Editor

As diabetes is increasing globally at an exponential rate, you need to start testing your blood glucose levels to manage your diabetes effectively. In 2000, around 171,000,000 people were suffering from diabetes worldwide and it is estimated that by 2030, 366,000,000 people might suffer from diabetes, according to World Health Organization (WHO). Diabetes is caused mainly due to excess sugar intake, obesity and lack of physical activity.

Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes, according to American Diabetes Association. If you have diabetes, you need to have the best glucose meter to help you better manage your diabetes by tracking any fluctuations caused by food, medications, exercise, stress and other factors.

As the demand for glucose meter is increasing among people, different types of glucose meters are manufactured. Nowadays, you can find glucose meters ranging from basic models to advanced meters with multiple features, compact design and user-friendly options.

Usually, glucose meters use similar technique to determine the blood glucose level but they might vary in features. To determine the best blood glucose meter, you need to look through a few models and examine its features.

Some simple tips that might help you to determine the best glucose meter are listed below:

Insurance:

Before choosing a blood glucose meter, make sure your insurance provider offers coverage for the specific glucose meter brand you are interested in. Typically, some insurance providers may only offer insurance coverage for specific models or brands and might limit the total number of test strips allowed.

Ease of use and maintenance:

You might have to often use your blood glucose meter to determine the level blood glucose. So, choose a glucose meter that is easy to use and requires less maintenance.

Display:

As modern glucose meters are compact in size, they have small display panels to display readings. Usually, people with poor eyesight might not be able to read the recordings properly from such small displays. So, look for a comfortable and convenient display to avoid unnecessary regrets later. If you need to take a reading at dark surroundings, you need to look for glucose meter with backlit display that glows even in poor lighting.

Size:

Blood glucose meters are available in a wide range of size, shape and outlook. When choosing a blood glucose meter make sure it fits within your pocket or hand bag with ease.

Advanced Features:

Nowadays, glucose meters are designed with advanced inbuilt features such as large screen, talking meter, colorful meters and backlit display. So, check out the features of a few models to determine the best one.

Cost:

Finally, you need to compare the price of glucose meters to pick the best blood glucose meter that suits your needs and within your budget.

Choosing an Insulin Pump can be difficult.

Insulin pumps represent a giant step forwards in diabetes management. Instead of constantly preparing and administering insulin by injection, pumps allows users to fine-tune their insulin delivery. Pumps as a whole and specific pumps in particular have both pros and cons for different types of users, however, so it is vital to read up on what is available.

Most conventional insulin users will mix shorter and longer-acting types of insulin to attempt to get blood sugar control over an entire 24-hour period. This is important because high blood sugar can have serious short and long-term consequences, but is annoying at best. Pumps remove this necessity as they can deliver short-acting insulin constantly. Users trigger a 'bolus' or larger dose based on their carbohydrate intake when they eat and receive a low, calculated dose at all other times.

There are some important points to consider when choosing an insulin pump. One of these is the pump's bolus and basal rate delivery minimum. For patients who are very small (mostly children) or those whose bodies are very sensitive to low doses of insulin, the best insulin pump might be one that can deliver tiny or very precise doses. An example of a pump that can deliver down to 0.025 units per hour is the Medtronic MiniMed Paradigm Real-Time Revel. It can also be set to deliver doses in 0.025 unit increments, allowing incredible precision even with larger doses.

The best insulin pump for a person who requires larger doses might be one with a bigger reservoir. The maximum delivery rate per hour may also be important in these cases. The Accu-Chek Spirit offers a 315-unit reservoir but the Real-Time Revel actually offers a higher rate of insulin delivery, at up to 35 units per hour. Some pumps have a maximum hourly rate of all the way down to 16 units.

All modern pumps are computerized. Most of them interact with software on your home computer in order to allow you to maintain logs of blood sugar and other trends. These can provide valuable information for your long-term health that you don't want to miss out on. Some pumps are only available with software that works on certain computers, so be sure to choose a pump with compatible software.

Choosing a pump that interacts directly with a blood glucose monitor allows finer control. Some pumps include a blood glucose monitor which can alert patients to rising or falling blood sugars and automatically calculate recovery or catch-up doses. The Real-Time Revel and OmniPod both send an alert when blood sugar is becoming dangerously high and function as simultaneous continuous blood glucose monitors and insulin pumps.

Almost all pumps have some method for disconnecting them in order to bathe or swim. However, a more convenient option may be a model that is waterproof and does not have to be removed. The OmniPod and the OneTouch Ping are both waterproof, the former for up to 25 feet deep for 60 minutes, and the latter for up to 12 feet with no time limit.

Some people are concerned about carrying the pump around, but most pumps are similar in size and weigh 3.5-4.5 ounces. There are some that are smaller, though, all the way down to the 1.8-ounce Dana Diabecare II. Most are about the size of a deck of playing cards and average just over 3 by 2 inches and three-quarters of an inch thick.

For people who really hate the tubing that is standard on all other insulin pumps, there is the OmniPod. This is the first tubing-free insulin pump. The wearable part is a small 'Pod' that attaches directly to the skin with adhesive and inserts a tiny cannula to deliver insulin. It requires replacing every 72 hours. The management software is all on a handheld Personal Diabetes Manager (PDM) which is used to calibrate the pod, view data and deliver boluses.

FDA-approved but not yet for sale, the Solo Micropump aims to provide an even more functional tubing-free system. It works a lot like the OmniPod but the attachable portion of the system can be repositioned and reused for 90 days. The pod itself also maintains basic information like the user's standard bolus size so that even if the PDM is left somewhere boluses can still be given. However, launch was originally scheduled for 2010 and has been rescheduled twice to late 2012.

Cost is an unfortunate thing to have to consider when dealing with healthcare, however many patients are forced to choose by price. Some insurance companies only cover certain pumps as well. Savvy users can sometimes find deals from certain companies who want them to switch, though.

Living with diabetes isn't easy but modern technology has made it a lot easier. Instead of calculating mixes of insulin and giving multiple daily injections, pumps make it possible for users to stick with one kind of insulin. People can decide what to eat when they like, rather than calculating it based on their current insulin levels. Many pumps have built-in features such as food libraries and continuous glucose monitors that make maintaining appropriate blood sugar levels easier as well. Even the problems of annoying tubing and non-waterproof pumps seem to have been relegated to the past.   

High-Fat Diets and Sedentary Lifestyles Contribute to Childhood Obesity

Type 2 diabetes was once considered an adult-only disease. Not anymore. Every year the number of cases of type 2 diabetes in children and adolescents increases.

Why?

Because kids are getting heavier and are exercising less.

Obesity is becoming an epidemic. As the incidence of obesity rises, the incidence of obesity-related diseases rises. Type 2 diabetes, high blood pressure, and high cholesterol are all associated with obesity and threaten potential long-term complications. The duration of diabetes is a strong predictor of risk for developing complications. How much more likely is someone to develop complications if that person is diagnosed with type 2 diabetes at age 15 instead of age 45? No one knows for sure, but giving type 2 diabetes a 30-year head start can’t help. Fortunately, we have good studies showing that complications are preventable. We know that controlling the blood sugar, the blood pressure, and the blood cholesterol is critical in preventing complications. Appropriate education, treatment, and control must start immediately.

Children who develop type 2 diabetes usually do so after age 10 or when puberty kicks in. The changing hormone levels associated with puberty cause increased insulin resistance.

Who’s at Risk, and Should Be Screened?

All children who are overweight or over 10 years old should be screened every 2 years if they have any 2 of the following risk factors:

• Has a family history of type 2 diabetes
• Is a member of a high-risk ethnic group
• Has high blood pressure
• Has high cholesterol or high triglycerides
• Has polycystic ovary syndrome (PCOS)
• Has acanthosis nigricans

Fasting blood sugar of 126 mg/dl or higher, indicates diabetes. Nonfasting blood sugar of 200 mg/dl or higher, indicates diabetes.

Coping With the Diagnosis

Dealing with type 2 diabetes can be especially challenging for an adolescent. Adolescents need support, and at the same time they struggle for independence. They want to fit in but must accept and cope with a chronic disease. Diabetes requires planning and many self-care strategies to prevent complications. Yet children live in the moment, tend to experiment, and generally feel invincible.

Overweight children are often teased, which can damage self-esteem. Children who have a hard time fitting in with their peers may not want to disclose that they have diabetes. Children who get chronic diseases may harbor feelings that they caused the diabetes because they did something wrong or because they were bad. Children with diabetes often experience a myriad of emotions, including anger, frustration, denial, fear, depression, and anxiety. Children need support. Seek the help of a counselor or mental health specialist who can meet with the child, as well as with other members of the family.

Parents can be supportive by talking with and listening to their children. Keep the lines of communication open. Provide options to children whenever possible. For example, children have to check their blood sugar. Monitoring is not an option. But you can allow the child to choose which finger to use. Remind older children that it’s time to check the blood sugar but don’t nag. Older children may not want their parents looking over their shoulder while the blood sugar check is being performed. But parents should have access to knowing what the numbers are. Blood sugar monitors retain a record of past readings.

Parenting Pointers

Parenting a child with diabetes takes knowledge, skill, patience, trust, finesse, courage, hope, support, discipline, and a great deal of responsibility. No one will tell you it’s easy. At first, the brunt of the responsibility for diabetes care falls on the parents. As children get older, they can begin to take on age-appropriate diabetes self-management tasks. The transfer of responsibility from parent to child is a tricky dance. Despite the fact that some children are quite capable of performing diabetes-related tasks themselves, parents should not relinquish their support and supervision. It’s crucial that the child isn’t overly burdened too soon. Kids can get burned out. They don’t get a vacation from diabetes. Responsibility for diabetes care should be shared between the child and caretakers. Instead of considering it “the child’s diabetes,” consider it “the family’s diabetes.”

Adolescence is a tricky time, when parents must supervise and support yet give up some of the control. Teens tend to be risk-takers and feel as if they’re indestructible. They want to fit in. They don’t want to be different and may not want their friends to know they have diabetes. Caregivers must convey the importance of diabetes self-management without using scare tactics. Don’t threaten a child with diabetes complications. Fear isn’t a good motivator and can actually leave the child feeling, “Why bother?” Children need praise and reinforcement. Use positive motivators such as allowing the child to earn a privilege for performing diabetes tasks. Let kids know that blood sugar control improves the ability to concentrate and do well in school. Well-controlled blood sugar also reduces fatigue and allows peak athletic performance. One thing has become evident to me; the kids who receive the most support and supervision tend to have the best blood sugar control.

Meal Planning

The nutritional management of diabetes involves establishing healthful eating behaviors that should last a lifetime. It’s important for parents to demonstrate healthful eating behaviors. Kids learn many eating habits from their parents. Children with diabetes should not be singled out to eat entirely different foods from the rest of the family.

Here are a few suggestions to improve childhood nutrition:

• Don’t skip meals. Eat three meals per day (plus snacks if desired).
• Choose healthful, lowfat snacks. Limit junk food.
• Strive for five! Choose at least five servings per day from a combination of fruits and vegetables.
• Choose lean meats and lowfat dairy products.
• Limit added fats and fried foods.
• Try to use higher fiber and higher water content foods.
• Eat fewer fast food meals. Consider fast food fat food.
• Discourage eating out of boredom or for emotional reasons.
• Limit eating in front of the television.
• Choose diet soft drinks instead of regular sodas and sugary beverages.
• Don’t force kids to clean their plates! Provide healthful menu selections and let kids choose from those selections and choose how much they want to eat. Children need to learn to quit eating when they’re full, by following their appetite cues.

Kids with diabetes are still kids!

It’s important to incorporate favorite foods in reasonable amounts, even if those foods aren’t the most healthful choices. It’s all about moderation. If a child has a well-balanced, healthful diet most of the time, that’s what counts. There’s room to fit a candy bar or a couple of cookies into the meal plan. Besides, if you don’t negotiate the inclusion of some favored items, those items tend to get eaten anyway. The kids just don’t tell you. It’s better to fit the item in at a designated snack time or mealtime. Treats can be traded for the usual carbohydrate snacks. Forbidding treats can lead to feelings of anger and isolation. Imagine being the only child at the birthday party who is not allowed to eat cake. The psychological impact of being singled out is probably more damaging than fitting a piece of cake into the meal plan for a child with diabetes.

In addition to the general dietary guidelines listed here, carbohydrate counting or the exchange system can be used to manage carbohydrate intake and distribution. A registered dietitian who is familiar with both pediatrics and diabetes can help to develop an individualized meal plan.

Children must learn that having diabetes doesn’t have to be a roadblock in life. Children with diabetes can do anything, and be anything. They should be encouraged to believe that they are capable of attaining their goals. The sky is the limit.

The fastest-growing segment of the American population consists of individuals aged 60 and older. In 1994, one out of every eight individuals in our country was over 65 years old. By the year 2020 it is estimated that one out of every six people will be over 65 years old.

Approximately 20 percent of people aged 65 years or older have diabetes, and just about half of those people don’t even know that they have it! Another 20 percent of people over the age of 65 have impaired glucose tolerance. That adds up to a full 40 percent of our senior citizens with some degree of glucose intolerance! That statistic is not matched the world over. Some societies report diabetes prevalence as low as 3.5 percent in their senior populations. Advancing age is a risk factor for developing diabetes, but having 65 candles on the cake doesn’t make diabetes an inevitability. Prevention and treatment strategies boil down to accessing health care and implementing self-care.

Health Care

Many individuals have had diabetes for several years before finding out about it. That’s why it’s so important to have a thorough exam at the time of diagnosis.

Initial visit should include, but is not limited to:

• Complete physical exam.
• Hemoglobin A1c
• A dilated eye exam by an ophthalmologist.
• A urine microalbumin to assess kidney health.
• A complete foot exam to assess for nerve damage and circulatory problems.
• Assessment for the presence or risk of heart disease (heart disease is the most common disease present in senior citizens).
• A referral to a registered dietitian for meal planning.
• A visit with a nurse educator to teach blood glucose monitoring.

Diabetes tune-up visits should be scheduled as necessary to achieve glycemic goals. Other diabetes education visits, and labs should be repeated as needed, or as indicated by ADA standards of practice.

Diabetes in the elderly is often undertreated, which is a real disservice. Diabetes should not be allowed to tarnish the golden years. Uncontrolled diabetes may lead to many problems including:

• Fatigue and lethargy
• Increased frequency of urination
  - which can cause incontinence.
  - which can interrupt sleep patterns
  - which can lead to dehydration
  - which can cause mineral deficiencies because certain minerals are lost in the urine (particularly zinc, chromium, and magnesium).
• Blurred vision
• Impotence
• Poor wound healing
• Decreased ability to fight infection
• Increased platelets aggregation which increases the risk of heart attack and stroke
• Confusion and hallucinations, which if not promptly treated can lead to coma and death.
• Hyperosmolar, hyperglycemic, nonketotic syndrome

Self Care: Nutritional Considerations
Barriers to Balanced Nutrition

As age increases, the sense of taste and smell may diminish. Food may lose some of its appeal. Some prescription medications may cause digestive complaints or cause taste changes. Besides appetite changes, social situations can contribute to malnutrition. The loss of a beloved mate can result in depression and a dwindling appetite. Cooking and eating for one just isn’t the same as sharing mealtimes together. Isolation is associated with poor eating habits, and living on a fixed income can dictate the types and amounts of foods available.

In some cases, advancing age brings physical limitations that impact the ability to shop for, prepare, and eat meals. Barriers include visual problems, arthritis, ill-fitting dentures, changes in strength and balance, and decreased mobility.

As a result, many seniors are nutritionally compromised.

Eating Tips For Seniors

• Eat 5-6 small meals per day.
• Distribute carbohydrate foods evenly throughout the day to improve glycemia.
• Choose fruit instead of fruit juice. Juice tends to exacerbate hyperglycemia.
• Eat fresh fruit, or buy fruits canned in their own juices or in water, not in syrup.
• Eat adequate amounts of protein.
• Frozen vegetables can be used as needed, and they keep well.
• Share meals with friends or family whenever possible.
• Eat a variety of foods.
• Try new recipes.
• Make extra and freeze leftovers for future use.
• Unprocessed potatoes, rice, dried beans, and pastas are cheaper than prepared items.
• Use foods with stronger flavors and seasonings if the sense of taste has diminished.
• Focus on using herbs and spices instead of added salt.
• Make foods look attractive.
• Set a fancy table.
• Increase fiber to treat and prevent constipation.
• Drink plenty of liquids.
• Keep active; it stimulates the appetite.

Senior Nutrition Alert

Calorie requirements decrease somewhat as the years pass by, but vitamin and mineral requirements don’t significantly decrease. It’s important to make every bite count. It’s important to choose nutritious and fortified foods and limit junk foods.

As the body ages, the sense of thirst diminishes. Thirst is not a reliable indicator of hydration and many senior citizens end up dehydrated. Uncontrolled diabetes further increases the risk for dehydration. Adequate fluid intake is crucially important. Like all of us, seniors should aim for at least 8 cups of fluid per day, and drink more on hot days. (Alcoholic beverages don’t count toward fluid goals.)

If a well-balanced diet is consistently obtained, vitamin supplements are not necessary. If a vitamin supplement is indicated, choose one that provides 100 percent of the RDA (recommended daily allowance). The vitamin supplements are in addition to, not in place of, healthful foods.

Nutrients that are most frequently inadequate in the senior population include:

• Vitamin B12: decreased stomach acid is to blame for poor B12 absorption. The RDA for seniors is 2.4 micrograms. Vitamin B12 is abundant in animal products (milk, meats, fish, eggs).
• Calcium: The RDA for seniors is 1200 milligrams per day. Calcium is best found in dairy products such as milk, yogurt, and cheese. Calcium fortified soymilk and tofu are available.
• Vitamin D: Lack of exposure to the sun, and omitting fortified milk can lead to poor vitamin D levels. The RDA for seniors is 10-15 micrograms per day.
• Vitamin C: Fruits and vegetables are the best sources of vitamin C. The RDA for female seniors is 75 milligrams; males 90 milligrams.
• Zinc: Best found in meat, liver, seafood, eggs, and whole grains, the RDA for adult females is 8 milligrams, and males 11 milligrams.
• Magnesium: Most abundant in nuts and seeds, legumes, and whole grains, the RDA for elderly females is 320 milligrams; males 420 milligrams.
• Folate: Found in leafy vegetables, legumes, and some fruits, the RDA is 400 micrograms per day.

Caution: Exceeding the RDA is not recommended because high intake of certain vitamins and minerals can cause toxicity.

Antioxidants have received a lot of attention in recent years, in relation to wellness and disease prevention. More studies are needed to better understand how antioxidants may affect diabetes management and treatment.

Several vitamins and minerals are classified as antioxidants. An antioxidant is a substance that reduces cellular damage. Our bodies produce some antioxidants naturally. Certain foods are also good sources of antioxidants. It’s well accepted that eating foods rich in antioxidants is a healthful thing to do. The jury is split on whether or not to use vitamin supplements to further boost antioxidant intake. Some studies show benefit from supplementing with antioxidant vitamins, while other studies aren’t so conclusive.

Oxidation is a process by which damage occurs as a result of contact with oxygen. Oxidation of iron results in rust, as illustrated by a nail that’s exposed to air. Food spoilage happens, in part, because of exposure to oxygen in the air. Even though oxygen is essential to humans, we aren’t exempt from oxidative damage. We won’t rust or spoil; the damage is more discreet. Oxidation leads to the formation of “free-radicals.” Free radicals form from normal cellular processes. Environmental hazards can increase free radical production. Exposure to the sun’s damaging rays, car exhaust, ozone, cigarette smoke, drugs, poisons, and pesticides can all amplify free radical production. (It’s not enough to take care of ourselves; we must take care of our environment!)

Free radicals are unstable molecules that can damage cells and tissues and can interfere with the immune system. Free radicals are also implicated in heart disease because they favor plaque formation in the arteries, which can lead to atherosclerosis. Free radicals are partially to blame for cataract formation, arthritis, and even the effects of aging.

An antioxidant is a substance that prevents oxidative damage caused by free radicals. Antioxidants hold promise in preventing and treating diseases like cancer and heart disease. The benefits that antioxidants play in diabetes are still unclear and are under study. Certain nutrients have natural antioxidant qualities. Vitamin C, vitamin E, beta-carotene, and selenium all act as antioxidants to protect the body from oxidative damage. Fruits and vegetables are naturally chalk full of antioxidants. To reap the benefits, eat at least 5 servings per day from a combination of fruits and vegetables. (A serving is approximately 1 small piece, or 1/2 cup. The exchange lists can be used for portioning.) Green tea also has antioxidant activity.

Tip: Eat at least five servings per day from a combination of fruits and vegetables.

Vitamin C
Besides acting as an antioxidant, vitamin C has many other useful functions. Among other things, it’s important for wound healing and fighting infections. It also facilitates the absorption of iron; so if you take an iron supplement, eat a food rich in vitamin C at the same time and you’ll absorb the iron better. Vitamin C is a water-soluble vitamin. Some of the vitamin C in foods is lost when the foods are cooked. Steaming or rapid cooking in a small amount of water can help to preserve the vitamin C content of foods. Raw foods contain the maximum amount of vitamin C. When most people think of vitamin C, they think of orange juice. Sure, oranges are a great source of vitamin C, but so are many other foods. The following foods are all rich in vitamin C:

Vitamin C Requirements
Recommended Dietary Allowance (RDA) for Vitamin C (in milligrams per day)
Adult women: 75
Pregnant women: 85
Lactating women: 120
Adult men: 90

The Tolerable Upper Intake Level (UL) for all adults is set at 2,000 milligrams per day.
Caution: Supplementation with vitamin C at the upper intake levels may cause upset stomach and diarrhea.

Vitamin E “Tocopherol”
Vitamin E is a fat-soluble vitamin. This vitamin is not lost by most cooking methods, except the high heat of deep-frying. The main function of vitamin E is to serve as an antioxidant. Fruits, vegetables, and grains supply some vitamin E, but salad oils and margarine supply the most. Vitamin E deficiency is very rare.
The following foods provide vitamin E

Tip: As you probably noticed, many foods rich in vitamin E happen to be high in fat. If you’re trying to lose weight, you shouldn’t eat more fat; instead you may choose to supplement vitamin E.

Vitamin E “Tocopherol” Requirements
Recommended Dietary Allowance (RDA) for Vitamin E (in milligrams per day)
Adult women: 15
Pregnant women: 15
Lactating women: 19
Adult men: 15

The Tolerable Upper Intake Level (UL) for all adults is set at 1,000 milligrams per day.
Tip: Vitamin E is sometimes measured in international units. To convert from milligrams (mg) to international units (IU), multiply by 1.5.
For example: 15 mg = 22 IU, and 19 mg = 28 IU.

Beta-Carotene
Beta-carotene is in the class of nutrients known as carotenoids. There are more than 600 types of carotenoids. Carotenoids, abundant in fruits and vegetables, have antioxidant properties. People who consume diets that are high in fruits and vegetables appear to have less risk for developing certain diseases, including cancer, stroke, and heart disease. Although eating fruits and vegetables has been shown to have health benefits, isolating individual carotenoids and taking them in pill form has not always shown clear-cut health benefits. Supplementation study results range from positive effects to negative health outcomes. Supplementation of carotenoids is not a replacement for eating whole foods.
Beta-carotene’s other important role is that it’s converted to vitamin A in the body. Vitamin A is necessary for vision, healthy skin, fighting infections, reproduction, and normal growth and development. Beta-carotene is a fat-soluble nutrient. Cooking doesn’t destroy it. A very large intake of dietary carotenoids can produce a yellowing of the skin, as avid drinkers of carrot juice can attest!
The following fruits and vegetables are rich in beta-carotene:

Beta-Carotene Requirements
No RDAs have been set for beta-carotene. Until more supplementation studies are done to prove safety, carotenoids should be obtained from a healthful intake of fruits and vegetables and not from a pill, unless under medical supervision.

Selenium
Selenium is a trace mineral. Selenium works in partnership with vitamin E to
prevent oxidative damage. The selenium content of food varies according to where it was grown, as soil and water selenium concentrations vary. Selenium deficiency in the United States is very rare.
The following foods are good sources of selenium:

Selenium Requirements
Recommended Dietary Allowance (RDA) for Selenium (in micrograms per day)
Adult women: 55
Pregnant women: 60
Lactating women: 70
Adult men: 55

The Tolerable Upper Intake Level (UL) for all adults is set at 400 micrograms per day.Final Tip:
If you aren’t sure whether you should take a vitamin or mineral supplement, you may want to contact a registered dietitian. A registered dietitian can evaluate your diet and your medical history to determine if a supplement could be beneficial.

Until recently most treatments for diabetic neuropathy have been painkillers that helped some people but not others. Even if they helped control the pain, they did nothing to reverse the neuropathy. My web page on “Diabetic Neuropathy” describes many of these treatments.

About half of us have some degree of neuropathy. It is probably the most common complication of diabetes.

We now have better ways to deal with neuropathy than these palliative measures that relieve or sooth the symptoms of neuropathy without effecting a cure. Some are drugs that are in development and are pending approval by the Food and Drug Administration.

But the most interesting treatments to prevent or reverse neuropathy are what we can broadly call gadgets. Most of these devices give earlier and better diagnoses, but at least one of them may at least temporarily reverse the symptoms.

This is the Anodyne Therapy System. It not only reduces pain but also improves circulation and increases feeling. The FDA has cleared it, and it is likely that your insurance will cover it.

More than 3,000 centers and hospitals now offer this treatment. A physical therapist places four or more pads on your feet. These pads give off infrared light that releases nitric oxide in your feet. This is especially important for people with diabetes, who often have low levels of nitric oxide, which can lead to poor circulation, pain, and numbness.

It is the only photo energy therapy with clinical studies published in peer-reviewed medical journals. I have read a lot of these reports and am impressed.

Buy a Neuropen Here

The most impressive of these reports is a recent double-blind, randomized, placebo-controlled study in a peer-reviewed journal, Diabetes Care. The study concluded that Anodyne Therapy treatments “improve sensation in the feet of subjects with DPN [diabetic peripheral neuropathy], improve balance, and reduce pain.” Two other gadgets can help you prevent the complications of diabetic neuropathy. One of them is free and the other costs $150. The free gadget is a disposable probe or monofilament to test our feet at home. It is equivalent to the Semmes-Weinstein 5.07/10 gram monofilament that your doctor uses.

The disposable probes don’t hurt, don’t require a prescription, and are quick and easy to use. You can get a package of 10 at no cost by calling the U.S. Bureau of Primary Health Care at 1 (888) 275-4772. While you are at it, it can be quite useful to make another call for a related government freebie. You can order a copy of the booklet, “Feet Can Last a Lifetime,” by calling the National Diabetes Information Clearinghouse at 1 (800) 860-8747. This booklet, of about 50 pages, shows where, why, and how to test your feet.

If you can’t feel the probe, trouble is brewing. You need to hightail it to a doctor.

If one foot is several degrees warmer than the other, even more serious trouble is in the offing. An ulcer could be brewing.

The FDA has just approved the TempTouch, a device that makes it fast and easy to check the skin temperature on the bottom of our feet every day. If one foot is 4 degrees warmer than the other, you have an early warning sign that an ulcer is developing. With that knowledge you can take action to prevent ulcers and therefore prevent an amputation. Xilas Medical in San Antonio, Texas, sells the TempTouch for $150.

There is also a newly developed screening system that measures how well oxygen is getting to the skin. I’m not surprised that people who have diabetic neuropathy not only have less nitric oxide (which the Anodyne Therapy may reverse) but also less oxygen.

Researchers at Beth Israel Deaconess Medical Center and Harvard Medical School writing in a recent issue of The Lancet, perhaps the world’s leading medical journal, found that people with diabetic neuropathy have less oxygen available to their skin.

They use a camera to capture images of the feet at different wave lengths. They call their screening method “medical hyperspectral imaging.”

If you have a low oxygen level in your feet, you need to pay special attention to them. Of course, all of us need to check our feet every day.

This gadget to measure the amount of oxygen in your feet isn’t on the market yet. But these four gadgets, all developed quite recently, show that we have come a long way toward preventing and perhaps even reversing diabetic neuropathy.

These gadgets are great. But you are even better.

The best way to prevent neuropathy, of course, is to keep your blood glucose levels as close to normal as possible. You can do it.

Sorry to hear that you have joined us! Diabetes is a lot to live with, but really, it is manageable! And if you are depressed, I can understand. Being depressed is pretty common with us, especially right after a diagnosis.

In fact, if you take care of yourself, you will be healthier and happier than you ever were. That paradox is something many of us experience. Learning about diabetes... will give you...power over the disease.

The first thing is to get a good doctor, if possible an endocrinologist, which is a doctor who specializes in diabetes. Have the doctor give you the tests that we get, particularly the A1c. Have you had that test yet? What was the number? Knowledge of these things will give you power over your diabetes and help to lift your spirits.

Have your doctor prescribe a blood glucose meter, test strips, and lancets. In most states, if you have a prescription for them they must be covered under your insurance policy. Test as often as the doctor says to or even more if you can afford more strips. The more you test, the more knowledge you will gain. That will give you more knowledge and power

Learning about diabetes on the Internet and through books will give you even more power over the disease. I picked my eight favorite diabetes Web sites, and one mailing list and newsgroup each a couple of years ago. See http://www.mendosa.com/amiratop10.htm. The Web sites are for information; think of the mailing list and newsgroup as primarily being for support.

You can see my favorite books about diabetes at http://www.mendosa.com/books.htm. One of these, Gretchen Becker, The First Year. Type Two Diabetes is just as the sub-title says: An Essential Guide for the Newly Diagnosed.

The related concepts of the glycemic index and the glycemic load are the most important and exciting areas of nutrition to learn about. The glycemic index is a scientific system of measuring how fast a carbohydrate triggers a rise in circulating blood sugar the higher the number, the greater the blood sugar response. The glycemic load is an even newer way to assess the impact of carbohydrate consumption. It is determined by multiplying a food's glycemic index by its available carbohydrate content per serving. You can find the most complete lists of glycemic indexes and glycemic loads on my Web site at http://diabetes.about.com/library/mendosagi/ngilists.htm

Besides this, everything that you can do to bring your diabetes under control falls under three headings:

• Exercise daily
  Most of us prefer to walk. But for people with leg problems, swimming may be the best alternative. You certainly have a nearby health club that you can join.
• Eat less.
  Eating fewer calories improves our blood sugar even before any weight loss, and weight loss is usually a beneficial side effect of eating less. Almost everyone with type 2 diabetes (myself included) is overweight. I know how hard it is to get down to the right weight, but every pound you take off gives you better control over your diabetes.

For most, but not all, of us this is still not enough. Take the medicine or insulin that the doctor prescribes. You may not have to take it all your life, once the effects of exercise and diet kick in. But your doctor will almost certainly prescribe it now to help you get your blood sugar in control. That's all there is to it. Go for it!

This article originally appeared on mendosa.com on September 10, 2002. Last modified: January 25, 2004

When it comes to blood glucose testing, with only a little simplification there are three types of people in the world – those who use insulin, those who control their diabetes without insulin, and those who don’t yet have diabetes.

People with type 1 diabetes and pregnant women who take insulin need to test at least three times a day, according to The American Diabetes Association’s Position Statement on Standards of Medical Care in Diabetes. But the recommendations are murky for people with type 2 diabetes who use insulin and anyone changing therapy and are especially murky for people who control their diabetes on diet alone. The statement doesn’t even consider people who control their diabetes with pills or with exercise.

Technically, self-monitoring of blood glucose (SMBG) is what we call blood glucose. The position statement says, “The role of SMBG in stable diet-treated patients with type 2 diabetes is not known.” Until now I never could understanding why they said that.

Now, a huge debate has broken out in the ADA’s professional journal, Diabetes Care. This debate explains why the professionals don’t know how often type 2s who don’t use insulin should test.

For people who use insulin the benefits of testing are obvious and well documented. If your levels are too low or too high, you can correct them immediately.

But what about those of us who don’t use insulin? Of course, we can exercise or not eat if our level is too high, or we can take a glucose tab if it’s too low.

Mayer Davidson, an M.D. who is a past president of the ADA, shocked me with his editorial that it is “a waste of money” for type 2s not using insulin to test. He does believe that if they test the best time is before and one or two hours after a meal.

Rather than checking fasting levels, in the last five years or so testing after meals has become the preferred time for those who have good blood glucose control. More on this later in a separate article.

Why does the ADA say the benefits of testing for non-insulin users is unknown? Because until quite recently there have been few well-designed studies. Few studies – but not no studies.

This year a team of Dutch doctors systematically reviewed these studies and found that six of them were randomized controlled trials. Their article, Self-Monitoring of Blood Glucose in Patients With Type 2 Diabetes Who Are Not Using Insulin, is available in full online. Those who tested were able to decrease their A1C level by 0.4 percent – statistically significant and clinically relevant. A decrease of that magnitude reduces the risk of eye, kidney, and nerve disease by 14 percent, according to the huge U.K. Prospective Diabetes Study.

Two more studies are so new that they haven’t even been published yet, but were presented at the ADA’s Scientific Sessions in June and are abstracted online.

A group of doctors in Atlanta presented their study of 552 people not on insulin. Those who tested at least once a day had an average A1C of 6.9 percent, but those who never tested had an average of 7.8 percent. But the A1C hardly changed if they tested more than once.

Doctors in Germany and Switzerland reported on their 10-year study of 3,268 people with type 2. Those who tested their blood glucose levels – whether or not they were taking insulin – were 33 percent less likely to develop complications of diabetes or to die than those who didn’t test.

The evidence is clear. All of us who have diabetes need to test our blood glucose levels. Others can wait.

Working with Medicare is one of the biggest challenges for people seeking coverage of diabetes supplies and services. '"People have a hard time with Medicare,'" says Tim Cady of Advanced Diabetes Supply (www.northcoastmed.com.), a division of North Coast Medical Supply in San Diego.

Tim should know, because his national mail order diabetes company specializes in helping people who have Medicare insurance get their testing and insulin pump supplies. Medicare is the nation's largest health insurance program, covering about 40 million people.

You are probably eligible for Medicare if you are disabled, have reached your 65th birthday or have permanent kidney failure treated with dialysis or a transplant. If Medicare is an enigma that you haven't unraveled, this column can help.

Q: Where can I find the government's own regulations to argue my case?

A: The Internet has two excellent resources:

The Official U.S. Government Site for People With Medicare at medicare.gov. Search for "Medicare Coverage of Diabetes Supplies and Services." Medicare's detailed regulations are available on the Web sites of each of Medicare's four Durable Medical Equipment Regional Carriers (DMERCs). Each of these DMERCs have the same regulations, and the easiest to find and use is that of Palmetto Government Benefits Administrators at http://palmettogba.com. Search for '"Chapter 38'mdash;Home Blood Glucose Monitors.'" It is the first link returned.

Once the deductible has been met, Medicare Part B will generally pay 80 percent of the cost of blood glucose testing supplies. Your supplemental insurance, if any, will usually pay most of the balance. Medicare is difficult to navigate now, but for most of us, it was impossible six years ago. In July 1998, Medicare expanded coverage of blood glucose meters and test strips for all people with diabetes. Earlier, it covered blood glucose monitors and test strips only for people with insulin-dependent diabetes. Medicare will cover everything you need for testing, whether you use insulin or not.

This includes:

• The Meter itself
• Test Strips
• Lancets

But Medicare sets some low test-supply limits. If you use insulin, the standard limit is 100 test strips and lancets every month. If you don't use insulin, the standard limit is 100 test strips and lancets every three months. The government seems to think that we test for the fun of it. Three tests a day when you use insulin and just once a day if you don't is far fewer tests than many of us need.

Well-written prescriptions, however, can get you what you need. They should not say, '"test once or twice a day,'" because Medicare would understand that to mean once a day. When you need to test more often than Medicare's limits, the prescription also has to give specific reasons. These can include fluctuating blood glucose, uncontrolled blood glucose, hypoglycemia, hyperglycemia or an adjustment in your medication.

64 DIABETES HEALTH / DECEMBER 2004 / www.diabeteshealth.com