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Friday, February 29, 2008

The Quality of ADA Dietary Advice

I was asked this question today on the ADA forum.

"Just what is low-fat/high-carb? My dietitian suggested 45-60 carbs per meal. That does seem like a lot sometimes. "

This was my reply on the Type 2 board.

"The USDA and the owners of this web-site (at least, they are again this week:-) have defined it pretty well here: Using the Diabetes Food Pyramid. Notice that fats of all types are right at the top, to be used minimally, and "bread grains and other starches" are at the base to be used in abundance.

That is associated with this other ADA web-page The Diabetes Food Pyramid: Grains & Starches which includes "The message today: Eat more whole grains! Whole grains and starches are good for you because they have very little fat, saturated fat, or cholesterol. They are packed with vitamins, minerals, and fiber. Yes, foods with carbohydrate -- starches, vegetables, fruits, and dairy products -- will raise your blood glucose more quickly than meats and fats, but they are the healthiest foods for you. Your doctor may need to adjust your medications when you eat more carbohydrates. "

I am departing for two months in a few days, so I will depart from my usual reticence on this subject on this forum.

In my lay opinion as a type 2 diabetic I think that the dietary information for type 2 diabetics on those pages, and on several associated pages, is the most dangerous and disgraceful dietary advice for type 2's that it is possible to give. In effect, it says that it's OK to eat food that you know will cause blood glucose spikes as long as you medicate to correct it. In fact, not just that it's OK but that it's healthier for you to do that.

It is made even more dangerous because the source is the most influential major authority in the world. I wrote about that a long time back, and little has changed since.

There has been a change of leadership at the ADA and many of the diabetics I know are hoping for changes in those guidelines."

Well, time will tell. I just hope that the changes occur within my lifetime; they may come too late for many.

Thursday, February 28, 2008

Motivation, Likes and Dislikes

On all the various forums I read there is a recurring theme from newly diagnosed people of grief over a lost lifestyle. And not just from newly diagnosed people.

How many times do we read "I hate testing" or "I can't exercise" or "I don't like vegetables" or "I don't eat breakfast" or "I couldn't give up my [insert your favourite treat]" or "I only ever eat one big meal a day" or "I don't like cooking" or "I haven't got time to cook/exercise/whatever" or just "I don't like...".

Motivation is a strange thing. The carrot and the stick. Some of us say we do best on the positive; others find the negative more effective. In reality it's a mix of both. Many of us have found that the improvement in our overall health once we took control of our diabetes was quite dramatic and we promote that as a positive. It is. But let's be honest, how many of us used that as the motivator when we started?

"Hey! I've just been diagnosed with diabetes! Ain't it great! Now I can get fit!" Yeah, right. That wasn't me.

If we're honest, the real motivator for me, and I suspect for most of you, was fear. We each have our own phobias, but diabetes gives us such a wide range of choices that there is something there for all.

Stop here if you don't like nasty reminders.

Consider why you are reading about diabetes. The experienced people on all forums try to mainly be up-beat and supportive, but support can sometimes mean that a jolt of reality is appropriate.

Just a few for starters:
o Death from many possibilities, the most likely being heart attack.
o Blindness, usually from retinopathy.
o Neuropathy, including associated wound healing problems and possible gangrene and salami surgery or amputation.
o Nephropathy, kidney disease, dialysis.

Positive motivation is great. But the reality is that if we don't take control of our own diabetes management the negatives can creep up on us all too quickly. My personal negative motivator is blindness; as a leukemiac death no longer scares me; I think I can live with amputation, and from what I've read dialysis is not an enjoyable long-term lifestyle.

But I love reading, I love seeing the beauty and grandeur of nature, I enjoy watching TV, I love watching my grand-daughter grow and I enjoy writing so blindness scares the shit out of me.

It took me a while to accept that my past lifestyle likes and dislikes were no longer relevant. I had to discover new likes and dislikes, because I am in this for the long haul.

It's amazing what you can learn to like once you realise that your life, and the quality of that life, depends on it.

Sunday, February 10, 2008

ACCORD, Foxes and Grapes

Of the stories I learnt as a child, the ones by an ancient writer named Aesop have often proven to be full of wisdom over the years.

Remember this one?

'One hot summer's day a Fox was strolling through an orchard till he came to a bunch of Grapes just ripening on a vine which had been trained over a lofty branch. "Just the thing to quench my thirst," quoth he. Drawing back a few paces, he took a run and a jump, and just missed the bunch. Turning round again with a One, Two, Three, he jumped up, but with no greater success. Again and again he tried after the tempting morsel, but at last had to give it up, and walked away with his nose in the air, saying: "I am sure they are sour."'

Going by the popular press and various responses in medical literature ACCORD appears to indicate to the experts that achieving normal HbA1c levels in long-term diabetics is obviously too hard for modern pharmacology without dangerous side-effects.

So obviously it can't be done. And obviously it isn't important any more.

Normal HbA1c has become a sour goal.

It never occurred to the fox to build a ladder or pile up some rocks.

It never seems to occur to the experts to review the traditional diet and lifestyle guidelines to see whether different ones may assist the HbA1c goal and reduce the medication levels and thus the side effects.

Years ago I also learnt a different lesson about goals. Good goals are set in concrete; plans to achieve them are drawn in sand.

I'll write more on ACCORD and it's interpretation in a few days.

Cheers, Alan

Everything in Moderation - Except Laughter

Friday, February 01, 2008


G'day All

Too often we see new people in denial. And sometimes we hear from others seeking motivation.

I read an inspirational story yesterday on the ADA forum that really brings home both the best and the worst in the way people handle this disease. The thread was started by a diabetic asking for "horror stories" for negative motivation and this was one of the replies.

I asked permission to post it in other forums and was told I can "post it anywhere you want." So here is Kat's Story.

Hi allow me to introduce myself. My name is Kathy and I am both a horror story and a diabetic survivor.
Let me start with my family history. My mother was a Type 1.5 diabetic. My Father is a type 2 diabetic. My brother is a type 2 diabetic. Me --I am a type 2 We have it covered! LOL

My Mothers story

My Mom was a Type 1.5. She was born in 1938. She was diagnosed in 1957. She decided for whatever reason to ignore the diagnosis. Until she was pregnant with me in 1963. Well I was born 13 weeks premature. Spent the first 3 months of my life in Baby ICU.

My Mom controlled her disease for years and gave birth to my brother in 1965. After that she suffered 4 miscarriages and tried no more -- she tried no more for babies and she once again decided not to fight the disease. In 1970 I stood by her hospital bed as she cried about them cutting of her leg. I was 7. In 1973 she suffered a major stroke. At 10 I learned to change diapers of the shell that used to be my Mother. In 1977 2 days before Christmas a 14 year old child (me) and a 12 year old son buried their 39 year old Mother. A 37 year old husband was left to raise a teenage daughter and his son.

When I get to Heaven my first question to my Mother will be why I wasn't important enough for her to give up Twinkies?

My Fathers Story

Raising 2 children he was diagnosed in 1984. He took a different approach -he controlled the disease. He did a wonderful job raising 2 children and controlling his disease. Today he is still only on oral meds. His last A1c was5.2. He walks over 5 miles a day-oh and he is 67 years old.
He has welcomed into this world 2 grandchildren and just 4 months ago his 1st great Grandchild.

My Brothers story

Type 2 diagnosed 6 years ago. Oral meds only. Last A1c 6.9. Up from a 6.3 last time. In fact his 6.9 is his highest in the last 4 years. Has 2 great kids. A good job and is happy and as healthy as he can be.

Kathy's Story- (this is me) LOL

From the time I was 21 I had blood work done every year. Jan to be exact. Never a problem. Just keeping an eye on the Beast . Until 2007. I was too busy to go get it done. Put it off for 2 months.

March 2,2007. Can't move my right arm. Trip to the ER. The next thing I remember is waking up in the ICU at St. Luke's -3 days later. Can't move my right arm or leg. Can't speak.
Husband says " honey you had a stroke." Now you think that would be the end of Kathy. After all look at Mother's Story.

Fast forward to March 16th 2007. Dr. says Kathy you are a diabetic. Sugar at admission was 384. Got me am A1c of 15.24.

Kathy decides to follow Dad's example with this disease and not Mom's. Sometimes a girl just can't be like her Mom. She also decided to fight, fight, fight to get her life back. She was not going to have her husband changing her diapers!

Fast forward to Dec 15th 2007. Kathy A1c 6.5. She is still aiming for 6.0!

Fast forward to 1/30/2008. Kathy can talk, Kathy can walk, Kathy can use her right arm. Okay Kathy still has a couple of fingers being stubborn-but she refuses to give up on them! In fact Kathy starts a part time job next week. Not only that but she gets the nerve to finally introduce herself to the great people on the ADA board. After all she was reading you guys before she could even move her right arm.

Hi My name is LuckyKat!!!
(Stroke Survivor and Diabetes Fighter!)

And also a very courageous and inspirational lady. Thanks Kat.