2013-05-24T16:42:02-04:00 Milt Bedingfield http://www.huffingtonpost.com/author/index.php?author=milt-bedingfield Copyright 2008, HuffingtonPost.com, Inc. HuffingtonPost Blogger Feed for Milt Bedingfield Good old fashioned elbow grease. tag:www.huffingtonpost.com,2012:/theblog//3.1786259 2012-08-16T17:29:51-04:00 2012-10-16T05:12:28-04:00

Milt Bedingfield http://www.huffingtonpost.com/milt-bedingfield/
On occasion your blood glucose level may start to dip a bit too low -- not seriously low yet, but low enough to where you start acting a little odd. You may drop low enough to where you might become the topic of conversation over lunch or in the break room, and not because of your good looks.

You see, there are times when your blood glucose is coming down and you may not notice it at first, particularly if you are wrapped up in a project or intensely concentrating on something else. You may fail to notice that you are beginning to shake and sweat, that your heart is beating fast and hard. or that you are not speaking clearly or making good sense. This situation is even more likely if you have had diabetes, particularly Type 1, for a long time.

This is when it becomes helpful to have someone there that knows you have diabetes and that also knows what to do if you start acting odd or looking odd (such as sweating and shaking in a 72-degree office or making inappropriate remarks during a staff meeting). In such situations, your confidante can encourage you to excuse yourself from the staff meeting to check your blood glucose level and then treat it if necessary.

I have heard frequent reports over the years where it seems that the last person to know they had a low blood glucose level was the victim that had it. I have had patients tell me that they are fine unless they get below 40. This comment usually inspires responses by loved ones to the tune of, " What are you, nuts? Are you kidding me?" If these people believe they are fine until their blood glucose drops below 40, then that means that they may try to drive, cook, or do something else in this impaired state.

In a more extreme situation, if you were to lose consciousness and people were standing around wondering the cause and what to do, your confidante would likely know (depending on the events leading up to your loss of consciousness), and be more likely to do the right thing in a prompt manner, like call 911.

In summary, you need to have someone that knows what is going on with you. Someone that you have told ahead of time, "Look if I ever start to act goofy, or do this or that, or start sweating and get lightheaded, this is what it means and this is what you need to do." This person becomes your safety net. I would recommend letting more than one or two people know. I think you would feel more comfortable in the long run.

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Milt Bedingfield http://www.huffingtonpost.com/milt-bedingfield/
Has this information been filed away in the part of your brain labeled, "Information I don't understand and sounds too confusing to learn," just waiting to be purged when possible? Whenever I hear a patient being told this I often wonder if they're going to ask, "Well, which is it, do I make too much insulin or not enough, and why does this happen?" I think if I had diabetes I would want to know. Let me see if I can explain it here.

I will start off by reminding you that it takes approximately 10 years to go from completely normal to actually having diabetes. I am sure this varies somewhat from person to person, however on average it takes 10 years.

After you eat a meal that has sugar in it, the sugar will enter the blood stream. In response to sugar entering the blood the beta cells, located throughout the pancreas, start making insulin. Typically, the greater the amount of sugar that enters the blood, the greater the amount of insulin produced by the beta cells in the pancreas. At least, this is the way it is supposed to work.

The insulin produced in the beta cells then enters the blood stream and looks for some sugar. Once it finds a sugar molecule it swims over and grabs a hold of it. (A little-known fact is that insulin only has one arm, so it can only grab ahold of one sugar.) The insulin then takes the sugar out of the blood vessel and over to a muscle, fat or liver cell. Once close to the cell the insulin starts heading over to one of the cell's many doors. The insulin then opens the door to the cell and escorts the sugar inside. Once this is accomplished the insulin is not reused and is basically put out to pasture. Meanwhile, other insulins are finding sugar in the blood and taking them to other muscle, fat and liver cells, thereby returning the level of sugar in the blood to pre-meal levels. Once blood sugar levels are back to normal the beta cells stop making insulin (except for little drips of insulin that constantly leak from the liver into the blood throughout the day) until sugar enters the blood stream again, perhaps after the next meal.

In the case of Type 2 diabetes, about 10 years before actually developing the disease, when insulin tries to open the doors so that the sugar can enter, the insulin finds that the doors have become much more difficult to open, and one insulin is no longer enough to get the doors open (I call this rusty hinges. Officially it is called the onset of insulin resistance.) This means the beta cells must make additional insulin to help get the doors open due to their rusty hinges. Over the course of the next 10 years, or thereabouts, increasing amounts of insulin are required to get the doors to the cells open so that the sugar can enter. (This is why you hear that you may be making plenty of insulin, however, it is not being used properly.)

Eventually, these beta cells that have been working so hard begin to fail (as would anything that is working in a manner in which it is not designed) and insulin production drops as a result. (This is when you hear that you are not making enough insulin.) As a result of this reduction in insulin production, sugar can no longer enter the cells as it is supposed to and remains trapped in the blood stream.

So you see, in the development of Type 2 diabetes, there is an overproduction of insulin followed by a reduction in insulin production.

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Milt Bedingfield http://www.huffingtonpost.com/milt-bedingfield/
Someday, after I am long gone, I foresee a headline on the front page of the local paper -- oh no wait, we probably won't have newspapers then, probably news updates will only appear on our personal information devices, commonly referred to as PIDs (I made that word up, but I think it will certainly catch on). Anyway, the headline will read, "Thumb size may be best predictor of longevity." The article will say something like this:

Researchers from an online university have discovered that the size of the thumb bones of men and women living in the early 21st century are inversely proportional to the size of the muscle mass in their thighs.

Thumb size was also found to be highly correlated with longevity. The study conducted by a group of scientists from the Silicon Valley Virtual University (hereafter referred to as SVVU) looked at both men and women between 25 and 50 years of age who died of obesity, Type 2 diabetes or heart disease between 2060 and 2070.

Radioactive isotope studies and basically looking through a high-powered microscope revealed that the thumb bone, which is connected to the wrist bone, which is connected to the arm bone, was more dense and contained a higher mineral content than persons born 100 years earlier.

Furthermore, evaluation of the thumb's surrounding musculature revealed a statistical significant 52 percent increase in size of the muscles that flex and extend the thumb. Dr. Tom Thomas Thomason, lead researcher of the study was quoted as saying, "We are puzzled by the findings at the moment but will enlist the support of the world's best minds and try to make sense of what we have found."

Off the record, Dr. Thomason said that once all of the data is looked at carefully by everyone involved, he believes that the present theory that anyone with a larger than usual thumb is caused by adolescent sucking of the thumb will be debunked in favor of a newly-emerging theory that larger thumbs are now the result of evolutionary changes adapting to the increasing reliance on remote control devices in the 21st century, such as remotes for the garage door, remotes for the television, remotes to lock and unlock the car, video game controllers, and texting.

In response to the highly repetitive nature of texting and the use of video controllers, muscles controlling the thumb(s) must become stronger and have greater endurance. We have uncovered some unpublished data that indicates the average male or female of high school age texts an average of 50-100 times per day. This places a tremendous overload on the flexion and extension muscles of the thumb.

Additionally, with all of the time spent using remote control devices for gaming and to make physical jobs easier, people in the early 21st century became far less active. It is my belief that this has led to the increase in death due to obesity, heart disease and diabetes.

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Milt Bedingfield http://www.huffingtonpost.com/milt-bedingfield/
On many of those days I was not particularly excited or looking forward to going to the gym. I knew how those workouts could hurt and quite frankly, on many days I didn't really feel like hurting. On most days, I would go ahead and get it done, but often, put it off until the end of the day. Back then, way back then, I was a competitive athlete and needed to train daily to get better for my competition. In order to train my body the best I could, I needed to work hard when I trained, which usually translates to the workout being uncomfortable. Remember the old saying, no pain, no gain? For competitive athletes that may be true, however, for the other 99 percent of the world that is not competitive, it simply is not true and following that advice is very rarely if ever a good idea.

What I do now and have done for years, is go to the gym with only a rough idea of what I want to accomplish with no formulated plan as to what I will be doing. I fly by the seat of my pants, I am spontaneous, I exercise in the moment (no, that's going a bit too far). And you know what? I look forward to going to the gym again. I have had some really good workouts the last several years with some good results. The big difference for me is that there is no pressure to run at a prescribed speed or for a predetermined amount of time. I run, or walk, or jog or a combination of all three as I feel the urge.

Or maybe I would ride the stationary bike, then walk on the treadmill for a while, then get back on the stationary bike and then lift some weights.

As an example of this, I get on the treadmill with little motivation. "I think I will just walk for a while (I will watch the news on the video screen)." Three minutes later, " I think this is too slow, I have only walked .2 miles. I guess I will speed it up a bit. I think I will give myself a little elevation too, say 5 percent at 4 mph." I start to break a slight sweat. "This is too easy, I think I would feel better going a little faster but not at 5 percent elevation. I will speed it up to a fast jog at 7 mph at 1 percent elevation." I may be happy here for three to four minutes. Then I slow it down to a fast walk at 4 mph and raise the elevation to 10 percent until I get bored with it or tired, whichever comes first. By now I have worked up a good sweat, I am warmed up and have a pretty good workout going. Oftentimes by now the mood strikes me to run fast for a while so I may speed up to 8 mph. Then once I am starting to get more tired than I want to, I will slow down long enough to catch my breath. Then, if not too tired, I will go lift weights for a while. If the chest press machine is busy I will go lift barbells or dumbbells etc. Then when I get tired of doing that I go home. Great workout, no pressure, little mental stress -- what could be better?

If the treadmill is just not doing it for me today, no big deal, I will find some exercise that I feel like doing.

Perhaps you have heard of "fartlek" training. I am told fartlek means "speedplay." This is where you have no set plan for a run, you simply speed up and slow down, when you get the urge. It is known to be very effective and is a form of interval training. In my eyes I have simply taken this concept and applied it to the entire workout.

In summary, I have gone from a far more rigid type of workout to one that allows for more flexibility, and it works for me. Why don't you give it a try. It might be just what you need to spice up your workout.

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Milt Bedingfield http://www.huffingtonpost.com/milt-bedingfield/ Obesity suggests physicians that maintain a more normal body weight themselves are more likely to recommend to their overweight or obese patients the need for weight loss and feel comfortable doing so.

The objective of the study, conducted between February 9 and March 1, 2011 by researchers in the Department of Health Policy and Management at Johns Hopkins Bloomberg School of Public Health, was to look at the impact of physician BMI on obesity care, physician self-efficacy, perceptions of role-modeling weight related health behaviors, and perceptions of patient trust in weight loss advice.

Bleich and colleagues discovered that physicians with a normal BMI were more likely to discuss weight loss with their obese patients than their colleagues with a higher BMI score. As I mentioned previously, the study showed that physicians with a normal BMI also had greater confidence in their ability to provide diet and exercise counseling to patients (53 percent vs. 37 percent, P=0.002).

Eighty percent of the physicians with a normal BMI felt that overweight or obese patients would be less likely to pay attention to weight loss advice from overweight or obese physicians, while only 69 percent of the physicians with an elevated BMI felt the same way.

Physicians with a normal BMI were more likely to believe that they should serve as role models to their patients in regards to maintaining healthy weight-related behaviors and performing regular exercise. And finally, something that I find very interesting, physicians with an elevated BMI were far less likely to record an obesity diagnosis or bring up the subject of weight loss with obese patients, unless the physician's perceptions of the patients' body weights met or exceeded their own body weight.

I find this study useful in helping us to understand why doctors, within the same specialty, diagnose and treat patients with the same illness in different ways. As this study suggests, perhaps it is influenced by the physician's own state of health. Could it be that the medication the doctor prescribes a patient for high cholesterol is the one that seems to work best in treating his own cholesterol? Maybe a lot of health care providers do feel uncomfortable prescribing exercise and weight loss, and therefore don't do it, if they themselves are quite overweight and cannot find the motivation to get out and get it done. Interestingly, I have heard countless times of physicians that tell their patients that they need to quit smoking but smell of cigarettes themselves.

I do believe that people involved in the health care industry, particularly doctors, nurses, dietitians, therapists and educators, should serve as healthy examples to their patients and that they be people that patients can aspire to.

Maybe this is one reason why doctors don't recommend exercise to patients with diabetes with the enthusiasm that patients need to hear.

Maybe it's because of their own personal situation and the attitudes they have toward exercise. In any case, good study. We need more on this topic.

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Milt Bedingfield http://www.huffingtonpost.com/milt-bedingfield/
In case you are new at this and don't know what I am talking about, let me explain. This is certainly something you will need to know about.

Have you ever watched any of the police or crime shows on TV? It seems to me that they all begin about the same.

A cell phone rings, a shirtless man or scantily-clad woman awakens from sleep and reaches over to the bedside table, switches on the lamp, and picks up the phone. All you hear is a one-sided conversation.

"Sanders... (pause)... When?... (another pause)... Any witnesses?... Be there in 20 minutes."

The next scene: The sound of an approaching siren, lights flashing and an unmarked car screeching to a halt. A crowd is standing around something, usually a dead person. You see Sanders walk up, now in some sort of a long coat, holding a steaming cup of coffee.

A uniformed officer comes up. Sanders speaks.

"Hey Johnson, what do we got?"

The uniformed cop reads notes off his note pad. "White male, approximately 30 to 40 years old, found dead, laying face down in the street about 1:15 a.m. this morning, by this lady, Joan Doe, while she was out walking her doberman."

"Anything else?" Sanders asks.

"Well, some witnesses say the dog was walking her," Johnson states.

Sanders turns his attention to the small woman, "How did you know the man was dead?"

"There was a chalk line around his body," she replies.

So you ask, what does any of this have to do with diabetes?

Does any of this sound familiar? I believe just about every police show starts off with a murder being committed.

Then what? A detective appears on the scene, asks a lot of questions and looks for clues that would help the detective solve the crime. Just before the end of the show, the detective has enough information to solve the murder. So, what does this have to do with you and your diabetes?

Every time you test your blood sugar and it's not what it's "supposed to be," either too high or too low, then a crime has been committed. What's the crime? A blood sugar that's out of range.

When you get a reading that is too high or too low, you should figuratively, pin your detective badge on and begin looking for clues as to what caused it.

Let's say you test your blood sugar two hours after breakfast. Your reading is 227mg/dl. Not so good. You turn your work ID around to its back side, the side that's got the picture of the detectives badge glued to it. That's right, for the next several minutes you are not Jim the software engineer, you are Detective Jim. Let's get started.

"So Jim, why is your blood sugar level so high two hours after breakfast? What could have caused it?"

"I don't really know," you say.

"Is it possible you ate too much for breakfast?" Jim asks.

"No, I counted my carbs, only had about 50 grams, 60 at the most, which is on my meal plan."

"Tell me," continues Detective Jim, "did you happen to check your blood sugar before breakfast, and if so what was it?"

"It was 180mg/dl." you answer.

"So, your blood sugar was high before you ate?" Jim acknowledges.

"Yes sir," you respond.

""So if it was high before breakfast, it's likely that it would be high after breakfast, even if you ate the right food." Jim comments.

"Well, yeah."

"So, now we know why you were high after breakfast, because you were already high before breakfast. Now the direction of the investigation needs to turn to look at why the blood sugar level was elevated before breakfast."

"Let's go back about two hours from when you woke up. What were you doing?"

"Sleeping."

"Did you eat anything in the middle of the night?" Jim asks.

"No," you reply.

"No, I never eat anything in the middle of the night unless my blood sugar goes down too low," you tell Jim.

"Okay, is it possible you forgot to take your diabetes medication last night?"

"I took one of my diabetes medications but not the other one because I ran out."

"What is the name of the medication you did not take and how much are you supposed to take?"

"Metformin, and I take 1000mg with dinner."

"We may have just solved the crime! Missing that evening dose of medication may be the cause of your high blood sugar before breakfast.

Just to be thorough, let me ask just a few more questions. Did you have a snack just before you went to bed?"

"No, not last night."

"Did you eat later than usual, or did you eat more than usual?"

"Well, both, I ate about two hours later than I usually do, and I ate more than I usually eat.

"I'm going to close your case now. My report will indicate that your elevated blood sugar after breakfast was primarily caused by your elevated blood sugar before breakfast, that is likely the result of two to three factors:

• missing your evening dose of metformin


• eating later than usual, and


• eating more food than usual.

"Learn from this investigation and try to do better next time," Jim suggests.

You flip your badge over and you are back to being Jim the software engineer.

I am going to speculate that well over half of the time, when a patient has elevated blood sugar levels above what they should be or below what they should be, if that patient plays detective for a couple of minutes, looking for clues that may have caused the high or low, they will be able to figure it out.

In summary, the motivated patient can then initiate steps to prevent the same problem from occurring in the future.

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Milt Bedingfield http://www.huffingtonpost.com/milt-bedingfield/ 1. Get yourself signed up for a comprehensive diabetes class. Don't go ask someone you know that has diabetes what to do.

Although there are people who are quite knowledgeable about diabetes, there are considerably more people who are not. Over the many years I have been a diabetes educator I have often found that people that have had diabetes for long periods of time know far less than they think they do, in part due to the fact that a lot of what they may have learned about treating the disease at the time of their diagnosis is outdated and has been replaced with current strategies as a result of new knowledge of the disease.

It is a common and often harmful misconception to assume that people that have had diabetes for many years know a lot about it. On frequent occasions patients have come in to our class making the comment, "I could teach this class." As I previously stated, treatment for diabetes has changed tremendously over the years and many longstanding patients hold steadfast to the less-modern way of treating the disease. These are not the people you want to learn from even though they are often more than willing to offer advice to try to help you out. Because of this, we subtly try to discourage people newly diagnosed with diabetes from sitting next to someone in class that has had diabetes for many years.

2. Get your very own blood glucose monitor. Do not use a monitor that was ever used by someone else. No exceptions!

Newly-diagnosed diabetes patients show up at our classes weekly with a blood glucose monitor that was given to them by a friend, relative, or colleague. This, on the surface, does not seem to be a problem, but it can end up being a big one. It is never recommended to use a monitor that was used by someone else due to the risk of passing on dangerous blood borne pathogens to the new user. A relatively clean looking monitor could potentially have germs you want nothing to do with all over it. Get a prescription for a blood glucose monitor from your doctor, or better yet, your doctor may even give you one.

3. Watch your carbohydrate intake until you can see a dietitian or attend a diabetes self-management class. Do not eliminate all carbohydrates and sugar from your diet.

It is natural to be scared or nervous when first diagnosed with diabetes. Usually it is far more of a concern of mine when people aren't at least a bit upset. Having diabetes is a big deal, a very big deal. It will affect most of what you do for the rest of your life.

As a result, it is common that once the doctor tells you that you have diabetes you go overboard and start cutting all foods out of your diet that contain sugar. Again, a completely normal response, but don't do it. This is of particular concern if the doctor has put you on insulin injections or a class of medications known as sulfonylureas. The combination of taking these diabetes medications plus significantly reducing your carbohydrate or sugar intake (the same thing) could allow your blood sugar levels to drop well below normal, resulting in you feeling very poorly (shaking, experiencing cold sweats, particularly above the neck, a pounding and racing heart and light headed).

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Milt Bedingfield http://www.huffingtonpost.com/milt-bedingfield/
So, you have had your surgery two days ago, and the surgeon walks into your room while making rounds. After he does a quick review of your vitals and asks you how you are feeling, you ask the doctor, "How do I keep this from happening to me again?"

The doctor replies, "You got to get out of that recliner at home and start being more active."

"What should I be doing?" you ask, expecting something detailed -- after all, you are lucky to be alive. You had three mostly-blocked arteries.

"Just walk, " he says.

"How fast?" you ask, expecting a bit more.

"Just start slow and build up," the doctor responds very casually. After all, he is not the one that suffered a major heart attack several days ago. The doctor appears to be finished talking about it as he makes his way toward the door.

Where is this story going you ask? Is there a point to imagining this happened to you? Most definitely, that is, if you are at all like me. And here it is. If I had just had a serious health scare such as the one just described, I would want far more detailed exercise advice than just being told to be more active or just walk.

Being told to "be more active" or "just walk" would simply not be good enough. I wouldn't know how far to walk or how long, how fast to go or how often. How much is enough? How much is too much? If I do too much am I likely to have another heart attack?

Doctors need to take the time to be a bit more detailed when giving instructions to their patients regarding not only the need for exercise, but how to do it. That is, doctors need to know the current guidelines for prescribing exercise so that they feel comfortable doing so. Ideally, patients need to leave the doctor's office with an exercise prescription in hand, complete with frequency, intensity and duration guidelines.

I believe providing patients with written prescriptions for exercise that contains all of the pertinent details as to how to do it, would increase the total number of people that exercise. The American College of Sports Medicine, in conjunction with the American Diabetes Association, has published a position paper on exercise prescription guidelines that explains in detail their current recommendations.

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Milt Bedingfield http://www.huffingtonpost.com/milt-bedingfield/
Increased physical activity (I just go ahead and call it what it is, exercise) and maintaining a normal body weight, usually referred to as making positive "lifestyle choices," has been cited repeatedly as central to preventing and/or controlling prediabetes and diabetes. The problem with this is that it seems not enough people with Type 2 diabetes are heeding this advice, and health care professionals such as doctors, nurses and certified diabetes educators are not explaining the need for exercise in strong enough terms.

Patients newly diagnosed with diabetes commonly realize the need for eating better, which in their minds means eating fewer carbohydrates, even if they don't recognize the need for reducing their fat intake and losing some weight, but they don't often see the relationship between having diabetes and the increased need for exercise. It has been my experience that when patients are willing to make a change in their lives to better manage their diabetes, it usually has to do with limiting the number of carbohydrates they consume, not increasing their activity level.

Limiting carbohydrates is a good start, but is not at all likely to be enough to effectively manage Type 2 diabetes long-term. It's only half of the equation, only part of the solution. Exercise is vitally necessary, as well as limiting carbs, because as more and more beta cells cease to function and less insulin is produced, carbohydrate intake will out of necessity need to be at a bare minimum, which still may not allow for good management of blood glucose levels.

It is my contention that health care providers, including physicians, nurse practitioners, and diabetes educators, need to impress upon their patients with Type 2 diabetes that getting regular, almost daily exercise is equally as important as watching what they eat. Not only that, we need to take the time to explain to patients the latest exercise guidelines established by the American Diabetes Association. If patients express concern about whether or not they can perform exercise due to a health condition, every effort should be made to help the patient problem-solve their situation so that some form of exercise is possible. Exercise is too valuable a treatment for patients to simply dismiss it due to a medical problem.

I believe health care providers need to make the need for exercise more clear to patients with Type 2 diabetes and go the extra step in recommending current exercise guidelines.

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Milt Bedingfield http://www.huffingtonpost.com/milt-bedingfield/
I always politely tell them it doesn't matter, because five $20 bills is the same as ten $10 bills, they both add up to $100.

Some companies are not concerned as to what time you arrive at work or what time you leave, just as long as you get your 40 hours in. The end result is the same.

When I was much younger, I remember hearing my dad say, "Six of one or a half-dozen of the other." I heard that so many times, but never could figure out what it meant. Eventually I got it but I wasn't so young anymore.

Closer to home, if your blood sugar is low and you are in the midst of a hypoglycemic episode, I doubt you care if you are treated with grape juice, candy corn, or glucose tablets. For most people experiencing hypoglycemia, it is so miserable they don't care how it's treated or what its treated with, just get the numbers up as quickly as possible.

In so many instances in life, the end result is going to be the same no matter how you got there, as I have tried to illustrate in the previous examples. But then there are cases where the end result is totally dependent on how you got there.

Imagine traveling by car from Florida to California with Albert Einstein as your companion, or maybe Mother Teresa. Think of the conversation, the questions, the great stories.

Contrast that with the same trip, but with a different companion, a regular guy like me. I can tell you the little that I know about Albert Einstein or Mother Teresa, but there's no way I can tell you what they can tell you.

This would definitely not be a situation where my dad could say that taking a trip to California in their company vs. riding with me was "six of one or a half-dozen of the other," because it's not.

By the same token, learning about diabetes from a certified diabetes educator is not at all the same as spending time with a diabetes coach.

The amount of diabetes knowledge that each possess could be worlds apart. This is not at all meant as a critical remark or to put diabetes coaches down in any way, as I do feel there is a valuable role for them, however, certified diabetes educators must pass a certifying exam every five years, indicating a high level of competency. By the time most educators achieve the CDE credential, they have accumulated a significant level of knowledge and considerable experience in the field of diabetes.

Diabetes coaches are frequently well-meaning volunteers with little to no diabetes experience who have a desire to help others with diabetes. The diabetes education that prepares them to be a diabetes coach may range from several hours to two days. I see the role of a diabetes coach as a motivator to help keep the person with diabetes on track with their exercise and meal plan. This is of significant importance.

Health care associations recommend that someone newly diagnosed with diabetes receive a minimum of 10 hours of diabetes education within the first year of being diagnosed. This is considered comprehensive education. Anything less than this, in my opinion, is shortchanging the patient and not preparing them optimally to properly manage their disease.

No, this is definitely not a case where being taught by a certified diabetes educator is six of one or a half-dozen of the other to being taught by a diabetes coach.

Diabetes is far too serious to mess around with. Get education immediately after diagnosis and get it from a certified diabetes educator.

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Milt Bedingfield http://www.huffingtonpost.com/milt-bedingfield/
During the 20 years or so that Chris struggled with his addictions, there were so many times when I would lay in bed at night and try to come up something that I could do to change the direction his life was headed. Early on, I thought a good talking to would do it. I didn't understand the disease. As time went on, I came up with other ideas. None worked, however, the idea I thought was the most likely to be successful I never tried. I never tried it because it was too unrealistic, at least I thought it was.You see, I had finally come to realize that unless I could get Chris out of that environment, totally away from the people that supplied him with drugs and the alcohol he would buy, nothing would ever change.

I imagined what would happen if Chris and I were stranded on a deserted island. Then what would he do? No alcohol, no drugs. If we wanted to eat we would have to hunt it or pick it. My days would be spent seeing my brother withdraw from the chemicals he had been ingesting, gradually getting back to the brother I knew. Early on, Chris would most likely be trying to figure out a way to escape from the island so he could get back to his addictions. My theory was that the longer I could keep him away from the drugs (or clean), the less likely he would go back to them. I never had a chance to try out my theory.

As unpractical as it may seem, imagine for the next few minutes, (bear with me here) the benefits of "isolation therapy" (as I will call it for lack of a better description) to some people with metabolic syndrome, pre-diabetes, Type 2 diabetes, weight management issues, and obesity. It is well known that the modern way of eating, characterized by convenience, excess and indulgence combined with the current trend to make life as physically easy as possible, leads to the vast majority of what ails us.

What do you think would happen if someone that is overweight with Type 2 diabetes that has a difficult time making wise food choices and getting exercise, is taken to a relatively secluded island for two months in the summer where they have to hunt, pick or pull from a tree their food. They have to clean it, prepare it and tidy up after themselves. If they want shelter from the elements they have to make it.

This is what I think. For those people that could stick it out for two months or so living this way, their lives would never be the same. My guess is that many of them would never return to a lot of the poor food habits and excesses that got them to where they were prior to the isolation therapy. I also hypothesize that by the end of the isolation period, there would be significant improvement in nearly all parameters of health and wellness, so much so, that many of their diabetes medications may need to be reduced or eliminated.

Think about it. Maybe the idea is not as crazy as it initially sounds. I would be interested in hearing your thoughts.

For more by Milt Bedingfield, click here.

For more on diabetes, click here.

For more on addiction and recovery, click here.]]> tag:www.huffingtonpost.com,2011:/theblog//3.1076161 2011-11-08T11:04:58-05:00 2012-01-08T05:12:01-05:00

Milt Bedingfield http://www.huffingtonpost.com/milt-bedingfield/
What do you do with all that candy? Hands down the smartest thing to do: throw it away. Proceed to the nearest trash receptacle and throw it away. I have always believed that the fun in Halloween was the dressing up in weird costumes and walking around the neighborhood with a bunch of your friends. It's not about all the candy you get at the door. After all, a lot of it is not even the good stuff.

Many people have the attitude, "Listen, Halloween only comes once a year. As soon as I eat what's left I will not eat anymore. It'll be out of the house and I will be done with it." OK, but by the time you have finished eating it you have consumed another couple of thousand calories or three, or four. Yep, a lot of calories in that chocolate. "But they are mini-candy bars," you say. So, you justify you can eat more of them. Remember these words, "several thousand calories" (only trying to help).

Please be aware, unthoughtful colleagues, yes, unthoughtful in that they are not really thinking of your best interest will bring their left over candy to the office, put it in a big bowl and put a sign near it in the kitchen that reads, "Help Yourself." Yeah, it gets it out of their house, removes them from temptation, but what about everybody else? Somebody at my office did that. A lot of the staff in my building are trying to lose weight too, always trying to resist temptation. Now they see a big bowl of candy in the kitchen every time they walk through, calling to them. By the way, by the end of the day, the overflowing bowl of Kit Kats and miniature candy bars was nearly gone. Not a good thing. A lot of people's healthy meal plans were sabotaged that day.

Think before you grab. Think before you put it in your mouth. Is the short-lived (very short-lived) pleasure that the goody brings worth the heartache and work it takes to shed the calories from your body? I think not, but of course it is ultimately up to you.

And finally, the next time you reach for a miniature bag of M&Ms, remember these words, "To burn up the amount of calories in one M&M, the average-sized person would have to walk the length of a football field."

Enjoy.]]> tag:www.huffingtonpost.com,2011:/theblog//3.982017 2011-10-28T16:40:23-04:00 2011-12-28T05:12:01-05:00

Milt Bedingfield http://www.huffingtonpost.com/milt-bedingfield/
I remember late in the afternoon on Saturdays, after the mowing and edging was done, my dad and I would settle down in the front yard with a trash can between us and start pulling weeds. I always got such satisfaction seeing how I uncovered some healthy St. Augustine grass after removing the weeds that covered it. I remember every so often my dad would look over at me and remind me to make sure I was getting the root of the weed when I pulled it. Otherwise he said the weed would grow back.

It is well-known that insulin resistance, what I like to call "rusty hinges," is what leads to type 2 diabetes in most cases. With type 2 diabetes nutrition plays a very important role. Because people with type 2 diabetes have a much harder time getting sugar out of their blood and into their muscle, fat and liver cells, they would be wise to put less sugar in the blood to begin with. This of course means there would be less sugar to remove from the blood. Although over time, consuming less sugar is likely to contribute to weight loss, which in turn will reduce insulin resistance, eating less sugar is something people with diabetes have to do since they cannot make adequate amounts of insulin. In time with more and more beta cells becoming dysfunctional less sugar can be consumed or more medication will be needed to keep blood sugar levels reasonably well controlled. Unfortunately, eating less sugar doesn't deal with the root of the problem, insulin resistance, exercise does. Exercise directly deals with the root of the problem, insulin resistance or "rusty hinges." Every time someone with type 2 diabetes exercises, in a sense, it's as if they are sanding the rust off of the hinges and then spraying them with WD-40. Exercise directly deals with the root of the problem -- insulin resistance -- like no other treatment. For many people with type 2 diabetes, exercise is the most important thing they can do to manage their diabetes.]]> tag:www.huffingtonpost.com,2011:/theblog//3.981997 2011-10-04T18:24:07-04:00 2011-12-04T05:12:07-05:00

Milt Bedingfield http://www.huffingtonpost.com/milt-bedingfield/
How about $40,000? Not too many years ago that was considered about the going rate for open-heart surgery. Fortunately, your health insurance would usually pay for a good chunk of that. But really, think about it, if your insurance wouldn't pay for it, and your quality of life was starting to go downhill fast, and you couldn't walk from the living room to the bathroom without getting out of breath or experiencing chest pain, would you have the surgery, even if you knew you had no way to pay for it?

What if the doctor told you that the open-heart surgery was necessary to save your life, that without it the quality of your life would continue to deteriorate until eventually you would be bedridden and then soon after die of heart failure? Would you elect to have this bank-breaking open-heart procedure? I'm thinking yes, you probably would. Even though it might cost close to $100,000 by the time all the medical bills are paid, I'm thinking most people would. I know I would, or I think I would.

So again, how much money should it cost you for 10 hours of diabetes education? Keep in mind it is not surgery and requires no hospital stay. (Well, at least not early on, for most people anyway.) In fact, highly-educated doctors are not even the teachers. In many cases, if you are lucky, a highly-trained, certified diabetes educator will provide the education.

Several years ago my mom developed lung cancer. The surgeon came in her room and asked her what she wanted to do. Before he had a chance to completely explain her options she responded, "Take it out. I want this out of me as soon as possible."

"So you want me to operate and remove the affected part of your lung," the doctor asked.
"Yes, as soon as you can, the sooner the better," she told him. My mom was 81. She had the surgery and is doing well. The total cost of the surgery, including the hospital and doctor bill, came to about $50,000. Without the surgery my mom might not be here now.

You know frequently, when first diagnosed with diabetes, a lot of people don't even feel bad, yet -- you know, the first year or so, before the onset of complications like heart disease (two out of three people with diabetes develop heart disease), nerve disease (diabetes is the leading cause of non-traumatic amputations), eye disease (diabetes can impair vision and lead to blindness) and kidney disease (diabetes is a leading cause of kidney dialysis).

Recently, I had two suspicious moles frozen. After they were frozen they swelled up, dried up and fell off. The doctor didn't really think either amounted to much but said he could get rid of them if they bothered me. It cost about $200. The thing about it is that unlike the open-heart surgery, lung surgery and diabetes education, if I hadn't had my two moles removed I would have been none the worse.

Just in case you haven't figured it out by now, receiving diabetes education soon after diagnosis is of the utmost importance. I tell people in class that I cannot imagine successfully managing diabetes without attending a comprehensive diabetes class. (The American Diabetes Association recommends all newly-diagnosed patients with diabetes receive 10 hours of comprehensive education soon after diagnosis.) By the way, insurance usually will cover 10 hours of diabetes education within the first 12 months of being diagnosed.

I can assure you that mismanaged or ignored diabetes will eventually lead to some life-changing problems, problems that you want no part of. Diabetes education is as much a lifesaver as open heart surgery and cancer treatment (and much less expensive at only a fraction of the cost). However, sadly, there are far too many people with diabetes that fail to see the value of education.

Over the last 15 or so years this has led to most hospital-based diabetes education programs closing their doors, as education programs could not support themselves. Now, most of the hospital-based diabetes education programs that still exist are outpatient programs, many of which struggle to survive, as patients are reluctant to pay more than a small co-payment or their deductible for education they feel is not worth the price.

Twenty-six million people have diabetes, 336 million worldwide. Another 72 million people nationwide have pre-diabetes. Although not curable, Type 2 diabetes is highly treatable if you know what to do.

I used to think that doctors were the only ones that could save lives. I have learned over the years that diabetes educators and the education they provide can save lives as well. It would seem as though there are two parts to diabetes education. Part 1: getting the person with diabetes to realize how important diabetes education really is. Part 2: educating the person with diabetes about diabetes. Right now diabetes educators may need to focus on part one so we can continue part two.

Yes, diabetes education is right up there with heart surgery, cancer treatment and substance abuse rehab when it comes to saving lives. Concentrated efforts by informed professionals in the health care and insurance industry need to be made to affect a change in the public perception of the role comprehensive diabetes education plays in the lives of those with diabetes.]]> tag:www.huffingtonpost.com,2011:/theblog//3.983587 2011-10-02T09:23:33-04:00 2011-12-02T05:12:04-05:00

Milt Bedingfield http://www.huffingtonpost.com/milt-bedingfield/
The general concensus is that there are about 26 million people with Type 2 diabetes, approximately 19 million that know it and another 6-7 million that do not. This means that there are a whopping 72 million with pre-diabetes, those with fasting blood sugar levels greater than 100mg/dl. but less than 126mg/dl. Normal blood sugar levels are less than 100mg/dl. first thing in the morning before eating.

What is so very unfortunate is that the vast majority of the 72 million people with pre-diabetes will end up developing Type 2 diabetes in the not-to-distant future. And although Type 2 diabetes is highly treatable, it is not curable, and these newly-diagnosed Type 2s will have it for the rest of their lives. In spite of what you may read or hear, Type 2 diabetes is not reversible or curable. Even with weight loss the best you can hope for is that it will be better managed.

You see, generally speaking, when you are a smaller person -- particularly if you are smaller because you carry less fat on your body -- you need less insulin than if you are a larger person. Someone that can lose a lot of excess fat and reduce their body weight can oftentimes get by with producing less than normal amounts of insulin. In these cases it may be that you can get by with the limited amount of insulin that you are still able to produce. If blood sugar levels return to normal, it is likely many people would think that the diabetes is cured, when in reality it is well-managed. It is this type of scenario that confuses people and leads them to believing that their diabetes went away (as I have heard often) or is cured.

As a certified diabetes educator for the last 18 years, what frustrates me the most is that in the majority of cases of pre-diabetes, particularly those with an early diagnosis, developing on to Type 2 diabetes is preventable. This is worth repeating. If those people with pre-diabetes make some serious lifestyle changes immediately, then the development of Type 2 diabetes may be prevented.

People with pre-diabetes need to be told at the time of their diagnosis, rather emphatically, what they need to do to lessen their chances of eventually developing Type 2 diabetes. Instructions need to be given. Referrals need to be made. The seriousness of the diagnosis needs to be conveyed to the newly-diagnosed patient. The patient needs to know that they may be able to avoid diabetes if they do this, this and this.

Newly-diagnosed pre-diabetes patients need to seek instruction on how much exercise to engage in, how to improve meal planning and how much weight needs to be lost. Taking this advice and acting on it quickly is likely to mean the difference in developing diabetes or not.]]>