.  Why? Because it's just one day.

You see, fighting diabetes is a long term fight.  It's a war of incremental victories that build on one another.  One little victory leads to the next leads to the next, etc.  Don't expect to see much of a difference the first day you walk for 30 minutes or as a result of the first day you really eat right.  It's going to take several days, at least.  And, remember, that everyone's body chemistry is different - so each of us will react differently as we exercise and eat right.  Remember, YMMV - Your Mileage May Vary!

The thing to remember is that most of us did not get diabetes in a day.  It might be the result of years of poor eating habits with very little exercise.  So, it might take a few days to begin for your body chemistry to catch up.  And, it might take months and longer for your A1c to get normal.  But, never, never stop fighting the good fight.  Never give in.  Fight to win the war and know it's going to be a long war.

I was dismayed that the person who posted the entry in June about being discouraged did not have any encouraging comments.  Nobody stepped up to say give it a chance.  Nobody said give it a bit of time.  I would have, but it wasn't clear to me how to leave a comment; I will really have to go back and look at the site to figure it out.

In the meantime - Fight the good fight.  Each day you eat right and exercise is a victory and will lead to controlling and managing your diabetes.  I know you can do this...I know you can win.

Thank you for reading this.


"The fight isn't over until you win." ~Robin Hobb


"Fall. Stand. Learn. Adapt." ~Mike Norton

Carb Revelation! It's Not Just About The Carbs

I lost about 60 pounds between diet and a bit of exercise.  My diet has been one of basic carb counting - not too difficult to understand or track.  But, and this is a revelation from yesterday during my walk - counting carbs is not enough; you have to look at the fat content!  What a concept, right?

For me, it was pretty basic diet - about 55 or 60 carbs per meal with snacks not to exceed 15 carbs.  That was it.  I just could not fully understand that diet in which you can exchange this for that to equal a number.  It just seemed a very difficult way to figure out what I could have to eat.  My carb counting was pretty easy once I knew what the carbs were and the portion size.

So, I get close to where the doctor wants me.  I had a BMI of 25.0, as I recall.  He wanted me at 24.9.  You remember about good ol' BMI's right?  Body Mass Index.  If you are above 24.9, you are overweight.  Need to check your BMI?  Look here.  And, if you want to understand more about BMI, read this article.

As I write this, I have a BMI of 25.3 - not great, but not too bad either.  And, it seems as though I have been unable to get much below 25.0.  Kind of frustrating for a guy who thinks he knows how to lose weight, right?  Well, I have to begin to learn more about fat and fat content, which I have never paid attention to in the past.

I mean, catbs turn into sugar so if I counted carbs, I would not only lose weight, but manage the diabetes.  How great is that?  And it worked for a long time.  If you are just starting out, I think carb counting is a good way to begin to manage and control diabetes.  But, if you want to make that breakthrough to getting to the right weight, you may have to look at fat.

Perfect example: I eat granola-type bars for snacks.  I found one very low carb bar - I mean it was like 9 net carbs - nice and low.  And, I sometimes use another type of bar in which the total carbs is about 18, or so.  Much, much more.  But...and this is an important but...the fat content was double in the low carb bar.  Double!  So, my current solution is to just eat about half of the higher carb, lower fat bar.  I emphasize current, because i have to look at the labels and might find a better balance.

Yes, there is a lot to think about when you have diabetes and it comes to your diet, but it soon becomes second nature.  You begin to look at the labels on all foods to find out what is good for you to eat.  I imagine I should do a food label explanation pretty soon.  That might be a good idea, huh?

So, I keep counting carbs.  But, now I am beginning to count fat - and I am sure I will come back to fat in a future blog because even I know there are different kinds of fat.  I will try to de-mystify and simplify fat when I blog about it.

I will continue to let you know about my adventures in weight loss.  By the way, when my doctor told me I had to 'lose a little weight' my BMI was 32.55.  Of course, I had no idea what a BMI was at that point, or I think I would have been discouraged.  But anyone can lose a little weight, right?  Sure glad that my doctor did not tell me I had to lose about 67 pounds, total.

As always, thank you for reading.