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Diabetes Type II is a chronic condition, and it is a serious illness. Lifelong attention to lifestyle, medication, and monitoring is the key to a good outcome. Diabetes Type II can be managed. However, once a person has a form of this disease, they always need to be vigilant in controlling their blood glucose levels. But if you have been diagnosed with Type 2 diabetes, your switch to a healthier lifestyle is providing you the opportunity to control this disease either with, or potentially without, diabetic medication.
Regular exercise is important for everyone. It is even more important you have diabetes. Exercise in which your heart beats faster and you breathe faster helps lower your blood sugar level without medication. It also burns extra calories and fat so you can manage your weight.
Exercise can help your health by improving blood flow and blood pressure. Exercise also increases the body's energy level, lowers tension, and improves your ability to handle stress.
Ask your health care provider before starting any exercise program. People with type 2 diabetes must take special steps before, during, and after intense physical activity or exercise.
The American Diabetes Association (ADA) recommends the following guidelines for blood glucose levels for most patients with type 2 diabetes:
|Before meals||2 hours after a meal:|
|<130 mg/dL||< 180 mg/dL
(less than 180 mg/dl)
A subject with a consistent fasting range above 126 mg/dl or 7 mmol/l is generally have hyperglycemia: In fasting adults, blood plasma glucose should not exceed 126 mg/dL
The good news is that paying attention to blood sugar control can help keep you healthy and prevent health problems from happening later. Some tips:
Obesity is thought to be the primary cause of type 2 diabetes in people who are genetically predisposed to the disease. A proper diet and exercise are the foundations of diabetic care with a greater amount of exercise yielding better results.
Oct 02, 2017 | www.heart.org
Prakash Deedwania, chief of the cardiology division and professor of medicine at the University of California, San Francisco School of Medicine explains:
Drinking a glass of wine is good for the heart in the sense that the main mechanism by which alcohol protects the heart is increasing good cholesterol. The grape skin provides flavonoids and other antioxidant substances that protect the heart and vessels from the damaging effects of free oxygen radicals produced by our body.
This is particularly true for diabetics because they have been shown to have a high production of free oxygen radicals. But we don't have any evidence specifically related to diabetes patients.
A glass of wine can also help individuals relax. The strongest evidence is in favor of wine, but some evidence recently showed beer and other types of alcohol may provide the same benefits related to increasing good cholesterol (HDL) .
In general, alcohol does not seem to have an adverse effect, unless an excessive amount is used -- and it increases calories, among other things. For example, excessive amounts of alcoholic consumption could be harmful by increasing the risk of high blood pressure , for which diabetic patients are already at high risk.
For all people, alcohol can lower blood sugar. So for people with diabetes, it is recommended that any alcohol be consumed with a meal. In all cases, alcohol still contains calories, so remember to include it in the meal plan (one alcoholic drink is 1 fat exchange). If further help is needed, seek the help of a registered dietitian.
Dec 26, 2016 | news.slashdot.org(betanews.com) 30 Posted by BeauHD on Tuesday November 29, 2016 @05:40PM from the medical-breakthrough dept. BrianFagioli writes from a report via BetaNews: Diabetic eye disease is caused by retinopathy. Affected diabetics can have small tears inside the eye, causing bleeding. Over time, they can lose vision, and ultimately, they can go blind. Luckily, Google has been trying to use machine learning to detect diabetic retinopathy. Guess what? The search giant has seen much success. Not only are the computers able to detect the disease at the same level as ophthalmologists , but Google is actually slightly better! "A few years ago, a Google research team began studying whether machine learning could be used to screen for diabetic retinopathy (DR). Today, in the Journal of the American Medical Association , we've published our results: a deep learning algorithm capable of interpreting signs of DR in retinal photographs, potentially helping doctors screen more patients, especially in underserved communities with limited resources," says Lily Peng , MD Ph.D., Product Manger at Google. She goes on to say "our algorithm performs on par with the ophthalmologists, achieving both high sensitivity and specificity . [...] For example, on the validation set described in Figure 2, the algorithm has a F-score of 0.95, which is slightly better than the median. F-score of the 8 ophthalmologists we consulted (measured at 0.91)."
Nov 26, 2016 | nutritionfacts.org
We can also do the opposite experiment. Lower the level of fat in people's blood and the insulin resistance comes right down . If we clear the fat out of the blood, we also clear the sugar out. That explains the finding that on the high fat, ketogenic diet, insulin doesn't work very well. Our bodies become insulin resistant. But as the amount of fat in our diet gets lower and lower, insulin works better and better-a clear demonstration that the sugar tolerance of even healthy individuals can be impaired by administering a low-carb, high-fat diet. We can decrease insulin resistance, however, by decreasing fat intake.
Sep 16, 2016 | www.nytimes.com
By GINA KOLATASEPT. 15, 2016
A few years ago, Richard Kahn, the now-retired chief scientific and medical officer of the American Diabetes Association, was charged with organizing a committee to prescribe a diet plan for people with diabetes. He began by looking at the evidence for different diets, asking which, if any, best controlled diabetes.
"When you look at the literature, whoa is it weak. It is so weak," Dr. Kahn said in a recent interview.
Studies tended to be short term, diets unsustainable, differences among them clinically insignificant. The only thing that really seemed to help people with diabetes was weight loss - and for weight loss, there is no magic diet.
But people want diet advice, Dr. Kahn reasoned, and the association really should say something about diets. So it, like the National Institutes of Health, went with the Department of Agriculture's food pyramid .
Why? "It's a diet for all America," Dr. Kahn said. "It has lots of fruits and vegetables and a reasonable amount of fat."
That advice, though, recently came under attack in a New York Times commentary written by Sarah Hallberg, an osteopath at a weight loss clinic in Indiana, and Osama Hamdy, the medical director of the obesity weight loss program at the Joslin Diabetes Center at Harvard Medical School.
There is a diet that helps with diabetes, the two doctors said: one that restricts - or, according to Dr. Hallberg, severely restricts - carbohydrates.
"If the goal is to get patients off their medications, including insulin, and resolve rather than just control their diabetes, significant carb restriction is by far the best nutrition plan," Dr. Hallberg said in an email. "This would include elimination of grains, potatoes and sugars and all processed foods. There is a significant and ever growing body of literature that supports this method." She is in private practice at Indiana University Health Arnett Hospital and is medical director of a start-up developing nutrition-based medical interventions.
But there are no large and rigorous studies showing that low-carbohydrate diets offer an advantage, and, in fact, there is not even a consensus on the definition of a low-carbohydrate diet - it can vary from doctor to doctor.
"There have been debates for literally the whole history of diabetes about which kind of diet is best," said Dr. C. Ronald Kahn, chief academic officer at Joslin, and no relation to Dr. Richard Kahn. But, he said, "the answer isn't so straightforward."
In support of a diet like Dr. Hallberg's, there is one recent short-term study , by Kevin Hall of the National Institute of Diabetes and Digestive and Kidney Diseases and his colleagues, involving 17 overweight and obese men, none of whom had diabetes. They stayed in a clinical center where they ate carefully controlled diets. The researchers asked what would happen if calories were kept constant but the carbohydrate composition of a diet varied from high to very low. The answer was that insulin secretion dropped 50 percent with the very low carbohydrate diet, meaning that much less insulin was required to maintain normal blood glucose levels.
"Since diabetes results when the body can't produce enough insulin, perhaps it is a good idea to reduce the amount of insulin it needs by eating very-low-carbohydrate diets," Dr. Hall said.
Some longer-term studies , though, failed to show that low-carbohydrate diets benefited glucose control. Even if diets are effective in the short term, Dr. Hall said, "the difficulty is adhering to the diet over the long term." In an analysis of weight loss diets (not specifically for diabetics) published this summer, he and Yoni Freedhoff of the University of Ottawa wrote: "Diet adherence is so challenging that it is poor even in short-term studies where all food is provided. When diets are prescribed, adherence is likely to diminish over the long term despite self-reports to the contrary."
But short-term studies of just a few weeks, which constitute the bulk of the diet studies, can be misleading, said Dr. C. Ronald Kahn. "In the short term, the low-carbohydrate diet sometimes does better on glycemic control," he said. "But as time progresses, the difference mostly disappears. What counts is which diet helps most with long-term weight loss. "
The reason the advantage sometimes seen with a low-carbohydrate diet tends to vanish, Dr. C. Ronald Kahn added, is probably a mix of people failing to adhere to the diets and their bodies' adjusting to them.
Another issue with low-carbohydrate diets, researchers said, is the question of what will happen to overall health if diabetics actually follow the diet for years or decades. (Heart attacks are the major killer of people with diabetes.) Insulin levels may be better, but, said Dr. Rudolph Leibel, a director of Columbia University's Naomi Berrie Diabetes Center, "effects of a low-carbohydrate diet on lipoproteins and vascular biology could offset such a 'benefit.'" In other words, it is not clear if a lower insulin level would translate into fewer heart attacks.
Dr. Hamdy, whose recommended low-carbohydrate diet is less restrictive than the one Dr. Hallberg suggests, reports that many patients in his clinic have been able to stay with the diet for as long as five years, losing weight and keeping it off. He presented his study at the 2015 annual conference of the American Diabetes Association and has submitted it for publication. It involved 129 patients. Half were able to lose weight and keep it off, and those who did maintained an average weight loss of 9.5 percent. Their diabetes was much improved.
It is impossible, Dr. Hamdy said, to separate weight loss from the diet's effects on diabetes because people following such a diet - which limits but does not forbid things like breads, pasta and rice - also lose weight.Advertisement Continue reading the main story
But multiple studies have found that when it comes to weight loss - the only proven way to help with blood sugar control over the long term - there is no difference among diets that restrict calories, fat or carbohydrates.
Experts like Dr. David Nathan, the director of the diabetes center and clinical research center at Massachusetts General Hospital and a professor of medicine at Harvard Medical School, advise dieting for people with diabetes. But, he said, "when we advise people to be on diets, the major goal is to lose weight."
What matters the most for controlling diabetes, Dr. Nathan said, "is how much weight you lose."
Sep 05, 2015 | observer.com
Total deaths are projected to rise by more than 50% in the next decade. It's important to remember diabetes can be prevented even if you're at risk because of family history.
Here are three steps you can take today to prevent the disease, which afflicts roughly one million Americas and killed 1.5 million people worldwide in 2012, according to the World Health Organization.
- Leave Sugar Behind
The FDA issued a serious warning in May of this year regarding a new class of type 2 diabetes drugs which may cause dangerous levels of blood acids. One of the problems with diabetes is the medications have many side effects. This leads us to urge patients to focus on preventing diabetes early in life through their lifestyle choices.
And yes, this starts with sugar.
A new study actually found that switching out just one sugary soda per day for water, or unsweetened coffee or tea – could lower the risk for type 2 diabetes, the most common form of diabetes, by 25 percent.
Americans consume nearly 130 pounds of added sugars per person every year. This includes both sugar and high fructose corn syrup. These sugars lead to obesity, type 2 diabetes, hypertension and heart disease and can be found in sweetened drinks, syrup, honey, breads, and yogurts. Since the 1970's sugar consumption has decreased 40 percent but this is slightly misleading since there has been an increase in fructose consumption in the form of high fructose corn syrup. With this type of sugar found in most sodas and sugary soft drinks we've discovered the sweetest of all sugars. Fructose leaves us craving more. Fructose consumption triggers euphoric or 'feel good' chemical activity in the brain, similar to a 'reward system' such that when you eat sugar, your brain feels pleasure. The more sugar you eat, the greater your threshold to reach this pleasure sensation is, so you need more and more daily.
A reduced-sugar diet has many benefits including weight loss, reduction in risk for diabetes, and a decreased risk of heart disease. A new study actually found that switching out just one sugary soda per day for water, or unsweetened coffee or tea – could lower the risk for type 2 diabetes, the most common form of diabetes, by 25 percent. The findings are based on detailed food diaries from over 25,000 middle-aged and older British adults. When the study started all participants were diabetes-free, but almost 1,000 were diagnosed with type 2 diabetes by study end. Overall, the study found that the more sugary soda people consumed, the higher their risk of developing diabetes. There was an increased risk of diabetes by about 22% for every extra daily serving.
- Preventing Pre-Diabetes from Becoming Diabetes
According to the Centers for Disease Control and Prevention, approximately 79 million American adults have pre-diabetes. As you might guess, pre-diabetes can, and often does, develop into diabetes. Unfortunately, chances are that the cardiovascular damage that occurs with type 2 diabetes is already occurring with pre-diabetes.
The good news, however, is that a diagnosis of pre-diabetes does not sentence you to a diagnosis of diabetes; rather, with some lifestyle changes, diabetes can be prevented.
First and foremost, losing weight is the best way to prevent diabetes. The CDC's National Diabetes Prevention Program indicates that people at risk for developing type 2 diabetes can delay or avoid the disease if they lose just 5 to 7 percent of their body weight.
Weight loss and physical activity can improve the body's ability to use insulin and process glucose. One of the easiest forms of exercise is walking – start by taking a walk around the block at lunch time, choose to take the stairs where possible and eventually build up to at least 30 minutes a day most days of the week.
Enjoy a Healthy Diet
Consume foods that are low in fat, sugars, and sodium. Choose low or zero-calorie beverages over sweetened drinks. eplace white carbohydrates (i.e. white bread, white rice) with whole grains, brown rice, etc.
If you do choose unhealthy options, eat them in moderation. Furthermore, when you have pre-diabetes, the amount of food you eat is as important as the types of foods you're eating.
Make sure to adhere to recommended portion sizes to ensure you don't overeat. For example, 3 oz. of lean protein (the size of the palm of your hand), 1 oz. of cheese (the size of your thumb), 1 cup of low-fat or nonfat dairy, 1 cup of fresh, non-starchy vegetables, ½ cup of starchy vegetables, 1 slice of whole-grain bread and 1/3 cup of brown rice or cooked whole-grain pasta.
Make Smart Substitutions When Cooking
Low-fat and low-calorie ingredients can make a big difference when it comes to your health. Some simple substitutions include: zero-calorie cooking spray for butter, milk for cream, low-fat or nonfat options for full-fat dairy products, unsweetened applesauce for oil or butter (only when baking) and sugar substitute for some of the sugar. It is also best to avoid frying foods; instead, try grilling, broiling or baking.
Monitor Your Cholesterol and Blood Pressure
People with pre-diabetes and type 2 diabetes are at an increased risk for high blood pressure and high cholesterol, respectively.
If you have high cholesterol, take an active role in controlling it: Aim to exercise at least 30 minutes most days, eat a diet low in saturated fats and don't smoke. The American Diabetes Association (ADA) recommends maintaining your blood pressure below 130/80 mmHg to prevent the complications that often accompany diabetes.
If you smoke, stop; if you don't smoke, don't start.
Be vigilant of the symptoms of diabetes and speak with your medical provider about testing for pre-diabetes. The ADA recommends testing those over age 45 as well as people who are overweight and have one or more risk factors including high blood pressure, a family history of diabetes or a sedentary lifestyle. Remember, diabetes can be prevented with some lifestyle changes.
- Drink Your Coffee Black
According to a new study published in the European Journal of Clinical Nutrition, drinking coffee may lower inflammation and reduce the risk of developing diabetes. The study found that people who drank coffee were about 50 percent less likely to develop type 2 diabetes compared to people who did not drink coffee. The scientists believe that the reason for a reduction in the risk for type 2 diabetes could be the effect coffee has on the reducing the amount of inflammation in the body. Among the coffee drinkers who were considered habitual coffee drinkers, 54 percent of them were less likely to develop diabetes compared to those who didn't drink coffee. This was true even after researchers took into account lifestyle habits or medical history such as family history of diabetes, smoking, high blood pressure, or drinking other caffeinated beverages.
If you have acid reflux, talk with your doctor. To stay hydrated, in between drinking your 3-4 cups of black coffee per day, drink 1 glass of water. That's what I do every day.
a positive correlation between blood glucose levels and development of dementia, both for patients with and without diabetes.
August 11, 2013A study published last week in the New England Journal suggests that blood sugar levels may be a more important indicator than previously realized for non-diabetics: high blood sugar levels were linked by the study's authors with increased risk of dementia (summary free; full article paywalled). The study followed more than 2,000 elderly participants, and found a positive correlation between blood glucose levels and development of dementia, both for patients with and without diabetes.
Re:Proves Bloomberg correct. (Score:1)
1) High Fructose Corn Syrup, the thing used in just about everything is a mixture of about 55/42% fructose and glucose respectively.
2) Fructose is almost immediately metabolized by the liver into glucose, once it leaves the small intestine.
So, it's basically the same damn thing to the body anyway.
Brain diabetes (Score:4, Informative)
This is particularly interesting because alzheimer's is now thought, by many researchers, to be a form of "brain diabetes."
There are clinical data which demonstrate that alzheimer's can be reversed to some extent with medium chain triglycerides, which are absorbed by cells directly and provide energy which isn't dependent on glucose uptake.
See: http://www.doctoroz.com/videos/alzheimers-diabetes-brain [doctoroz.com] and http://w.numedica.net/literature/Reger%202004.pdf [numedica.net] for more info.
So imbalanced body chemistry leads to problems? (Score:2)
Okay, so perhaps it is over-simplifying the over-all issue and doesn't recognize the increased understanding of what affects what in what ways. It's important, so I'm not going to discount that value.
But the short of it is always this:
1. The body is a chemical machine. It needs good balance. When people screw with it too much beyond its tollerance, it's bad. We know this already. We hear "balanced diet" all the time. Trouble is, "balanced diets" are mostly a lie and because of human diversity, what is balanced for one person isn't balanced for another. 2. People are constantly trying to cut the head off of the body when it comes to illness. If it's "mental illness" they want to blame something mental. If it's something else, they want to blame the body in some way. It's as if this "blood brain barrier" is a thing that people believe contains the soul and spirit of a person. "Magic" right?
It's just not like that. We're all machines through and through. We know chemicals can affect our mood, our judgement, our response time, out ability to think clearly and some would say even enhance our thinking on some ways (I disagree, but okay...) We know we can affect our minds with chemicals and yet we STILL want to believe the mind is separate from the body.
Everyone needs to stop thinking this. Everyone. Laymen, Medical professionals, Police, Justice, Welfare services, Employers and more. Just Everyone.
I see this as completely obvious. Other people still cling to their ideas which are simply and demonstrably wrong.
This wouldn't surprise most diabetics (Score:1)
I was an undiagnosed Type 2 for a very long time, and since diagnoses it's become clear to me that brain function and mood are very closely tied to my blood sugar levels.
Undiagnosed I would experience bouts of temper or melancholy that came from nowhere in particular, and these have been mostly eliminated since I started to medicate.
When sugars a low it's very hard to think at all, you can't concentrate, and it's hard to coordinate movement. Those that think lows can be cured by simply eating chocolate haven't drunk 10 pints of beer and then tried to find a source of sugar in a three bedroom house!
When sugars are high you can be hyper for a time, before you begin to lose control of your body temperature and the slightest thing can send you into a rage.
Uncontrollable rage is very common indeed in teenage diabetics.
Aug. 4, 2011By Nancy Klobassa Davidson, R.N., and Peggy Moreland, R.N.
192 comments posted
This blog is the first in a two-part series in which we discuss the top 10 diabetes myths.
Hello, bloggers. I've been looking at articles from a number of popular diabetes magazines and other resources about diabetes myths. Each one seems to have its own list of the top five or 10 diabetes myths.
I decided to develop my own list of the top 10 diabetes myths that I've heard as a diabetes educator at the Mayo Clinic in Rochester, Minn. I'll reveal five this week, five next week.
Here goes (drum roll).
I have borderline diabetes or just a touch of diabetes.
Either you have it or you don't. Two fasting blood sugar readings over 126 milligrams per deciliter (mg/dL) or 7 millimoles per liter (mmol/L); a random blood glucose over 200 mg/dL (11.1 mmol/L); or an A1C of 6.5 percent or higher are all considered diabetes.
I don't know why I got diabetes, I never eat sweets.
Just about everything you eat is converted into glucose - sugar - so for most people with type 2 diabetes, what you eat is not as important as how much you eat. When you overeat, you're adding extra calories your body doesn't need for energy, so your body will convert these extra calories into fat. Being overweight is a predisposing factor for developing diabetes.
I can't eat carbohydrates; it makes my blood sugars go high.
Of course they do - even people who don't have diabetes will see an elevation in their blood glucose after eating. Carbohydrates should be approximately 50 percent of your daily food intake each day. Carbohydrates are your fuel, without them you will have little energy.
If I have to go on insulin; that must mean my diabetes is really bad.
You know, insulin has gotten a bad rap through the years. It's the blood glucose control that determines whether you go on insulin; if diet alone or diet along with oral or noninsulin-injectable diabetes medication(s) is not controlling the blood glucose, insulin is necessary.
Insulin causes complications of diabetes.
Again, insulin has gotten a bad rap. Insulin is a natural hormone and is probably one of the safest medications around. Insulin helps control the blood glucose, which in turn slows down or prevents diabetes complications.
Your thoughts? What are some of the diabetes myths you have come across?
Have a great week,
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Controlling Blood Sugar in Diabetes How Low Should You Go - Harvard Health Publications
The sweet spot
Research has modified some long-held assumptions about the treatment of diabetes, and new studies are likely to further refine our standards and goals. Still, some principles seem clear:
1. Diet, exercise, and weight control should be the cornerstone of management for all diabetics. In fact, a healthful lifestyle can prevent many, if not most, cases of type 2 diabetes, and it can lower blood sugar levels and improve the outcome for all patients with the disease.
2. Good blood sugar control is important for all diabetics. Tight control reduces the risk of microvascular complications (kidney disease, nerve damage, and eye disease) in type 1 diabetes. It also helps protect type 1 patients from macrovascular complications (heart attack, stroke, and cardiovascular death); it may have similar benefits for patients with newly diagnosed type 2 diabetes and healthy blood vessels, but is unlikely to help patients with longstanding type 2 diabetes and cardiovascular disease.
Patients who can achieve near-normal blood sugar levels with lifestyle therapy and simple drug programs should do so. Current ADA guidelines call for:
- achieving HbA1C levels of less than 7.0%; this corresponds to an average blood sugar level below 154 milligrams per deciliter (mg/dL).
- The ADA also recommends striving for fasting blood sugar levels below 131 mg/dL
- and peak post-meal levels below 180 mg/dL.
3. Patients who take insulin and others who aim for tight blood sugar control should monitor their own blood sugar levels. They should also learn to recognize symptoms of hypoglycemia, including anxiety, racing heart, sweating, tremors, and confusion, and they should know how to raise excessively low sugar levels and how to get help in emergencies.
While the ADA guidelines remain important, many experts believe that one size does not fit all, that blood sugar goals should be adjusted according to the needs of individual patients. In general, an HbA1C target of 7.0% to 7.5%, which corresponds to an average blood sugar level of about 150 to 170 mg/dL, seems reasonable for many patients with type 2 diabetes.
- Medical therapy should be intensified when HbA1C levels exceed 8%, which corresponds to an average blood sugar level of about 180 mg/dL.
4. Because diabetes is a major cause of cardiovascular disease and premature death, patients should carefully control other risk factors. Current guidelines set targets for diabetics below targets for otherwise healthy individuals;
- these include blood pressure readings below 130/80 millimeters of mercury (mm Hg) and LDL cholesterol levels below 100 mg/dL.
- Interestingly, however, reports from the ACCORD investigators suggest that even lower targets for blood pressure do not provide additional benefits for patients with type 2 diabetes.
5. Because special medications can slow the progression of diabetic kidney disease, patients should have regular urine tests for microalbuminuria; blood tests of kidney function may also help.
Regular screening for eye disease (diabetic retinopathy) will also lead to helpful preventive treatment. Foot care is important, too.
A study conducted in the neurology clinic at the University of Utah examined patients who came to the clinic complaining of peripheral neuropathy of unknown origin. Peripheral neuropathy is the medical term for a kind of nerve damage which causes pain, tingling, "pins and needles" or burning sensations in the hands and feet.
The University of Utah neurologists found that patients who were not known to be diabetic, but who registered 140/mg or higher on the 2-hour sample taken during a glucose tolerance test were much more likely to have a diabetic form of neuropathy than those who had lower blood sugars. Even more telling, the researchers found that the length of time a patient had experienced this nerve pain correlated with how high their blood sugar had risen over 140 mg/dl on the 2-hour glucose tolerance test reading.
It is important to note that this study also showed that only the glucose tolerance test results corresponded to the incidence of neuropathy in these patients, not their fasting blood sugar levels or their results on the HbA1c test This is significant because most American doctors do not offer their patients glucose tolerance tests, only the fasting glucose and HbA1c tests that fail to diagnose these obviously damaging post-meal blood sugars.
Ian Urbina's front-pager in the New York Times on diabetes is yet another piece of evidence arguing against the notion that the solution to the health care crisis is for the system to treat health care more like a consumer good.
With much optimism, Beth Israel Medical Center in Manhattan opened its new diabetes center in March 1999. Miss America, Nicole Johnson Baker, herself a diabetic, showed up for promotional pictures, wearing her insulin pump.
In one photo, she posed with a man dressed as a giant foot - a comical if dark reminder of the roughly 2,000 largely avoidable diabetes-related amputations in New York City each year. Doctors, alarmed by the cost and rapid growth of the disease, were getting serious.
At four hospitals across the city, they set up centers that featured a new model of treatment. They would be boot camps for diabetics, who struggle daily to reduce the sugar levels in their blood. The centers would teach them to check those levels, count calories and exercise with discipline, while undergoing prolonged monitoring by teams of specialists.
But seven years later, even as the number of New Yorkers with Type 2 diabetes has nearly doubled, three of the four centers, including Beth Israel's, have closed.
They did not shut down because they had failed their patients. They closed because they had failed to make money. They were victims of the byzantine world of American health care, in which the real profit is made not by controlling chronic diseases like diabetes but by treating their many complications.
Insurers, for example, will often refuse to pay $150 for a diabetic to see a podiatrist, who can help prevent foot ailments associated with the disease. Nearly all of them, though, cover amputations, which typically cost more than $30,000.
Patients have trouble securing a reimbursement for a $75 visit to the nutritionist who counsels them on controlling their diabetes. Insurers do not balk, however, at paying $315 for a single session of dialysis, which treats one of the disease's serious complications.
Not surprising, as the epidemic of Type 2 diabetes has grown, more than 100 dialysis centers have opened in the city.
"It's almost as though the system encourages people to get sick and then people get paid to treat them," said Dr. Matthew E. Fink, a former president of Beth Israel.
Attempt to split it in three dozes did not improve results.
To obtain meaningful data for treatment decisions, it is helpful for the patient to monitor for several consecutive days (e.g., 2-4 days). In addition to obtaining fasting and preprandial glucose levels, consider obtaining glucose readings 2-3 hours postprandially, as postprandial hyperglycemia has been implicated as an additional cardiovascular risk factor. [1C]
Postprandial monitoring is particularly recommended for patients who:
- • have an elevated A1C but fasting glucose is at target
- • are initiating intensive (physiologic) insulin treatment programs
- • are experiencing problems with glycemic control
- • are using glucose-lowering agents targeted at postprandial glucose levels
- • are making meal planning or activity adjustments
Guidelines for healthy adults:
Physical activity should be an integral component of the diabetes care plan to optimize glucose control, decrease cardiovascular risk factors, and achieve or maintain optimal body weight. [1B]
A moderate-intensity aerobic (endurance) physical activity minimum of 30 minutes (min) 5 days per week or vigorous-intensity aerobic physical activity for a minimum of 20 min 3 days per week should be achieved unless contraindicated. Activity can be accumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes.
A target of 60-90 minutes, 6-7 days per week is encouraged for weight loss if overweight or obese.
Exams and Tests
Your health care provider may suspect that you have diabetes if your blood sugar level is higher than 200 mg/dL. To confirm the diagnosis, one or more of the following tests must be done.
Diabetes blood tests:
- Fasting blood glucose level -- diabetes is diagnosed if it is higher than 126 mg/dL two times
- Hemoglobin A1c test --
- Normal: Less than 5.7%
- Pre-diabetes: 5.7% - 6.4%
- Diabetes: 6.5% or higher
- Oral glucose tolerance test -- diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours
Diabetes screening is recommended for:
- Overweight children who have other risk factors for diabetes, starting at age 10 and repeated every 2 years
- Overweight adults (BMI greater than 25) who have other risk factors
- Adults over age 45 every 3 years
You should see your health care provider every 3 months. At these visits, you can expect your health care provider to:
- Check your blood pressure
- Check the skin and bones on your feet and legs
- Check to see if your feet are becoming numb
- Examine the back part of the eye with a special lighted instrument called an ophthalmoscope
The following tests will help you and your doctor monitor your diabetes and prevent problems:
- Have your blood pressure checked at least every year (blood pressure goals should be 130/80 mm/Hg or lower).
- Have your hemoglobin A1c test (HbA1c) every 6 months if your diabetes is well controlled; otherwise every 3 months.
- Have your cholesterol and triglyceride levels checked yearly (aim for LDL levels below 70-100 mg/dL).
- Get yearly tests to make sure your kidneys are working well (microalbuminuria and serum creatinine).
- Visit your eye doctor at least once a year, or more often if you have signs of diabetic eye disease.
- See the dentist every 6 months for a thorough dental cleaning and exam. Make sure your dentist and hygienist know that you have diabetes.