Managing Your Blood Glucose

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Minorities, Poor Have Tougher Time Monitoring Diabetes

Sunday, March 16th, 2008

Friday, Mar. 14, 2008; 4:18 PM
Copyright © 2008 ScoutNews, LLC. All rights reserved.

FRIDAY, March 14 (HealthDay News) — Minority and low-income Americans with insulin-treated diabetes are less likely to monitor their blood glucose than other diabetics, a new study shows.

The researchers examined data on 16,630 Hispanic, black and white adults aged 19 and older with insulin-treated diabetes to come to this conclusion.

At every income level, fewer Hispanics and blacks reported daily self-monitoring of blood glucose than whites. The study was to be presented Friday at the American Heart Association’s Annual Conference on Cardiovascular Disease Epidemiology and Prevention, in Colorado Springs, Colo.

“Minority and financially vulnerable adults with insulin-treated diabetes appear to have lower reported rates of self-monitoring of blood glucose [SMBG] — a vital disease management component,” study author Dr. Deborah A. Levine, an assistant professor in general internal medicine at the Ohio State University College of Medicine, said in a prepared statement.

“Efforts to improve diabetes control, including the collection and use of SMBG data in Hispanic and black populations with diabetes [particularly those on insulin], are warranted given that Hispanics and blacks have a higher frequency of diabetes-related complications compared to whites. We need to better understand income’s role in racial and ethnic disparities in SMBG to offer effective programs and policies to improve SMBG by minorities,” Levine said.

The study found that among those with annual household incomes of $20,000 and higher, SMBG rates were 85 percent for whites, 78 percent for Hispanics, and 77 percent for blacks. Among those with household incomes of less than $20,000, SMBG rates were 85 percent for whites, 79 percent for blacks, and 65 percent for Hispanics.

The researchers also found that among those with household incomes of less than $20,000, 49 percent of Hispanics received diabetes education, compared with 62 percent of whites and 64 percent of blacks.

“Receipt of diabetes education varied significantly by race-ethnicity only in the less-than-$20,000 income group,” Levine said. “At incomes of $20,000 or more, both Hispanics and blacks had 40 percent lower odds of daily SMBG compared to whites. At incomes of less than $20,000, however, the odds of daily SMBG decreased by 70 percent for Hispanics compared to whites, but did not change for blacks.”

These racial and ethnic disparities in self-monitoring of blood glucose were not fully explained by demographic characteristics such as health insurance, health status, or diabetes-related measures such as diabetes education, disease duration or end-organ damage, Levine said.

The findings suggest that poverty significantly worsens self-monitoring of blood glucose and receipt of diabetes education among Hispanics. This means that income must be “explicitly considered when assessing SMBG performance and designing SMBG interventions for Hispanics with insulin-treated diabetes,” Levine said.

In 2005, 15.1 million U.S. adults (7.3 percent of the adult population) had diagnosed diabetes, according to the American Heart Association. Of those, 13.2 percent were non-Hispanic black females and 10.7 percent were non-Hispanic black males; 11 percent were Mexican-American males and 10.9 percent were Mexican-American females; and 6.7 percent were white males and 5.6 percent were white females.

More information

The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about diabetes control.

Posted in Checking Your Blood Glucose, Complications, Managing Your Blood Glucose | No Comments »

DAVID MENDOSA: Setting Slack Standards

Sunday, March 9th, 2008

We live in a culture of low targets,” writes Hana, one of my regular correspondents in England who has diabetes. For example, her nurse told her that that walking for half an hour three times a week was enough exercise to make a difference, and it doesn’t have to be fast walking. “I do a lot more than that,” she says.

I agree with Hana. Like Western culture as a whole, the medical establishments in the U.S., the UK, and probably most of the rest of the Western world set the bar far too low for people with diabetes. In the U.S. the American Diabetes Association sets the standards that count.

Every year the ADA looks at the goals it thinks that those of us with diabetes should reach and summarizes them in “Standards of Medical Care in Diabetes.” It is gradually setting higher standards, and not all of the standards that it sets are slack, particularly those for cholesterol and blood pressure control.

But many of us who have lived with diabetes for many years think that in four areas the standards are too lax, and that if we personally don’t choose to set the bar higher we won’t have as many years left.

A1C
No standard is more important than our A1C level, which measures our average blood glucose over the past two to three months. The ADA says that generally its goal for non-pregnant adults in general is less than 7 percent.

Considering that the average A1C level of American adults with diabetes is between 8.5 and 9 percent, as an ADA doctor once told me, it’s the right direction. But is it enough?

that it’s up to 6.2. The Accu-Chek meter company The answer to that question is what is an average level. The large UK Prospective Diabetes Study saidsays that it’s 5.0. Dr. Richard K. Bernstein told me that it’s about 4.5, where he has been able to keep his own level for many years in spite of his type 1 diabetes.

Personally, I have recently been able to get my A1C level down to 4.6 to 5.4 in different tests from different labs recently. I’m pleased, because it’s clear that the closer we bring our levels to normal, the fewer complications we are likely to get.

New studies are coming forth regularly that show the closer our A1C levels are to normal the better. Just this month a study in the top medical journal, Lancet, demonstrated that more than 60 percent of retinopathy cases were among patients with levels below 7.
Then, why set the goal at 7 percent? The ADA says that it’s because of the greater problem with hypoglycemia when we shoot for a normal level. Certainly, if you are taking one of the diabetes medications that can make you go hypo — specifically insulin or one of the sulfonylureas — you need to be careful. Otherwise, we have no reason not to shoot for a normal level.

Exercise
Hana’s nurse in suggesting that all the exercise she needs is 90 minutes a week is indeed stetting a low standard. Even the ADA aims higher. It recommends that those of us who can do it get 150 minutes of moderate-intensity aerobic physical activity a week as well as resistance training three times a week.

But even the U.S. government’s current recommendation for adults to lose weight is 60 to 90 minutes of exercise on most days of the week. That works out to up to 360 minutes of exercise a week.

Dr. Alan Rubin, an endocrinologist in San Francisco and the author of Diabetes for Dummies told me that he personally gets at least 90 minutes of exercise per day and that the only way his patients have been successful in losing weight is getting several hours of exercise every day.

Taking heed, I make sure that I get about 14 or 15 hours of exercise every week. I needed it to lose weight and to maintain that weight loss.

Weight Loss
When I started taking Byetta in February 2006, I weighed 312 pounds. Today I weight 158. That’s almost a 50 weight loss.

The ADA, on the other hand recommends that, “For obese individuals, a modest weight loss of 5 to 10 percent of body weight may be indicated.”

If I had paid attention to the experts, I could have hoped to reduce my weight by 31 pounds and would weigh 281 pounds today. On my 6′ 3″ frame I would still be obese with a BMI of 35.1, instead of having the low normal BMI that I have today of 19.7.

Carbohydrates
Of all of the ADA’s lax standards, nothing disturbs some people with diabetes more than its recommendations that we eat a lot of carbohydrates. It recommends that we get 130 grams of digestible (net) carbohydrates per day. The big beef of most detractors of a low-carb diet is that it’s too difficult for us to follow.

Dr. Bernstein stands at the low-carb end of the spectrum. His recommendation is essentially about 42 grams of carbs per day.

The jury’s still out on this one. But the remarkable new book, Good Calories, Bad Calories, by Gary Taubes, finally persuaded me that a high fat-diet — in other words one that makes a low-carb diet possible — is safe for my heart.

The common complaint about the ADA’s lax standards is organizational inertia. But that’s not fair.

Diabetes can be overwhelming, especially when we get our diagnosis and realize that we have to totally change the way we live. The ADA certainly realizes that if it told us to change our lifestyles this drastically, even more of us would go into denial and essentially say, “Shove it.”

If the ADA had set honest standards, it would be little like telling someone to eat an elephant, my favorite Certified Diabetes Educator tells me. “Initially seems overwhelming and impossible,” she says. “But if you do it one bite at a time, especially by setting smaller more easily attained goals, you’ll get there eventually.”

But those of us who have lived with the disease for several years know well that we feel better and can expect to live longer, healthier lives when we set our own standards much higher. For us, getting to these goals eventually means getting there now.

Article by: David Mendosa.

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Test helps diabetics detect nerve trouble

Sunday, March 2nd, 2008

By Steven Reinberg
HealthDay Reporter Friday, Feb. 29, 2008; 1:00 PM
Copyright © 2008 ScoutNews, LLC. All rights reserved.

FRIDAY, Feb. 29 (HealthDay News) — Fasting blood sugar levels are typically used to diagnose diabetes, however, a common complication of the disease that can lead to blindness begins at blood sugar levels below what is considered diabetic, Australian researchers report.

Retinopathy is a vascular condition where the small blood vessels in the eye become damaged; other complications of diabetes include heart, kidney and circulatory problems.

“Retinopathy, which is one of the complications traditionally associated with diabetes, occurs at fasting glucose levels below the threshold that is used to define diabetes,” said lead researcher Dr. Tien Y. Wong, chairman of the Department of Ophthalmology at the University of Melbourne.

In the study, Wong’s team analyzed three studies that looked at retinopathy among 11,405 people. The report was published in the March 1 issue of The Lancet.

The researchers found that the overall prevalence of retinopathy ranged from 9.6 percent to 15.8 percent in the general population. In addition, they didn’t find evidence of a particular blood glucose level that would indicate the presence of retinopathy. In fact, 60 percent of retinopathy cases were missed by the current threshold for diabetes diagnosis, which is 7.0 mmol/L.

The finding suggests that eye damage happens much earlier and at lower blood sugar levels than what is currently used to pinpoint the presence of diabetes, Wong said. “This suggests that diagnostic threshold may have to be revised, so that we can pick up more people who are at risk of eye and other complications,” he noted.

In addition to retinopathy, signs of cardiovascular disease also appear to develop at glucose levels below those defined as diabetes, Wong said.

One expert agrees that fasting blood sugar levels may not be the best way of diagnosing diabetes and those at risk for diabetes.

“It is becoming more common that studies are showing that a fasting blood sugar value is not necessarily the best way to judge diabetes or diabetes control,” said Dr. Stuart Weiss, an endocrinologist at New York University Medical Center.

Weiss noted that right now there is no other marker for diabetes. However, many new studies point to the use of blood sugar levels after eating as being better markers for risk, he said.

“Fasting blood sugar is not all that helpful,” Weiss said. “The problem is that a lot of our thinking is based on fasting. That’s an issue we need to focus in on,” he said.

Posted in Checking Your Blood Glucose, Diabetic Neuropathy and Nerve Damage, Managing Your Blood Glucose | No Comments »

Indian herb may help diabetics control blood sugar

Tuesday, February 26th, 2008

NEW YORK (Reuters Health) – An extract of Coccinia indica, a perennial herb that grows abundantly in India, may help people with mild type 2 diabetes control their blood sugar levels, the results of a new study suggest.

In the journal Diabetes Care, researchers note that while Coccinia indica, also known as Coccinia cordifolia, has been widely used in traditional treatments of diabetes, carefully controlled studies have not been done.

To examine the effects of this herb on blood sugar levels, the India-based researchers randomly assigned 60 adults with newly detected type 2 diabetes to receive Coccinia extract or placebo. The subjects were between 35 and 60 years old and were being treated with diet and lifestyle modification only.

According to Dr. Rebecca Kuriyan, from the Institute of Population Health and Clinical Research in Bangalore, and colleagues, there were significant differences in blood sugar favoring Coccinia extract over placebo after 90 days of treatment.

Fasting blood sugar levels at 90 days in people taking the Coccinia extract fell by an impressive 16 percent, while fasting blood sugar levels rose slightly in the placebo takers. Likewise, patients in the Coccinia extract group had an 18-percent decrease in post-meal blood sugar levels at the study’s end, whereas the placebo group experienced a small increase in post-meal blood sugar levels.

This study suggests that Coccinia extract has a potential blood sugar lowering action in patients with mild diabetes. Kuriyan and colleagues note however that additional studies are needed to identify the mechanisms involved.

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Tight Diabetes Control

Tuesday, October 30th, 2007

Keeping your blood glucose levels as close to normal as possible can be a lifesaver. Tight control can prevent or slow the progress of many complications of diabetes, giving you extra years of healthy, active life.

But tight control is not for everyone and it involves hard work.

By the Numbers

Good control means getting as close to a normal (nondiabetic) blood glucose level as you safely can. Ideally, this means levels between 90 and 130 mg/dl before meals, and less than 180 two hours after starting a meal, with a glycated hemoglobin level less than 7 percent. The target number for glycated hemoglobin will vary depending on the type of test your doctor’s laboratory uses.

In real life, you should set your goals with your doctor. Keeping a normal level all the time is not practical. And it’s not needed to get results. Every bit you lower your blood glucose level helps to prevent complications.

What Tight Control Does

No one knows why high glucose levels cause complications in people with diabetes. But keeping glucose levels as low as possible prevents or slows some complications.

The Diabetes Control and Complications Trial (DCCT) proved it. Researchers followed 1,441 people with diabetes for several years. Half of the people continued standard diabetes treatment. The other half followed an intensive-control program. Those on intensive control kept their blood glucose levels lower than those on standard treatment, although the average level was still above normal. The results? In the tight-control group, compared with the standard-treatment group,

Diabetic eye disease started in only one-quarter as many people.
Kidney disease started in only half as many people.
Nerve disease started in only one-third as many people.
Far fewer people who already had early forms of these three complications got worse.

Living With Tight Control

To get tight control, you must pay more attention to your diet and exercise. You must measure your blood glucose levels more often. And, if you take insulin, you must change how much you use and your injection schedule.

In intensive therapy, you provide yourself with a low level of insulin at all times and take extra insulin when you eat. This pattern mimics the release of insulin from the normal pancreas.

There are two ways to get more natural levels of insulin: multiple daily injection therapy and an insulin pump. Both are good methods. Your choice should depend on which best fits your lifestyle.

In multiple daily injection therapy, you take three or more insulin shots per day. Usually, you take a shot of short-acting or Regular insulin before each meal and a shot of intermediate- or long-acting insulin at bedtime.

With an insulin pump, you wear a tiny pump that releases insulin into your body through a plastic tube. Usually, it gives you a constant small dose of Regular insulin. You also have the pump release extra insulin when you need it, such as before a meal.

With either method, you must test your blood glucose levels several times a day. You need to test before each shot or extra dose of insulin to know how many units to take and how long before eating to take it. Also, you may want to test 2-3 hours after eating to make sure you took enough insulin. You must adjust your insulin dose for how much you plan to eat and how active you expect to be.

You do not need to figure these things out on your own. Whatever method you choose, your health care team (your doctor, dietitian, diabetes educator, and other health care professionals) should spend a lot of time teaching you about it. Your team will help you make guidelines for how much insulin to take and when. You will also come up with guidelines for eating and exercising. These guidelines may change several times as you test them out.

You shouldn’t try tight control on your own. A good health care team is a must. Choose a doctor who understands diabetes well or is willing to learn for your sake. Your doctor should have ties with other health professionals you need, such as dietitians and a mental health worker. If you live in a small town, look at your options carefully. You may be better off driving to a city to see a specialist.

How to Keep Going and Going

Starting a program of tight control is exciting. But it can also be overwhelming. How do you keep from running out of energy?

One way is to start slowly. For example, you might start by checking your blood glucose more times each day. Get used to that first. Then start multiple daily injections. Once you’re used to those, add your new exercise program and make the changes in your diet.

If you are newly diagnosed with diabetes, look honestly at yourself. Are you still angry and depressed that you have diabetes? If so, you already have a big challenge facing you. You may want to wait to try tight control until after you’ve come to terms with the changes in your life.

Keep your goals realistic. No matter how hard you try, your blood glucose readings will not be perfect every time. If they are often too high or too low, you should talk to your doctor about whether your plan needs to be adjusted. But if “wrong” levels happen only sometimes, that’s life. With practice, you will become more skilled at choosing the right insulin doses for various situations.

If you need to, take a breather from the new routine. Having some time off may make it easier to stick to your plan when you start again.

Pluses and Minuses

One big reason to try tight control is to prevent complications later. But tight control has effects you can enjoy right now. You will probably feel better and have more energy. Also, because you adjust your insulin dose to your life, and not the other way around, you have more freedom. You can vary your activities more. And you’re not locked into having your meals at the same time each day.

Tight control is especially good for pregnant women. It can reduce the risk of birth defects in the baby.

But the DCCT found two major problems with tight control.

First, people had three times as many low blood glucose reactions (hypoglycemia). You will need to be alert to the symptoms of hypoglycemia so that you can treat yourself quickly. Also, you should always check your blood glucose levels before you drive.

If you often have low blood glucose reactions when you try tight control, talk to your doctor. You may need to ease up on your goals or go back on standard therapy for a while.

Second, people on tight control gained more weight than people on standard insulin treatment. The average in the DCCT was 10 pounds. If you are concerned about putting on pounds, work with your dietitian and doctor to devise a meal and exercise plan to prevent it.

You should also consider the cost. You will need to see your health care team more often. Pumps cost about $5000, and pump supplies run $60 to $80 a month. Multiple injection therapy is much cheaper. But you will still use more supplies, like test strips and syringes, than before.

Tight Control and Type 2 Diabetes

The DCCT studied only people with type 1 diabetes. But doctors believe that tight control can also prevent complications in people with type 2 diabetes.

Most people with type 2 diabetes do not take insulin. You may be wondering how you can achieve tight control without it.

One way is to lose weight. Shedding excess pounds may bring your glucose levels down to normal. The key to losing weight and keeping it off is changing your behavior so that you eat less and exercise more. Your doctor should work with you to find an eating and exercise plan you can stick to.

Even if you don’t need to lose weight, exercise is helpful in controlling your blood glucose levels. It makes your cells take glucose out of the blood.

You will need to check your blood glucose regularly. You should decide with your doctor how often. Once a day or even once a week may be enough for some people with type 2 diabetes.

If exercise and good eating habits are not enough to keep your glucose under control, you doctor may prescribe pills. And if these don’t work, you may need to take insulin.

People with type 2 diabetes should talk to their doctors before starting tight control.

Tight Control Is Not for Everyone

Tight control is not safe for everyone with diabetes.

Children should not be put on a program of tight control. Having enough glucose in the blood is vital to brain development. Some doctors say that tight control should wait until a child reaches 13; others say after the age of 7 is okay.

Elderly people probably should not go on tight control. Hypoglycemia can cause strokes and heart attacks in older people. Also, the major goal of tight control is to prevent complications many years later. Tight control is most worthwhile for healthy people who can expect to live at least 10 more years.

Some people who already have complications should not be on tight control. For example, people with end-stage kidney disease or severe vision loss probably should not try it. Their complications are probably too far along to be helped. Some people who have coronary artery disease or vascular disease should not try tight control. People who have hypoglycemia unawareness probably should not go on tight control.

Tags: Conditions & Treatments, Managing Your Blood Glucose, Tight Diabetes Control
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