Guest guest Posted July 7, 2008 Report Share Posted July 7, 2008 DIABETIC DOTER By Harry D. Bates, Ph. D. Revised October 2006 Attention all diabetics! After a lot of consideration I have decided to write an article, which condenses a lot of my research and personal experience into the bare essentials one needs to know in order to master diabetes control. It by no means tells the complete story, but it certainly can lead one to mastery of blood glucose level control. If you like to be spoon fed, then you need to read and master the knowledge in this article. I have condensed thousands of pages of reading and research into the very few nine pages which follow. I do not wish to waste your time. So, if you are a diabetic with an A1C of 5.5 or lower, and you do not have any diabetic complications, then just skip reading this entire article. If you are a health professional or a loving friend of a diabetic, I encourage you to continue reading and share this article with a diabetic friend or another health professional like a physician, nurse or nutritionist. It may very well save someone's life and prevent some serious complications as a result of diabetes. I looked up the meaning of dote. Of course like most English words the word has more than one meaning and so, I looked it up in a couple of dictionaries to see if there was some kind of consensus on exactly what the meaning of the word, dote, was. One meaning given indicates being foolish or senile due to old age. I confess I am no where as young as I use to be, and I definitely qualify for full pension benefits from social security at retirement age of 65. I do believe, however, that I am still in possession of my mental faculties and what I write here is not foolish at all. Another meaning is shower with love or show excessive attention for. Since I am not feeble minded, I confess that I am being somewhat lavish and excessive in my attention. I think you might be, too, if you were stricken with diabetes or know someone who is diabetic and you care about their health as well as your own. After becoming an insulin dependent diabetic almost three years ago, August 2003, it became necessary for me to learn how to master glucose level control. If I knew a long time ago what I know today, I probably could have prevented myself from becoming a diabetic in the first place. Alas, this probability no longer exists for me. I write this article in hopes that others may learn in time to prevent themselves from becoming a diabetic, or if they are already a diabetic, one may prevent themselves from becoming a diabetic or experience the ravages of diabetic complications. The old saying, " An ounce of prevention is worth more than a pound of cure. " Is really true.I hope the tiny bits of information I present here can help you prevent a whale of trouble down the road. Diabetes is both a genetic and an mostly behavioral causation. In some rare cases some environmental cause such as an accident, injury or disease may destroy the pancreas where the insulin producing cells are located. If diabetes runs any where in your family, then there is a good possibility that you also carry the gene or genes that can dispose you to the development of this disease. There are several forms of diabetes, and I am only concerned here with diabetes mellitus, the most common form, which occurs in two types. Diabetes I or diabetes type 1 is the rarest form of diabetes and is primarily genetic in origin. A person with this type is often referred to as being a juvenile diabetic, since it occurs early in childhood and means that the person's body does not produce insulin, which makes him/her insulin dependent for the rest of their life until a cure is perfected. This means the person's life is dependent on an outside source of insulin, and without this insulin the person will die. The most prevalent form of diabetes is diabetes II or diabetes type 2. Over 90% of all diabetics fall into this category. While type 2 diabetes is the most common form, it also happens to be the form of diabetes that is most preventable. At the same time, if someone has diabetes type 2, the ravages of diabetic complications can be stopped or prevented, and in many cases reversed, by mastering some simple rules of blood glucose control presented below. With today's technology and knowledge there is no reason preventing both the type 1 diabetic and the type 2 diabetic from living a normal life span without diabetic complications. I want this to be a message of hope for the diabetic and all of you out there who are potential diabetics. It has often been said that experience is a great teacher. Experience also means that someone has had some failures, and hopefully they have learned from them. Well, I offer myself to you as an experienced master of diabetes and diabetes prevention and diabetes blood glucose control. By necessity and research I have become a diabetes expert. I can backup every thing I say here with research citations and practical day by day experience. However I will not do so, since the purpose of this article is to condense the knowledge and technology regarding diabetes into a simple article, which can be accepted or rejected as you wish. It can be frustrating for some to advise and be unheeded. I know this full well, because I have been both on the advising end and the unheeding end of this situation. All of us at one time or another has lived in the world of denial either part time, intermittently or full time. We may say to ourselves that ignorance is bliss and believe it to be so. This may very well be true, since you have not yet been nudged with the reality of diabetes. However, if diabetes has reared its ugly head, living in the world of denial, where ignorance is bliss, is no longer a safe option. Diabetes is in the top leading causes of death and destruction in this country. To see where diabetes is most prevalent I ask you to take a close look at what I call the soda pop and fruit juice cultures in the world, and there you will find a high incidence of diabetes. When it comes to diabetes, ignorance is not blissful, since it is down right deadly and devastating. Once you have diabetes, make no mistake, you have got it, and most likely will have it for the rest of your life. How do I know if I have diabetes or even if I am a candidate for diabetes? This is a very good question to ask. Without messing around let's go to the bottom line and answer this very simple question, so there is no doubt as to whether you are or you are not a diabetic. If you are a type 1 diabetic or a juvenile diabetic and you are reading this article, the answer is clear. You are a juvenile diabetic already under the care of a physician. Otherwise you would be dead. Without enumerating all the symptoms of diabetes it would be wise for you to know if any of your family members, distant or close, has ever been diagnosed as being diabetic. If the answer is " yes " , then there is a higher probability that you are a candidate for diabetes, too. Then how can I know for sure whether or not I am a diabetic? As far as I know, there is only one way to know for sure. It requires a blood test, which can be prescribed by your physician or performed in his office. There is no way for sure to tell if you are diabetic by someone just looking at your outward appearance and behavior. So, it will take a sample of your blood for the tests, which can be of two types. A fasting glucose level blood test can easily tell if you are a candidate for diabetes. The fasting blood test is taken after a period of fasting in which you have consumed no food or drink for a period of around nine or ten hours. It is usually done in the morning following your overnight sleep and before breakfast. Special tools are needed to perform a fasting blood test for your blood glucose level. It requires a blood glucose monitor and someone with the knowledge of how to operate it along with some test strips for the monitor and some lancets needed to prick your finger for the blood sample. Depending on the kind of glucose monitor you have, the glucose level is either read in milligrams per deciliters or moles per deciliter. In the USA a monitor reading of 108 is the same as a reading of 6.0 moles as measured in the United Kingdom and other countries. The number 18 can be used to convert from one reading to another either by multiplying or dividing. A reading of 6.0 moles is the same as a reading of 108 in USA readings. Numbers are important to know when it comes to diabetes. Just as there is an important number for your age, height or weight your fasting glucose level is an important indicator of diabetes or your likelihood of becoming a diabetic. So do not be daunted by the use of numbers, because they are important and they can help simplify your life and the direction you need to go. Just as the age of 10 shows you are a young person and an age of 89 shows you are a very old person, glucose monitor readings tells a story, too. Research studies show that a reading of less than 100 for an individual's fasting glucose level indicates a probability of one in four of a person ever developing diabetes. A fasting glucose reading of 100 or more indicates a probability of three out of four for this person to develop diabetes. To put it simply a reading of 100 or more means a 75% chance of developing diabetes. The latter category is classified as pre-diabetics, if your fasting blood glucose level is 100 to 126mg/dL or 140 to 199 after eating. This does not mean that you are a diabetic, if you fall into this group, but it does signal you to take precautions and most likely a change in your behavior, or you stand a better than average chance of developing diabetes, if you do not. These numbers and others are presented not to intimidate you, but to inform you. An informed citizen is in a better position to make wise decisions, and the same holds true for the informed diabetic. Am I a diabetic? This question requires a definitive answer. It also indicates the need for another kind of blood test. Whereas the fasting glucose level shows your glucose level at the moment at which it was taken, there is another type of blood test that will tell what your glucose level has been on the average for the past three months. If your fasting glucose level is 109 or greater than 6.0 moles, then you need to get a second kind of blood test known as a Hemoglobin A1C or shortened to HbA1C or just plain A1C. This blood test is not routinely done unless requested by you or your physician to prescribe this specific A1C test. If your fasting glucose level runs 109 or more, your physician has probably already ordered the A1C test, but check with him to be sure. Like the batting average in a baseball game the hitter is ascribed a batting average based on his unfolding average of hits as the season proceeds. If the batter has a batting average of 300, this means he gets three hits in an average of ten turns at bat. This batting average is reported as a single number of 300. Similarly the average level of sugar or glucose in the blood stream is reported as a single number reflecting the average glucose level in the blood for the past three months. The higher the A1C number is the more seriously it should be taken. If your A1C is above 6.0 you can be diagnosed as a diabetic. The AMA and the ADA, the American Medical Association and the American Diabetes Association respectively, report that if your A1C is 7.0 or higher, that you probably have diabetes. I prefer to use the lower number, because I believe it more accurately reflects the real and true situation. You may ask, " Why do you say this? " I say this for at least a couple of reasons. I know many people who have suffered the ravages of diabetic complications including me with A1C's of 7.0 and lower. Another reason is knowing the range of a non-diabetic A1C level, which varies between 4.2 and 5.2, which is well below an A1C reading of 6.0. Few people know this including doctors and other members of the medical profession, and even fewer report what normal non-diabetic A1C levels are. This is a very good reason for you to know the meaning of numbers as it relates to a diabetic and a non-diabetic. Even the non-diabetic's average fasting glucose level ranges around 82-83, and few, if any, are told this. Well, for me what exactly does all this mean? Simply put it means that if your A1C is higher than 6.0, you are probably a diabetic, and if your A1C is 7.0 or higher, you are definitely a diabetic. It also means that it is now time for you to learn some more numbers and terms and what they mean in the management of your diabetic condition. Diet, exercise and possibly medications are essential elements in the management of diabetes. Both you and your physician need to work together in order to master glucose level control, and nothing short of mastery is required in order to prevent diabetic complications and possibly reverse some complications that have already occurred. For certain mastery of glucose level control will accomplish at least two things. You will feel better, and you can also prevent diabetic complications. It is rare for the diabetic, either type 1 or type 2, to develop diabetic complications with an A1C of 5.5 or less. The nearer a diabetic can get to the A1C level of the non-diabetic; the better off they will be. Insulin is a hormone, which is essential for all living cells of the body. It is produced in the body organ known as the pancreas. It is responsible for carrying nourishment to every cell in the body. Insulin is utilized by the body to convert carbohydrates into glucose, which is the energy fuel for the body. Glucose is the simplest known sugar transported by the blood stream. Insulin is also known as the storage hormone, since it is utilized in converting excess glucose into fat. The body constantly monitors the amount of glucose in the blood stream, in order to regulate the amount of insulin that is required. In the diabetic this system is broken. The pancreas is no longer able to produce enough insulin to deal with the carbohydrates consumed, or the body is no longer able to utilize the amount of insulin in the system, commonly known as insulin resistance. The diabetic can reduce the amount of carbohydrates consumed, or resort to oral medications to prevent the body from converting the more complex carbohydrates into simple glucose sugar, take oral medications to reduce insulin resistance or stimulate the pancreas with oral medications to produce more insulin, or inject insulin from an outside source in order to furnish the required amount of insulin needed. One or more of the foregoing remedies is the only presently known way to bring the blood glucose levels into the normal range. Insulin only works on carbohydrates. Insulin does not work on fat. Insulin does not work on protein. The glucose level in the blood stream is constantly changing like the waves on the ocean. The higher the glucose level is the higher the peak of the wave is. The lower the glucose level is the deeper the valley or trough of the wave is. Like the waves of the ocean the more erratic and rapid the glucose levels are; the more damage will be done to the body systems such as: blood vessels, nerves, body organs like the eyes, heart, liver, kidneys, genitals, and appendages like the hands and feet as well as the digestive system including the pancreas and liver, and the immune system which can impair your ability to combat infections. Diabetic complications are primarily the results of extreme peaks and long lasting peaks in the blood glucose levels. Extreme low glucose levels can cause some very unpleasant symptoms, the body organs to shutdown and even cause instant death. These are the reasons why it is essential to establish and maintain blood glucose cycles with all its highs and lows in the normal and therapeutic range. Without a doubt the glucose monitor is the diabetics best friend. It provides the only way the diabetic can tell for sure what the present glucose level actually is. Once you know you are a diabetic, several tools along with the glucose monitor are required in order to gain mastery over glucose level control. These tools are primarily in the form of knowledge and the ability to count. Then what is it I need to know? The blood glucose level for all humans the world over mostly resides in the normal range. The normal range here is defined as lying between 70 and 120 two hours after eating. This is the target goal for all diabetics known as the two hour post prandial blood glucose level. Post means afterwards, prandial means meal and the time is two hours after you have eaten. Research shows the most important time to take a blood glucose level reading is two hours after carbohydrates have been consumed. Maintaining a two hour post prandial glucose level of 120 or lower insures the diabetic an A1C of 5.5 or lower, which is near the normal range for a nondiabetic. Achieving and maintaining this target goal will dramatically reduce the probability of diabetic complications and in many instances even reverse some of them. While the target goal is simple to state, reaching it takes lots of effort and mastery of carb counting. This usually takes several weeks or even months to accomplish, because many factors can complicate the situation. Every individual handles diet, exercise and medications differently. It takes trial and error to discover how the individual is affected by diet, exercise and medications. Experiencing success and failure is a great teacher, and learning what these experiences teach the individual is the heart of mastery. No knowledge means no mastery. No effort means no mastery. This means that the diabetic will encounter and learn to deal with a lot of frustration in gaining mastery. Before the individual became a diabetic a built-in automatic governing system was in place inside the body, but now it is no longer automatic. The system is now broke. The diabetic will need a glucose monitor or sugar meter and the supplies that go with it. It requires frequent monitoring on a conscious level and carb counting to govern the therapeutic blood glucose range. This will no doubt entail lots of effort and frustration, as well as some emotional and physical pain. Persistence will eventually pay with mastery of glucose level control. What does it mean, if I am below the target goal of 70? It means you are headed for trouble very soon. A mistake was made. Not enough grams of carbohydrates were consumed, the medication dosage is too much and exercise performed is the most common cause for this result. Usually taking one or two glucose tablets will bring you back into the normal range without shooting your glucose level sky high, which is definitely to be avoided. Taking glucose tablets are recommended because this will yield measurable results depending on how much a single glucose tablet will raise your blood glucose level in half an hour. A four gram carb glucose tablet will raise most people's glucose level by around twenty points or so. Before embarking on an exercise program it is usually wise to take one or two glucose tablets around a half hour beforehand, depending on the pre-exercise blood glucose level, since the muscles burn glucose during the exercise routine lasting an hour or more. This can prevent the low blood glucose level from happening, and in many instances prevent the occurrence of the rebound effect. What is the rebound effect? Simply put it is the body's way of countering extreme and potentially hazardous low blood sugar levels. It usually happens in times of physical exertion for prolonged periods of time like an hour or so, depending on the amount of glucose in the blood stream and body reserves. What happens is this. When the muscles through use burns up the available glucose and the blood stream, the brain signals the pancreas to produce another hormone called glycogen, which is able to convert other food sources other than carbohydrates into simple glucose, and usually it does a lot of it, causing the blood glucose level to spike high. It is definitely advisable for the diabetic to know how his or her sugar levels are affected by exercise and work. It is never good for the diabetic to do physical exertion for a long time if the blood glucose level is near or above 250 points, and I would suggest at least a 10% lower reading for any diabetic, and especially if one happens to be a type 1 diabetic. This translates to a mole reading of 13.9. Placing physical stress on such a diabetic can produce serious consequences and even death. Ketoacidosis is to be avoided at all costs, since it can be a real killer. When it occurs, it requires immediate and urgent measures, possibly like a trip to the emergency room or special knowledge and supplies by a medical specialist. When a person is in ketoacidosis, they do not require more glucose; rather they require some specialized hormones, since one's life hangs in the balance. It is always wise for the diabetic to have some glucose tablets on hand to counter or prevent harmful low blood glucose readings. What does it mean, if my two hour post prandial goal is above 120? It usually means too many grams of carbs were consumed, the medication dose is too low or you have exercised too much or a combination of the preceding factors. Before one can become a master at blood glucose level control one must first become a master at carb counting. Several books and guides, as well as on line resources, are available for the individual to learn about the amount of grams of carbs contained in a serving of a particular food item. It can be confusing to know all the different kinds of carbohydrates, which are plentiful. There are all kinds including complex carbs, simple carbs, fast acting carbs, slow acting carbs, effective carbs, sugar carbs, net carbs, refined carbvs, total carbs, good carbs, bad carbs, and on and on. It's enough to make the head spin. Insulin eventually gets around to working on all of them, since insulin only works on carbohydrates. Fortunately, under USA law food and drink packaging information usually carries the number of grams of carbohydrates on the label. The diabetic would be well advised to stick with the total number of grams of carbs. The key to gaining mastery over blood glucose levels is quite simple, CHARTING. If you are determined on having normal or as near to normal blood glucose levels as possible, then you will simply have to do it now and regularly until mastery of blood glucose control is established. Starting a file or a log book or whatever is readily accessible to you is an excellent step, and I might add the most important step in starting an active charting system to document the time of each blood glucose monitor reading, amount of medication used, the number of grams of carbs consumed, exercise routine, and any unusual events or activities that you feel are important to be considered in your blood glucose management. For instance noting an infection and medications used to combat it is an important chart reminder. I strongly feel that the main key to mastering blood glucose management and control is first starting a chart that is under your control. If you can control this charting, then it follows that down the road you will control your blood glucose levels. Of course this assumes that you, the diabetic, are in charge of what you eat and drink, what you do, and what medications and their amounts you use. As long as you are reliant on others to manage your blood glucose levels, you will never gain mastery. As long as it is possible, the most important thing for a doctor, a nurse, or another diabetic to do is to teach the individual how to be in control of one's own blood sugar levels. Now when it comes to the nurse following doctor's orders, I thoroughly understand. It is ingrained into all nurses to only follow the doctor's orders. But others comply happily, since they know that your best interests are at heart and the doctor's orders are just a phone call away. Let us not forget that the nurse as well as the doctor is required to keep accurate records and this includes keeping written orders as well as verbal orders. So have your doctor or nurse read this so that they thoroughly understand Also it follows that if you can follow your progress or lack of it by charting what is happening to you, and then you have documented proof as to what is going on. This kind of a record can make the doctor or nurse feel even more confident about what they recommend. It also assures confidence in what the diabetic requests. Does this mean that you have to chart every thing every day for the rest of your life? You may ask. The answer is " no " . You only have to do it until you have convinced yourself and possibly your doctor and nurse that you have achieved and maintained mastery for at least a reasonable amount of time, say two or three months. Then you only need to resort to charting, when something unusual happens like noting high or low blood sugars that seem on the surface to be unreasonable according to what you already know. Mastery like freedom only requires eternal vigilance. Before it got broke the normal person, the non-diabetic, had a brain and a pancreas that worked every second of every day, day after day monitoring the glucose level in the blood stream. I laugh at those who think they can gain mastery with one glucose monitor test per month, per week or per day. While it may not be impossible to do, it is absurd to even begin to think that it is probable or even realistic. It takes about one minute for a person to do a glucose level test. No one can look at you and tell you what your blood glucose level is. Right now the only way to tell for sure is with the old finger prick, because it requires some of your blood. I know it hurts. Unfortunately, mastery requires some pain. The more pain you are willing to endure is an indicator of how willing you are to gain mastery. Likewise the longer one avoids this painful process; the longer mastery will take, if it is achieved at all. Whether you are a diabetic or a health professional, you could be fooling yourself into believing that mastery can be achieved by reading some recommendations in a book or those presented by a knowledgeable person. While such knowledge and information is extremely helpful, it is still no substitute for practical experience. I have always heard, " There is no substitute for experience. " , and if you know of one, please let me know. So mr. Diabetic, don't be foolish or as I say to be stupid and think you only need to check your glucose level once per day. Unfortunately, some people think the morning fasting blood glucose level is all that is needed to tell what is going on. For the non-diabetic this may be true. For the diabetic this is pure folly. After all for the diabetic it is those high peaks and spikes that cause the majority of diabetic complications. If the diabetic does not know when these unwanted spikes occur and how to prevent them, then they are doomed to have them. Typically, the highest glucose level is reached in the blood stream about one hour or less after eating. The brain tells the pancreas to send out more insulin to deal with those carbohydrates and soon the blood stream glucose level goes back to normal. Well, that is what happens, if you are a normal person, but if you are a diabetic, then this system is broke and the glucose level stays high or even goes higher. This is the reason the practical guide of a two hour post prandial glucose level is recommended for every diabetic. At least this will tell you what is going on inside your body, and you can take these measurements as an indicator of what to do. Practically all diabetic complications are caused by high blood glucose levels. Of course one would ask, " Why is this? " The complications come about as a result of oxygen starvation or suffocation. None of the cells in your body live forever. They are constantly being replaced. As the cells die, they are replaced with a new cell. The cells die as a result of a natural process occurring all the time called glycation. When the blood sugar level is too high, the glycation process is speeded up. In other words the cells die at a higher rate. The red blood cells typically carry nourishment to the other body cells, and this nourishment is composed of nutrients and oxygen. When the glucose level rises too high, this sugar is converted to a compound called sorbitol inside the body, which sticks on the red blood cell preventing it from carrying oxygen. In effect the red blood cell now is dead. Research shows that sorbitol forms rapidly at a glucose level of 160 or higher, and it even begins at lower levels around 140 or rather begins to speed up at this point. This is why the two hour post prandial blood test is best, since it will show you how much glucose and potential sorbitol is being dumped into the blood stream. The cells cannot live their normal life span, if they are being deprived of oxygen. The A1C can be taken as a measure of the glycation rate. If the normal rate of glycation is 5.0%, a 6.0% or an A1C of 6.0 is 20% higher than an A1C of 5.0. I use the 20% difference as a general rule, since when a 20% difference is encountered in most measurements, this usually signifies a statistically significant difference. Just think about this for a minute. Even the American Diabetes Association last year finally stated that the normal glucose level is nearer the A1C 5.0 level, not the 6.0 level or even the 7.0 level as advocated earlier by others in the medical fields. Running near normal glucose levels is the key to avoiding diabetic complications. When an A1C of 5.0 is taken as the base line, an A1C of 7.5 indicates a death rate of the red blood cells at a 50% higher rate. When a person understands this paragraph, it becomes a no-brainer as to the importance of avoiding high glucose spikes in the blood stream. .. Yes, you have guessed it, provided you have been reading this article and thinking at the same time. I can hear it now. " Oh, my aching fingers! not to mention my pocket book? " Believe me; I feel your pain. While a glucose monitor is relatively inexpensive and the cost of the test strips appear to be so at first glance, by multiplying the cost of each test strip by3, 4, 6, or 8 rapidly runs up the cost of a day's test strips and multiplying this cost by the days of the month can show that glucose monitoring is a painful and costly undertaking. Oopps! is this the slip of the tongue? Remember diabetes is among the top three or four leading causes of death. The cost of mastering glucose level control is cheap when one considers the expense of staying in the intensive care unit ICU for a few days with a heart attack, not to mention the cost of the emergency room visit or the ambulance ride. I tell you the cost is cheap, cheap cheap, when compared to the cost of pain and expense of heart by-pass surgery, foot or leg amputations, visual loss or blindness and sexual dysfunction due to neuropathy and kidney dialysis with its inherent medical cost plus all those trips to be hooked up to the machines for a few hours. If you think I am joshing, then you are completely ignorant. Getting down to it now is what is needed. This means getting down to the boring grind of counting day in and day out for the rest of your life. The route to achieving mastery is not glamorous. Counting the number of grams of carbohydrates consumed, counting your medication doses and number of doses used, counting the units of insulin injected, taking blood glucose measurements and charting all of it plus relevant factors is what is required. While hardly anyone gets eagerly excited to do this, nevertheless this is what you must do in order to achieve and maintain blood sugar control. As simple as it sounds, it is not easy. For many just crossing this hurdle takes a lot of effort to muster the will to do so. Then actually doing it is another matter altogether. The reward is life enhancing. Besides that, you will feel better. Form a close bond and relationship with your doctor for it is he/she only who has the power to prescribe the needed medications, if it is necessary. Show him/her your progress or lack of it in diabetes management and request their assistance and cooperation in helping you master blood sugar level control. This is extremely important. Any doctor who refuses to comply with your request in the matter needs to be replaced. Different doctors have different recommendations and different prescriptions. The diabetic needs to use the one that works and promotes health for the individual diabetic. Suppose your are a type 1 or a type 2 diabetic on insulin. There are several types of insulin. Fast-acting insulin or short-acting insulin like Humalog or Novolog are dosed to deal with prandial carbohydrates consumed, since they act rapidly and for a brief period of time. Slow-acting or long-acting insulins like Lantus or Humalin N are dosed to establish a basal dose of insulin which stays in the system for a long period of time. There are also mixture insulins, which combine a long-acting insulin in combination with a short-acting insulin. The mixture insulins, in my opinion, do not provide as accurate blood glucose level control as the pure or straight insulins do. You will have to establish at least two things. First, establish a set number of grams of carbs to consume at each meal. Secondly, use the prescribed number of units of fast-acting insulin in a prescribed ratio, then I would highly recommend you follow this advice. Start at keeping your carb consumption constant and dosing fast-acting insulin accordingly. Begin with a 1:15 ratio and slowly and gradually increasing it. The ratio is determined by the number of units of fast-acting insulin dosed in relation to the number of grams of carbs consumed. This is done until you are well satisfied that a specific number of units of fast-acting insulin can handle a specific number of grams of carbs. It is important to do this in conjunction with taking the slow acting insulin. Remember that the slow-acting insulin as a general rule of thumb will constitute approximately 50% to 60% of your daily insulin requirement. The fast acting insulin will constitute in divided doses the remaining 40% to 50% of your remaining insulin requirement. If your ratio at 1:15, this means one unit of fast-acting insulin for 15 grams of carbs consumed, causes your sugar level to rise above acceptable levels, then the ratio needs to be changed to a 2:15 ratio. If your sugar level still rises above acceptable levels with a 2:15 ratio, then you need to increase it again to a 3:15 ratio and so on and so on until the ultimate sugar level control is achieved. If the ratio used shows a glucose level two hours later as being too low, then adjust the fast-acting insulin downward to the amount of grams of carbs consumed. Once you know for sure how many units of fast-acting insulin are required to handle 15 grams of carbs, then you can double the carb level to 30 grams of carbs and like wise the number of units of fast-acting insulin to handle it. Always remember small numbers mean small mistakes, and big numbers mean big mistakes. Fine tuning your insulin requirements by adjusting simultaneously the fast-acting insulin and the slow-acting insulin is a tedious and laborious process, not to mention the frustration that one encounters, while doing it. Similar statements can be made about diabetics on oral medications for glucose level control. Establish a time and the specific strength of the oral medication to be used along with a specific number of grams of carbohydrates to be consumed at each meal. If your two hour post prandial glucose level is above 120 or 6.66 moles, then you have either consumed too many carbs, or you have not taken a high enough dose of oral medicine. It can only be determined by trial and error. In many cases a combination of oral medications and fast-acting insulin can be utilized together to achieve the desired results. However this combination is not done lightly. It may even require the diabetic to convince the doctor that he knows what to do, since the prescription of fast-acting insulin is a very serious matter. The knowledge and skill at its use is absolutely essential. I have reached the point in my life where I am never ceased to be amazed at the accomplishments of an individual once they put their mind to it. Likewise, I am never ceased to be amazed at the ignorance and incompetence of those who know better or should know better, and refuse to see and acknowledge what needs to be done. I reach this conclusion after consulting numerous health professionals like myself and lots of diabetics, who have related their stories to me. Many, including patients and health professionals, either fail to see a clear danger signal, when it stares them in the face or fail to act on the warning sign presented, which is even worse. Failing to act out of ignorance is one thing, while failing to act out of negligence is entirely another. For the diabetic it is essential that they be informed and knows the difference. Before a person can master anything they first must be aware that it exists. One cannot prevent or remediate heart attacks or strokes, if the underlying cause of these is a result of running high blood sugar levels is unknown to them. The same can be said for people running chronic infections or losing vision as a result of uncontrolled high blood glucose levels. How many of us are willing to face the truth about diabetes? An even better question to ask is how many of us take the warning signs of diabetes seriously and inform others about the dangers of this disease and what can be done to avoid any further complications this disease imposes. I know some people who run a fasting blood sugar of 122, and their physician has not even cautioned them that they need to exercise some caution about their diet. How about those diabetics who run an A1C of 7.0 or higher, and they are not even informed that they are in serious trouble right now? On the other hand I know some diabetics who use insulin and still they eat all the sugar they want without any regard to what it is doing to their body. They are not told that refined carbohydrates like sugar, flour and fruit juices is like a poison to their system, which it definitely is. Like the teenager, who perpetually disregards the speed limits, these diabetics think nothing will come of it, if they eat all these dangerous foods, since after all they are feeling just fine, and nothing serious has happened yet. It does make me wonder just how long a person can play around with a rattlesnake before it bites them. If necessary, read this article several times and save it for future reference, and better yet, share it with some one who needs to know. Encourage the diabetic and those who care. The life enriched may be yours or a love one. I stand by my words presented here. The real question is, do you? Well, knowing what I say here can get you off to a good start. I am stopping here, since I want this to be an article about mastery of glucose level control and not a book. If you think it took a long time to read this article, then you have a glimmer of the time needed to claim mastery. The doing of it takes a lot longer than the reading of it. I know you can do it by only engaging in the process now. So form your alliances with your medical professionals, diabetic support friends, if necessary, and family members now and get on with it. Help is there, and you can count on it. All you need is the knowledge of what and when to count, then count, count, count, count. By doing it you will live longer and feel better and better. Now that you have read this article, I encourage you to send it to others whom you feel needs to read it, too. Your help in getting the word out about this article is appreciated. You can send any comments or suggestions to me by placing the word " doter " in the subject line of an email sent to: lindaharrybates@... Harry D. Bates is presently a retired psychologist in the State of Georgia, where he was born in 1940 in the community of Experiment, Georgia. He worked for several decades both in the public sector and the private sector as a counselor and ultimately as a psychologist. His credentials held include the following: Ph. D.in counseling psychology from the University of Georgia in 1984, licensed applied psychologist, MRC Master of Rehabilitation Counseling from the University of Florida in December, 1963, Nationally Certified Rehabilitation Counselor, CRC, licensed professional counselor, licensed marriage and family therapist, BSA degree Bachelor of Science in Agriculture from the University of Georgia in June, 1962 and high school graduation in June of 1958 from GAB, Georgia Academy for the Blind. His experience also includes teaching in the public sector in adult education and conducting workshops at the university. He was diagnosed as a type2 diabetic in June 1987, and has experienced the following diabetic complications: three heart attacks, two heart bypass surgeries, Two mild strokes, hard to manage infections, slowed wound healing, sexual dysfunction and vision loss. His ambition is to teach others how to manage diabetes and prevent diabetic complications. Experience is a hard teacher, and he has had plenty of it. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 5, 2008 Report Share Posted August 5, 2008 Yes, I agree that this is worth a read regularly and is well written and a great motivation source. Cheers, Brett. DIABETIC DOTER Surely an essential read for newly diagnosed and good to reread often for the rest of us. Thank you Harry! DIABETIC DOTER By Harry D. Bates, Ph. D. Revised May 2006 Attention all diabetics! After a lot of consideration I have decided to write an article, which condenses a lot of my research and personal experience into the bare essentials one needs to know in order to master diabetes control. It by no means tells the complete story, but it certainly can lead one to mastery of blood glucose level control. If you like to be spoon fed, then you need to read and master the knowledge in this article. I have condensed thousands of pages of reading and research into the very few pages which follow. I do not wish to waste your time. So, if you are a diabetic with an A1C of 5.5 or lower, and you do not have any diabetic complications, then just skip reading this entire article. If you are a health professional or a loving friend of a diabetic, I encourage you to continue reading and share this article with a diabetic friend or another health professional like a physician, nurse or nutritionist. It may very well save someone's life and prevent some serious complications as a result of diabetes. I looked up the meaning of dote. Of course like most English words the word has more than one meaning and so, I looked it up in a couple of dictionaries to see if there was some kind of consensus on exactly what the meaning of the word, dote, was. One meaning given indicates being foolish or senile due to old age. I confess I am no where as young as I use to be, and I definitely qualify for full pension benefits from social security at retirement age of 65. I do believe, however, that I am still in possession of my mental faculties and what I write here is not foolish at all. Another meaning is shower with love or show excessive attention for. Since I am not feeble minded, I confess that I am being somewhat lavish and excessive in my attention. I think you might be, too, if you were stricken with diabetes or know someone who is diabetic and you care about their health as well as your own. After becoming an insulin dependent diabetic almost three years ago, August 2003, it became necessary for me to learn how to master glucose level control. If I knew a long time ago what I know today, I probably could have prevented myself from becoming a diabetic in the first place. Alas, this probability no longer exists for me. I write this article in hopes that others may learn in time to prevent themselves from becoming a diabetic, or if they are already a diabetic, one may prevent themselves from becoming an insulin dependent diabetic or experience the ravages of diabetic complications. The old saying, " An ounce of prevention is worth more than a pound of cure. " Is really true.I hope the tiny bits of information I present here can help you prevent a whale of trouble down the road. Diabetes is both a genetic and an mostly behavioral causation. In some rare cases some environmental cause such as an accident, injury or disease may destroy the pancreas where the insulin producing cells are located. If diabetes runs any where in your family, then there is a good possibility that you also carry the gene or genes that can dispose you to the development of this disease. There are several forms of diabetes, and I am only concerned here with diabetes mellitus, the most common form, which occurs in two types. Diabetes I or diabetes type 1 is the rarest form of diabetes and is primarily genetic in origin. A person with this type is often referred to as being a juvenile diabetic, since it occurs early in childhood and means that the person's body does not produce insulin, which makes him/her insulin dependent for the rest of their life until a cure is perfected. This means the person's life is dependent on an outside source of insulin, and without this insulin the person will die. The most prevalent form of diabetes is diabetes II or diabetes type 2. Over 90% of all diabetics fall into this category. While type 2 diabetes is the most common form, it also happens to be the form of diabetes that is most preventable. At the same time, if someone has diabetes type 2, the ravages of diabetic complications can be stopped or prevented, and in many cases reversed, by mastering some simple rules of blood glucose control presented below. With today's technology and knowledge there is no reason preventing both the type 1 diabetic and the type 2 diabetic from living a normal life span without diabetic complications. I want this to be a message of hope for the diabetic and all of you out there who are potential diabetics. It has often been said that experience is a great teacher. Experience also means that someone has had some failures, and hopefully they have learned from them. Well, I offer myself to you as an experienced master of diabetes and diabetes prevention and diabetes blood glucose control. By necessity and research I have become a diabetes expert. I can backup every thing I say here with research citations and practical day by day experience. However I will not do so, since the purpose of this article is to condense the knowledge and technology regarding diabetes into a simple article, which can be accepted or rejected as you wish. It can be frustrating for some to advise and be unheeded. I know this full well, because I have been both on the advising end and the unheeding end of this situation. All of us at one time or another has lived in the world of denial either part time, intermittently or full time. We may say to ourselves that ignorance is bliss and believe it to be so. This may very well be true, since you have not yet been nudged with the reality of diabetes. However, if diabetes has reared its ugly head, living in the world of denial, where ignorance is bliss, is no longer a safe option. Diabetes is in the top leading causes of death and destruction in this country. To see where diabetes is most prevalent I ask you to take a close look at what I call the soda pop and fruit juice cultures in the world, and there you will find a high incidence of diabetes. When it comes to diabetes, ignorance is not blissful, since it is down right deadly and devastating. Once you have diabetes, make no mistake, you have got it, and most likely will have it for the rest of your life. How do I know if I have diabetes or even if I am a candidate for diabetes? This is a very good question to ask. Without messing around let's go to the bottom line and answer this very simple question, so there is no doubt as to whether you are or you are not a diabetic. If you are a type 1 diabetic or a juvenile diabetic and you are reading this article, the answer is clear. You are a juvenile diabetic already under the care of a physician. Otherwise you would be dead. Without enumerating all the symptoms of diabetes it would be wise for you to know if any of your family members, distant or close, has ever been diagnosed as being diabetic. If the answer is " yes " , then there is a higher probability that you are a candidate for diabetes, too. Then how can I know for sure whether or not I am a diabetic? As far as I know, there is only one way to know for sure. It requires a blood test, which can be prescribed by your physician or performed in his office. There is no way for sure to tell if you are diabetic by someone just looking at your outward appearance and behavior. So, it will take a sample of your blood for the tests, which can be of two types. A fasting glucose level blood test can easily tell if you are a candidate for diabetes. The fasting blood test is taken after a period of fasting in which you have consumed no food or drink for a period of around nine or ten hours. It is usually done in the morning following your overnight sleep and before breakfast. Special tools are needed to perform a fasting blood test for your blood glucose level. It requires a blood glucose monitor and someone with the knowledge of how to operate it along with some test strips for the monitor and some lancets needed to prick your finger for the blood sample. Depending on the kind of glucose monitor you have, the glucose level is either read in milligrams per deciliters or moles per deciliter. In the USA a monitor reading of 108 is the same as a reading of 6.0 moles as measured in the United Kingdom and other countries. The number 18 can be used to convert from one reading to another either by multiplying or dividing. A reading of 6.0 moles is the same as a reading of 108 in USA readings. Numbers are important to know when it comes to diabetes. Just as there is an important number for your age, height or weight your fasting glucose level is an important indicator of diabetes or your likelihood of becoming a diabetic. So do not be daunted by the use of numbers, because they are important and they can help simplify your life and the direction you need to go. Just as the age of 10 shows you are a young person and an age of 89 shows you are a very old person, glucose monitor readings tells a story, too. Research studies show that a reading of less than 100 for an individual's fasting glucose level indicates a probability of one in four of a person ever developing diabetes. A fasting glucose reading of 100 or more indicates a probability of three out of four for this person to develop diabetes. To put it simply a reading of 100 or more means a 75% chance of developing diabetes. The latter category is classified as pre-diabetics, if your fasting blood glucose level is 109 or higher. This does not mean that you are a diabetic, if you fall into this group, but it does signal you to take precautions and most likely a change in your behavior, or you stand a better than average chance of developing diabetes, if you do not. These numbers and others are presented not to intimidate you, but to inform you. An informed citizen is in a better position to make wise decisions, and the same holds true for the informed diabetic. Am I a diabetic? This question requires a definitive answer. It also indicates the need for another kind of blood test. Whereas the fasting glucose level shows your glucose level at the moment at which it was taken, there is another type of blood test that will tell what your glucose level has been on the average for the past three months. If your fasting glucose level is 109 or greater than 6.0 moles, then you need to get a second kind of blood test known as a Hemoglobin A1C or shortened to HbA1C or just plain A1C. This blood test is not routinely done unless requested by you for your physician to prescribe this specific A1C test. If your fasting glucose level runs 109 or more, your physician has probably already ordered the A1C test, but check with him to be sure. Like the batting average in a baseball game the hitter is ascribed a batting average based on his unfolding average of hits as the season proceeds. If the batter has a batting average of 300, this means he gets three hits in an average of ten turns at bat. This batting average is reported as a single number of300. Similarly the average level of sugar or glucose in the blood stream is reported as a single number reflecting the average glucose level in the blood for the past three months. The higher the A1C number is the more seriously it should be taken. If your A1C is above 6.0 you can be diagnosed as a diabetic. The AMA and the ADA, the American Medical Association and the American Diabetes Association respectively, report that if your A1C is 7.0 or higher, then you are a diabetic. I prefer to use the lower number, because I believe it more accurately reflects the real and true situation. You may ask, " Why do you say this? " I say this for at least a couple of reasons. I know many people who have suffered the ravages of diabetic complications including me with A1C's of 7.0 and lower. Another reason is knowing the range of a non-diabetic A1C level, which varies between 4.2 and 5.2, which is well below an A1C reading of 6.0. Few people know this including doctors and other members of the medical profession, and even fewer report what normal non-diabetic A1C levels are. This is a very good reason for you to know the meaning of numbers as it relates to a diabetic and a non-diabetic. Even the non-diabetic's average fasting glucose level ranges around 82-83, and few, if any, are told this. Well, for me what exactly does all this mean? Simply put it means that if your A1C is higher than 6.0, you are probably a diabetic, and if your A1C is 7.0 or higher, you are definitely a diabetic. It also means that it is now time for you to learn some more numbers and terms and what they mean in the management of your diabetic condition. Diet, exercise and possibly medications are essential elements in the management of diabetes. Both you and your physician need to work together in order to master glucose level control, and nothing short of mastery is required in order to prevent diabetic complications and possibly reverse some complications that have already occurred. For certain mastery of glucose level control will accomplish at least two things. You will feel better, and you can also prevent diabetic complications. It is rare for the diabetic, either type 1 or type 2, to develop diabetic complications with an A1C of 5.5 or less. The nearer a diabetic can get to the A1C level of the non-diabetic; the better off they will be. Insulin is a hormone, which is essential for all living cells of the body. It is produced in the body organ known as the pancreas. It is responsible for carrying nourishment to every cell in the body. Insulin is utilized by the body to convert carbohydrates into glucose, which is the energy fuel for the body. Glucose is the simplest known sugar transported by the blood stream. Insulin is also known as the storage hormone, since it is utilized in converting excess glucose into fat. The body constantly monitors the amount of glucose in the blood stream, in order to regulate the amount of insulin that is required. In the diabetic this system is broken. The pancreas is no longer able to produce enough insulin to deal with the carbohydrates consumed, or the body is no longer able to utilize the amount of insulin in the system, commonly known as insulin resistance. The diabetic can reduce the amount of carbohydrates consumed, or resort to oral medications to prevent the body from converting the more complex carbohydrates into simple glucose sugar, take oral medications to reduce insulin resistance or stimulate the pancreas with oral medications to produce more insulin, or inject insulin from an outside source in order to furnish the required amount of insulin needed. One or more of the foregoing remedies is the only presently known way to bring the blood glucose levels into the normal range. Insulin only works on carbohydrates. Insulin does not work on fat. Insulin does not work on protein. The glucose level in the blood stream is constantly changing like the waves on the ocean. The higher the glucose level is the higher the peak of the wave is. The lower the glucose level is the deeper the valley or trough of the wave is. Like the waves of the ocean the more erratic and rapid the glucose levels are; the more damage will be done to the body systems such as: blood vessels, nerves, body organs like the eyes, heart, liver, kidneys, genitals, and appendages like the hands and feet as well as the digestive system including the pancreas and liver, and the immune system which can impair your ability to combat infections. Diabetic complications are primarily the results of extreme peaks and long lasting peaks in the blood glucose levels. Extreme low glucose levels can cause some very unpleasant symptoms, the body organs to shutdown and even cause instant death. These are the reasons why it is essential to establish and maintain blood glucose cycles with all its highs and lows in the normal and therapeutic range. Without a doubt the glucose monitor is the diabetics best friend. It provides the only way the diabetic can tell for sure what the present glucose level actually is. Once you know you are a diabetic, several tools along with the glucose monitor are required in order to gain mastery over glucose level control. These tools are primarily in the form of knowledge and the ability to count. Then what is it I need to know? The blood glucose level for all humans the world over mostly resides in the normal range. The normal range here is defined as lying between 70 and 120 two hours after eating. This is the target goal for all diabetics known as the two hour post prandial blood glucose level. Post means afterwards, prandial means meal and the time is two hours after you have eaten. Research shows the most important time to take a blood glucose level reading is two hours after carbohydrates have been consumed. Maintaining a two hour post prandial glucose level of 120 or lower insures the diabetic an A1C of 5.5 or lower, which is near the normal range for a nondiabetic. Achieving and maintaining this target goal will dramatically reduce the probability of diabetic complications and in many instances even reverse some of them. While the target goal is simple to state, reaching it takes lots of effort and mastery of carb counting. This usually takes several weeks or even months to accomplish, because many factors can complicate the situation. Every individual handles diet, exercise and medications differently. It takes trial and error to discover how the individual is affected by diet, exercise and medications. Experiencing success and failure is a great teacher, and learning what these experiences teach the individual is the heart of mastery. No knowledge means no mastery. No effort means no mastery. This means that the diabetic will encounter and learn to deal with a lot of frustration in gaining mastery. Before the individual became a diabetic a built-in automatic governing system was in place inside the body, but now it is no longer automatic. The system is now broke. The diabetic will need a glucose monitor or sugar meter and the supplies that go with it. It requires frequent monitoring on a conscious level and carb counting to govern the therapeutic blood glucose range. This will no doubt entail lots of effort and frustration, as well as some emotional and physical pain. Persistence will eventually pay with mastery of glucose level control. What does it mean, if I am below the target goal of 70? It means you are headed for trouble very soon. A mistake was made. Not enough grams of carbohydrates were consumed, the medication dosage is too much and exercise performed is the most common cause for this result. Usually taking one or two glucose tablets will bring you back into the normal range without shooting your glucose level sky high, which is definitely to be avoided. Taking glucose tablets are recommended because this will yield measurable results depending on how much a single glucose tablet will raise your blood glucose level in half an hour. A four gram carb glucose tablet will raise most people's glucose level by around twenty points or so. Before embarking on an exercise program it is usually wise to take one or two glucose tablets around a half hour beforehand, depending on the pre-exercise blood glucose level, since the muscles burn glucose during the exercise routine lasting an hour or more. This can prevent the low blood glucose level from happening, and in many instances prevent the occurrence of the rebound effect. What is the rebound effect? Simply put it is the body's way of countering extreme and potentially hazardous low blood sugar levels. It usually happens in times of physical exertion for prolonged periods of time like an hour or so, depending on the amount of glucose in the blood stream and body reserves. What happens is this. When the muscles through use burns up the available glucose and the blood stream, the brain signals the pancreas to produce another hormone called glycogen, which is able to convert other food sources other than carbohydrates into simple glucose, and usually it does a lot of it, causing the blood glucose level to spike high. It is definitely advisable for the diabetic to know how his or her sugar levels are affected by exercise and work. It is never good for the diabetic to do physical exertion for a long time if the blood glucose level is near or above 250 points, and I would suggest at least a 10% lower reading for any diabetic, and especially if one happens to be a type 1 diabetic. This translates to a mole reading of 13.9. Placing physical stress on such a diabetic can produce serious consequences and even death. Ketoacidosis is to be avoided at all costs, since it can be a real killer. When it occurs, it requires immediate and urgent measures, possibly like a trip to the emergency room or special knowledge and supplies by a medical specialist. When a person is in ketoacidosis, they do not require more glucose; rather they require some specialized hormones, since one's life hangs in the balance. It is always wise for the diabetic to have some glucose tablets on hand to counter or prevent harmful low blood glucose readings. What does it mean, if my two hour post prandial goal is above 120? It usually means too many grams of carbs were consumed, the medication dose is too low or you have exercised too much or a combination of the preceding factors. Before one can become a master at blood glucose level control one must first become a master at carb counting. Several books and guides, as well as on line resources, are available for the individual to learn about the amount of grams of carbs contained in a serving of a particular food item. It can be confusing to know all the different kinds of carbohydrates, which are plentiful. There are all kinds including complex carbs, simple carbs, fast acting carbs, slow acting carbs, effective carbs, sugar carbs, net carbs, refined carbvs, total carbs, good carbs, bad carbs, and on and on. It's enough to make the head spin. Insulin eventually gets around to working on all of them, since insulin only works on carbohydrates. Fortunately, under USA law food and drink packaging information usually carries the number of grams of carbohydrates on the label. The diabetic would be well advised to stick with the total number of grams of carbs. The key to gaining mastery over blood glucose levels is quite simple, CHARTING. If you are determined on having normal or as near to normal blood glucose levels as possible, then you will simply have to do it now and regularly until mastery of blood glucose control is established. Starting a file or a log book or whatever is readily accessible to you is an excellent step, and I might add the most important step in starting an active charting system to document the time of each blood glucose monitor reading, amount of medication used, the number of grams of carbs consumed, exercise routine, and any unusual events or activities that you feel are important to be considered in your blood glucose management. For instance noting an infection and medications used to combat it is an important chart reminder. I strongly feel that the main key to mastering blood glucose management and control is first starting a chart that is under your control. If you can control this charting, then it follows that down the road you will control your blood glucose levels. Of course this assumes that you, the diabetic, are in charge of what you eat and drink, what you do, and what medications and their amounts you use. As long as you are reliant on others to manage your blood glucose levels, you will never gain mastery. As long as it is possible, the most important thing for a doctor, a nurse, or another diabetic to do is to teach the individual how to be in control of one's own blood sugar levels. Now when it comes to the nurse following doctor's orders, I thoroughly understand. It is ingrained into all nurses to only follow the doctor's orders. But others comply happily, since they know that your best interests are at heart and the doctor's orders are just a phone call away. Let us not forget that the nurse as well as the doctor is required to keep accurate records and this includes keeping written orders as well as verbal orders. So have your doctor or nurse read this so that they thoroughly understand Also it follows that if you can follow your progress or lack of it by charting what is happening to you, and then you have documented proof as to what is going on. This kind of a record can make the doctor or nurse feel even more confident about what they recommend. It also assures confidence in what the diabetic requests. Does this mean that you have to chart every thing every day for the rest of your life? You may ask. The answer is " no " . You only have to do it until you have convinced yourself and possibly your doctor and nurse that you have achieved and maintained mastery for at least a reasonable amount of time, say two or three months. Then you only need to resort to charting, when something unusual happens like noting high or low blood sugars that seem on the surface to be unreasonable according to what you already know. Mastery like freedom only requires eternal vigilance. Before it got broke the normal person, the non-diabetic, had a brain and a pancreas that worked every second of every day, day after day monitoring the glucose level in the blood stream. I laugh at those who think they can gain mastery with one glucose monitor test per month, per week or per day. While it may not be impossible to do, it is absurd to even begin to think that it is probable or even realistic. It takes about one minute for a person to do a glucose level test. No one can look at you and tell you what your blood glucose level is. Right now the only way to tell for sure is with the old finger prick, because it requires some of your blood. I know it hurts. Unfortunately, mastery requires some pain. The more pain you are willing to endure is an indicator of how willing you are to gain mastery. Likewise the longer one avoids this painful process; the longer mastery will take, if it is achieved at all. Whether you are a diabetic or a health professional, you could be fooling yourself into believing that mastery can be achieved by reading some recommendations in a book or those presented by a knowledgeable person. While such knowledge and information is extremely helpful, it is still no substitute for practical experience. I have always heard, " There is no substitute for experience. " , and if you know of one, please let me know. So mr. Diabetic, don't be foolish or as I say to be stupid and think you only need to check your glucose level once per day. Unfortunately, some people think the morning fasting blood glucose level is all that is needed to tell what is going on. For the non-diabetic this may be true. For the diabetic this is pure folly. After all for the diabetic it is those high peaks and spikes that cause the majority of diabetic complications. If the diabetic does not know when these unwanted spikes occur and how to prevent them, then they are doomed to have them. Typically, the highest glucose level is reached in the blood stream about one hour or less after eating. The brain tells the pancreas to send out more insulin to deal with those carbohydrates and soon the blood stream glucose level goes back to normal. Well, that is what happens, if you are a normal person, but if you are a diabetic, then this system is broke and the glucose level stays high or even goes higher. This is the reason the practical guide of a two hour post prandial glucose level is recommended for every diabetic. At least this will tell you what is going on inside your body, and you can take these measurements as an indicator of what to do. Practically all diabetic complications are caused by high blood glucose levels. Of course one would ask, " Why is this? " The complications come about as a result of oxygen starvation or suffocation. None of the cells in your body live forever. They are constantly being replaced. As the cells die, they are replaced with a new cell. The cells die as a result of a natural process occurring all the time called glycation. When the blood sugar level is too high, the glycation process is speeded up. In other words the cells die at a higher rate. The red blood cells typically carry nourishment to the other body cells, and this nourishment is composed of nutrients and oxygen. When the glucose level rises too high, this sugar is converted to a compound called sorbitol inside the body, which sticks on the red blood cell preventing it from carrying oxygen. In effect the red blood cell now is dead. Research shows that sorbitol forms rapidly at a glucose level of 160 or higher, and it even begins at lower levels around 140 or rather begins to speed up at this point. This is why the two hour post prandial blood test is best, since it will show you how much glucose and potential sorbitol is being dumped into the blood stream. The cells cannot live their normal life span, if they are being deprived of oxygen. The A1C can be taken as a measure of the glycation rate. If the normal rate of glycation is 5.0%, a 6.0% or an A1C of 6.0 is 20% higher than an A1C of 5.0. I use the 20% difference as a general rule, since when a 20% difference is encountered in most measurements, this usually signifies a statistically significant difference. Just think about this for a minute. Even the American Diabetes Association last year finally stated that the normal glucose level is nearer the A1C 5.0 level, not the 6.0 level or even the 7.0 level as advocated earlier by others in the medical fields. Running near normal glucose levels is the key to avoiding diabetic complications. When an A1C of 5.0 is taken as the base line, an A1C of 7.5 indicates a death rate of the red blood cells at a 50% higher rate. When a person understands this paragraph, it becomes a no-brainer as to the importance of avoiding high glucose spikes in the blood stream. . Yes, you have guessed it, provided you have been reading this article and thinking at the same time. I can hear it now. " Oh, my aching fingers! not to mention my pocket book? " Believe me; I feel your pain. While a glucose monitor is relatively inexpensive and the cost of the test strips appear to be so at first glance, by multiplying the cost of each test strip by3, 4, 6, or 8 rapidly runs up the cost of a day's test strips and multiplying this cost by the days of the month can show that glucose monitoring is a painful and costly undertaking. Oopps! is this the slip of the tongue? Remember diabetes is among the top three or four leading causes of death. The cost of mastering glucose level control is cheap when one considers the expense of staying in the intensive care unit ICU for a few days with a heart attack, not to mention the cost of the emergency room visit or the ambulance ride. I tell you the cost is cheap, cheap cheap, when compared to the cost of pain and expense of heart by-pass surgery, foot or leg amputations, visual loss or blindness and sexual dysfunction due to neuropathy and kidney dialysis with its inherent medical cost plus all those trips to be hooked up to the machines for a few hours. If you think I am joshing, then you are completely ignorant. Getting down to it now is what is needed. This means getting down to the boring grind of counting day in and day out for the rest of your life. The route to achieving mastery is not glamorous. Counting the number of grams of carbohydrates consumed, counting your medication doses and number of doses used, counting the units of insulin injected, taking blood glucose measurements and charting all of it plus relevant factors is what is required. While hardly anyone gets eagerly excited to do this, nevertheless this is what you must do in order to achieve and maintain blood sugar control. As simple as it sounds, it is not easy. For many just crossing this hurdle takes a lot of effort to muster the will to do so. Then actually doing it is another matter altogether. The reward is life enhancing. Besides that, you will feel better. Form a close bond and relationship with your doctor for it is he/she only who has the power to prescribe the needed medications, if it is necessary. Show him/her your progress or lack of it in diabetes management and request their assistance and cooperation in helping you master blood sugar level control. This is extremely important. Any doctor who refuses to comply with your request in the matter needs to be replaced. Different doctors have different recommendations and different prescriptions. The diabetic needs to use the one that works and promotes health for the individual diabetic. Suppose your are a type 1 or a type 2 diabetic on insulin. There are several types of insulin. Fast-acting insulin or short-acting insulin like Humalog or Novolog are dosed to deal with prandial carbohydrates consumed, since they act rapidly and for a brief period of time. Slow-acting or long-acting insulins like Lantus or Humalin N are dosed to establish a basal dose of insulin which stays in the system for a long period of time. There are also mixture insulins, which combine a long-acting insulin in combination with a short-acting insulin. The mixture insulins, in my opinion, do not provide as accurate blood glucose level control as the pure or straight insulins do. You will have to establish at least two things. First, establish a set number of grams of carbs to consume at each meal. Secondly, use the prescribed number of units of fast-acting insulin in a prescribed ratio. then I would highly recommend you follow this advice. Start at keeping your carb consumption constant and dosing fast-acting insulin accordingly. Begin with a 1:15 ratio and slowly and gradually increasing it. The ratio is determined by the number of units of fast-acting insulin dosed in relation to the number of grams of carbs consumed. This is done until you are well satisfied that a specific number of units of fast-acting insulin can handle a specific number of grams of carbs. It is important to do this in conjunction with taking the slow acting insulin. Remember that the slow-acting insulin as a general rule of thumb will constitute approximately 50% to 60% of your daily insulin requirement. The fast acting insulin will constitute in divided doses the remaining 40% to 50% of your remaining insulin requirement. If your ratio at 1:15, this means one unit of fast-acting insulin for 15 grams of carbs consumed, causes your sugar level to rise above acceptable levels, then the ratio needs to be changed to a 2:15 ratio. If your sugar level still rises above acceptable levels with a 2:15 ratio, then you need to increase it again to a 3:15 ratio and so on and so on until the ultimate sugar level control is achieved. If the ratio used shows a glucose level two hours later as being too low, then adjust the fast-acting insulin downward to the amount of grams of carbs consumed. Once you know for sure how many units of fast-acting insulin are required to handle 15 grams of carbs, then you can double the carb level to 30 grams of carbs and like wise the number of units of fast-acting insulin to handle it. Always remember small numbers mean small mistakes, and big numbers mean big mistakes. Fine tuning your insulin requirements by adjusting simultaneously the fast-acting insulin and the slow-acting insulin is a tedious and laborious process, not to mention the frustration that one encounters, while doing it. Similar statements can be made about diabetics on oral medications for glucose level control. Establish a time and the specific strength of the oral medication to be used along with a specific number of grams of carbohydrates to be consumed at each meal. If your two hour post prandial glucose level is above 120 or 6.66 moles, then you have either consumed too many carbs, or you have not taken a high enough dose of oral medicine. It can only be determined by trial and error. In many cases a combination of oral medications and fast-acting insulin can be utilized together to achieve the desired results. However this combination is not done lightly. It may even require the diabetic to convince the doctor that he knows what to do, since the prescription of fast-acting insulin is a very serious matter. The knowledge and skill at its use is absolutely essential. I have reached the point in my life where I am never ceased to be amazed at the accomplishments of an individual once they put their mind to it. Likewise, I am never ceased to be amazed at the ignorance and incompetence of those who know better or should know better, and refuse to see and acknowledge what needs to be done. I reach this conclusion after consulting numerous health professionals like myself and lots of diabetics, who have related their stories to me. Many, including patients and health professionals, either fail to see a clear danger signal, when it stares them in the face or fail to act on the warning sign presented, which is even worse. Failing to act out of ignorance is one thing, while failing to act out of negligence is entirely another. For the diabetic it is essential that they be informed and knows the difference. Before a person can master anything they first must be aware that it exists. One cannot prevent or remediate heart attacks or strokes, if the underlying cause of these is a result of running high blood sugar levels is unknown to them. The same can be said for people running chronic infections or losing vision as a result of uncontrolled high blood glucose levels. How many of us are willing to face the truth about diabetes? An even better question to ask is how many of us take the warning signs of diabetes seriously and inform others about the dangers of this disease and what can be done to avoid any further complications this disease imposes. I know some people who run a fasting blood sugar of 122, and their physician has not even cautioned them that they need to exercise some caution about their diet. How about those diabetics who run an A1C of 7.0 or higher, and they are not even informed that they are in serious trouble right now? On the other hand I know some diabetics who use insulin and still they eat all the sugar they want without any regard to what it is doing to their body. They are not told that refined carbohydrates like sugar, flour and fruit juices is like a poison to their system, which it definitely is. Like the teenager, who perpetually disregards the speed limits, these diabetics think nothing will come of it, if they eat all these dangerous foods, since after all they are feeling just fine, and nothing serious has happened yet. It does make me wonder just how long a person can play around with a rattlesnake before it bites them. If necessary, read this article several times and save it for future reference, and better yet, share it with some one who needs to know. Encourage the diabetic and those who care. The life enriched may be yours or a love one. I stand by my words presented here. The real question is, do you? Well, knowing what I say here can get you off to a good start. I am stopping here, since I want this to be an article about mastery of glucose level control and not a book. If you think it took a long time to read this article, then you have a glimmer of the time needed to claim mastery. The doing of it takes a lot longer than the reading of it. I know you can do it by only engaging in the process now. So form your alliances with your medical professionals, diabetic support friends, if necessary, and family members now and get on with it. Help is there, and you can count on it. All you need is the knowledge of what and when to count, then count, count, count, count. By doing it you will live longer and feel better and better. Now that you have read this article, I encourage you to send it to others whom you feel needs to read it, too. Your help in getting the word out about this article is appreciated. You can send any comments or suggestions to me by placing the word " doter " in the subject line of an email sent to: hdbates@... Harry D. Bates is presently a retired psychologist in the State of Georgia, where he was born in 1940 in the community of Experiment, Georgia. He worked for several decades both in the public sector and the private sector as a counselor and ultimately as a psychologist. His credentials held include the following: Ph. D.in counseling psychology from the University of Georgia in 1984, licensed applied psychologist, MRC Master of Rehabilitation Counseling from the University of Florida in December, 1963, Nationally Certified Rehabilitation Counselor, CRC, licensed professional counselor, licensed marriage and family therapist, BSA degree Bachelor of Science in Agriculture from the University of Georgia in June, 1962 and high school graduation in June of 1958 from GAB, Georgia Academy for the Blind. His experience also includes teaching in the public sector in adult education and conducting workshops at the university. He was diagnosed as a type2 diabetic in June 1987, and has experienced the following diabetic complications: three heart attacks, two heart bypass surgeries, one mild stroke, hard to manage infections, slowed wound healing, sexual dysfunction and vision loss. His ambition is to teach others how to manage diabetes and prevent diabetic complications. Experience is a hard teacher, and he has had plenty of it. Quote Link to comment Share on other sites More sharing options...
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