The Best Reason For Not Keeping Your Diabetes A Secret

I can think of at least several good reasons for not keeping your diabetes a secret. It is usually a good idea to let at least a few of your close friends and/ or colleagues that you see on a regular basis know you have diabetes. Today, however, I want to focus on perhaps the most important reason for not keeping your diabetes a secret.

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 confidant 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 was the victim that was low. I have had patients tell me that they are fine unless they get below forty. 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 forty, 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 conciousness and people were standing around wondering the cause and what to do, your confidant would likely know (depending on the events leading up to your loss of conciousness) 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.

Milt Bedingfield is a certified diabetes educator and exercise physiologist.
Milt's other website can be found at: http ://www.MasteringType2Diabetes.com

4/ 4 = 100%

Type 2 Diabetes: I Got This

Several years ago I took my daughter to her first high school dance. She was going to meet her girl friend at the dance. She didn't have a date, she was to young for that as far as I was concerned, but she did want to go to the dance because she thought it would be fun. As we got in the car and headed down the street I asked her if she had this and that, trying to make sure she had everything. She seemed a little tense. Finally she told me in a tone that let me know I was bugging her, "I got this." So, I stopped asking.

A few quiet minutes later and a little further down the road my daughter blurts out, "I don't have my ticket. I left it in my bedroom. We have to go back."

So much for, "I got this." Ever since that day when my daughter tells me, "I got this" I tell her,
"That's what I'm worried about."

About a week ago, I was in the grocery store and saw someone that I have known for close to thirty years. We were not close, but someone I used to see almost daily and now only run into once or twice a year. She has type 2 diabetes.

Back when she was first diagnosed over ten years ago she told me one day how she came to find out she had type 2 diabetes. She told me she was on vacation and developed an infection on her big toe. The infection worsened and would not heal no matter what she did. The doctor she went to apparently suspected diabetes as wounds many times do not heal as they should when you have diabetes. He is the one that diagnosed her diabetes. Unfortunately, for my friend however, her toe was so badly infected it could not be saved and was amputated shortly after her diagnosis. Apparently she had diabetes for a while without knowing it. There are many, many people, an estimated five million people that have diabetes today and don't yet know it.

So, you are wondering, what does that have to do with taking your daughter to a dance and her forgetting her ticket? Remember when I said I was asking my daughter questions in the car trying to make sure she had not forgotten anything and she said, "Dad, I got this?" and then several minutes later she blurted out. "Dad, I forgot my ticket". Well, I guess to put it bluntly, no she hadn't "Got this." But she certainly thought she did.

Similarly, when my friend told me she had developed type 2 diabetes, and particularly when it had progressed to the point of her needing to have her big toe removed, I emphasized the need for her to attend a comprehensive diabetes class to learn more about the illness and how to take care of herself. After all she already had one toe removed, which is no small consequence of having diabetes. In spite of my strong encouragement to get education, the response I got was very similar to my daughter's "I got this", or "I know what to do". After hearing her response I tried again to convince her but my comments fell on deaf ears. She wasn't really deaf but you know what I mean.

Last week when I saw her at the grocery store, she was heavier than I had ever seen her. She was in a motorized cart. She didn't look good to me. I didn't approach her because I didn't want to rehash her situation or all that had gone wrong since our talk many years ago. I just felt sad and highly frustrated.

Why is it that when someone that knows about diabetes and how it can ravage the human body when not understood and cared for, recommends to someone that they seek education about the disease so they can take better care of themselve, they refuse to do so. So often they rely on a friend they know with the disease and choose to get advice from them, a terrible idea. There is a tremendous amount of misinformation out there. Often they will tell me that they read a book about diabetes or heard a TV doctor talk for ten minutes about it, or was told by their doctor just to "watch it". What on earth does that mean? What is the patient supposed to watch? They don't know what to watch because they never got educated about diabetes!

I feel myself getting excited now so I will stop. I feel sad for my friend but at the same time aggravated at her for not doing what I suggested, because she doesn't look healthy. Remaining overweight is one of the worst things to do when you have diabetes.

The worst thing about this situation is that it happens so frequently. Perhaps you yourself have type 2 diabetes and have been putting off attending a class about the disease. Do yourself a favor, a tremendous favor, and attend a ten hour comprehensive diabetes class where the instructors are Certified Diabetes Educators. It will change your life, for the better.

Milt Bedingfield is a certified diabetes educator and exercise physiologist and has been teaching people with diabetes about the disease and how to care for it for the last 19 years.
Milt's other website can be found at: http ://www.MasteringType2Diabetes.com

For People With Type 2 Diabetes, How Important Is The 30 Day Blood Glucose Average Feature?

When you have type 2 diabetes just how important is the 7, 14 and 30 day average feature on your blood glucose monitor? In my role as a diabetes educator teaching patients about diabetes, I rarely ever use the feature. Sure, it has its place, however, the way it is often used by patients, it can give results that are often misinterpreted.

As an example, say I have a patient that reports his 30 day average has gotten worse since his medication regimen was changed. The patient is frustrated and assumes that the new medication is not working because his 30 day avereage has gone way up. Prior to the medication change the 30 day average was 126mg/dl. Now, the average has risen to 158mg/dl. Obviously the new regimen is not working, right? No,  not necessarily.

I always ask the patient at that point when are they checking their blood sugar. They will often tell me that since the change in medication the doctor has recommended before breakfast and two hours after the start of dinner. Then I will ask them when they were checking their blood sugar before the medication change. The response is frequently before breakfast and before dinner. Do you see the problem? Blood sugar levels are nearly always going to be higher after a meal versus before a meal, we know that. But now the most recent 30 day average is made up of 50% pre meal blood sugar values and 50% after meal values, instead of 100% premeal blood sugar values as was the case before the medication change. You see in this case we are not comparing oranges to oranges and apples to apples.

If using the 30 day average was to be of benefit here, that is, to get an idea as to whether a certain treatment modality was working or not, the patient would have needed to test his blood sugar at the same time of day and under very similar conditions. I suggest that if you are going to want to use the 7 day, 14 day, or 30 day average feature that is an option with many blood glucose monitors, that you establish a pattern of testing and stick to it for a period of time. You might find it helpful to ask your doctor which times of the day he or she would like for you to test and then stick with it.

Keep in mind that anytime you deviate friom this schedule and do some random tests during the day it will make it hard to compare one 30 day average to anotheras the results will be skewed by the unscheduled blood sugar tests.

Milt Bedingfield is a certified diabetes educator and exercise physiologist. Milt's other website can be found at: http ://www.MasteringType2Diabetes.com

Exercise Decreases Insulin Resistance Even Without Weight Loss

In recent articles I have referred to insulin resistance and how it leads to type 2 diabetes about eighty percent of the time. There are two known causes of insulin resistance: being overweight and leading a sedentary lifestyle.  There is no clear evidence that one of these conditions is more harmful than the other or is more responsible for insulin resistance.

What is very clear though is that being overweight, even if only ten pounds or more, and getting little exercise, causes insulin resistance and can ultimately lead to type 2 diabetes.

Now can the insulin resistant overweight person decrease his or her insulin resistance by losing some weight even if not getting any exercise? Most definitely, no doubt about it.

Generally speaking, in cases where the patient is overweight, weight loss is routinely recommended as a first line treatment for type 2 diabetes. Sometimes simply eating better such as more nutritious foods and less junk food is enough to cause weight loss. When patients can do this it is wonderful, however, research shows that maintaining the weight loss for an extended period of time without simultaneously performing exercise is very, very difficult. As you probably well know the lost weight usually comes back within one to two years after losing it.

 What if a person with insulin resistance starts exercising regularly but fails to lose any weight? Is the exercise beneficial? Has it helped? Yes it has, it definitely has, no mistake about it. Exercise will lower insulin resistance even if no weight has been lost. (Are you beginning to see why exercise is such a big deal?) Perhaps the person didn’t lose any weight because they made up for the calories burned during exercise by eating more. Maybe the person did lose some fat but gained muscle mass equal in weight to the amount of fat lost. The scale would show no change in weight even though the percentage of body fat had been reduced. Hence, using traditional bathroom scales is a big drawback when measuring exercise/diet success.

 Anyway, my point is, that exercise can and does reduce insulin resistance even without weight loss. So when I do encourage exercise it is primarily to reduce insulin resistance and secondarily to promote weight loss.

If weight loss does occur as a result of starting to exercise or exercising more, then you can expect even greater improvements in insulin resistance.

I do want to make it clear that when I recommended exercise to a patient, it is first and foremost to help in reducing insulin resistance, secondarily it is to assist a patient in their weight loss efforts. Research has repeatedly shown that exercise by itself is not likely to result in sustained weight loss. Similarly, research has also shown that diet plans that significantly restrict caloric intake are not successful for long-term weight loss when carried out exclusive of exercise. The best chance for long-term success with weight loss is to gradually work up to exercising a minimum of 250 minutes per week and to reduce caloric intake.

Milt Bedingfield is a certified diabetes educator and exercise physiologist. Milt's new website can be found at: http ://www.MasteringType2Diabetes.com

So Which Is It, With Type2 Diabetes Do You Make Too Much Insulin Or Not Enough?

When you have type 2 diabetes and you have been told that you have it because your pancreas either fails to make enough insulin or that the insulin that it makes is not able to be used properly (That's a mouthful), have you ever thought to yourself, "Huh?"

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 ten 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 ten 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 a hold 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 cells 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 insulin's 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 ten 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 ten 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 over production of insulin followed by a reduction in insulin production.

Milt Bedingfield is a certified diabetes educator and exercise physiologist. Milt's other website can be found at: http ://www.MasteringType2diabetes.com

Have We Really Come A Long Way Baby? Think Again.

One morning, while attending an American College of Sports Medicine Conference, I had the pleasure of eating breakfast with Dr. Boyd Eaton, a radiologist and medical anthropologist from Emory University and proclaimed expert in “evolutionary nutrition” by USA Weekend.

As it turned out Dr. Eaton was to be a presenter at the conference later that day. When Dr. Eaton asked what I did for a living and learned of my profession as a diabetes educator our conversation soon focused on a subject he is passionate about. The contrast between our modern day diet and associated health problems (including insulin resistance and diabetes) and the lifestyle and health of our ancestors thousands of years ago.

 During our conversation and later in his presentation he told me that there is more of a genetic difference between an African American and Caucasian than between modern man and man thousands of years ago. In fact, and I quote, “ 99.9% of our genetic heritage dates from about 40,000 years ago-before our biological ancestors had even evolved into Homo Sapiens-and that 99.99% of our genes were formed prior to the development of agriculture some 10,000 years ago. That the vast majority of our genes are ancient in origin means that nearly all of our biochemistry and physiology are fine-tuned to conditions of life that existed before 10,000 years ago. Genetically, our bodies are now virtually the same as they were then. The problem is, our diet isn’t.”

 Could this be the cause of our diabetes?  Dr. Eaton goes on to say, “That 10,000 years ago, pre-agriculture, we were all hunter-gatherers, hunting meat such as deer and bison, gathering fruits, vegetables and nuts. It was a lifestyle that required considerable physical exertion. Skeletal remains indicate that our ancestors were typically more muscular than we are today.”  With few exceptions, we now live in a time that requires very little physical exertion. After all, when was the last time you had to go hunt down and kill your breakfast?  Could this be the cause of our diabetes? Could it be a combination of both our lifestyle in general, what we eat and what we do, (or don’t do), causing us to be out of sync with our genes?

Dr. Eaton believes that a dramatic shift away from eating as our ancestors did is responsible for “diseases of civilization” now accounting for 75% of all deaths in the West. 

What did you have for breakfast this morning?

Did it come in a wrapper or a box? Was it sweetened with high fructose corn syrup? Did your breakfast pop out of a toaster or was it handed to you through your car window.

Or, did you pull it from the ground, a tree branch or vine? Did you have to rinse the dirt off first? Does it taste better raw or uncooked?

 I think Dr. Boyd may have something here.

What do you think?

What do you do?

Milt Bedingfield is a certified diabetes educator and exercise physiologist. Mlt has been teaching people with diabetes about the disease and how to care for it for the last 19 years.
Milt's other website can be found at: http ://www.MasteringType2Diabetes.com

New Emphasis On Resistance Training For People With Type 2 Diabetes

There is renewed interest in resistance training for people that have type 2 diabetes. It is not just about aerobic (or cardio as people often refer to it) exercise any longer. More and more research is showing that performing resistance exercises two to three times per week can be just as beneficial as doing aerobic exercise for people with type 2 diabetes.

For at least the last couple of decades, or more, performing resistance training (hereafter referred to as RT) was considered taboo for many people with type 2 diabetes because of the potential risk of aggravating a preexisting blood pressure problem, thereby increasing all of the health risks associated with high blood pressure.To the contrary, RT in some form or another is now encouraged by The American College of Sports Medicine for patients with type 2 diabetes as long as their blood pressure is normal or they have high blood pressure that is under good control. In addition, it is assumed that the patient has the approval from their doctor to do RT and that there are no other contraindications.

In regards to the blood pressure, however, the key point to make here is that the blood pressure needs to be well controlled before engaging in RT. If the blood pressure is not well controlled that is when serious health problems are likely to arise.

In fact, it is well known by many healthcare professionals, that patients with controlled hypertension that properly perform RT on a regular basis can actually improve their resting and sub-maximal blood pressure as well as reduce some, or sometimes all, of their hypertensive medications.

The latest guidelines from the American College of Sports Medicine and American Diabetes Association recommend that RT be included as part of a well balanced exercise program that also includes aerobic exercise and stretching. The frequency of the RT should be three times per week if possible.

RT is often thought to be lifting barbells or dumbbells or using "the machines", but these are just two methods of doing RT. Stretch cords will provide resistance when stretched and are used often in exercise classes. If you have used stretch cords before and found that the resistance provided by the cords became too easy after a while and seemed of little benefit after a while, all you need to do is go to a cord that provides greater resistance or use two cords instead of one. Properly used, stretch cords should work for just about anybody, even those with plenty of muscles.

Another option is getting in a pool, lake or other large body of water (the bath tube does not count), and using the resistance that the water provides to strengthen your muscles. Keep in mind that the slower you move a body part through the water, the less the resistance, whereas the more rapidly you move through the water the greater the resistance.

The most important thing to remember here is that if you have high blood pressure that you make sure it is under good control before you begin doing RT. Secondly, select a type of resistance training that works best for you.

Milt Bedingfield is a certified diabetes educator and exercise physiologist. Milt has been teaching people with diabetes about the disease and how to care for it for the last 19 years.
Milt's other website can be found at: http ://www.MasteringType2Diabetes.com

Concerning Exercise, Try Just Doing The Warm-Up

Are you new to exercise? Maybe you have never been one to exercise or perhaps it has just been way too many years since you have done it. Now you may not be planning on reading this entire article because you try to avoid anything that has to do with exercise. You may have started reading this in hopes I was going to write something informing you that you didn't need to exercise. Well please be patient and read just a bit farther. I have some information here that I think you may like to hear, an idea you might even consider trying.

Many years ago I was a competitive athlete. I ran, I biked and I even swam. I would do these activities sometimes all three in one day. Now please, keep reading, in spite of what I just wrote I may be a lot more like you than you think, even if you have not been doing much of anything.

For me, the most unpleasant part of any workout, be it a run, a swim, or a bike ride is the first few minutes. Parts of my body would ache sometimes. Many times I was stiff, either in my knee, my back or my neck. Any of this sound familiar? You see athletes are not immune from arthritis, sore joints and just generally feeling lousy or lazy sometimes. What may be different about them and you, is that they know if they start slowly, easily, and get through the first 5-10 minutes of easy exercise, generally known as a warm-up, then things are going to rapidly start looking better. 

Yesterday, the 4th of July, I was talked into running a 5K road race with my oldest daughter. She had never done one before and was ready to give it a try. She said I had to do it with her. Boy, that would be fun I thought if I were in shape for running. But I am not. For several different reasons I had not been running in quite some time and was concerned that I would have a really hard time with it, particularly in Florida with high heat and humidity. However wanting to supprt my daughter I agreed to do it, hoping that I would not die and embarrass her.

We both agreed to take it easy and that we would be victorious if we finished even if it were in last place. With that attitude, the gun went off and we took off, both being careful to maintain a slow and steady pace. We jogged slowly, mindful of our breathing and slow pace. But even then, I found myself starting to wheeze a bit, my legs grew heavy and I would have liked to have walked until I gained control of my breath. After all I couldn't really slow my pace any more than I was already going. All I could do was focus on controlling my breathing, staying loose and relaxed and not going any faster. And then, for me, after about half a mile, things started looking up. I was sweating pretty good, which meant my body's cooling system was now up to speed and working well. My breathing became far less labored and the heaviness in my legs was going away. That meant the coronary blood vessels feeding my body's most important muscle, my heart, had dilated as well as the millions of small capillaries running throughout all of my leg muscles. The result, plenty of oxygen and nutrients were now being delivered to my heart muscle as well as all of the muscles working so hard in my legs. Simply put, my body had adapted to the stress of what I was doing, running. I began to feel much better, finished the race, and with the exception of some minimal soreness in my calves, feel fine and more alive and energetic than the day before the race.

Here's my point, I knew I would get there eventually, if you are apprehensive about starting an exercise program such as walking. swimming or biking, because you believe it may simply be too uncomfortable, consider this. Start off by simply doing a warm-up and then you're done. A warm-up is that early part of the exercise session that allows you to slowly prepare your body for more vigorous exercise to follow. The difference in what I am suggesting is do not follow the warm-up with vigorous exercise, at least not for now anyway. A good warm-up should be slow, generally in this case lasting 10-12 minutes.

Let's say you want to do this by going for a walk. OK, first go outside and get somewhat used to the temperature. Maybe sweep part of your garage for 5 minutes, or just stand in the driveway admiring your house until you start to get warm. then start walikng down the sidewalk slowly with no intent of picking up your pace. You may start to break a sweat. Ahhh, the warm-up process has begun. You are sweating now. You feel it under your arms and the front of your shirt starts to get wet. Your breathing rate goes up a bit and you begin needing to take deeper breaths. You begin to realize you are going to need to take a shower with soap when you get home. You are doing great, all systems are go. You maintain the same pace. Then all of a sudden after maybe 5,6,7 or 8 minutes, it starts to get much easier. Your breathing may even slow a little bit. You may feel twenty pounds lighter and that you are not breathing through a sock any longer. What has happened to you? You have warmed up.

For now, if you are a beginner with some unpleasant past experiences, go ahead and call it a day. Because of doing this warm-up everything you do for the rest of the day will be easier. Go ahead, try it for  a week.

Milt Bedingfield is a certified diabetes educator and exercise physiologist and has been teaching people with diabetes about the disease and how to care for it for the last 19 years.
Milt's other website can be found at: http ://www.MasteringType2Diabetes.com

Have You Been Avoiding Taking Insulin?

I saw a patient today with a long history of type 2 diabetes. The nurse practitioner had recommended the patient start taking a long acting basal insulin and the patient needed to be taught. The gentleman was very nice and proceeded to tell me all of the things he had done over the last nearly twenty years since being diagnosed to keep his diabetes under control.

From the information my patient gave me, he has been eating very well for years, that is, reading labels and counting his carbs. He has been getting a good amount of exercise that includes a combination of walking and jogging, plus lifting weights at a gym almost daily. He is also moderately lean and definitely not on the heavy side.

The patient was accepting of the fact that it was time to start taking insulin just not a day he was looking forward to. After all it had been almost twenty years since his diagnosis and type 2 diabetes is thought to be a progressive illness. The rate at which it progresses, however, is likely to be more dependent on the type of lifestyle a patient lives. I wanted to make sure my patient knew that, that his longstanding effort to take care of his diabetes and himself were of benefit.

"Mr. Jones," I told him, by the way Mr. Jones is a fictitious name, "You know you are a much older man now and you have had your diabetes for a long, long time. Many people with diabetes have to start taking insulin much sooner than you did. This very likely is a result of the efforts you made to take good care of yourself over those years. Watching your carbohydrate intake, maintaining a good bodyweight and getting all of that exercise probably contributed greatly to you being able to avoid taking insulin for so long. I don't want you to ever feel like working so hard to take good care of yourself was a waste of time. You are in your seventies, now apparently without any known complications from your diabetes. That is a really big deal and quite an accomplishment for someone that has had diabetes for as long as you have."

The good thing was that the patient seemed to know that and realized that all he had done over the years had been of great benefit tio him. Unfortunately, a lot of patients need to be reminded of that.

It's good when they know.

Milt Bedingfield is a certified diabetes educator and exercise physiologist. Milt has been teaching people with diabetes how to care for it for the last 19 years. Milt's other website can be found at: http ://www.MasteringType2Diabetes.com

People With Diabetes Should Never Underestimate The Impact Emotional Stress Has On Blood Glucose Control

I recently had the privilege of speaking with a truly world class athlete who happens to also have diabetes. And when I say world class, what I mean is that at various times in his life he has been better in his event than any other athlete in the world. With me being a diabetes educator and him being a world class athlete with diabetes, there were many questions I wanted to ask but had to limit it to only a few as time was short. What was so interesting to me is that many of the answers he gave me were not what I would have expected.

As an example, this athlete (I will keep him nameless) trains an average of 4-8 hours a day. He may workout sometimes three times per day with some sessions lasting as long as two to two and a half hours. I was wondering what strategy he used to keep his blood glucose level from going to low during the workout. He told me that he purposefully allows his blood glucose level to elevate to slightly over 200 mg/dl.,  before his workout begins and will avoid his mealtime insulin. He said this results in him not feeling the greatest during the first part of his workout, however, it helps keep him from dropping too low. He will also stop and eat someting during the workout on occasion if he feels like he needs it.

I want to point out, and stress, that this is what seems to work for him, and that I am not endorsing this for everyone or anyone. I would bet that he settled on this regimen based on his own trial and error and in conjunction with his doctor and diabetes care team.

What was really shocking to me was how his blood glucose responded to the physical and mental stresses of competition. He told me that just before compettition he was OK with his blood glucose level being around 150 mg/ dl., however, within several minutes after finishing his competition his blood glucose levels had actually risen several hundred points.There is no doubt his competition was extremely vigorous. A frequent result of extremely vigorous exercise is an increase in blood glucose levels, however not usually to the tune of 200 to 300 points.

It is well known that in the liver, glycogen is converted to glucose and then released into the circulation during exercise. This is normal. It is also known that in the face of danger or stress, good or bad, and excitement, the liver will release glucose into the bloodstream. In the case of this world class athlete, the physical stress, in addition to the emotional excitement and stress of competing against the best in the world, causes such a release of adrenalin, that large amounts of glucose are then released from the liver into the blood causing a very significant rise in blood glucose. At this point the athlete would need a corrective dose of fast acting insulin to get his blood glucose back down to more reasonable levels.

After dealing with many athletes over the years, ranging from barely active to high caliber, I have found that the emotional stress alone, of competition is sufficient to raise blood glucose levels dramatically.

Non-intense, non-competitive activities are likely to have far less influence on raising blood glucose levels.

Milt Bedingfield is a certified diabetes educator and exercise physiologist and has been teaching people with diabetes about the disease and how to care for it for the last 19 years.
Milt's other website can be found at: http ://www.MasteringType2Diabetes.com

For Those Newly Diagnosed With Diabetes: Never Use Garden Tools On Your Toe Nails

It was a Tuesday, late morning, a pretty day. I was going to try to see one more patient before going to lunch. This would mean my afternoon would be fairly light. I always tried to get most of my patients assessed before eating lunch. This way if I ate too much lunch and was sluggish or sleepy after eating I wouldn't be sitting across from my patient desperately trying to keep my eyes from closing while asking them questions about their diabetes history.

Anyway, I grabbed the forms I needed and went into the patient's room to assess why he was in the hospital and how diabetes was involved. Back in the mid 1990's, doctor's could admit their patients to the hospital for a 3-4 day stay for having uncontrolled blood sugar levels. I believe that was the case with this sixty plus year-old gentleman.

I positioned a chair near the foot of the patient's chair and sat down to conduct my assessment. An initial patient assessment is required of all diabetes patients that we teach.
I explained to the patient who I was and why I was there. The patient was good-natured and answered the questions I asked the best he could.
Over the course of the next thirty to forty minutes I asked the patient numerous questions to help me get a better feel for his knowledge about diabetes.

Typically, my assessment of the patient will yield information that determines what I need to teach the patient, areas of diabetes self-care that either the patient is not doing or not doing very well. For the most part it was a routine assessment, nothing significantly outside the range of what I typically hear, until I got to his feet.

Shortly after taking a seat and getting started I glanced casually to my left and got my first good glimpse of the patient's feet. If my jaw dropped I don't think the patient saw it, at least he didn't say anything if he did. I think it did though. Anyway, it was really good that the rest of the assessment didn't take too long because I was definitely going to need some extra time to discuss this patient's feet.

With all else having been discussed, it was time for me to address the feet.
The patient was semi-sitting up in bed with his legs stretched out in front of him, crossed at the ankles. His feet were not covered. They were OK feet, as far as feet go. They were long, pale and dry, particularly around the heels, not-unusual for someone with diabetes. The skin was unremarkable with no splotches, discoloration or subsurface evidence of broken capillaries so often present in older patients.
Hardly unremarkable however, were his toe nails, undoubtedly, some of the thickest nails I have ever seen and poorly kept to say the least. When you see toenails like this you say to yourself, "Man, don't you ever take a look at your feet?"

"So, how are your feet?" I asked.

Before he responds, he rearranges the position of his feet slightly, rubbing them together gently and wiggling a few of his ten unsightly toes.

"They're OK, " he responded.

I'm sitting there, looking at his feet, thinking, "Are you kidding me, you think this is OK? If this is OK I think we are going to have to examine your eyes also"
This is what I am thinking, mind you, not what I am saying.

"Yeh, they're do'in pretty good now. My toe nails are kind of thick and I used to have a hard time cuttin em."

" Yeh, I can see that. So what do you do now, how do you get them trimmed?"

"Well, I'll tell ya. Regular toenail clippers, you know, the same ones you use to trim your fingernails, those don't work at all. They just break," he told me.

"I tell you what I did," the man starts to explain as he looks down the length of the bed at his feet the same way a newly engaged lady admires her engagement ring.

"You know I'm retired. And I spend a lot of my time now, out taking care of my roses.
One day I was out pruning my rose plants, and I got to thinkin; I bet these Rose clippers would work on my toe nails. So after I was finished with my roses I went in and tried em. They trimmed em right up. I mean they worked great. You can see em. I haven't had a problem with em ever since."

The man looked proud, as if he had just made a great discovery. I got out of my chair and bent over the bed to take a closer look, a closer look at the toe nails, pruned by the pruning shears, meant to be used on the thorny Rose bush. Truly amazing, I thought.
I found my nose to be about a foot away from his feet, hands on my knees, staring, the same way you would stare at the destructive path a deadly tornado might make as it cuts through a town or city.

As I returned to my chair and sat back down, I remember thinking, how do I break it to this man that using pruning shears to trim his toe nails is really a bad idea? I could have said, "What are you, nuts?" but my better judgment got the best of me, thank goodness, and it never came out.
"Eventually, in a calm voice, I tried to diplomatically, compassionately, explain the potential problems with what he had done. The patient, obviously a bit deflated when he learned that his toe trimming method was not the great idea he thought it was, agreed to let a podiatrist look at his toes soon to see if he could assist the patient with proper foot care.

Before I left the patients bedside that day, I reviewed some of the topics we had discussed during my visit. When it came to foot care I told the patient to remember the following and he should be alright:
If your toenails ever become so long, or thickened that you cannot trim them with regular toenail clippers, never, ever, go to the shed and pick out some gardening tools to use on your feet. Instead, go see a podiatrist.

Although some folks may think using Rose pruning shears is innocent enough, this may eventually lead to the use of electric hedge trimmers and even gas powered chain saws. As I am sure you can see now, the use of garden tools for the purpose of trimming body parts that grow excessively or out of control, is inappropriate and should be discouraged.

Just as Dr. Heimlich named the maneuver for relieving a choking victim after himself, I have taken it upon myself to name the above-mentioned rule, Milt's Rule.
As yet not a well known rule, but give it time.

Milt Bedingfield is a certified diabetes educator and exercise physiologist and has been teaching people with diabetes about the disease and how to care for it for the last 19 years.
Milt's other website can be found at: http ://www.MasteringType2Diabetes.com

What Researchers May Say About Diabetes, Obesity And Heart Disease

Someday, many, many years from now, long after the epidemic of type 2 diabetes has settled in and further ravaged our already struggling healthcare system, anthropologists and other social scientists will search for clues as to why highly educated populations such as the United States, Europe, and those elsewhere, succumbed to such an illness. Particularly in light of all that we know about what usually causes type 2 diabetes and how to best treat it.

Someday, again 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 pesonal informational devices, commonly referred to as PID's (I made that word up, but I think it will certainly catch on). Anyway the headline will read, "Thumb size my be best predicter 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 is 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 that 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 that 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% 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 high 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 and female of high school age texts an aveage of 50-100 times per day. This places a tremendous overlod 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.

Milt Bedingfield is a certified diabetes educator and exercise physiologist and has been teaching people with diabetes about the disease and how to care for it for the last 19 years.
Milt's other website can be found at: http ://www.MasteringType2Diabetes.com

When You Go To Exercise, Do It on Your Terms

Almost never do I go to the gym and do the workout I plan to do. I used to. Years ago I did. I had a plan and I followed it to the letter. Warm up on the treadmill at 3 mph, 0% elevation. then run at 7 mph for 30 minutes, then warm down at 3.5mph for 5 minutes. After no more than a 3 minute break it was over to the stationary bike for 20 minutes at 20 mph, and so on, and so on.

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% 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 eights.

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% 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% elevation. I will speed it up to a fast jog at 7 mph at 1% elevation." I may be happy here for 3-4 minutes. Then I slow it down to a fast walk at 4mph and raise the elevation to 10% 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. Often times 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.

Milt Bedingfield is a certified diabetes educator and exercise physiologist and has been teaching people with diabetes about the disease and how to care for it for the last 19 years.
Milt's other website can be found at: http ://www.MasteringType2Diabetes.com

Newly Diagnosed Diabetes

You are newly diagnosed with diabetes, type 2, the one considered to be the lifestyle illness. That is probably why you have been getting up several times during the night to go to the bathroom. And you wake up in the morning tired and with little energy not just because you had to get up so often the night before but also because having untreated diabetes makes you fatigued and with little energy. That is also more than likely why you have been so thirsty lately and having to drink so many fluids. As for the vision changes you have experienced over the past several months, there is a good chance you can blame that on your newly diagnosed diabetes as well.

Adult onset type 2 diabetes

In nine out of ten cases it will be type 2, what’s frequently still referred to as adult onset even though teenagers and young adults in their twenties and thirties are now routinely being diagnosed with the disease. Twenty years ago it was rare to see anyone in a diabetes education class younger than fifty or sixty, now it is all too common.

What causes type 2 diabetes?

Type 2 diabetes is considered a lifestyle illness. It is estimated that 80% of the people diagnosed with type 2 diabetes develop it as a result of being too sedentary and being a bit overweight. Consider the fact that even being fifteen to twenty pounds overweight significantly increases your risk of developing type 2 diabetes and getting little to no regular exercise raises the risk even more. As a country we get less exercise than ever in our history.

Treating type 2 diabetes

Don’t panic. Definitely do not panic. It seems there are two responses I typically see from newly diagnosed patients. There are those that do not realize the seriousness of the diagnosis and go on about their lives as if nothing has changed, and those that get really scared and stop eating anything which contains sugar. Neither approach is good. What would be best probably is an attitude right about in the middle.

Now for the good news

The good news is that although type 2 diabetes is not curable (neither is type 1 for that matter), it is highly treatable. That is to say that for those people that are motivated to take care of their diabetes and do what needs to be done to take care of themselves, their future looks bright. Granted, pricking your finger (It doesn’t hurt if you do it right) to test your blood sugar levels and being more careful with what you eat and going for a walk or swim every day is something you may prefer not to mess with, if you will do these things, along with following directions given to you by your doctor, you can live a pretty normal life.

Once you learn the specifics of what you need to do and get your blood sugar levels under good control you can usually expect your vision to stabilize and likely improve. You can look forward to sleeping through the night without getting up to go to the bathroom and you can expect to have much more energy. With good blood sugar control you should definitely start to feel better again.

Diabetes Education

On your initial list of things you’ll need to do, right at the top should be to ask your doctor for a prescription to attend a comprehensive diabetes education class. The American Diabetes Association recommends ten hours of diabetes education for everyone with newly diagnosed diabetes within the first year of being diagnosed. I tell patients that I cannot imagine them taking good care of their diabetes without first attending a comprehensive diabetes class. You will want to make sure that you receive comprehensive training taught by only certified diabetes educators, not wellness coaches or well meaning lay people with limited diabetes knowledge, anything less and you are being short changed.

Living with type 2 diabetes

Everything can be alright. Your life can still be good. Get educated about diabetes, follow your doctor’s advice and stay motivated to do the right things. In spite of what you may of heard or seen, people with diabetes can do quite well and live a long and healthy life.

Milt Bedingfield is a certified diabetes educator and exercise physiologist and has been teaching people with diabetes about the disease and how to care for it for the last 19 years.
Milt's other website can be found at: http ://www.MasteringType2Diabetes.com

New Study Explains Why Doctor's May Be Apprehensive To Recommend Weight Loss And Exercise

If getting exercise and maintaining a healthy body weight are so important, particularly for patients with prediabetes or diabetes, have you ever wondered why your physician may not have really emphasized to you the need for exercise and losing weight, that is if you need to lose weight? As it turns out, a study published in the January issue of 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 9th and March 1st, 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 themselves (30%vs18%, P=0.001). 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% vs. 37%, 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 sixty-nine 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 perception of the patients' body weight 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 healthcare 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 healthcare 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 towards exercise. In any case, good study. We need more on this topic.

Milt Bedingfield is a certified diabetes educator and exercise physiologist and has been teaching people with diabetes about the disease and how to care for it for the last 19 years.
Milt's other website can be found at: http ://www.MasteringType2Diabetes.com

Newly Diagnosed With Diabetes? Experts Say Wear Your Detectives Badge On The Left

When your doctor diagnosed you as having diabetes, did he issue you your detective's badge right then, on the spot, or did it arrive in the mail a few days later? Oh, it doesn’t make much difference either way as long as you start wearing it soon after you get it.

By the way, do you think people with diabetes should wear their badge all the time or only for two to three minutes immediately after eating? My thinking is that it should be left up to the person to see what works best for them.

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 if nobody has told you already. Let me test your current level of knowledge and then let’s say we build on that.

Have you ever watched any of the police or crime shows on TV? Of course you have, probably hundreds of them. It seems to me that they all begin about the same. The scene opens something like this. 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.

“Phillips.” Then a short pause.

 “When?” Another pause.

 “Any witnesses?” Pause again, this time a little longer. Phillips searches for his watch on the nightstand, glances at it and puts it on his wrist.

 “Be there in 20 minutes”.

In the next scene you hear the sound of an approaching siren, lights flashing and an unmarked car screeching to a halt. (Of course it’s dark out, it’s three in the morning.) A crowd has gathered, all looking down at something, usually a dead person, commonly referred to as the victim. You hear a door slam and see footsteps entering the picture. The camera pans upward. You see Phillips, now dressed in a long, drab looking coat, holding

what appears to be a steaming, cup of black coffee. Detectives rarely drink hot chocolate, on the job anyway. A uniformed officer walks up.

Without so much as a “Hey how you doin?,” or “Good to see you,” Phillips asks, “ Hey Johnson, what do we got?”

The uniformed cop reads notes off of his very, very, small note pad. “White male, approximately thirty to forty years old, found lying face down on the sidewalk about 1:15AM this morning, by this lady, Joan Doe, while she was out walking her Doberman.”

“Was he dead?” Phillips asked.

“Well he wasn’t breathing when we arrived at the scene sir,” replied Johnson.

“Anything else,” Phillips asks?

“Well, some witnesses have come forward and said the dog was actually walking her,” Johnson states for the record.

Phillips 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.

Phillips, in a rapid fire manner, orders Johnson to interview every witness and to knock on the doors of every house in a one block radius to see if anyone heard or saw anything. He then tells Johnson to get forensics to examine the victim for signs of foul play and to determine the cause of death.

The camera then zooms in on Phillips face as he speaks to Johnson in a low but stern voice, “We’ve got to find out if this poor man died as a result of tripping on the sidewalk or if someone wanted him dead.”

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

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 ever written starts off with a murder being committed. Then what, a detective appears on the scene, asks lots of people lots of questions, looks for clues, evidence, anything that would help the detective solve the crime. And then, just before the end of the show, with about 6 or 7 minutes left, the detective has enough information to solve the murder. So again, what does this have to do with you, a detective’s badge and 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. Whether it’s too high or too low, it’s dangerous. Lows are dangerous now and highs will cause serious problems in the future. In either case, the cause of the highs and lows needs to be identified.

I have told patients and emphasized to them many times, that if you check your blood sugar, find it to be too high and respond by saying, “Wo, that’s a high blood sugar,” put your meter away and then go on about your business, then there is little point in testing your blood sugar levels. Conversely, if every time you get a reading that is too high or too low you, figuratively, pin your detectives badge on your shirt and begin looking for clues as to what caused the high or low, then that is worthwhile, something that can lead to better management of your diabetes. I tell patients that the day they develop diabetes, they need to accept the role as detective.

Let’s say you test your blood sugar 2 hours after breakfast on a Monday morning, you have just gotten settled at work, 227mg/dl. Hmm, not so good. You turn your work ID around to it’s 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.

You begin by asking yourself some very straight- forward questions using the best Rod Serling voice you can muster, albeit in a hushed tone. You don’t want the people in the next office to hear you.

“So Jim, why is your blood sugar level so high two hours after breakfast, what could have caused it?” There is a pause in the questioning as you think for a moment.

You answer yourself honestly as if you are under oathe.

“ I don’t really know,” you say.

“Is it possible you ate too much for breakfast?”

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

“Well tell me, did you happen to check your blood sugar before breakfast, and if so what was it?”

“ As a matter of fact I did and it was 180mg/dl.”

“So actually what you’re telling me is that your blood sugar was high when you sat down to eat”.

“Yes sir.”

“Don’t call me sir unless you want me to call you sir.”

“Ok, that is correct, my blood sugar was high before breakfast.”

(Imagine how Rod Serling’s voice would sound when he has just figured out something and apply here, well, the next sentence)

“So if it was high before breakfast isn’t it likely that it would be high after breakfast even if you ate the right food?”

“Well yeh.”

“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.”

“Ok, how about two hours before that.”

“Still sleeping.”

“And finally, two hours before that.”

“I had just gone to bed.”

“What you are saying then is that you were sleeping for six hours just prior to waking up.”

“Is there anyone that can verify that you were sleeping for six hours before you woke up?”

“Yes, my wife.”

(If you are going to be a good detective you can’t be afraid of asking the tough questions)

“The reason I asked that is because if you were to get up and go to the bathroom sometime during the night and on the way back to bed you stop by the kitchen for a glass of milk, or an oreo, or two, or sometimes even three, then you can expect to have a high morning blood sugar.”

“ No, I never eat anything in the middle of the night unless my blood sugar goes down to low.”

“Ok, is it possible you forgot to take your diabetes medication last night?”

“Let’s see, I’ll tell you what happened. 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’s 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. Missing one dose of a medication is sometimes all it takes to allow your blood sugar levels to become elevated. 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 2 hours later than I usually do and I ate more than I usually eat.

Some friends of ours were in town that we had not seen in about 15 years since we moved from Seattle to Tampa so we could be near my daughter, Madeline, who is almost 27 now and is married with 4 lovely children, ranging in age from 2-7. They are the cutest things and I tend to spoil them. We went out to dinner with them and I think we ate too much,”

“ First of all just the facts sir, save the gushy stuff for your friends. Please don’t go off like that again.”

“Sorry.”

“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.

“I feel terrible, so guilty,” you wine.

“Don’t, just learn from this investigation and do better next time.”

“Ok, it’s a deal, thanks for not being too hard on me, Jim.”

“You are quite welcome. It’s been a pleasure investigating your case. See you next time your blood sugar is too high. Bye now.”

You flip your badge over, back to being Jim the software engineer.

I am going to speculate that well over half of the time, probably three quarters of the time that a patient has elevated blood sugar levels above what they should be or below what they should be, if they play 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. Once this is done, the patient may be able to say something like, “After playing detective with my blood sugar readings for about a month I noticed that about eighty percent of my high blood sugar’s were the result of apparently eating too much dinner. Once I started eating less at dinner my blood sugar levels and HbA1C improved dramatically.”

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

Milt Bedingfield is a certified diabetes educator and exercise physiologist and has been teaching people with diabetes about the disease and how to care for it for the last 19 years.
Milt's other website can be found at: http ://www.MasteringType2Diabetes.com

Need Help Managing Your Newly Diagnosed Diabetes? Ask For a Certified Diabetes Educator

Let's say I go to the bank to withdraw one hundred dollars. The teller asks me if I want five twenties, three twenties and four tens or a fifty, a twenty, two tens and two fives?

I always politely tell them it doesn't matter, because five twenties is the same as ten tens, they both add up to one hundred dollars.

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 forty 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 Theresa. 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 Theresa 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 versus 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 form 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 their is a valuable role for them,however, Certified Diabetes Educators must pass a rigorous 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 that 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.

The American Diabetes Association recommends 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 short changing 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 or one half of the other to being taught by a Diabetes Coach.

Diabetes is far to serious to mess around with. Get education immediately after diagnosis and get it from a Certified Diabetes Educator.

Milt's other website can be found at: http ://www.MasteringType2Diabetes.com

Milt Bedingfield is a certified diabetes educator and exercise physiologist and has been teaching people with diabetes about the disease and how to care for it for the last 19 years.

An Appeal to Physicians Regarding Exercise

Imagine you are lying in bed two days after having open-heart surgery in which three of your coronary arteries were replaced -- a procedure commonly referred to as a "coronary artery bypass graft," or CABG. This was preceded by a trip to the emergency room three days earlier after experiencing a progressive squeezing in your chest similar to being hugged by the largest bear at the zoo. Just before surgery, the surgeon tells you that with the extent of your coronary blockage you are very lucky to be alive. Pretty scary.

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.

Milt Bedingfield is a certified diabetes educator and exercise physiologist and has been teaching people with diabetes about the disease and how to care for it for the last 19 years.
Milt's other website can be found at: http ://www.MasteringType2Diabetes.com

When You Have Newly Diagnosed Diabetes, Do This, Not That (Part 1)

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 that are quite knowledgeable about diabetes, there are considerably more people that 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 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 anyone else's. No exceptions!
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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 someone else's blood glucose monitor 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).

Milt Bedingfield is a certified diabetes educator and exercise physiologist. Milt has been teaching people with diabetes about the disease for the last 19 years.
Visit Milt's other website at: http://www.MasteringType2Diabetes.com

What Is It Going to Take to Get Exercise On An Even Keel With Diet For People With Type 2 Diabetes?

There is no doubt that when you have type 2 diabetes everything you put in your mouth is going to have some effect on your blood glucose levels. We first and foremost think about the carbohydrates or sugar we eat, however, in addition to that we have to take into consideration the effect proteins and fats have as well. An excess ingestion of protein is likely going to raise blood glucose levels. A moderate to heavy consumption of fats in a meal will slow down the rate at which glucose leaves the stomach and enters the blood. Without a doubt nutrition plays a tremendous role in the successful management of type 2 diabetes. The same is true for type 1 diabetes as insulin infusion into the body needs to basically match the amount of carbs consumed, however, for the time being I am going to limit my comments to type 2's.

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 it seems not enough people with type 2 diabetes are heeding this advice, and healthcare 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 less 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 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 healthcare 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 to valuable a treatment for patients to simply dismiss it due to a medical problem.

I believe healthcare 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.

Milt Bedingfield is a certified diabetes educator and exercise physiologist. Milt has been teaching people with diabetes about the disease and how to care for it for the last 19 years. Visit Milt's other website at: http://www.MasteringType2Diabetes.com