Diabetes Diets and Your Meter

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In reviewing some of my blogs, I havefound several that have gained readership beyond what I anticipated. This says there is a need for people to understand what they need toknow at the early stages and to review some topics after they havegained additional knowledge. It is important to say that I am not anexpert, but hopefully my readers are finding some information thatthey have been able to apply with the help of their meters and thatthey are adapting some information to their own management ofdiabetes.
Also, this statement may prove helpfulto some as they read other diabetes blogs or websites – “whatworks for me, may not work for you.” Other people use this - “yourmileage may vary” to help them understand that the results worked,but not as well as they hoped. Those of us that blog about diabetesunderstand that, and know that some ideas are helpful, some ideasmake sense, but don't get the great results for them, and a few ideasjust don't help. I have found this happens to me and I have a few –now many pages of helpful sites (the URLs and a brief summary) that Iuse to review from time to time. I apply what I find works for meand keep the information for future reference. Sometimes when onething quits working, I return to my list and see if something else isnow working.
I may overuse this, but testing isimportant and goes a long way to helping you discover what you bodywill allow and still get the test results you want. The meters arenot expensive (often your doctor will hand them out free), but it isthe test strips that are expensive. Insurance will only cover alimited number. I have found it worthwhile to talk with the medicalinsurance people about allowing extra testing shortly afterdiagnosis. Some will allow extra for a couple of months and then goback to their allowance, but most will require a letter from yourdoctor. Forget Medicare, they will only allow one or two test stripsunless you are on insulin and then you are allowed four test stripsper day. This is unreasonable at best and criminal what they will doto people needing to learn how different foods affect blood glucosereadings. For those unable to obtain or afford extra test strips,okay, check with the manufacturer for financial assistance. Most dohave this and if you follow their instructions, you may qualify.
In writing about diabetes diets, I madesome statements about the collusion between four government agenciesand four diabetes organizations. Now another blogger on thenutrition side is speaking out about two government agencies andtaking their “experts” to task for our obesity epidemic. Shealso has an excellent discussion about her organization and theirpart in promoting the obesity epidemic. This is also why they do notwant us testing to see how different foods affect our diabetesmanagement. This last sentence is what drove my thoughts in writingabout getting our test strips back from Medicare. It even caused meto listen to one of the candidates for congressional representativefrom my district and ask some rather direct questions about why USDAwas working so hard to give out bad nutritional advice – to which Iwas totally ignored and then several others asked similar questionswhich were also ignored. Since the candidate is the wife of ourcurrent Secretary of Agriculture, it did my spirits good to see herdefeated.
There are many good reasons to ignoresome of the quasi professionals in the Academy of Nutrition andDietetics and the American Association of Diabetes Educators whenthey do not attempt to help many of us with type 2 diabetes which Iblogged about here. Even my cousin that is a certified diabeteseducator has now disowned me for some of my positions. Anothercousin that has been helping me with nutrition when I am a volunteerpeer mentor says she likes working with me and was very surprised atthe reception she has received and has continued to have with some ofone doctor’s patients. Once she stated she would not be pushinghigh carbohydrates and low fat, but wanted to work with them at thelevel they were at, whether low carb or what ever type of regimenthey were wanting to discuss, she has been well received. She hasnow consulted with another group of patients with the same doctorthat are interested in nutrition.
My second peer mentoring session with ahusband and wife practice in Kansas for October was good. Theprimary discussion was on different meters and the proper bloodglucose levels or guidelines they should follow. I wish I would havehad the second question from Diabetes Mine and the second comment tothe discussion, but we did cover most of the points. Many were notenthused about the ADA guidelines and wondered about the points inJenny Ruhl's website here and here. I stated that they wereexcellent targets for many people. I asked if anyone washypoglycemically unaware or recently had a low that they were notaware of until they tested. No one had such an experience that theywere aware of and I warned them about this and knowing the signs ofsweating, nervousness, being lightheaded, and the other symptoms. That did bring one admission from a patient saying now that he knewwhat to look for; he may have had one in the last month. He admittedthat when he tested the reading was 73 mg/dl and an hour later thereading was 88 mg/dl.
I asked him how long it had been sinceeating and he said about 7 hours because he had not felt good andskipped the noon meal. I asked what medication he was taking and hestated it was one of the sulfonylureas and yes he had taken it atnoon. I advised him to talk to the doctor before leaving thatafternoon and ask about skipping the medication when he felt like noteating. When the doctor came to get the next patient he did ask andshe stated he should not have taken the medication unless he wasabove 150 mg/dl. He said he had not tested and she advised him toalways test if he knew he would not be eating. She stated this wouldguide him on taking the medication. She asked if there were otherquestions on medication and not eating – there were so she saidthey would cover this later before the session ended. I thenexplained what can happen if someone was high and took theirmedication without eating and got the hypoglycemia symptoms, buttheir test showed they were in the upper 80s or in the 90s. I saidthe symptoms of hypoglycemia can happen when they have a rapid dropin blood glucose levels. One person spoke up and said like a falsepositive. I agreed, but warned them that testing was important justthe same.
Next I asked if any of them had pizzafrom time to time. Of the 12 patients in the room eight admitted tohaving a piece or two with the family. So I then asked how many wereon a regimen of higher that 40 percent fat for a meal. Six answeredyes, and I talked about not testing at one or two hours post meal,but at three or four hours and said this was known as the “pizzaeffect” because of the fat content that would slow the absorptionof carbohydrates. I said I realized many of them could not use thatmany test strips, but for those that could, they should test at halfhour intervals starting at 2 and one-half hours after eating and testuntil the 4 and one-half hour mark. One woman said she had read thissomeplace and had tested at the 2 hour, 3 hour, and 4 hour points andher high had been somewhere between the 3 and 4 hour points, so sheknew I was right. I stated that it would vary from person to person,but that even a few people might have the high after four hours. Oneperson asked if this would apply to her being on insulin. I saidyes, and asked which insulin. She said Novolog and I saiddefinitely, and advised her that she could be like me and only have a3 and one-half hour effective period. She stated that as far as shecould determine she was getting a 4 to 4 and one-half hour effectiveperiod. I suggested that she think about not injecting her insulinuntil after she had eaten, but to test before meals as always andcount her carbs she would be eating to determine the dose, but not toinject until the end of the meal. She said she would ask the doctor.
I then had a few other questions beforethe end. I wished everyone happy holidays and both doctors asked meto remain online until all questions had been answered. The firstquestion was the woman on insulin and the doctor said let her thinkon it, and she faced the video cam and asked if I had suggested thisand why. I responded that this had been raised when discussing the“pizza effect” and the doctor said now she understood thequestion and that she agreed with my suggestion and it would maximizethe effectiveness of the insulin. Then she stated that this wouldalso be a good idea for those on sulfonylureas. Then she asked ifanyone thought they had slow emptying stomachs although she did notthink anyone did. No responses, so she continued that injectingafter eating could also help these people in case anyone had friendswith this problem.
The rest of the questions were answeredand the husband asked how people felt this was working. Of the 14people present, only one said it was not helpful and that was becausehe was still not on medications. The other person that was not onmedications said it still was a help for him because he knew whatneeded to be done if he had pizza with the grandchildren. He said hewould have to exercise longer, but how to test was still valuable tohim. The husband asked how many would attend in January and 13 ofthe 14 said yes. Then a person asked a question about something Ihad written in my blog about the reason insurance companies limitedtest strips. The wife asked, “the one saying about the collusionbetween four government agencies and the four diabetes professionalgroups and them not wanting us to learn what high carb and low fatdiets did to our health.” The person said yes, and the doctor saidshe agreed and her husband said he agreed as well. He went on to saythat how were we going to maintain our health on the limited numberof strips.
He then announced something thatsurprised even me. They had written all of the test stripmanufacturers and all of the insurance companies they knew were beingused by people there and were waiting to receive replies from two ofthe manufacturers. He said the responses to date would requirecopies of the front page of each person's federal form 1040 for theprior two years and they would need two copies of each, one set forthe test strip manufacturer and one set for the insurance company. Once they had all the copies, they would send them all in and thenthey would be provided with a list and what would be allowed for eachperson. At that time, an email would be sent to each person with thedetails and a return form to say if they wanted to participate ornot, and what their cost would be and the amount the insurancecompany would allow.  He concluded by saying that it may notbenefit everyone, but unless they participated, they would not know.