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Why KeepDiabetes A Secret?
Having a diagnosis of type 2 diabetesis probably not something you would shout from the rooftop, butshould you keep it a secret? Many people do just this and will nottalk about it even to family members unless it is necessary. Extremesecrecy can be difficult. There was a situation a few years ago nearhere that made me laugh. Husband did not tell wife or anyone abouthis diabetes diagnosis. Two weeks later, his wife answered thetelephone, and it was husband's doctor office calling to remind himof his diabetes education class the next day.
When husband learned this had happened,he hired a lawyer to sue the doctor's office for failure to keep hismedical records private. Judge had a sense of humor and askedhusband if he loved his wife and he answered yes. The judge said ifthis were true, why had he attempted to keep his disease a secretfrom his wife? The judge said he could understand the secrecy desirefor the husband's affair uncovered by the sheriff. He handed downthe following judgment. One-dollar fine to the doctor office – toremind them to be more careful and court costs on the husband for thelawsuit and wasting the court's time. He gave instructions to thewife that should she ever decide to divorce her husband, all shewould need to do is file the paperwork and it would be granted. Inaddition, he wanted the court proceeding widely published.
PresentlyThere Is No Cure
A topic that often surfaces shortlyafter diagnosis is “the cure.” I am somewhat hesitant to discussthis here, but if I can prevent anyone from avoiding this approach,it will be worth it. There are charlatans out there just waiting toseparate you from your hard-earned money. They exist in small townAmerica, in the large cities, and on the internet. They have theskill and arguments to make it sound very convincing and may bedoctors or just cunning salespeople. They have one thought, and itis getting you to hand over your hard-earned money for their falseclaims. Read my blog here for more.
There are also researchers and medicalpeople that have plans to (as they claim) put diabetes is remission. They promote extreme low calorie regimens and certain supplementplans which may make it seem like diabetes is stopped and are safe touse. Just be careful as these are for the short term and researchhas not proven they will succeed for the long term. The stress onyour body using these extreme low calories diets has not beenresearched beyond a few months. They have proven that they work forthe short-term and that is their promotion to obtain your money. Then in a few months when your blood glucose levels start back towardthe stratosphere, they will try to sell you another round of the sameregimen. Your long-term health is being put in jeopardy. Do notattempt these plans without your doctor's knowledge.
Acronyms andTheir Use
As you start reading and looking forinformation on the Internet, you will come across many acronyms usedby people to avoid typing long or even short strings of words. Thiscan be discouraging for the new person with diabetes. What do theymean in the context of the sentence? One that you need to be verycareful with is this one – ADA. It still means American DiabetesAssociation and Americans with Disabilities Act. Many still use itfor the American Dietetic Association, but as of January 2012 it wasofficially changed to AND (Academy of Nutrition and Dietetics).
Changes in names can be a good thing,but the change above was solely to camouflage a takeover of competingoccupations and eliminate competition by criminalizing people notbecoming certified under their organization. This is not a veryprofessional objective.
How you see acronyms will vary witheach writer. Many will give the program or profession name in oneparagraph and then start using the acronym in the next or laterparagraphs. Others will use the full explanation followedimmediately by the acronym and then use the acronym for the rest ofthe article. Some writers assume that their readers know the meaningof the acronym and never give the full name. These are the writersthat make it difficult for all types of readers. Time after time.when there is the possibility of confusion, I have seen commentsasking for the full definition of an acronym. Some people areespecially sarcastic about this and provide a definition they know iswrong and abrasive, but the writer seldom clarifies. Some writers dothen provide the correct meaning for the acronym. A few writers docorrect their habits, and the rest just disappear.
I do use acronyms, and if you catch menot giving the full meaning, please let me know. I use the fulldefinition and then the acronym in parenthesis or the acronym withthe full definition in parenthesis. I have used the full definitionin the first paragraph or two and then start using the acronym;however, I am trying to break that habit.
Some of theTesting Basics
Hopefully, you are now comfortable withtesting and are doing it regularly. You need to understand what theblood glucose (BG) readings mean and what actions are available toyou. Whether you are endeavoring to manage your diabetes withexercise and diet without medications, or are using an oralmedication, you need education about both and when to test. Mosteveryone tests upon rising from sleep and this is termed fastingblood glucose (FBG) and your goal should be between 80 mg/dl(milligrams per deciliter) (4.4 mmol/L) and 100 mg/dl (5.6 mmol/L,(millimole per liter). Or, as many write, keep fasting blood glucose(FBG) under 100 mg/dl.
Then we come to the next meal. Hopefully, you will be under 100 mg/dl for the pre-meal blood glucosereading (preprandial). If you are not, then consider what you atethat would keep you higher. I like the goal of one hour post mealreading being 140 mg/dl (7.8 mmol/L) or lower (postprandial). At thetwo hour postprandial blood glucose reading should be 120 mg/dl (6.7mmol/L) or lower. However, if these become your goals, be careful aseating the American Diabetes Association's recommended mealconsumption of carbohydrates will make these goals unachievable formany patients.
Testing is the only way you have indetermining how different foods and food quantities affect your bloodglucose levels. A term you will see in blood glucose management isself-monitoring of blood glucose (SMBG – is the acronym). You willalso need to test more frequently in the beginning to learn how longbefore you reach the high level of your BG. Many suggest one hourafter first bite and for some people this can be too early. If youare a speedy eater (gobble down your food) this may work; however,studies have shown that you should eat slower for greater bloodglucose management. Some writers do use the word control instead ofmanage for the same meaning. Some will suggest testing more oftenuntil you are comfortable with when your high level of BG happens. Isuggest starting at the one-hour mark and testing every half hour thefirst few times until you see the readings start decline. Somepeople will test every 15 minutes. Somewhere between the highestreading and the lower next reading, the high may have occurred.
Occasionally the high mark can happenbefore the one-hour mark or beyond the three-hour mark. Thisindicates that the food you ate enters the blood stream quickly andwas easily digestible and probably contained little fiber, if any. If it is after three hours, this indicates a higher than normalamount of fat, example – pizza. If you are saying this isconfusing and too much to learn, you may as well know up front thatthere are not firm guides or rules to follow. It is important toknow that what works for me, may not work for you. It is importantto know that you need to become your own lab rat to determine how thedifferent foods affect your system and what works for you. Manypeople keep a detailed journal during this time of the readings, whatwas consumed, and other observations that they feel is important. Read my blog here for further discussion of postprandial testing.
How often you test will depend on yourdesire to bring diabetes under excellent management and your budget. You will also need to find out how willing your doctor is to go tobat for you with the insurance company for additional testingsupplies. Some companies will allow some extra test strips in thefirst few months, but then want to restrict you thereafter. Otherinsurance companies will only allow a set number of test strips perday. I recommend that you talk with your insurance company to findout what they are willing to allow. You may need to bargain withthem and attempt to convince them of the need for allowing more teststrips for the first three to five months. Don't be surprised if youare denied, but it is still worth the effort. If your budget willallow for the test strips, the knowledge you gain will be worth thecost. Medicare will not allow extra test strips.
As you are testing you are also lookingfor trends. If you are bouncing up and down at the two-hourpostprandial, looking at your food log may provide clues as to why. If your FBG is on an upward trend for a couple of weeks then beconcerned and be more careful of your last meal of the day. Also donot let a lot of time pass after rising in the morning as this allowsyour liver to dump more glucose into the system and can distort thetrend. Many people can also have what is termed the dawn phenomena(DP) which is the livers function to dump glucose into your system togive you energy for waking up and starting the day. Upward trendsshould always be of concern and if they continue or start to trendupward more rapidly, always consider talking with your doctor. Hemay request an office visit and may increase the dosage of yourmedication or start you on a new medication.
Never be concerned with some bouncingup or down of BG readings, as this can happen if you are coming downwith an illness or can vary with the food you ate at the previousmeal. Trends up or down for longer that a month should be talkedabout with your doctor. He/she may need to adjust you medication. Trends under 80 mg/dl should always be talked about with your doctor. More about this in the next blog.
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