Diabetes Everyday

Living your best life with diabetes. Toby Smithson provides professional guidance with personal experience.

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Thoughts About Blood Sugar Monitoring

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I read a great article recently that included blood glucose testing, but parts of the article really bother me.  While the article was essentially about whether health tracking is useful with all of the new apps available for users, one angle of the article was about how unsuccessful home blood sugar monitoring has been over a 3o year period. The author called people with diabetes “early adopters” of health tracking, and pointed out that most hate it.

First, a 2001 study found only 5% of people with diabetes actually do daily testing, 65% admitting to testing less than once a month.  More concerning to me, the reason people don’t test is that they see testing as an enemy – out to remind them how poorly they’re doing. Add to this a move in some circles to stop reimbursements for testing supplies based in large part on evidence that people with diabetes don’t use testing to change behavior, and a big problem is brewing. There is a terrible disconnect within our medical system.

I know how incredibly valuable testing is….with type 1 diabetes it’s simply impossible to work things out by guessing. But, testing can be valuable for type 2 diabetes too if you use the tool to get relevant information, and to make changes. Here’s an example. My friend Mike often tests after meal just to see how a certain food has affected his blood sugar. His behavior changes aren’t major – if his blood sugar goes too high he knows that particular food doesn’t fit his metabolism well. This is how blood sugar testing can serve to improve control over time, and improved control means better health.

Contrast this to another friend who has been prescribed one test each day, first thing in the morning. Essentially, a fasting glucose 365 times a year. Guess what? Her blood sugar is virtually the same every day. There is no data upon which to make changes, and there’s no data that could possibly be any more valuable than an A1C every 3 to 6 months. This is a waste of resources and a burden on my friend, but I can’t convince her to stop because this is what her general practitioner has told her to do. She hates it, of course.

Here’s the problem. Medical policy makers in government programs and with private insurers do not provide adequate coverage for education and support time with diabetes educators.  More time with educators could result in a better understanding of testing, and less anxiety about doing it because a purpose could be defined. Some of the responsibility is with patients. But, most people want to do better with self management, and this complex condition does require active participation by those of us who stand to benefit the most – patients. I hope our members at DiabetesEveryDay will share their thoughts about testing with me. I am concerned about this marvelous tool being so misunderstood by those who could gain so much.

 

Toby’s Secrets to Weight Loss

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I’ve been reading an article published in the Lancet, an esteemed British medical journal, about weight loss predictions. An international group has done mathematical modeling on weight loss, and is challenging the “standard” formula that reducing calories (or expending energy) by 500 per day will result in a weight loss of one pound per week as a “myth”.

The article describes a very complex evaluation of our bodies’ energy balance, and how variations in body composition (fat vs. lean) at the beginning and as weight loss occurs changes the dynamics of weight loss. The bottom line is that the 500 calorie per day “standard” overestimates potential weight loss considerably in almost any case, and that the body composition of the individual has a significant effect on the long term pattern of weight loss.

Determining whether this information should replace the “standard” model is beyond my “job description” as they say. I’m perfectly willing to leave this up to the National Institutes of Health. We all recognize that the “standard” could not apply to everyone in every stage of weight loss, and I’ll wait to see what happens next…if anything.

Here’s what I know about successful weight loss…

  • Focusing on the number…..lose 30 pounds…..is less effective than focusing on adopting and sustaining a healthier lifestyle. By less effective I mean easier to stay with over the long haul. Focus on the number can lead to discouragement if the number comes too slowly, and the article I’m reading suggests that the number will come more slowly than expected. A focus on living healthier, however, brings a sense of satisfaction every day because new behaviors are the objective….weight loss will come as a fringe benefit.
  • Being “mindful”. The term “emotional eating” may be overused, and it suggests an emotional imbalance as we use it. But, eating can be emotional, or instinctive or mindless for any of us….it is built into our survival senses, and overcoming overeating requires us to use our “thinking” brain. We are preparing to shoot a video with tips on eating mindfully….it is so important for weight loss and for diabetes management.

If you doubt how mindless eating can play a role in your life read “Mindless Eating” by my friend Dr. Brian Wansink (www.MindlessEating.org).  Dr. Wansink is now at Cornell University, but much of this entertaining book describes his work at the University of Illinois spying on students’ eating behaviors at a restaurant set up for research. I hope to have Dr. Wansink DiabetesEveryDay Radio someday soon.

Those are my secrets to weight loss. At DiabetesEveryDay we discuss weight loss now and then because so many struggle with this issue, and weight is a significant factor in diabetes risk and diabetes management. I know my “secrets” are not dramatic, but effective weight loss is a long range, “baby steps” undertaking, and if we expect dramatic results we may be disappointed. Adopt healthier habits, and celebrate your success every day instead.

Diabetes Lifestyle Importance Known, Not Practiced

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Findings from the “Study to Help Improve Early Evaluation and Management of Risk Factors Leading to Diabetes” (SHIELD) revealed some interesting information about the behaviors of people with diabetes. SHIELD is the largest nongovernmental longitudinal survey in the U.S., and the results were presented at the 2011 American Diabetes Association meeting.

Investigators from a variety of institutions in the US analyzed responses to surveys distributed to a diverse population of U.S. adults, some of whom already had either type 1 or 2 diabetes. The screening survey was completed by 211,097 adults and the follow-up survey five years later was completed by 11,238 adults.

The data showed that 87% of 3,867 type 2 respondents in the baseline survey said that they knew that obesity contributes to the onset of diabetes or can exacerbate confirmed diabetes. However, while 70% of type 2 respondents said that they had tried to lose weight over the prior year, only 34% had maintained their goal weight for more than six months.

With respect to exercise, 63% of type 2 respondents in the screening survey said that their primary care practitioner had recommended an increase in physical activity in the last 12 months. However 87% said that they had not been active over the previous seven days. About 20% of patients reported that they would rather take a medication for their health conditions than alter their lifestyle.

The study suggests that people with diabetes who access healthcare and receive information about the importance of lifestyle do not make significant behavior changes. “The results contradict the widely held notion that diabetics who are well informed about their disease and have good access to health care are likely to favorably alter their lifestyles per their physicians’ recommendations,” James Gavin III, MD, with Emory University School of Medicine in Atlanta, Georgia, said. Findings from the “Study to Help Improve Early Evaluation and Management of Risk Factors Leading to Diabetes” (SHIELD) revealed some interesting information about the behaviors of people with diabetes. SHIELD is the largest nongovernmental longitudinal survey in the U.S., and the results were presented at the 2011 American Diabetes Association meeting.

Investigators from a variety of institutions in the US analyzed responses to surveys distributed to a diverse population of U.S. adults, some of whom already had either type 1 or 2 diabetes. The screening survey was completed by 211,097 adults and the follow-up survey five years later was completed by 11,238 adults.

The data showed that 87% of 3,867 type 2 respondents in the baseline survey said that they knew that obesity contributes to the onset of diabetes or can exacerbate confirmed diabetes. However, while 70% of type 2 respondents said that they had tried to lose weight over the prior year, only 34% had maintained their goal weight for more than six months.

With respect to exercise, 63% of type 2 respondents in the screening survey said that their primary care practitioner had recommended an increase in physical activity in the last 12 months. However 87% said that they had not been active over the previous seven days. About 20% of patients reported that they would rather take a medication for their health conditions than alter their lifestyle.

The study suggests that people with diabetes who access healthcare and receive information about the importance of lifestyle do not make significant behavior changes. “The results contradict the widely held notion that diabetics who are well informed about their disease and have good access to health care are likely to favorably alter their lifestyles per their physicians’ recommendations,” James Gavin III, MD, with Emory University School of Medicine in Atlanta, Georgia, said.

Lifestyle Intervention Improves Health for Diabetes Patients

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Lifestyle Intervention Improves Health for Diabetes Patients

Lifestyle intervention for weight loss in obese individuals with diabetes may reduce high-sensitivity C-reactive protein (hs-CRP) levels, according to a report published in the November issue of Diabetes Care.

L. Maria Belalcazar, M.D., of the University of Texas in Galveston, and colleagues compared the impact of intensive lifestyle intervention (ILI) to diabetes, support, and education (DSE) on 1,759 obese adults with type 2 diabetes. The participants in the study were randomly assigned to either the ILI or DSE group.

The researchers found that, after one year, hs-CRP levels in the ILI group dropped by 43.6 percent from baseline, compared to a 16.7 percent drop in the DSE group. The ILI group experienced weight loss and body mass index reductions of 9 kg and 3.2 kg/m², respectively, compared to reductions of 0.8 kg and 0.3 kg/m² in the DSE group. ILI participants also showed a 19 percent improvement in fitness level and improved cholesterol levels.

“Our report supports a substantial benefit of lifestyle intervention for weight loss on the chronic inflammatory state characteristic of diabetes and highlights the contribution of improved glycemic control achieved with lifestyle changes to the reduction of elevated hs-CRP levels in obese sedentary individuals with diabetes,” the authors write.Lifestyle Intervention Improves Health for Diabetes Patients

Lifestyle intervention for weight loss in obese individuals with diabetes may reduce high-sensitivity C-reactive protein (hs-CRP) levels, according to a report published in the November issue of Diabetes Care.

L. Maria Belalcazar, M.D., of the University of Texas in Galveston, and colleagues compared the impact of intensive lifestyle intervention (ILI) to diabetes, support, and education (DSE) on 1,759 obese adults with type 2 diabetes. The participants in the study were randomly assigned to either the ILI or DSE group.

The researchers found that, after one year, hs-CRP levels in the ILI group dropped by 43.6 percent from baseline, compared to a 16.7 percent drop in the DSE group. The ILI group experienced weight loss and body mass index reductions of 9 kg and 3.2 kg/m², respectively, compared to reductions of 0.8 kg and 0.3 kg/m² in the DSE group. ILI participants also showed a 19 percent improvement in fitness level and improved cholesterol levels.

“Our report supports a substantial benefit of lifestyle intervention for weight loss on the chronic inflammatory state characteristic of diabetes and highlights the contribution of improved glycemic control achieved with lifestyle changes to the reduction of elevated hs-CRP levels in obese sedentary individuals with diabetes,” the authors write.