julia sherman's Website

Standards, it is all about logical standards

Thu, 04 Feb 2010 19:49:13 GMT

Standards, it is all about logical standards

As many of you know I am diabetic. And often that comes with the “I have to try it” new food or product mentality.
And frankly I am dismayed at the idea that sugar free foods are better for you. Anticavity wise yes. But for diabetes, come on its not that good for you. Just look at the stuff that they have to add to make up for the sugar, and look at the reduced size of an item to compensate for those additives.
That wonderful mint under taste does not belong in a pseudo Oreo!
No its does not belong in soda or cereal either And those sugar free items are misleading to so many. In a recent discussion with my support group, we were talking about out of control numbers. Many newly diagnosed think if they buy sugar free items they can eat all they want. But it took two hours to explain that Sugar free is not carbohydrate free. But Many educators are not driving home certain points. Either because they do not know, or they do not live the experience daily. That’s another point. We need lay diabetes educators who live the process day in and day out.
And we need to have STANDARDS that are maintained. For example:
I have encountered too many CDES who come up with their own skewed ideas.
New idea is its ok to test once in a while. It is not. You have to test at least twice daily.
The new thought that testing does nothing for type 2s is SO WRONG. If anything type 2s need more testing as they often have more advanced complications and oral medications are not as efficient and often fail versus Insulin.
Others say that all you have to do is stay away from cookies cake and bread. I HAVE HEARD THEM SAY THIS IN CLASS! Amazing that they do not even go by the standards of care that they are supposed to know.
Some CDES do not know about Ketones or if they spout don’t know how to explain what it is.
Many CDEs don’t understand exchanging, insulin and reaction, or how about algorithms for insulin sliding scale for type 2s.
Many say exercise but give no examples or options. So many Diabetics head to a gym only to become dissatisfied at the options and intensity.
The benefit of Lay DE’s that are diabetic is we have experienced good education, bad education. We live false information that often has catastrophic consequences and when we get good information it changes our day and the quality of our lives. As any DE who is not diabetic how low blood sugar feels and they can’t answer. They can’t explain Dawn Phenomena, nor can they explain glycogen secretion during exercise.
They can’t explain how some oral medications work and many times they cant answer simple questions on using vitamins. And what’s even more frightening is many do not go for continuing education.
Lay diabetes Educators do. We live it. So we want to know more.

Now I am not saying there are not good CDES I was fortunate enough to experience the best of the best. Mary and the team at Baptist in Downtown Knoxville were the best of the best. I know I am living proof that standards reinforced information, information and education that is time tested and true is the key. I am living proof.

I am often numb and dumbfounded at the diabetics in our community. There is really no reason that they that are facing limb loss, stroke etc.
I get this way because no matter how hard we try to get the point across, the ultimate one who has the ability to control it, is the individual. We can talk until we are hoarse. W can be there when they go back into the hospital and we can give support.

Sure I get colds that hang on. But otherwise I am active and for the most part healthy.
It is time for Diabetes Educator reform and expansion. Certify Lay diabetes Educators who are diabetic. These are the most comfortable people to pass on tried and true information in a time where many RN CDEs are making stuff up.
I run the Pointe Diabetes Center. I am Diabetic, I am an Aqua Fitness instructor and a CAM doctor and Pharmacy Tech.I am diabetic and I work with the NDEP/NIDDK to bring tried and true information to you, the diabetic public.

Small intestine bypass surgery, just a theory that may work admits researcher

Thu, 04 Feb 2010 19:42:16 GMT

I have been reading a whole ot about a new surgery touted to cure diabetes. They say if you have type 2 and you go for this you cure your diabetes.
This is dangerous medicine at the very least. First I have to admit, in the world of medicine the word CURE has to be taken with a box of salt and in fact any doctor worth his salt would never use such a phrase.
Diabetes is now a pandemic. Almost everyone is being diagnosed with it and those that are truly diabetic are getting lesser care than they need. In essence diabetes is fast becoming a fad disease.
When so many contradictions on what constitutes diabetes, doctors become numb in confirming through further tests the level of diabetes a patient has. It has become so common to place anyone who is diagnosed with diabetes on oral medications that is often those who need insulin that are being overlooked.
There is a slow movement to go back to the original language and use time honored proven conclusion tests for diagnosing diabetes. Many other countries stick by fasting levels of over 120 or above as suspect. And place the person in hospital for an OGGT/GTT (oral glucose tolerance test or glucose tolerance test) and follow up insulin level test to positively without a doubt confirm diabetes and what type they are.
But these are to decide that you have diabetes. Many are being diagnosed as diabetic due to obesity, lifestyle or what is even more scary, when a person comes in with a normal glucose reading of 110 they are told they are diabetic. This is dangerous.
One things that si even more dangerous is the panic to prevent diabetes. SO many new supposed cures have hit the market it is scary to think that people may be harming themselves more by accepting these procedures.
A new procedure that a doctor developed was the removal of the jejenum/duodenum loop r curve from the small intestine to cure diabetes. This si the tiny area just past your stomach where it comes in contact with the major intestine. In this small area the digestion process of carbohydrates begins.
Let me tell you, you need carbohydrates for a host of biological functions. A doctor decided that if you remove this, you cure diabetes.
In a study that explains the theory of how this works, in essence you are setting yourself up for more trouble.
I have to say, before I get barraged by it worked for me emails and so on that while it may appear to work, and you a have absolute diabetes it will not cure it. It just masks it and sets you up for more trouble.
The operation works by stopping the signal of the release of insulin to digest carbohydrates in the loop. This procedure is a form of gastric bypass.
The food then lands in the small intestine where it is digested.
Carbohydrates are still digested in the small intestine., You are still having glucose converted in the intestines and with no signal for insulin to be released you still have build up of glucose
The process of elevated glucose albeit is slower. And with any gastric bypass surgery your benefit towards a supposed obese diabetic, is that you loose weight. They go on the theory that all obese people are diabetic. This is simply not true.
What they are touting as diabetic are considered borderline, pre diabetic, metabolic syndrome, Incretin Reponses etc. They lump all of these diabetic like conditions as diabetic. And this gives false hope to those who are diabetic, who opt for the surgery. All you do is loose weight.
While they say that loosing weight will help prevent or stop diabetes, this too is false information for the millions who are truly diabetic and opt for the surgery to cure them
The only true diabetes treatment that is effective and longstanding is Insulin. With all fo the varieties we now have of delivery, we no longer have to be afraid of the poke.
In all, even after the surgery you will still need to digest carbohydrates. If you do not digest carbohydrates you stand to be hypoglycemic and can go into insulin shock. If you are diabetic, your body cannot utilize glucose of any type, no matter the surgery. The initial reaction maybe positive, simply because you are not digesting carbohydrates yet.
And like any gastric surgery your diet will be restricted for a while, until you heal. Giving you a false positive lower glucose reading. But slowly it will build up.
Many are placed on oral medications for a number of reasons. So in effect are you now cured or just a victim.
The surgery has not been around for that long, it is only about three years max. And with that we do not have the follow up data or their diagnostic lab work to confirm diabetes, which makes it suspect surgery.
In an article, these surgeries are based on animal research

Dr. Rubino's research findings in animals show that procedures based on a bypass of the upper intestine may work instead by reversing abnormalities of blood glucose regulation. so the research was not on humans! The article further goes to say conjecture, implied etc. And even the researcher is not so sure it is going to work.
As a full-fledged Insulin dependant diabetic, I am not afraid of the poke. As one who had the benefit of gallbladder removal and having to change my diet to vegetarian, I can tell you that while I am loosing weight, I am still diabetic. And that biology won’t change.
So if you are considering this here is some friendly advice:
Make sure you are not full blown diabetic.
Insist on an in hospital glucose tolerance test and an overnight insulin level blood test to confirm if you are or are not. When doing these tests they are definitive and not just guidelines with interpretations. Numbers do not lie.
If you find that you are NOT diabetic, make some healthy changes before opting for surgery to bring your levels down.
Attend Diabetes self-management classes that are recommended to you or if you do not like that clinical atmosphere find a provider that you feel comfortable with to explain everything and your options.
Get a second and third opinion. Never go under a knife in hopes of cure on the first try.
This is brought to you by
Pointe Diabetes Center Mobil Education Unit
An NDEP partner
http://www.sciencedaily.com/releases/2008/03/080305113659.htm

Stevia NOT carb free

Tue, 02 Feb 2010 22:09:41 GMT

Many patients are being convinced that Stevia is better for them than Splenda. This is a false idea. Stevia is a SUGAR alternative In fact it too, like sugar cane is a sucralose and fructose.. It has a carbohydrate rate, and has the same is low calorie rate. It depends on if it is blended with other sugars, such as Sun crystals is blended.
Stevia is banned in the European Union. The UK has not determined its actual positive use. The UK also banned High fructose corn syrup as being harmful and is in agreement is the FDA.
While Stevia is touted as being the same as sugar, it also has a few extra ingredients that may not blend well with certain medications. It is listed as an herbal sweetener. And like all herbals, it may not mix well with certain ingredients or medications.
The carbohydrate rate is 2 grams per teaspoon. If you use it to sweeten cereal, sweet your tea or coffee you are going to be up in the air as far as uncounted carbohydrates. The small packets that are often served at the table on their package say they contain 4 grams of carbohydrate per packet. Real sugar has 4 grams of carbohydrate per packet or teaspoon as well.

Pointe Program in your neighborhood

Tue, 02 Feb 2010 22:00:47 GMT

We are starting to v= branch out and travel into other parts of the country with our rich seminars, and email newsletters. All designed to give you live 24/7 access to the finest in diabetes self management, support and information.
We are now in our second issue of Factoring Diabetes Newsletter.
It has monthly information for you to take to your doctor.
Updates on findings, and FDA warnings, printables and timely recipes. This service is free.

Gout and the diabetic, a bad combination

Tue, 02 Feb 2010 21:55:35 GMT

Gout, That painful swelling of foot, toe and ankle
What is gout?
Gout is the build up needle like shards of proteins and uric acids that attack and settle in large joints. It can be your hand as well as the traditional foot big toe.
These shards do damage. And the body tries to react to them, as little splinters by swelling. The foot continues to swell to painful proportions while the splinters or shards do damage to the joint. Here is a picture of what gout needles look like
To prevent gout make sure you eat well balanced and not a massive amount of proteins or fats.
If you do manage to get gout, there are some medications. The best thing to do is keep it cool and elevated. Painkillers will be prescribed. The foot will swell and the toe will probably become a bunion toe until it all settles back. When the foot begins to reduce down in size, usually one to three weeks, the skin will dry and crack like sunburn.
Don’t worry. Keep the skin moisturized with a really good alcohol free moisturizer. Like Aveeno, Oil of Olay, anything that says extra moisturizing.
Use a gentle puff to slough off any dead skin. DO NOT PEEL or pick at it. Gout ina diabetic takes about 6-8 weeks to begin to heal.
Make sure your diet is balaned and you drink plenty of water. Reduce soda, coffee and tea and fruit juice. Take insulin on a sliding scale. Since it is a disease and injury all diabetics should be on insulin to help keep tight control and speed healing. If you have to go out it is recommended that you get extra large non-binding slippers and if possible get the use of crutches. Any pressure can cause soft tissue damage and pain.

Thisi staken from teh current february issue of the Factoring Diabetes Newsletter for Pointe Program Participants.
If you would like to obtain back copies and current copies please send an email to
shermandn@medscape with the words newletters please in the subject line.

Byetta is NOT Insulin

Mon, 18 Jan 2010 01:43:01 GMT

Byetta is not insulin
Some physicians are mis-informing patients about Byetta.
In some of the diabetic forums we are seeing questions posed about Byetta and asking us why is it not brining down my blood sugar levels.
It seems as though many doctors are under the impression from drug reps that Byetta is as good as insulin, a form of insulin or just like insulin.
This is not so.
Byetta allows the body to use what insulin it is producing and allo0w the body to work more efficiently. But it is not insulin. A side effect for some is the reduction of weight. Byetta somehow allows the brain to signal when its full and allow to control how much you eat, thereby allowing you to loose weight.
In November of 2009 the FDA issued a warning that the continued and long term use of Byetta can lead to kidney problems and kidney failure.

Here is a link to the article on CNN news that gave us the first warning to pass along to our patients. http://www.cnn.com/2009/HEALTH/11/04/byetta.diabetes.risks/index.html

Black Box Warnings

Mon, 18 Jan 2010 01:33:39 GMT

There are some new things for 2010.

Some of your prescribed medications will be labeled with a Black Box Warning. This black box means that the severity of side effects can be deadly and that they are not mixing well with other anti-diabetic, Ace inhibitors, diet, blood pressure or other medications. If anything according to the FDA and new reviews some are canceling each other out making medications fail. Which can lead to the prescribing of more medication than you really need and that can be problematic and not effective.
So here is a word of advice, At least twice a year go over your medication, especially if it has just been increased and new medications added, to see which are what are called Concomitant or contraindicated. We have seen many, many and can I add another many drug interactions because physicians look towards what the medications do; and not how they can interact.
Also some herbal medications have a negative interaction with prescribed medications. Many for High Blood Pressure or ACE inhibitors especially have bad interactions with certain herbal medications. This too will be in the black box warning.

The areas only Mobile Education Service

Thu, 11 Jun 2009 19:02:28 GMT

We are proud to be the ares only mobile education unit in the East Tennessee area. And we have been doing this for 4 years!
The thing about being Mobile is we come to you. No waiting in an uncomfortable office wasting your time, no having to be somewhere at a specific time, no arranging for transportation.
A new concept, go to where you are and you get better results.Imagine learning about diabetes, getting a bit of exercise in your own home,office or in a group setting at work.

And what is even better is we now have an execise trainer! yes we not only teach you about diabetes, but we also customize to you an exercise routine that fits your interets, mobility and level of health and time.
In our mobile setting we do on site glucose testing, have availble all CLIA waived tests and the results can be sent to you and your doctor. Accurate labs that doctors use now in teh comfort of your hom with a few finger sticks!
We have an aquatics and aerobics/general fitness trainer too and more.
And what is even better we accept ALL insurances!

Learning to live with diabetes can often interrupt your day and become overwhleming. But scheduling an at home or at office visit can give you more personal attention at a time frame you can deal with and you can grasp makes learning to live with diabetes easier.
Call today to schedule your visit!

Factoring Diabete e book

Sun, 31 Aug 2008 18:27:34 GMT

I wrote it, I live it, I use it! Its the basics of self managment and explains what is happening in your body as well as recipes, coloring pages and more. It's designed for the newly diagnosed or the person who has never had diabetes managment education Now availabe in Ebook.
http://www.lulu.com/content/447268

The Question

Tue, 05 Aug 2008 03:32:16 GMT

Many years ago I started and ran the Bi County Diabetes support group for the ADA here in Jefferson County TN. We set up a booth at the fair which was busy. Companies wanting to get the word out on diabetes sent me all kinds of goods to help promote, I even got in on a clinical study for Chromium.
What happened at the fair was nothing short but mind blowing, and not in a good way.
Jefferson county has a very high population of diabetics, I mean those with “sugar”. They don’t quite grasp the concept of diabetes but they understand they have high sugar.
Now think about this, you are at the fair, your diabetic and what is there to do other than play skill games and ride rides.. Eat.
And Eat and Drink we all do. It’s just part of the thrill of the day, aside from sunburn and sore feet. As I stood at my little table with my samples, the nut house lady (the woman who makes toffee nuts) was a booth away. So I asked if she could make some with Splenda. She did and it was a hit! She could have sold so much of Splenda toffee almonds and peanuts, but she didn’t want to. So I got the only batch in the world back then of toffee Splenda almonds.
So manning a booth is long and arduous. But we did it. Fielding questions, giving out samples,books form the ADA, providing meters for people who didn’t have any and referrals to local diabetologist and diabetes center at Baptist. And this one woman comes by, shes complaining that her feet hurt. So we ask is she diabetic, and sure enough she says she has “Sugar”. We tried to explain that her feet hurting is a nerve damage and she has to watch her diet carefully. We gave her samples, asked if she wanted ot test her blood, she declined and walked away.A few minutes he came back and teh conversation repeated itself so out of curiosity we asked. Are you drinking diet soda? NO she says jingling the cup with the ice. It plain Coke, Jumbo size.
So she was complaining about her feet hurting, her face burning, she’s always in the bathroom and of course commenting on all the people in her family that has "sugar". She was All the signs of uncontrolled. So we questioned more, how often do you test? She had no idea of what we were talking about. Do you have a meter? She didn’t want one. And so she continued explaining about her lower legs and feet. She would walk around and come back again. Finally, after a different drink in her hand, my partner was talking with her and asked. “I have a simple question, would you rather have your feet or your coke?” to the answer surprised us both, she admitted she wanted her Coke.

So before you eat that piece of carbohydrate, and don’t take that shot or medication, you have to ask yourself, do you want your feet?

Side note
Locally the rational is often honest and simple. And what is quite disturbing and is very thought through. We have been told by more than one diabetic individual that if you let your “ sugar go up” and you have to go for amputations or other care and it’s done enough damage you can file for and possibly get disability, A sad fact for some people.

Many people here are really afraid of diabetes education, and that is something That has to be overcome with patience and programs brought to their level.

Welcome!

Tue, 05 Aug 2008 01:59:13 GMT

Welcome to my home on the web, where you can find resources and tools to help manage your diabetes. Use this site to send me email, check my schedule, download blood glucose logs and other helpful tools, and learn more about diabetes.

The tabs located at the top right of the page will help you find what you need. Use the "About Me" tab to find out more about me and see my group schedule. The "Resources" tab is a library of helpful tools and information to help you manage and learn more about your diabetes. Finally "Columns" will take you to a collection of my personal tips, practice updates, and other useful information that is updated regularly.