Re: new diabetic with questions

July 6, 2005

Mike,

No, you are not overreacting!!! You Dr is wrong, wrong, wrong!

256 is very bad-Has anyone explained to you about all the horrendous

complications that can befall an uncontrolled diabetic? With those #'s, you are

uncontrolled, no question.

To avoid those complications, the goal for bg must be that of a normal

non-diabetic, 70-110mg/dl & less than 140mg/dl post-prandially (after meals).

There is some debate about what the post-prandial goal should be, but suffice

to

say it's not 256mg/dl.

When you say " I stick to the diet " , I'm going to assume (correct me if I'm

wrong) that you were given the standard ADA high-carb/low-fat " Exchange " diet

plan. If so, that is part of your problem!

Carbohydrates are the problem---For Type 2 diabetics, there is one food type

only that makes bg's go up and that is carbohydrates, so controlling carb

intake has to be the cornerstone of achieving good bg control. Notice I didn't

say " low-carb " (although that's what I do), because each of us has a

different tolerance for how our bodies handle carbs.

Additionally, some carbs are worse than others. Some carbs can make bg's

rise faster & farther than pure table sugar! This is the concept of the

" glycemic index " (GI) which is a measure of how fast & high your bg will go

with a

given food. " Starchy " carbs (Potatoes, pasta, rice) are particularly high GI

and intolerable to many of us who are trying to achieve control with diet &

exercise. Each " gram " of carbs can raise bg's 3-5mg/dl!, so a glass of milk

(approx 12g carbs) could raise your bg 36-60mg/dl as an example. A medium baked

potato is the same as eating 1/4 cup of sugar!

OK, next " testing " . Education is your best tool for achieving control & bg

testing is the means to know if what you are doing is working.

For someone in your situation (newly diagnosed & trying to control

unsuccessfully), testing twice a day is " never " going to allow you to know

enough to

achieve control safely, particularly when using insulin.

To learn what is going on I recommend (others will too) testing at the

following times: fasting (in the am, preferably before your feet hit the floor,

reasons explained later), immediately before each meal and 1 & 2 hours after

meals, and bedtime. This amounts to approximately 11 times a day. That sounds

like a lot, & it is, but it's the only way to know what's going on, how your

food is effecting your bg's and what effect exercise is having (if you're doing

that).

Testing that much is not a " forever thing " ! After you've achieved control,

you can test much less, but if you're using insulin, it'll be more than twice a

day, for sure. IMHO, testing twice a day for an insulin user is just plain

dangerous.

Mike, your Dr seriously doesn't understand diabetes or how to treat it,

based on what you've told us so far, and I'd suggest finding another (interview

candidates after you've learned from this list some of the things you should

know & the questions to ask), preferably an Endocrinologist, who specializes

in diseases/conditions of which diabetes is one. There are also Endo's who

specialize in diabetes, & one of those would be best.

Have you had or did your Dr even suggest have a Glycosylated Hemoglobin Test

(HbA1c) done? This is a test that measures your average bg's over the past

6-weeks to 3 months, & is the best indicator we have for complication risk.

Normal non-diabetics have HbA1c of 6% or less. From what you've said, yours may

be in the 10-15% range, but that's a guess.

Well, I've just scratched the surface, & I'm sure Vicki will chime in with

her excellent " newby letter " that goes into much more info than I could here

without writing forever. I know I've missed some things, but most importantly

think about changing Drs (IMHO).

Ask questions & we will try to answer thru the perspective of our

experiences at living with & controlling this thing (to varying degrees).

, T2, dx'ed 4/98, controlling with LC & Supplements

Average fasting bg 100mg/dl, last HbA1c 5.6%

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

I probably had diabetes maybe 6 months before being diagnosed by my

doctor. I thought I had a kidney infection, and the urinalysis came

back with my blood sugar at 503. I was put on Lantus injections once

a day, and I check fasting in the morning and 2 hours after I eat

dinner in the evening. I've had some ups and downs and even had

readings of 80-130 about half a dozen times. Recently, it has been

going back up and it was 256 this morning, and 238 this evening. I

called the doctor's office and he said 256 wasn't bad. In the past,

he has raised my dose of lantus from 10 units, to where I'm now

taking 30. I have been going to classes and I stick to diet. It just

bothered me today when he said 256 wasn't bad. Am I overreacting?

It's been about 45 days since I was diagnosed, but looking back at

the eye trouble I had, I've probably been more like 6 months since I

started having trouble. Diabetes does run in my family (aunt's

uncle's and grandparents).I really am anxious to be " stable " as I

can't get any new glasses until I am. If I told the eye doctor what

my last weeks readings were, I doubt it could be called stable.

Thanks.... Mike

July 6, 2005

Mike,

Have you suffered a trauma or illness, both of which can cause bg's to go up?

Also, has there been any discussion with you about the possibility of your

losing your pancreas' ability to produce insulin, leading to this upward spiral

in bg's?

There is a type of diabetes known as LADA (Latent Autoimmune Diabetes in

Adults) that is the equivalent of being a Type 1 with no insulin production.

LADA's like type 1's are insulin-dependent & must have it thru injection as

their bodies no longer produce any.

There are tests that can verify if there is still insulin production by the

pancreas.

Just something to discuss with your Dr, although from what you've said, I

doubt he'd even recognize the term LADA. Oops, the skeptic in me creeping out

again---Down Boy!

, T2, etc.......................

>>>>>>>>>>>>>>>>>>>>>>>>>>.

Yes, I've had an aunt who passed away a few years ago who was diabetic, and

she spent the last 2 years of her life on dialysis. So I'm very well aware

this is nothing to play with. This doctor has always been great in everything

else, and we've been seeing him for at least 5 years. I'm on 30 units of

Lantis once a day. What bothers me, is I've had it in the low 100's even a

couple

of 80's. I haven't changed my diet or anything and this past week it just

keep spiraling up.

July 6, 2005

<snip>

I called the doctor's office and he said 256 wasn't bad.

<snip>

Hi Mike

Please do two things as a matter of urgency.

1. Change doctors ASAP; preferably get a referral to an endo. But if

you can't, any quack would be better than the one you have.

2. Read this link:

http://www.alt-support-diabetes.org/NewlyDiagnosed.htm

Then come back and ask lots of questions after reading that. But

please see a new doctor as soon as possible.

Cheers Alan, T2, Australia.

--

Diet and not enough exercise.

I have no medical qualifications beyond my own experience.

Choose your advisers carefully, because experience can be

an expensive teacher.

Everything in Moderation - Except Laughter

July 6, 2005

Mike, are you doing any exercise? That will burn off glucose and bring

your numbers down. Do you know what you did differently that caused

your sugar to be up in the 250 range? And yes, 256 is VERY bad. If

your doc says it is OK, I think you should start looking for another

doctor.

> I probably had diabetes maybe 6 months before being diagnosed by my

> doctor. I thought I had a kidney infection, and the urinalysis came

> back with my blood sugar at 503. I was put on Lantus injections once

> a day, and I check fasting in the morning and 2 hours after I eat

> dinner in the evening. I've had some ups and downs and even had

> readings of 80-130 about half a dozen times. Recently, it has been

> going back up and it was 256 this morning, and 238 this evening. I

> called the doctor's office and he said 256 wasn't bad. In the past,

> he has raised my dose of lantus from 10 units, to where I'm now

> taking 30. I have been going to classes and I stick to diet. It just

> bothered me today when he said 256 wasn't bad. Am I overreacting?

> It's been about 45 days since I was diagnosed, but looking back at

> the eye trouble I had, I've probably been more like 6 months since I

> started having trouble. Diabetes does run in my family (aunt's

> uncle's and grandparents).I really am anxious to be " stable " as I

> can't get any new glasses until I am. If I told the eye doctor what

> my last weeks readings were, I doubt it could be called stable.

>

> Thanks.... Mike

July 6, 2005

I think you're absolutely correct, that 256 IS very bad. If I had a

doctor who said that, I'd look for another doctor, Mike. Pronto.

What kind of diet are you following? The ADA high-carb exchange plan?

Or something more in the line of Bernstein?

It could very well be that just Lantus alone isn't adequate. Taking a

fast-acting insulin such as NovoLog or Humalog for meals with dose based

on carbs eaten at that meal would certainly improve your numbers.

Vicki

Re: new diabetic with questions

> Mike, are you doing any exercise? That will burn off glucose and bring

> your numbers down. Do you know what you did differently that caused

> your sugar to be up in the 250 range? And yes, 256 is VERY bad. If

> your doc says it is OK, I think you should start looking for another

> doctor.

>

>> I probably had diabetes maybe 6 months before being diagnosed by my

>> doctor. I thought I had a kidney infection, and the urinalysis came

>> back with my blood sugar at 503. I was put on Lantus injections once

>> a day, and I check fasting in the morning and 2 hours after I eat

>> dinner in the evening. I've had some ups and downs and even had

>> readings of 80-130 about half a dozen times. Recently, it has been

>> going back up and it was 256 this morning, and 238 this evening. I

>> called the doctor's office and he said 256 wasn't bad. In the past,

>> he has raised my dose of lantus from 10 units, to where I'm now

>> taking 30. I have been going to classes and I stick to diet. It just

>> bothered me today when he said 256 wasn't bad. Am I overreacting?

>> It's been about 45 days since I was diagnosed, but looking back at

>> the eye trouble I had, I've probably been more like 6 months since I

>> started having trouble. Diabetes does run in my family (aunt's

>> uncle's and grandparents).I really am anxious to be " stable " as I

>> can't get any new glasses until I am. If I told the eye doctor what

>> my last weeks readings were, I doubt it could be called stable.

>>

>> Thanks.... Mike

>

July 6, 2005

Mike, you're absolute right to be skeptical about your doctor's analysis

that 256 " wasn't bad " . It is.

I'm going to append my newby letter. There's a lot of good information

there. Please be sure to check out all the links.

<<

First of all, let me refer you to two of the best books about

diabetes.Read 'em and you'll learn a lot:

The first one is called

" The First Year, Type Two Diabetes, An Essential Guide for the Newly

Diagnosed " by Gretchen Becker. Gretchen is a list member and her book

is an excellent guide. It's in paperback and available online from

Amazon if your local bookstore doesn't have it.

The second book is called " Dr. Bernstein's Diabetes Solutions " by

K. Bernstein, M.D. You can get it from the library but it's

such a good reference that you

really should have it in your home library. Dr. Bernstein is a longtime

type 1 who controls his diabetes using a lowcarb diet as well as

insulin.. Many of us - both type 1 and 2 -- on this list have found

great success using his plan or a modified version thereof.

.

And here's the URL to Dr. Bernstein's website, where there's lots of

good stuff:

http://www.diabetes-normalsugars.com/index.shtml

These two bo oks will give you good basic information on the ins and

outs of diabetes management.

I would further refer you to an excellent informational website titled "

" What They Don't Tell You About Diabetes "

http://www.geocities.com/lottadata4u/

If it isn't there for some reason, let me know and I can email you the

contents -- I have it in my archives now.

I would also refer you to Mendosa's website, where

there's a wealth of diabetic information and good links. He also has

an online diabetes newsletter which is very good. It's also an

excellent source for information about the GI index (glycemic index).

www.mendosa.com

There's one thing that's sure to make BGs rise and that's carbohydrates.

Cutting out high GI carbs is an excellent way to control your BGs and

the more you cut, the better. Most of us find that the " whites " --

breads, cereals and pastas, in fact anything made with grain - will

raise our BGs. Also, rice and potatoes will do the same. And of course,

cakes and cookies and sweets of all kinds, including fruits and fruit

juices.

Watch out for " low calorie " foods; often they're higher in carbs. Learn

to read food labels.

Dr. Bernstein recommends about 40 carbs a day total. This is really only

for the dedictated low carber and IMHO hard to maintain over the long

run. However, I've read that the average American eats about 300 carbs a

day, so the truth is somewhere in between. The best thing you can do

for yourself (if you haven't already) is buy a meter and use it

FREQUENTLY. At the beginning you want to learn how different foods

affect your BG and to do this you need to eat one food at a time,

testing first...then test one and two hours afterwards. Weigh out the

amounts and keep good notes. You'll use up a lot of strips in the

beginning but the rewards are definitely worth the expense and bother

because in the end, you'll know what foods to avoid and which are okay.

Diabetes is a very individual disease and we often say YMMV - " your

mileage may vary " -- what works for one may not work for another.

You want to aim for postprandial (two hours after meal) BG of 120.

Keeping your BGs between 70 and 140 are your goals. If you can do this

longterm, you can probably avoid the dreaded consequences of longterm

poor BG control...and I'm sure I don't have to list those for you. (I

will if you want, though).

Here's my own list of pretty lowcarb veggies:

Spinach

Cauliflower

Broccoli

Summer squash (zucchini, crookneck)

Spaghetti squash

Mushrooms

Asparagus

Greenbeans

Cabbage

Sauerkraut

And of course lettuce and avocados which aren't a veggie but a fruit

..but they're definitely lowcarb. I have a large mixed lettuce salad with

avocado every night with dinner.

You can eat a reasonable portion (4-6 ounces) of meat, chicken, fish

without problem; it's all protein, no carbs.

Berries are the lowest carb fruit but even so, you should eat them very

sparingly. Here's the website of the USDA, which you'll find very

helpful. It has carbs, calories, protein, etc.

http://www.nal.usda.gov/fnic/cgi-bin/nut_search.pl

It's helpful to have a food scale. A cup measure isn't nearly so

accurate. I use a Salter scale. It weighs in both grams and ounces and

cost me somewhere around $35. I got mine at a local gourmet shop but

they're available online too. Just do a Google search for " Salter food

scales " .

The A1C is a test that measures your average BG for a three-month period

with slightly more weight given to the latest month. All diabetics

should have this test every three months. And you should ask for, and

keep, copies of all your lab reports.

Good luck. And keep those questions coming. There's a really steep

learning curve at the beginning of your diabetes education but hang in

there -- it will all make sense eventually. And remember -- the only

stupid question is the one you didn't ask.

Vicki, diabetic since 1997, A1Cs comsistently under 6 for a long time,

no complications, planning on forever no complications,

smile.

new diabetic with questions

>I probably had diabetes maybe 6 months before being diagnosed by my