Understanding Diabetes

        In July of this year (2006) I "Officially" became a diabetic.  I had missed the first early sign of my body telling me there was something wrong when it shifted the focus of my left eye in order to get my attention.  After staying that way for several days I gave the VA a call for an appointment for a new lens prescription, which was granted but for a month later.  Apparently my body wanted attention for the high sugar condition much sooner than that so it decided to get my immediate attention with a yeast infection, something I had thought only females got, was I ever wrong.  Within an hour of discovering that yeast condition I was at my Doctor friend's office for a professional look-see.  Immediately upon seeing it, and after pants up, he called in his nurse to draw blood to test for diabetes.  He gave me a pill for the infection and said the it would be gone in a few days but I could see the concern on his face for we have been friends for some 30 years now.  The first thing next morning he gave me a call and informed me that the blood work was in and showed that I was now diabetic with a blood/sugar reading of 308, whereas a normal reading was between 60 and 120.  Up until that time I was about as ignorant about diabetes as one could be.  He told me to come in as soon as I could, which I did and he then turned me over to his nurse who then gave me the lowdown on diabetes.  I was given a test meter kit and was given instruction on how to use it in conjunction with a new way of eating and why.  I was instructed to switch from sugar and butter to "Splenda" and "Smart Balance" and told to eat smaller portion and more often than normal.  I then began life as a diabetic.
       When I got back home I immediately called the VA to inform them of my diabetic condition and was given a new appointment with my Primary Care doctor.  My eye exam then came up and when told of my newfound diabetic condition they immediately passed on the vision test and opted for an eye exam instead.  One look into the problem eye confirmed the symptoms of diabetes.  The doctor and I talked for a while then he put his findings into my computer records.   He told me that I could forget about the new lenses for a while because the diabetes would now be playing with my eyes and more than likely things would return to normal with a little diet control to get that blood sugar down. 
       Earlier that morning I had an appointment for my monthly blood thinner check and mentioned my newly found diabetic condition to the nurse that was to prick my finger for the blood thinner level check.  She as well immediately showed concern for my well being and asked if I had let my Primary Care Doctor know of my condition.  After showing her the copy of my blood work my doctor friend had given me she immediately checked my records and made sure the condition was posted.  I then went over to the Primary Care desk and let them know as well of my newly found condition.  The gentlemen at the desk then also made sure the information was in the computer and asked for my paperwork so he could make a copy for the doctor, no need though because I already had a copy for him as well.  The gentlemen then immediately took the copy to the Primary Care doctor's nurse.  Later that day I was worked into the schedule and had a meeting with my Primary Care doctor a few days later.  I was then worked into the schedule for the next available slot for their all day class on diabetes.  With all that now behind me I went home to wait on the class and to take my sugar readings every Sunday morning due to limited test strips, in order to see how my eating changes had changed.  My doctor friend had asked me to keep him informed of my progress via his email, which I did.  He was somewhat dismayed that I was taking only one reading a week but understood when I told him that the new diet and the switch to Splenda and Smart Balance and slow weight loss would be taking a while to show up.  Since there was nothing I could do even if the readings were still high, except to diet even more, that was about all I could do, especially since those initial little test strips would be running out and new ones would be over $1 each.  
         I found the switch to Splenda and Smart Balance to be an easy one.  I found that the 3:00 snack cut my evening supper appetite and intake down about to half of what I would normally eat.  I also found that changing my post supper snack to fruit or cheese was an easy change for me.  About a month or so into things I found I was getting perkier in the mornings and that I had gone down one notch on the old belt.  The need for my afternoon nap did not diminished much, which I still take as my heart saying, "sugar or not I need my rest".  I guess like many others my age (59 at this writing) I am slowly wearing out and the best I can hope for is a patch here and a patch there.
       My VA diabetes class came up and it was very informative.  It was an all day class with several instructors and in it several myths were dispelled.  I had a real let down though because the information packet said that lunch would be provided.  I figured that with the diet change and the switch over to sugar substitutes they would have more or less a little gourmet buffet designed just for diabetics, sort of a get aquatinted type lunch to show just how good and tasty these new foods can be.  Wrong, we all got meal tickets to the employee lunch facility in the other building and had "mystery" meat for lunch.  What a disappointment.
       So here is the gist of what I learned in the VA's class about diabetes.  Our bodies need energy to function and it gets that energy through the foods we consume by turning the carbohydrates (carbs) in them into glucose, which is then absorbed by the blood.  About one teaspoon of glucose is all we need to function normally.  The blood then sends this glucose all through our system where every cell has a chance to take in what they need to do what they have to do.  Every cell though has a "gate keeper" in the form of insulin, which allows the glucose to enter.   In most of us the balance between the glucose and insulin works just fine but in some it doesn't.  In some cases it does not work at all and those people die unless they have a substitute supply of  insulin.  This condition is referred to as "Type 1" diabetes.  In the other case, called "Type 2" diabetes, our body is still producing insulin but for some reason it is not doing what it is suppose to do good enough.  For most of us we have just added more "body mass" than our insulin output can handle.  For others, our bodies just are not recognizing the insulin in the way it is suppose to.  When this happens the blood can not get rid of the extra glucose it has to carry and the cells needing the glucose start complaining.  Most of the cells and organs in our bodies can handle or store a little extra glucose but not the brain.  Let there be too much glucose in the system and the brain lets you know because other parts of the body begin to cry out for attention to get rid of the stuff.
Let it get too high and body organs start to deteriorate.  If you don't do something about it being too high then things like like blindness and amputation of the toes and limbs start to come into play.  Let your glucose get too low, below the 60-120 point range, and you have a good chance of passing out, which then leads to a whole bunch of other bad things. 
       I knew the pancreas was where insulin comes from but I didn't know anything else about it, even where it was in our body.  The pancreas has two functions, one being to make the enzymes that counteracts the acids the stomach pours in to break down the food we eat so it can start its journey down the intestines where it can all be absorbed into the body.  The other function of the pancreas is to release some of the hormones it produces into the body at various times.  Insulin is just one of those hormones and actually only relates to about 1% of the pancreas's activity.  Inside the pancreas, which is usually between 6"-10" long and located behind the lower portion of the stomach, are "Beta Cells", which are the cells that produce the insulin we need at the various rates we need it.  No Beta cell activity means NO insulin, which in turn means you have to take insulin injections before every meal.  Some Beta cell activity may mean injections of other medications, which encourage the Beta cells to do their thing.  There is a group of medications (www.mendosa.com/insulin.htm) for Type 1 diabetics tailored specifically for needs of the individual.  For Type 2 diabetes there is diet and exercise, shots, and there is the oral pill  (www.mendosa.com/drugs.htm).  I am now on the pill (Glyburide-5mg...an insulin pusher) and it has dropped my stagnant glucose reading from around 200 to the 90's.  I am now going to take more readings after certain meals I really enjoy to find out just how much of a glucose effect they have while on the pill.   What I have learned is that the KFC buffet that I enjoy is still OK according to my readings, then again I don't make a pig of myself there and only have water and a smidgen of desert with it.  I think the oriental buffet I use to also enjoy will kill me though if I consume the same amounts as I normally do..
       As for the food side of things the switch to Splenda as a sweetener and Smart Balance to fry with, along with the 3:00 PM snack seems to be bringing my levels down slowly.  Due to my heart condition and a next to useless left knee, exercise for me is pretty much out.  What a diabetic wants to stay away from is a spike or more so a somewhat continous spike in the glucose level due to over eating of a large meal.  A spike is when you eat more glucose producing foods than your insulin can compensate for.  The 3:00 snack seems to take away about half my supper appetite.  It seems my readings have also shown that my after supper snacks were really jumping my readings by 50 points or more.  To me, that was where my REAL glucose problem was.  When I stopped the snacking, akin to smokers giving up cigarettes, I saw a definite lowering in my morning readings. 
       The dietitian showed us how to read food labels and where some deception lies.  Since glucose is made up of three items (sugar, starch, and fiber) just reading the amount of sugar (anything that ends in "ose") on a label doesn't give you an accurate picture of just what that food will do to you per serving.   Forget the sugar count, look instead at the carbs amount which takes in all the things that will finally turn into glucose.  A typical adult needs between 3 and 5 "servings" at any given meal.   A "serving" is what you can easily fit into the palm of your hand or 15 carbs.  A small size person can have about 3 such servings before they take in more glucose then they can work out.  3 servings times 15 carbs means that a small person should only take in up to 45 carbs a meal.  At presently 265 lbs and with my blood work numbers in hand the dietitian restricted me to 4 servings per meal.  With more fruit now in my diet and shelled peanuts (a free food) as a slight snack, I have gone down one belt loop in these last two months so it looks like things are working for me.  There are food listings that show the amount of carbs in a single food item and you can swap out servings, just don't go over your given serving allotment.  Meats are considered a free food with little to no carbs and as a lover of chicken of all kinds this was fine with me.  Eating healthy though means removing the skin and fat from meats. 
       Since we are now in "fats", the only "good fat" in our food is called mono saturated fat, which actually helps the blood.  Both other primary fats (Polyunsaturated and Trans Fats) are bad for you.  Total fats for a day should be less than 15 grams.  Unsaturated and trans fats are what makes quite a few fast foods taste so good to us.  Both these types of fats are very calorie dense which tend to clog up the arteries.  There are only three cooking oils you should be using and those are Olive Oil, Canola Oil, and Peanut Oil.  For those of you unfamiliar with Peanut oil, your food doesn't come out tasting like peanuts and Peanut oil has the highest temperature use of the cooking oils, which means it is very hard to burn or overheat.  These three cooking oils tend to slow down the glucose process, which in turn takes some of the peaks out of the glucose amount thus allowing more insulin to do its thing.  Most veggies are considered "Free" foods because then have such a small little crab count (under 5 carbs) and so few calories that they really don't matter much.  The exception to this is corn and peas, both of which have a higher sugar content.  Nuts and meat are the other primary "Free" foods that you can enjoy yourself with, though still watching the calories. 
    Those label makers try their best to trick the general public into buying their products.  When buying bread for instance, only go for the low calorie "Whole Wheat Flour" breads.  Don't be fooled by "Enriched Wheat", which is colored to make it look like whole wheat.   Remember as well that all sugars end in "ose" because the Lactose in milk is sugar, as well as the Fructose in fruit.  Others such name changes are sucrose, dextrose, levulose, and maltose.  Remember too that fiber is also needed in our systems to sort of scrub out our intestines.  A typical adult needs about 25-30 grams of fiber a day and fiber only comes from plants like wheat.  If you aren't sure about a cereal pick in the morning go with the All Brand cereals, I like "Total" because it seems to be the lowest in carbs and taste pretty good with Splenda.  Splenda though has competition in a product called "Alterna', which is made of the same ingredients and is right next to it in Wal-Mart and is quite a bit lower in price.  Salt is also something to be reckoned with when reading labels and for a typical adult the salt limit seems to be 2,400 mg a day.  Most items seems to have several hundred mg of sodium, salt's official name, and soups are bad about that. 
    So just what can I eat and how much of it?  For the most part eat in moderation, which for most of us means about half of what we normally eat, at least for now.  For those of us though that need to know more about the numbers pertaining to exactly what we eat the Internet has many sites which tell just that.  Probably the best site I found for that is "http://www.caloriesperhour.com" (2nd one down).  You can have a lot of fun with this little gem of a food calculator but it will bring a tear to your eyes when you find out just how many carbs are really in those special things you like to eat and now have to cut back on. 
That Big Mac that I liked so much weighs in at 730 calories and a whooping  47 carbs, very close to my limit for an ENTIRE meal.  Those carbs really add up fast.  If you are going out for some fast food such as "Captain D's" or "Taco Bell", this site tells you the numbers you need to choose by.  I told you their little food calculator would bring tears to you.  Another nice site for that is Diet & Exercise.Com  (http://www.dietandfitnesstoday.com/fastfoodsearch.php).  Knowing the carbs, calories, and fat content of a particular food is just the beginning though.  How those foods effect your glucose count also is important and this is where the "Glycemic Index" and "Glycemic Load" of a particular food comes in.  The Glycemic Index tell you how fast a food turns to glucose (0-55 is low while 70 and above is high) and the Glycemic Load (0-10 is low while 20 and above is high) tells you how long that glucose will last.  A short list of both indexes is found at the Mendosa web site at;  (http://www.mendosa.com/common_foods.htm) while a longer and more comprehensive list is found at the Diet & Fitness Today web site;   (http://www.dietandfitnesstoday.com/glycemicindex.php). 
    To better understand how these indexes work lets look at the Boston Marathon.  In any given marathon there are three types of runners, the ones that think they can win, those just wanting to finish the darn thing for bragging rights, and the "rabbits".  The ones that think they can win and the ones that just want to finished are only interested in LONG TERM energy because the winner is looking at just over 2 hours of running while most of the others are just looking to finish at all, hopefully before dark.  At most pre race dinners the food of choice is spaghetti with everything on it...a HUGE Glycemic Load here.  The "rabbits" in the race though are the ones not looking to finish the race, instead they just want the notoriety of being in first place for the cameras for the first few miles.  For the "rabbits" soda pop and lots of potatoes will give them their high peak in glucose for that quickie energy they need.  For the most part try to stay away from the foods with the high Glycemic Index numbers because those peak out way above your insulin level.  Try to eat the foods with the low Glycemic Load numbers.  Most of the time the foods with the low GI number also have a low GL number as well but some don't. 
    Lets take on meters now.  My doctor friend gave me an Accu-Chek "Aviva" and a tube of test strips to test with while the VA gave me an Accu-Chek "Advantage".  His nurse calibrated the meter with their "test" solution as did the VA.  The VA Advantage is on the left of the picture.  The VA also gave me the printed charts I was to use to log in my readings for prebreakfast, p
relunch, presupper, prebed, and a space for comments.  I was to take initial readings at all three pre meal times as well as pre bedtime.  This was to track where I was going wrong with my new eating habits.  After two weeks of readings I found out that my 3 PM snack was dropping my presupper reading significantly while my late evening snacking was canceling all or most of that out.  I also found out the meters are not very reliable but then again they are all we have at this time.  The VA said the meters could be as much as 15% off, which in military terms ACTUALLY means they can be 30% or more off.  In my case I took identical readings with both meters and though manufactured by the same company, through 16 readings, they averaged 37 points difference.  I then took this even further and took immediate back-to-back readings with the same meter from the same blood.  The VA meter had a 37 point spread while the other meter had a 53 point spread.  The VA meter spread on three other occasions were 89, 115, and 31, not very impressive.  All the above readings were taken from the fingers and here, as an inventor, I saw a problem.  Blood was rather hard to get from my index finger and my longest finger while it almost flowed from both my pinkie and spare fingers.  That tells me the blood is somewhat stagnant in some places and free flowing in others.  I think there is a problem here even though the VA and my doctor friend say "not", they say its all the same.  To also be considered in all this is the fact that when my doctor friend took another blood test to send to the lab I had the nurse use some of that arm/vein blood, straight from the needle, to see what both my meters said.  They drew the blood right after lunch so this was not the "fasting" time when such tests should be taken for the more accurate readings before the prior meal's glucose starts to take effect.  Like little kids, both meters must have realized that they were now in a doctor's office and both were on their BEST behavior.  The VA meter showed 133 while the doctor's meter showed 123, my lowest and closest readings ever.  When the blood work came in the following day the lab's reading was 132, just 1 point under the VA meter reading.  So what does this tell me?  It tells me that the meters are not very accurate and that the finger blood readings, the only point where we can get at it easily, are not very reliable.  I will keep taking the readings though but now I'm only looking for an upward or downward trend and with only the first one or two numbers to be taken seriously.   To me, if you simply round off the 2nd number, completely forgetting that 3rd number, you will get the most accurate reading available through those meters.  A 285 becomes a 3 and a 145 becomes a 1.  Its that simple.
    I took a little time to explore the Internet for magazines on diabetic cooking and found "Diabetic Cooking" at (http://www.diabeticcooking.com/) at just $14.95 a year.  I have ordered the magazine and was told, due to the holidays, my first issure would be here in February.  I also wrote them asking for immediate past issues that I could give to my VA diabetes class instructors for use in the classroom, as yet they have not abliged me in that request.  Most of the other web sites for diabetics have a receipt section.  For the most part you can just replace the sugar you may be using with Splenda.  You may not get the carbs all the way down but you sure will lower them quite a bit, remembering again not to make a pig of yourself thinking you have just eleimated all the carbs.  As for deserts, "Blue Bunny" ice cream
with it's lower carb count sure does taste good.  It's at Wal-Mart.
    From time to time I will update this little piece on diabetes.  Realize though that every person is different and I could just be the exception here, which I have seemingly been throughout my life.  At least you now have the knowledge needed to better understand diabetes and with which to further study it on your own.  As for Vietnam veterans, diabetes is on the VA list of Agent Orange induced diseases, which in turn is pension supported at 20%. 

John Galkiewicz