I think we are all in agreement on several critical points: 1. FU&W's hubby needs immediate medical attention because the wife runs the very real risk of waking up to "something real bad." His BG levels approach life threatening status when they go much above 22 mmol/l (400mg/dL) which is most often treated with an IV insulin drip here in the States (injected insulin does not work reliably at such high levels due to absorption/activity inconsistencies using injected industrial doses). 2. Proper control of diabetes can/will/does reverse complications provided they have not advanced beyond the point of no return as had happened to Kevin (his story is linked here: Terminal and Scared ). The human body is in a ceaseless state of repair and recovery provided that it is properly nourished and the abuse that it had been subjected to has been halted. 3. Having endured diabetes for more than ten years makes most of us assume that the patient "should have learned" what is needed to properly manage their disease by this time. If it is still uncontrolled after more than a decade, it is tempting to always blame the patient for their own neglect. However, I recently counseled a patient who was on insulin for a number of years but wasn't able to get her A1c below 7.4 "no matter how she tried." She had been using static (prescribed) doses and never deviated from them so her health care team was the real one at fault. She is culpable only in that she failed to reach out and get educated on her own. Therefore, I prefer to withhold judgment on FU&W's hubby as he could be a victim of the same substandard healthcare advice. In the case of my friend (actually, a friend of a friend), I successfully counseled her on dynamic insulin dosing and, over a few days, she was able to finally get her BG levels down to safe ranges (~100mg/dL or 5.5 mmol/l) by combining dynamic dosing with a more controlled diet. She had previously been following ADA (US) or NHS (UK) "protocols" which can be toxic to diabetics. It will be interesting to see what her next A1c test will reveal (scheduled in 2 months).
The rest is really up to FU&W's spouse. Bruno is correct in stating that HE is the only one who can make the changes required to improve his health and possibly preserve/extend his own life. Hopefully, our combined comments will provide him with the incentive to do what is urgently needed and I wish them both well.
Bruno, I already agree with what you might be thinking: that the symptoms and complications that FU&W's hubby has endured should have been incentive enough to wake up and face reality. Time will tell ... one way or the other. View Thread
In 1983, a trial known as the Diabetes Complication and Control Trial (DCCT) was begun to see if improving blood sugar made a difference in the outcomes of diabetes. In particular they looked at changes in vision (or retinopathy), kidney disease (nephropathy), coronary disease (CVD), all-cause mortality, neuropathy, and numerous other "complications" of diabetes. The DCCT was supposed to be a 13 year study but it was called short after just 10 years. That's because the results of improved blood sugar control was so dramatic that the researchers didn't want to keep the results a secret.
"Near-normal control of glucose, beginning as soon as possible after diagnosis, would greatly improve the long-term prognosis of Type I diabetes." Although the study itself focused on Type 1s, it applies equally to Type 2 because all diabetics will suffer the same damaging complications from high blood sugars. The announcement continued, "The demonstration that near normal glucose control substantially lowers microvascular and cardiovascular complications has heralded a new era of Type I diabetes care."
It should be noted that the DCCT's definition of "normal" was based on targets of hemoglobin A1c of 6.0 (an average blood sugar of 140mg/dL). Just think if the study had set targets of true normal for the study's participants which is A1c's in the range of 4.2 to 4.6; that's the range that Dr. Bernstein sets as targets for his own patients. Dr. Bernstein claims that normalizing blood sugars doesn't just "substantially lower" the complications but actually reverses them. Not only has he seen this in his own patients but experienced it personally. By lowering his BG levels to the 83-85 mg/dL level, Bernstein states: "I've had diabetes for 65 years, and I'm in pretty good health. I also reversed the kidney disease I developed while on the ADA diet."
Michelle and Bruno, my own evaluation of FedupAnd Worried's husband is that his history of blood sugar control has been exceedingly poor or spotty at best (thus the "Fedup" portion of her handle) and he is currently totally uncontrolled (thus the "Worried" portion of her handle). To Fedupand worried: Brunosbud was trying to say in a roundabout way that control over diabetes is strictly up to your husband and no one else. It is solely your husband's responsibility to gain control over this disease; even if his own health care team has been less than competent in providing him with guidance. That's because good diabetes control is one of self-management and there are many of us here in the forums that do just that.
It is not too late but time is growing short (a ticking time bomb might be more accurate). Your hubby needs to become proactive and make a decision to take action now (in Bruno's words, "come in out of the cold). We can help provide tips, guidance and support (even how to effectively use insulin if he has never been taught). Just let us know if you and your husband want to proceed. If not, your future posts are in danger of being in the past tense (sorry, but IMO there's no way to sugar coat it).View Thread
Fedupandworried, in reviewing your post and thinking with a clearer head, I can't stress how urgent it is for your husband to seek professional help, even without insurance coverage. His levels are in the range that will continue to degrade his health. His 16 mmol/L reading is equivalent to 289 mg/dL in Stateside measurements and jumping into the thirties is life-threatening. At that level, it would require E.R. treatment (the Emergency Room in a hospital) if he is located here in the U.S.
Can you clarify your situation with regards to your geo location and whether my assumptions about your glucometer readings are in mmol/L? In the interim, your husband should drink lots of water and go on a temporary fast to possibly prevent his condition from getting worse. This might provide a breather and provide you with an opportunity to get things sorted out. The concerns you expressed are valid ones that require immediate medical attention. To answer your concerns more directly, the answer is YES to both of your questions.View Thread
Just got back from a late family gathering and threw caution to the wind from a dietary standpoint. I was rewarded with a surge that went up to 188 mg/dL but even that's still well below your hubby's numbers. Fortunately, I was able to correct it with an adjustment dose of insulin and was back down to 100 within a few hours (and still dropping). I use regular insulin most of the time and inject it with conventional syringes. The cost at Walmart pharmacies is less than $25 for a 10 ml vial of Novolin-R and $12.50 for a box of 31G x 8mm syringes/needles. That should be affordable to almost everyone except for those on public assistance.
The 16 and thirties readings you wrote in your post suggests that it is in mmol/L which is the measurements used in Europe, Canada, or elsewhere other than the States. Does your husband understand the proper dosing procedures for using insulin such as his I:C (insulin-to-carb) ratio, how much a single unit will lower his blood glucose; how high a single gram of carbohydrate will raise it; etc. etc.?; These are very basic facts that he must know in order to use insulin effectively to control his diabetes. If a meter displays HIGH instead of a numerical reading, it usually means that the reading is "off the charts" (higher than the range that the glucometer can accurately measure). THAT may be the reason why he is headed for renal failure and a potential cardiac event. Both are conditions that are known to be caused by uncontrolled diabetes and persistent high blood glucose numbers. Good control requires discipline, lifestyle changes (in both diet and activity), and both the willingness and capability to learn. If all of the preceding applies to him, tell us how we can help steer him towards this goal.View Thread
I think this thread is getting too far off topic. pajoo49 is a newly diagnosed diabetic. Her PCP has started her on metformin but has assured her that an A1c of 8.7 is "mid-range (6.5 — 13)." Clearly, her PCP is not up-to-date and indicates that pajoo49 should embark on her own quest for information instead of accepting everything that she is told at face value. I used Bernstein and Ruhl as references because, IMHO, their writings on diabetes are among the best I have read. I have approximately 32 books on diabetes in my personal library includingNeal Barnard's Program for Reversing Diabetes and McDougall's The Starch Solution. The latter two books have been virtually useless in my own personal quest in normalizing my blood sugars. My current A1c is now back down to 4.8 from a previous high of 5.0 during yet another round of dietary experimentation. McDougall and Bernard are heavily influenced by their PCRM and PETA biases. If I had to summarize their books in a single sentence, I would have to say that "their recommendations are more like a religion than it is science." Delores, I would love to debate the issue with you in greater detail but don't believe that this thread is the appropriate place.
pajoo49, whenever you are ready, please post back with any questions that you may have regarding weight reduction, possibilities for "reversal," dietary suggestions, metformin side effects, or virtually anything else that might help you stay on top of things to pursue a course that's going to work for YOU. Forum rules do not permit us to provide medical advice (few of us are qualified to do so anyway) but it doesn't mean that we can't provide opinions or discuss things that you may find to be of value. In the final analysis, you should discuss everything with your doctor anyway so be sure to read the WebMD disclaimer at the bottom of the forum page so that there's no misunderstanding.View Thread
Hi and welcome to the forums. Replies to new posts are often sparse on weekends but please check back frequently as "regulars" here can provide you with lots of tips and also answer most questions you might have. Your A1c is considered to be extremely high and is equivalent to a daily average of slightly over 200 mg/dL. That's virtually guaranteed to result in future complications and fulfill predictions of diabetes being a "progressive" disease. The progressive term really applies primarily to people with uncontrolled diabetes but is totally untrue for those of us who are able to lower our respective blood glucose levels down to normal or near normal ranges. The safest HbA1c range at which most diabetics can avoid or minimize the risk of complications is the "5% Club." That means maintaining an A1c under 6.0% (my avatar represents my own long term maximum recommendation).
As you may have already discovered, you will read lots of seemingly conflicting information regarding carbs, protein, fats and glycemic index/load factors. You will also read lots of opinions that "we're all different" but more often than not, it's simply an excuse, rationalization or cop-out for dismissing failure to reach desired targets. Glycosylation damage is generally a very s-l-o-w process and each of us varies only in how long it takes before symptoms become detectable. That's what makes diabetes such a dangerous and insidious disease: you won't feel anything while your body is undergoing the damage. And the younger you are, the more resilient you may be. However, nothing lasts forever and neglect will come back to haunt uncontrolled diabetics in spades; especially as one ages. The story of Kevin (Terminal and Scared ) on the diabetes.co.uk website is a poignant example of the end result. Kevin's thread is a long one (35 pages) but you only have to read the first 2 pages to get a good grasp of his situation.
To get you started, there are two websites that offer lots of wisdom at a fantastic price: FREE! All it will require is an investment in time, personal determination, and follow through: 1. Dr. Bernstein's Diabetes Solution . Major chapters from a previous edition are included in the link but you can purchase a revised, updated version from Amazon.com and other retailers in both ebook and printed formats. 2. Blood Sugar 101 by Jenny Ruhl. Jenny is not a healthcare professional but it does not diminish what she has to say because everything on her site is fully referenced and documented. Although lacking formal healthcare credentials, the importance and facts behind what she has to say may help provide greater insight and understanding into what you need to know; irrespective of what others may tell you.
That should suffice for your first "assignment." All the best. View Thread
Although we do not enjoy true medical freedom here in the States, I suppose we should consider ourselves fortunate that at least we still have alternatives available to us even if we have to pay for it ourselves out-of-pocket. To date, I have been paying for my own test strips. Although I have been paying premiums to Medicare for nearly nine years, any "benefits" that I have drawn from the program amounts to less than ten percent of the premiums I have paid into it (yes, that includes lab fees and doctor's visits, most of which have been paid out-of-pocket).
My very first attempt to obtain strips through Medicare was in September when I decided to switch my brand of strips over to FreeStyle under their Promise program . The Promise program is supposed to allow members to purchase 100 strips for only $15 and, unlike competing strip programs, did not disqualify Medicare-insured patients from participating. Sounded great until I actually tried it and the experience turned out to be a nightmare of errors, incompetency and bureaucratic stupidity. I won't go into the details except that errors were made by two different pharmacies as well as the doctor's office. Medicare did grant initial approval but under the initial error (incorrect strip type) but refused to honor an amended request (for the correct strips type) because they treated it as an additional claim instead of an amended one. It's been nearly two months and I'm still paying for my own strips.
Compared to the diabetics in the UK, I guess I'm not any worse off. Apparently over there, the protocol that many physicians follow is to deny coverage for test strips to all T2 diabetics unless they are on insulin. For those who are persistent, one poster claimed that test strips were limited to 100 test strips twice a YEAR! You can read about it in this forum thread on the diabetes.co.uk website. I can't help but wonder where all these folks got their diabetes and healthcare education and have spent countless hours searching online to see if I could find a reasonable explanation. The results of my research can be summarized into two possible causes as follows:
1. Villages across the country have reported a mysterious disappearance of their resident idiots. Rumor has it that these village residents weren't abducted by UFO's but have simply taken employment positions in various bureaucracies; others have been elected to a public office. The rumors are just that so please take it with a grain of salt and don't waste time trying to verify this at Snopes.com . 2. Scientists at the University of Nebraska and John Hopkins Medical School have discovered a virus that some believe is more dangerous and insidious than the ebola virus that has occupied so much of the media's attention during the past few weeks. The virus is called ATCV-1 and primarily affects algae. Previously thought to be harmless to humans, the scientists have discovered that it can be easily transferred from plants to humans and was found in actual tests to have infected 43% of the subjects in the test study. Rumor has it that the ATCV-1 virus is highly contagious and can be spread not only via the air but via auditory channels (you could get infected just by listening to someone who is infected). Rumors also say that ATCV-1 has reached epidemic proportions in government circles. Again, this is just rumor so don't bank on it. You can read more about the ATCV-1 virus at the links provided above or visit some of these links: newser.com , International Business Times , HuffPost UK , UPI , and others. Disclaimer: the ATCV-1 virus is real; my comments may not necessarily be although ... OMG, I think I'm infected!View Thread
Dolores, Will DuBois is a frequent contributor to several publications and blog sites. The article that appeared in the October issue of Diabetes Self-Management is actually Part Three of a four-part series. Part Four has not yet been published but, based on past trends, will be forthcoming 3 to four months following Part Three (probably sometime in the December 2014 to January 2015 time frame).
There's another, older (June 2013), article published on the Diabetes Self-Management site that may be of benefit to both newly diagnosed diabetics and seasoned veterans alike. The article is entitled Blood Glucose Monitoring: When to Check and Whyand was written by Rebecca K. Abma, an independent freelance writer. It covers the topic fairly well and it appears that the author has done her homework.
When I made my own self-diagnosis, I arrived at my conclusion based on multiple BG tests throughout the day (my first 100 strips only lasted about a week). I needed to determine how certain food items and meals affected me and you are correct about frequency: before eating a meal or a specific food, one hour after, two hours after, and four hours after. For the first six months, I kept detailed logs so that I could analyze effects, trends, and other factors that would better enable me to fine tune my blood glucose control. The logs included the types and portions of food(s) ingested, activity/exercise including time, even the impact that skipping a meal had on my BG levels. In the final analysis, the benefit(s) that one derives from carefully monitoring their diabetes is reflected by the individual effort invested. Newly diagnosed diabetics will be able to take advantage of newer technologies such as CGMs (Continuous Glucose Monitors) and hybrid technologies such as Abbott's FreesStyle Libre flash system (click on the link to view a brief video).View Thread
My intent was never to jump on you or anyone else; only to try to explain the facts behind the headlines and, hopefully, to provide additional education along the way. Your posting served a very useful purpose in showing what far too many patients and doctors continue to believe is healthy. I did locate the ADA's Standards of Care recommendations on UCSF's website at this page . The link for the ADA recommendation is at the bottom of the page or you can download a copy by clicking here .The current ADA recommendation for A1c is on the first line of the chart, far right, which states: "<7 or <6 if no risk of lows." That simply means under 6.0 if there is no risk of lows and finally defines good control as being in the 5% club (which many of us already follow). However, how many doctors and patients are even aware of this change? Especially when several friends have told me that their endocrinologists threatened to drop them as patients if they fall below 6.2%! Too bad, really, because it is the patient that's going to ultimately pay the price!View Thread