A DIABETIC DIARY, Part 15

Odds & Ends, Blood Test Results - Taking the good with the not so good

Odds & Ends

If you would have told me a year ago, "Hey, Dave, a year from now, you'll be taking 5 prescription medications a day, you'll hardly ever put a drop of alcohol to your lips and you will no longer be smoking," I would have laughed in your face. Some fortuneteller you are.

I recently had a discussion with my sister-in-law about one of those mysterious liquid supplements that are meant to cure you of all sorts of ailments. I didn't pay much attention to what it was because I don't believe a cure-all exists anywhere in any form. We read about some never heard of fruit that Amazon natives have been using for hundreds of centuries. We hear it cures cancer, diabetes, hypertension, liver and kidney diseases and bad breath, to mention just a few. Then, and on the other side of the spectrum, we'll learn about all kinds of supplements, each designed to perform a certain function to enhance your life and health. Ginkgo biloba for the mind, for instance. My best advice to you is to not believe everything. For one thing, since the FDA (or any other country's equivalent) doesn't necessarily regulate natural cures, i.e., herbal supplements, how do you know what it will do if you don't let your doctor know first? Every person's body is different. No one pill will work for everyone. Some people have allergies, others don't. Blood types vary. Men and women are different. Men don't suffer from iron deficiencies, for example. Supplements don't always mix well. I've often read to not take St. John's wort with ginkgo biloba. Did you know that? The list of reasons can go on and on and it is impossible to take supplements that promise an eternal life, free of maladies. Besides, my prescription blood pressure medication is derived from snake venom. South American variety. I have a printout that tells me of possible interactions.

"I take Peruvian Ma La Qua Potion every day and I haven't been sick in 48 years." - Ellen B., Baltimore, MD

Do you know Ellen B. or anyone who does? I didn't think so. She doesn't exist, but her fictional testimonial does.

I average anywhere from 80 - 130 visitors a day now on this website. Am I bragging? No. A good chunk of those hits are from people searching for information on diabetes. One such search is on "coconut cures for diabetes" and one of the very first things a doctor told me after being diagnosed with type 2 was to avoid all coconut like it's the plague. I know for a fact that I ate a Thai soup for dinner one night before I was officially diagnosed, but testing my glucose levels twice a day, and my sugar skyrocketed. The culprit? Coconut milk in the soup base.

Blood Test Results

Every diabetic must undergo blood work every three months for the rest of their lives to show how glucose levels are and how your kidneys and liver are functioning. The doctor will prescribe and adjust your medications accordingly. A short time ago, I went in for tests and had a follow-up visit a week later.

"No really bad news to report," my doctor told me soon after he entered the room.

"Good. Then I can leave?"

"No, there are a few things we need to discuss."

The fasting level of my glucose on the morning of my test was 140. That's high. My overall level for that 3 month period was 5.6, up from the previous test of 5.5. Not bad at all (Previous test results and ranges can be found here). He proceeded to double my Glucotrol/Glipizide medication, but, at least, I'm not on Metformin yet. Glucotrol stimulates insulin production in the pancreas. Metformin slows glucose production in the liver. As long as my pancreas is functioning modestly, I'm in better shape overall.

"You know I take cinnamon capsules everyday, right?"

"Cinnamon shows a lot of promise in diabetics," he responded. I used to take 3,000mg a day, but have since dropped it to 1,000. I give some credit to cinnamon for that 5.6 number.

My cholesterol went up. Originally, I was put on 40mg of Lovastatin. That brought those numbers way down, but at the same time, greatly reduced my good cholesterol, too. He put me on a combination prescription of 500mg Niacin/20mg Lovastatin. This time, my overall cholesterol was 181, triglycerides were 184, LDL was 101 and my good cholesterol (HDL) jumped from 29 to 43. He doubled my medication to 1,000/40. Niacin helps bring good cholesterol up and it did, but 20mg of the statin wasn't enough to keep the bad down. One of the unpredictable consequences of diabetes is that medications are constantly adjusted and when you think you've gotten it under control - POW - something else pops up.

"Your urine was very yellow and thick."

"Huh?"

My blood test said TURBID. That means cloudy. My specific gravity was low. He wasn't too concerned, but these might be signs of excreting red blood cells, which leads me to his next discussion.

"I'm a little concerned about your platelet count. It's been testing low, but not too low to warrant further testing at this time. I wouldn't worry about it yet." YET? When a doctor brings up something that concerns him, you tend to get a little bit nervous. "If it remains low or drops, we'll have to set you up with a (bone marrow) biopsy. In the meantime, we'll keep a close watch on that number from now on." My red cell count was low, but he didn't mention it.

"Oh, great news! I noticed that on my previous tests, especially since my brother-in-law went through AML (leukemia) and his platelet counts were really bad."

"Well, you don't have leukemia because your other numbers are within range."

"Are there any supplements I can take to increase my platelets?"

"No, but there are prescription medications available. Like I said, don't worry about it yet."

OK, I won't worry, but it will be on my mind. "Does it have anything to do with the diabetes?"

"No. Are you ready for your prostate examination? Remember, we discussed it last time?" Oh, yeah, how could I forget?

It ain't fun getting old. Does anyone know where I can order that Peruvian Ma La Qua Potion?

Rated R for Rectum

We've known each other for a number of years and our relationship has always been professional, although, he has told me things that I would say are rather intimate. I haven't seen him in months and he told me then that it was time. "I'm not ready," I responded. "Next time." Yesterday was that special day.

Other than high school gym class and the showers we took together, I had never been naked with a man, certainly not in an intimate fashion by any means. Actually, it was my high school doctor some 40 years ago. Women, I love them. Men? Never.

Somehow, he convinced me to unbuckle my belt and slowly drop my pants. What compelled me to do such a thing? Could it be that, after all these years, I needed to get this done? To put it behind me, so to speak, so I could get on with my life and to feel like the manly man I truly am? You know, men doing manly things together. Bonding.

He touched me. He touched me again. I coughed. I coughed again. He asked me to turn around. I acquiesced for the simple reason that it was a friendly request and I liked his demeanor. He made me feel calm. Besides, it wasn't like he was just a stranger in some back alley, probing and chipping away at my masculinity. Assume the position! I was not looking forward to what he was about to do.

He penetrated me from behind. I could not gaze into his eyes. Ooh, I silently moaned. It was a new sensation and I sensed that this man knew what he was doing. I've been touched there before, but this was the first time it was a guy. For a fleeting moment, I felt like a woman. "You should have had this done years ago." I didn't know what to think. He was right, but I didn't quite know how to respond. How should I react? What should I have said? Before I had a chance, it was over.

"Is that it?" I asked.

"Yes," he said. "Your prostate is a little spongy, but not bad for a man your age."

I pulled my pants up. After all that anxiety and trepidation, it turned out to be a simple procedure. "You know," I said, "that was nothing compared to that barium enema you put me through months ago for polyps I didn't have."

"Yes, but we did find out you have diverticulitis. I would recommend that you start taking saw palmetto to help keep your prostate healthy. Other than that, you're good for another year." I felt whole.

"Great!" I exclaimed, as I limped out of his office. I can't wait to mark it on my calendar.

Should restaurants be required to list calories and fat grams on their menus?

Again, this was a matter of debate at Helium.com, where writers are invited to express their opinions, for or against. This is what I wrote.

Should restaurants be required to list such information on their menus? I can think of a simple way to circumvent that problem. Have the wait staff memorize and recite each item instead, but then I would probably have to listen to all sorts of disclaimers about the increased risks of heart attacks and strokes from consuming one of those meals. My ears would clog and my blood pressure would rise from having to listen to all those asterisks. You want cream* and sugar* with your coffee*? Here, you'd better read this first.

Time for a reality check.

I used to make a marinade I sold in the Orlando, Florida market. It was my own recipe and the first thing I did was call the FDA to find out what I needed to do to make it shelf stable. The advice the kind man at the other end of the phone gave me was just that. What he told me was common sense and not governed by law. One of the things I remember was that I should put a lot number on each bottle to protect me in case of a complaint. That way, if I produced a thousand bottles in a particular batch and there was only one complaint, certainly, I was not at fault. 999 bottles stood behind the integrity of my product and, obviously, other factors were involved, such as whether the person marinated the food in the refrigerator, as I clearly instructed on the label.

He told me to take random bottles to a testing lab to ensure that bacteria levels were safe. They were and this protected me and the consumer. Back then, small batch food goods did not need labels listing "Nutritional Facts", but I thought it was only right to provide information anyway and it made me look more big time than I was (the FDA defines a small business as one with food sales of less than $50,000 a year or total sales of less than $500,000.) Needless to say, it was not cheap. I had to give up my secret recipe to a different type of testing lab in order to determine the nutritional values, but my secret was safe with them. When you make thousands and thousands of bottles of marinade over a period of many years, one should feel compelled to offer practical and educational information to allow the consumer to decide, whether law or not. Besides, the cost was passed on at the wholesale level and given the price of the lab work, it didn't amount to too much in the overall scheme. Initially, yes, but not so much in the end because it worked by volume sales.

Since the FDA's effective date of May 8, 1994, I have been reading nutritional labels on all sorts of packaged food items I buy. I have been aware of trans fats for a long time and I insisted that nothing of that nature would ever go into my product when I made it. I used olive oil. My marinade was low in fat, sugar and sodium and packed with flavor. Since being diagnosed with type 2 diabetes last year, I am even more keenly aware of what I eat and I read labels with a vengeance now. Have you heard of "interesterified soybean oil" or "high in stearic acid"? I have and I've written about it on a diabetes post.

By replacing one fat with another less saturated one, has it made it safer to consume? Labels on packaged goods don't tell you that and they aren't required to do so. For example, a recent study of interesterified fat was found to depress the level of HDL (good cholesterol) more than trans fat. In addition, it raised blood glucose levels and depressed the level of insulin. This suggests that interesterified fat could lead to diabetes. The nutritional panel alone does not paint you (oil base, of course) an entire picture, so you've got to read the list of ingredients, too, to formulate what may or may not be healthful to eat. I wonder what type of fat is replacing partially hydrogenated ones in the restaurant industry as many of them now tout ZERO TRANS FAT!? Something to chew on and I guarantee it won't be listed on any menu.

In the late sixties, through the seventies, I was in the restaurant business. I think we can all agree that it is a very competitive industry, but do you have any idea how much it would cost to produce such information? OK, perhaps the big shot corporations can absorb the cost and pass it on through a modest increase in price since they deal in volume, but what about the small Mom & Pop shops? How can they cost effectively do what the Dardens of the world can do? If Olive Garden sells a spaghetti with meatballs dish with nutritional info for $8.95, how can Momma Lombardo down the street compete after paying the cost of a lab test? She has to sell her dish for $13.95 to recoup. Where went the competitive edge? What about daily specials? Would poor Momma have to send off a list of ingredients for testing before she could offer it? How can a profit be made on a one time special, made up that day at the whim of the chef because an exotic fish became available if the proprietor must send the recipe out first for scrutiny and inspection? Meanwhile, the fish and tomatoes are rotting while she awaits the results. Maybe, the chef makes up the dish as he goes and continuously samples and adjusts it. Needs a little more wine, less chicken stock, he thinks. Oops, I smell a lawsuit because the data doesn't match the end result. The food police are on their way!

What about government sanctioned standardized guidelines instead, made readily available (for a fee) to businesses and open for the taking, so that a particular dish sold at any restaurant should approximately contain this amount of calories, fat and everything else required by law to disclose? Offer different versions on the list, from rich in calories to guilt-free. Categorize lists according to cuisine. Remember, I did not have to place nutritional facts on my marinade bottle. That was left for mass produced products. Some restaurant chains already list information on the menu or on a separate sheet and it helps with sales as more and more diners become nutritionally savvy, but big chains can afford dietitians. A lot of their food comes out of regional commissaries. Would I want to require it? No. Let supply and demand dictate whether it is offered. If customers demand it, restaurants should supply it. Or don't eat there. Soon, the message would become clear by the empty tables if that's what people want. Personally, I don't want to ruin my appetite by having to read what I already know might not be good for me. Not on the menu, at least.

Lobster Bisque....................................................................................9.00
Our secret family recipe, just the right serving size of 637 calories, made with 68% of your total fat 25g (100%), saturated fat 15g (60%), trans fat 3g (15%), cholesterol , etc., etc., etc. % of your daily values, based on a 2,000 calorie diet. Yummy.

Prime Rib..........................................................................................28.00
Depends on whether you eat the fat or not.

Offer a separate printout if it must be required and place it on display for consumers to take or leave. Does the government really have to tell me this menu is USDA, United States Disclaimer Approved, before I order Momma's special, Fettuccine Alfredo, made with cheese, heavy cream, egg yolks and a dash of statin, and it's about to fill me with a month's worth of badness at one sitting? It kind of takes the fun away from eating out. Maybe, I'll call for takeout instead, but then, I'd have to listen to all those asterisks over the phone first.

Should cell phones be banned in restaurants?

This was a matter of debate at Helium.com, where writers were invited to express their opinions, for or against. This is what I wrote.

For all you know, I may be sitting here at the Tech Noir Internet Cafe, eating my Bavarian Ham and Brie Croissant with arugula, baby spinach and alfalfa sprouts while working out deals with my day trader over the phone, between sips of my iced frappe latte parfait with imported organic vanilla bean essence. If food is served, it is a restaurant, at least to the health department. I'm not, but you can picture that scenario, and in this kind of establishment, cell phones may play a crucial role.

I think everyone would agree that smoking is not a healthy vice. Neither is second hand smoke and that is why many states have banned lit cigars and cigarettes from all public buildings and that includes restaurants. Cell phones cause no health danger, other than the fights that might ignite from the rudeness of blabbers and those who want a nice, quiet repast. That could be a problem.

I certainly wouldn't go to a 5 star restaurant and read the Podunk Times while slurping a delightful lobster bisque. Chomping my filet mignon drenched in ketchup with my mouth open? How rude. On the other hand, I have no problem with cell phones down at the fast food joint and local greasy spoon, where the hustle and bustle of activity and conversation tend to neutralize cell phone chatter. "You want fries with that?" Personally, I don't like to carry on a private conversation in front of people, especially strangers. Who I talk to and what I talk about is no one's business but mine, but there I might be inclined to answer and talk as quietly as I can without disturbing others. In between bites, of course.

Back to smoking for a moment. You don't see churches with NO SMOKING signs hung all over the place. They don't need them. You don't normally see TURN OFF ALL CELL PHONES signs, either. It's just common sense and proper etiquette that tell us to refrain from certain behavior depending on the setting. Why can't people learn to take that same politeness and respect with them wherever they go before the government intervenes at the behest of the annoyed? Since restaurants aren't the only places that suffer from this form of aural intrusion, where would legislation stop?

As far as I'm concerned, a cell phone is nothing more than a phone that's not plugged into a wall and it works almost everywhere. It is a utility, for crying out loud. Oops. Did I just scream that? In the past, we couldn't take our phones with us. Now we can, and the main problem lays with the courtesy challenged, those ego-fed bean heads who want to show others, especially strangers, how important they are. All other conversation must cease. Look at me! I think it should be at the discretion of the individual restaurant to allow or bar cell phones. Because ambience and cuisine vary tremendously, it should be a management decision. There shouldn't be an across the board ban.

All of this kind of makes me wonder, do parents still teach their children to sit up straight and chew with their mouths closed? Do they tell them to hang up the phone, it's time for dinner? Probably not.

A Message From Paris: To My Adoring Fans Everywhere!

Do you want to know what really happened to me, boys... why they let me out? Let me tell you, it was not fun in there. The TP was like wax paper. The food was... well, I don't even want to go there. It was, like, SOOOOO bad! Back to the TP tissue issue. For 3 solid days, I couldn't poop. Beautiful girls like me don't poop anyway, do we (wink, wink)? Oh, I pee peed alright, but I had to hold in that horrible food for, like, 3 days!!! Since I never pass gas (God forbid!) it got pretty nasty back there. The guards found me all pukey like and rushed me to the jail infirmary, where the not so beautiful female nurse discovered I had become quite impacted. Hectum in the rectum, oh my!

(Memo to nurse: Cut your fingernails.)

Anyways, I was taken to the hospital where I was given an enema. Canned peas and corn went flying all over the room! They decided to send me home. My tummy can't handle that type of food. Gimme a break! Corn flakes for breakfast, bologna and cheese sandwich for lunch? American cheese? Get real. Don't ask me about the meatloaf.

My poor little rearend hole hasn't been this sore since... well, we won't go there, either, since I don't talk to him anymore.

Thank you all for your support! I will be a good girl from now on. Ouch!

Love & Toodles,
Paris

A DIABETIC DIARY, Part 13

Proud of my 5.5

I have emphasized the importance of periodic tests to check your average blood glucose values, blood lipids (cholesterol and triglycerides), and kidney function. When I got the results back from my most recent tests, done at the end of April, I was very encouraged by what I saw. I switched to a new doctor since then and he hasn't seen the report, but I think he will be impressed too.

From previous tests, my triglycerides dropped from 222 to 128. Less than 150 mg/dL is ideal. Total cholesterol went from 216 to123. The normal range is 125-200 mg/dL. My bad cholesterol (LDL) dropped from 135 to 68. The desirable range in diabetics should fall below 100 mg/dL and <70 for those with known heart disease. Unfortunately, my good cholesterol (HDL) also dropped from 37 to 29. It should be > or equal to 40 mg/dL. I don't know what caused that, but I will research ways to improve it. More exercise will help, I'm sure.

Everything on my Comprehensive Metabolic Panel w/EGFR was fine except for my fasting glucose reference interval, which stood at 126. It should range from 65-99 mg/dL. What totally amazed me was the result of my Hemoglobin A1c test. Originally, I clocked in at 8.o%, a relatively high number. The non-diabetic range is less than 6.0%. This time, my number is 5.5%, an incredible improvement and something I am quite proud to crow about. I attribute this and the other results to several different factors: I am on a prescription medication for blood pressure and to loosen my arteries to protect my kidneys, I take a statin drug for cholesterol, and I take a sulfanilurea medication for diabetes. I do not consume processed sugar and my fat intake is way down. I exercise more than I did before I was diagnosed and I drink a lot less alcohol. I try to eat better overall. Of course, I miss pizza and fried chicken, but hey, you gots to do what you gots to do.

I did a tremendous amount of research on supplements for diabetics, primarily for those with type 2. I really tried to weed out the junk stuff and to make a concerted effort to avoid conflicts with other supplements and medications. Here are the results of what I've found and a list of what I take daily. Bear in mind, I made sure my doctor knows exactly what I'm taking and what his thoughts are on each one. Can I say for sure that these supplements have helped? Of course not. I've only been taking them for a few months. I would have to have similar test results over a much longer period of time to assume otherwise, and my tests may vary as much in myself as they will in any other individual. I would not recommend any other treatment without consulting your own physician first. OK, I do think cassia cinnamon can be a small miracle for people like us.

1.) 2,000 mg cassia cinnamon. This type of cinnamon may help promote sugar metabolism.

2.) 200 mcg chromium picolinate. May help promote insulin effectiveness and regulate blood sugar.

3.) 250 mg magnesium. I take this because of neuropathy. It may help with nerve impulses.

4.) Omega 3 fish oil/alpha lipoic acid. I alternate daily between these two for heart health and to fight against free radicals, plus antioxidant benefits.

5.) multivitamin

6.) 1 gram apple cider vinegar tablet with min. 35% acetic acid. Studies have shown that apple cider vinegar helps control blood sugar spikes in type 2 diabetics.

1.) 81 mg aspirin. Because my doctor told me to.

I take all of these supplements with my evening meal, except for the aspirin, which I take whenever I remember to.

When he looked over my list, he was amazed. He said that the only patients he ever sees that take these supplemental cocktails are diabetics and those with AIDS. Whether they help or not are subject to further studies. He approved most of them in a round about sort of way by checking them off one by one and saying they seem to be OK. He only questioned two of them. Chromium picolinate may alter DNA, but if I'm not thinking about having children at my ripe old age, it should be fairly safe. He takes it himself. His children are grown. He seems to think it might be of more benefit to help ward off diabetes, though. He was puzzled by the magnesium and when I told him it's for neuropathy, he just shrugged. That one, he was less sure of. I wonder what he'll think after reading my test results? I'm running them up to his office this afternoon, but I won't see him again until the middle of July. In the meantime, please discuss these with your doctor before going on any sort of regimen. Just because you read about them here does not mean they are right for you. Besides, I'm still exploring other supplements. It doesn't give me license to eat pizza and fried chicken, either, so watch your diet!

A DIABETIC DIARY, Part Eleven

The Benefits of Cassia Cinnamon and Oolong Tea

I ran out of cinnamon capsules last week. My numbers had been running around 120-130 something in the morning. That's somewhat high, but not too bad. Like I've said in past posts, under 100 is ideal. Partially, it's due to Dawn Phenomenon, which I wrote about here. I could probably do a little more work on what I eat and increase my exercising, too. Last night, my sugar was 160. This morning it was 159. I think it's because I've been too lazy to go buy cinnamon.

In December 2003, Diabetes Care published an article on a Pakistani study about the effects of cinnamon on type 2 diabetics. In the study, 30 women and 30 men were broken into 6 groups. Of that, half were given varying amount of cassia (cinnamomum cassia), otherwise known as Chinese cinnamon, and the other half were given placebos. The first 3 groups were given 1, 3, or 6 g of cinnamon daily. After 40 days, all three levels of cinnamon ingested reduced the mean fasting serum glucose (18–29%), triglyceride (23–30%), LDL cholesterol (7–27%), and total cholesterol(12–26%) levels, with no significant changes in the placebo groups. Changes in HDL cholesterol were insignificant.

Cassia has a long history as both a spice and medicine. It is the inner bark of a tropical evergreen tree native to southern China and mainland Southeast Asia west to Myanmar. Medicinally, it has been widely used to treat digestive problems, but the most intriguing of all is in the treatment of diabetes. Scientists have discovered that it has insulin-like properties and its active ingredient, called polyphenols (tannins, lignins, and flavonoids), can boost levels of proteins which are crucial to promoting normal insulin signaling processes, a healthy inflammatory response, and increasing glucose transportation throughout the body. Tannins are present in red wines. That may be one of the reasons why small amounts of red wine can be of benefit to diabetics. Cassia might also lower blood pressure, making it potentially useful to those suffering from hypertension. The USDA has three ongoing studies that are monitoring the blood pressure effect.

It seems like a relatively benign form of treatment, although risk factors are always an issue. There haven't been any long term studies done on cassia to make a firm determination. There is concern about the potential for toxic buildup of the fat-soluble components and some European health agencies have warned against consuming high amounts of cassia, due to a toxic component called coumarin. Although not present in large amounts, coumarin has been found to be moderately toxic to the liver and kidneys. It is where warfarin (Coumadin®) is derived (synthetically), so it may have ever so slight anticoagulant properties, as well. I wouldn't worry about it. People have been eating cinnamon for thousands of years and I've never heard of anyone dying from it or causing any type of harm.

There are various forms of cinnamon on the market. You want to buy cinnamon cassia (cassia cinnamomum), a close cousin of true cinnamon (Cinnamomum verum, synonym C. zeylanicum), which is native to India and Sri Lanka. If you can't find it, I think regular cinnamon will do in a pinch. One is just better than the other.

I strongly recommend all diabetics talk to their primary care physician and/or endocrinologist about cinnamon. I recommend this treatment, unless you are allergic to it. If you decide it might help, I'd start with 500 mg per day, gradually increasing, if necessary. I usually take 3,000 grams per day. Remember, don't expect overnight success. The original study took 40 days. Those on insulin must be extra cautious because they may have to reduce the amount they take or at least monitor their glucose more often during the day at first.

Another article in Diabetes Care, in June of 2003, suggests oolong tea, a type of tea that is partially fermented during processing that proved to lower plasma glucose in a test of 20 type 2 diabetics who also took hyperglycemic drugs. They were given 1,500 milliliters per day for 30 days. Their glucose fell from 229 to 162 on average. A group not given oolong tea, but water instead, showed no change. Bear in mind, green tea is not fermented at all and black tea is fully fermented. The only problem with oolong tea is trying to find it. It is imperative it comes from China. Also, 1,500 ml is a little over 5 cups, so I'd think about brewing a nice big pot and turning it into iced tea.

You may also find this article helpful. This particular study reviews herbs and dietary supplements for glycemic control in diabetes. Please remember, you can always ask me questions. I will do everything in my power to find the right answers. I'm not a doctor or anything, but I learn easily and well and I know how to weed out improper information.

Well, I'm off to the health store. I want my BG level to go down.

A DIABETIC DIARY, Part Ten

HELP!

Between my two blogs, I have software where I can cross reference information. This is not for stalking or spamming or for any other seedy reason. I do it because I can get a good grasp of questions posed on search engines and how people are directed to my site. This post is not just dedicated to diabetes because it may help with any sort of medical condition.

The following question really bothered me because I don't know if this person from Decatur, Alabama got an answer that helped and that is only what I want to do here. I wish I could have responded personally, but the information I get does not give me all of the particulars. In other words, I don't know who any of you are and I don't need to know.

I am a diabetic with no insurance where can I get medical help?

I have no health insurance. I did a search for "free Orlando clinics" and found Shepherd's Hope in this area. They got me on the proper path to deal with my disease and I chronicled it here and in ensuing posts. I'm sure there are clinics all around the country that help the poor and/or uninsured. On the federal level, the Hill-Burton Act was passed in 1946 to do just this. My advice would be to go to that site and explore clinics closest to where you live. I would further suggest you first do a search like I did, only replace "Orlando" with your town. If that doesn't work, try using alternative key words along with your search, such as medical or health, like "free health care decatur alabama" until something pops up. If your search yields nothing in your area, go to Hill-Burton and look through these locations.

Here's another popular search:

comprehensive metabolic panel w/EGFR glucose

I have a link on this post that directs you to an explanation of it. Basically, it shows your fasting blood glucose level and will more than likely determine whether you're diabetic or not. Creatinine goes along with that test and is useful in the evaluation of kidney function. This all goes along with

what is A1C test?

which is also linked from the same post. A1C gives a 2-3 month overview of blood glucose levels. Mine was 8.0, which meant I'm diabetic. 7 or below is what you're aiming for.

I get a lot of questions about interactions between drugs, such as

can I take aspirin with Glipizide?

No one on the Internet can make that determination for you. You must ask your primary care physician or specialist about any drug interactions and possible side effects. They alone know about your condition and whether allergies or other things play into the scheme. You might also try asking your pharmacist, since they know what prescriptions you're on. They may give you an answer. I'm of the school of thought that they keep up with drugs more than doctors do, but that's just my opinion. I get the same questions about Lisinopril and Lovastatin because those are the other two pills I take. Ibuprophen. Tylenol. All sorts of questions.

There are many other search questions, too numerous to list here. My advice would be to keep searching, but don't believe everything you read on the Internet. I've read about "Coconut Cures" for diabetes when doctors have told me to avoid all coconut. Before I was diagnosed and didn't know any better, I ate a Thai dish that had a coconut milk base. My sugar was sky high later that night. No way will I believe in any sort of miracle coconut cure or whatever else may be lurking out there. As is with any medical condition, all people react differently. There are no blanket cures to be found online, just like not all diets work for all people. Do you really buy into all those diet pill claims you see on TV?

Please, please, if you have a question about anything, e-mail me at marinadedave@yahoo.com or ask here. I might be able to help steer you in the right direction. I certainly would never, ever steer you wrong.

Oh Mee, Oh My (Hic)

Poor Jennifer Mee. She's the 15 year old girl from St. Petersburg, Florida who can't seem to shake off the hiccups. She's had them for more than 3 weeks now. I can definitely relate. Two years ago, I had them for a week and a half and they pretty much drove me nuts, or as my friends might say, nuttier than I already was. I did a lot of research on the Internet, trying to find any sort of cure. I experimented with just about everything I read, to no avail. I tried holding my breath. I put sugar under my tongue and in the back of my throat. I breathed into a paper bag and drank out of the wrong side of a glass. Nothing. Zero. Zilch. I could not sleep at night and I got desperate. Finally, I made an appointment to see a doctor. My doctor had died, so I had to find a new one, one who had never met me or knew of my medical history.

When I got in to see this new doctor, I (hic) explained (hic) my (hic) dilemma. He looked down my throat. "I don't like the redness I'm seeing," he said. He listened to my neck, chest and abdomen. After a few minutes of careful examination, he made a diagnosis. "I believe you have a lung tumor." My heart sunk down into my butt. That should have been enough to scare the hiccups away, but it didn't.

"You're kidding?"

"No, that's pretty much what I think it is. I've had cases like this before and that's what it generally has turned out to be. I'm going to schedule you for chest x-rays and an upper GI."

"Oh, wow. In the meantime, can you give me anything, like Thorazine?"

"Thorazine? How do you know about that?" he asked.

"I looked it up on the Internet."

"No, really, how did you know about Thorazine?" He gave me a rather sharp and puzzled look.

"I'm telling you, I tried looking for a cure on the Internet and read about it." Thorazine (chlorpromazine) is a drug prescribed for schizophrenia. Seriously. It's also used to treat chronic hiccups. I think he wondered if I had a history of schizophrenia or some other psychotic problem.

"Yes. I'm going to give you a prescription for that." I felt a little relieved, in the hope that this drug would cure me. Hic, I mean, heck, I was more concerned with getting rid of this immediate problem than I was about dying of lung cancer. I left, and hiccuped my way to the pharmacy.

When I got home, I immediately unscrewed the cap and swallowed one of those pills. An hour later, nothing. Man, I thought, this is crazy. I took another one. About an hour later, I was in some sort of la la land I had never been to before. Wow. I was somewhere up in the clouds and decided I needed to get into bed. That was it for me. I woke up the next morning and the hiccups were gone. Bingo! Cured! My first solid night of sleep in what seemed like forever.

The following week, I went to get the tests done and a few days later, I went back to see the doctor. As I was walking into one of those waiting rooms, he passed me in the hall and said he had some good news and some bad news, but don't worry, the bad news isn't that bad.

He walked in with some papers. "You do not have a tumor. You have a hernia on your esophagus. You also have one here and here." He pointed to parts of my stomach. "You also have GERD." GERD is short for gastroesophageal reflux disease. I have always had bad heartburn and I knew I had damaged my esophagus through the years.

"I want you to get some Prilosec OTC and take 2 capsules (not one) a day."

"For how long?"

"Until I tell you to stop." which I interpreted as never. "I'm also going to write a prescription for an ulcer medication, not that you necessarily have one, but it will aid in the GERD."

I had a couple of follow up visits and everything seemed fine. I never really got the hiccups again, at least not like that. Every time I do hic a few times, I get scared. Oh, by the way, I asked what I should do with the rest of those schizo pills. "Throw them away. You don't need them." Yeah, right, like I was going to do that. Hah! At least, I never drove when taking them. That would have been crazy.

A DIABETIC DIARY, Part Nine

The Amazing Healing Power of GLUCOBATE!

I would ask ALL DIABETICS to go to the Glucobate website and explore a little bit. Browse through the links and testimonials. It doesn't matter which link you click, they're all the same. If you don't go to a link, come back and click Here.

Remember when hucksters would travel from town to town hawking their magic elixirs from the backs of their wagons, barking out that it would cure whatever ails you? Today, they do it on the internet.

There is no cure for diabetes.

A DIABETIC DIARY, Part Eight

Dawn Phenomenon and Somogyi Effect

A very puzzling aspect of diabetes is the contradiction in everything. Glucose levels can bounce around and there doesn't seem to be a clear cut semblance of rhyme and reason to it all. Some people experience weight gain. Some drop pounds. I fit into that category. Sometimes, I'm satisfied with the food I eat. Other times, I cannot satiate my appetite, no matter how much I eat. I have to be very careful with that, too, not just with the types of foods I consume.

A friend of mine works for a bookstore in Winter Park, Florida, called Bargain Books. It was very nice and extremely appreciated when John gave me two books, Diabetes for Dummies and Cholesterol for Dummies. You can't beat good, caring souls. As I was leafing through the diabetes book, I stumbled upon Dawn Phenomenon in the glossary of terms and decided to explore it online. I have this problem and I know many other diabetics do, too.

My blood glucose level is always higher in the morning than it is at night. Why? It doesn't make any sense that an empty stomach level would be higher. My mother has always said that it's a mystery what diabetes does and how the body reacts to it. Everything can flipflop around and doctors don't always seem to have the answers. My father has maintained that what you ate the day before can have that sort of effect on you the next day. Sounds reasonable enough, but then I stumbled upon that phrase. Everyone experiences Dawn Phenomenon, whether diabetic or not. We all have a biological clock. Technically, this one is referred to as Circadian Rhythms and it is rather simple to explain. Your body uses carbohydrates, protein and fat to store energy and during sleep, you use that stored energy to help keep your chemicals balanced. These "macro-nutrients" are converted to glucose stored in the liver and muscles.

Overnight, your body releases some hormones. They come in the form of Growth Hormones from the anterior pituitary gland, cortisol from the adrenal cortex, glucagon from the pancreatic alpha-cells, and epinephrine, otherwise known as adrenalin. These hormones trigger an increase in insulin resistance and add stored or new glucose to your bloodstream. All of this adds up to higher blood glucose levels and a diabetic can have real problems with it.

This activity normally occurs during the hours from 4am - 11am and explains why my sugar is higher in the morning, but what can be done to resolve it? There are different ways to bring that overnight level down and everyone must experiment on their own. One method is to eat a light snack with a slow digesting fat and protein content, such as peanut butter or deli meats and cheeses. The theory is that it holds your blood glucose level high enough overnight to avoid the problem. Some people eat a green apple, such as a Granny Smith or take vinegar supplements to ward off Dawn Phenomenon or Somogyi Effect, which I will try to explain next. Try eating breakfast when you first get up and test your sugar later. There are different things which may or may not work for you. This is not a disease that has any uniformity to it.

Somogyi Effect is often referred to as Liver Dump and usually occurs in insulin-using diabetics and those who go hypoglycemic during the night. When your glucose level drops too low, the liver kicks in and does its best to stimulate and release glucose. One way to try to determine whether you have Dawn Phenomenon or Somogyi Effect is to test your glucose between 2am - 3am several nights in a row without snacking before you retire. If you test normal, it's likely Dawn Phenomenon. If you test low, it could be Somogyi Effect and setting your target number a little higher before you go to bed may eliminate the problem.

I'm going to try the peanut butter (or cheese) snack before I enter the realm of Sleeptown and see if that helps reduce my glucose in the morning. I've been running around 150-160. If that doesn't help, I might have a small (2 ounce) glass of red wine and see what happens. Alcohol lowers blood glucose and it may do the same thing as eating an apple or taking vinegar pills. Who knows? Like I said, it's a very contradicting disease and it could be either Dawn Phenomenon or Somogyi Effect. Certainly, I will talk it over with a doctor, next time I see one.

A DIABETIC DIARY, Part Seven

Most people don't understand diabetes. There are plenty of misconceptions out there. Fortunately, I had been researching it for years before I got the disease because my mother has had it for a long time. Of course, there's still plenty for me to learn. I seriously doubt anyone who has it will ever quite fully understand what are the right and wrong ways to deal with it. For example, some things may effect you one day and not the next. Why? Who knows. I am going to try to explain some of the areas that I get questioned on by my friends.

Before I knew I had it, I had been feeling below par for some time. When I realized what I had and was officially diagnosed by a medical professional, it explained why I had mood swings and why I was rather irritable at times. Normally, I've never had much of a temper. One always wants to believe they are healthy and to find out about this can bring you into an emotional quagmire, which I did kind of fall into. It became almost an obsession for the first month and that seemed to be the topic of most of my conversations. Some of my friends started to drift away in fear that, uh-oh, here comes Diabetes Dave again. I noticed it, too, and began to realize I needed to get on with my life. Granted, it can snowball on you. I wasn't feeling well at all and that was compounded by my fear. I believe the blood pressure, diabetes and cholesterol medications have helped me tremendously. My blood glucose levels have come down and I don't feel nearly as achy and weak as I used to. Mentally, I have adjusted as well. I no longer think my life will be cut short. Most people can live long lives as long as they maintain a proper regimen of diet, exercise and monitoring sugar and lipid levels regularly.

One fallacy is that we must give up many of the foods we've always enjoyed eating. Everyone thinks we cannot eat sugar. With proper drugs, there is no reason to stop eating all sugar. Certainly, I'm not going to play a game of Russian Roulette with myself by buying candy and other junk none of us should really eat to begin with. Where I used to do that, instead I eat an orange or an apple. This way, I get natural sugar and nutrition, to boot. Carbohydrates are the real culprit. They raise blood glucose levels. That means a big plate of spaghetti is no longer an option. Neither are many breads, particularly those made with bleached flour. Rice, potatoes, corn and other starchy foods should be kept to a minimum. Instead of eating a plate full of mashed potatoes, I eat less than a quarter. We need good carbs at each meal. Some say to curb fruit and bean consumption because of it, but my first doctor told me I could eat all the fruits and vegetables I want. Beans, too. Eating a diet in carbohydrate-rich foods with low glycemic indices like fruits, beans and oatmeal may reduce the odds of someone getting diabetes. This also has the added benefit of increasing your vitamin, mineral and fiber intake. Protein is very important with each meal. Now, every time I go to the grocery store, I carefully examine the nutritional facts for fat, cholesterol, sugar and sodium content. It's a pain, yes, because many of the things I would like to eat are somewhat suspect. Once in a while, I'll treat myself.

Not all diabetics are on insulin. I'm not. I take a pill. Type 2, or adult onset, means that your pancreas isn't producing as much insulin as it should to properly process sugar in your body. That's where energy comes from. It could also mean that your organs aren't doing the job with the insulin, too. It might be a combination of the two. In type 1 diabetics, the pancreas produces no insulin and the only way to get it is through injections. Ironically, type 2 can eventually turn into type 1 as the pancreas stops producing altogether, but never the other way around. That is the fate a lot of diabetics face and it's not because you're not taking care of yourself, it's just the nature of the disease. It is progressive.

Exercise is of the utmost importance. If you remain a couch potato, your heart, kidneys, liver, eyes and nervous system will begin to fail. I try to park far away from a store so I am forced to walk a greater distance. Every little bit helps.

You don't have to be obese to be a diabetic. I'm certainly not and never was. As a matter of fact, I lost a lot of weight because of it. The most I've ever weighed was 205. I settled in at around 185 for many years. The other morning, I weighed myself. 158. All my friends are really noticing it now. I don't want to lose any more!

Diabetes is brought on by many factors. It could be from a poor diet, especially what's in processed foods today. New York City recently passed a law banning trans fats in all restaurants. Now I know why. You want to increase your chances of getting it? Keep eating those Twinkies. If you ever have felt that smooth grease on the roof of your mouth while eating something tasty, that's the trans fats in action. Remember, trans fats have a higher melting temperature than your body. That means every time you eat something containing it, it solidifies in your system and starts to go to work clogging your arteries and doing other nasty deeds. Long ago, the government gave hydrogenated and partially hydrogenated oils the green light, assuming it was a healthy alternative to the saturated animal fats in other products, like butter. They were wrong. Avoid trans fats at all costs! Studies have shown that vegetarians have a much lower risk of getting diabetes type 2. Lack of exercise will also contribute to greater risks of getting sick. I can attest to that. Remember that genetics play a giant role in acquiring diabetes. If someone in your family has it, there's a good chance you will, too, especially if you don't take care of yourself. Age also increases the risk. People over 45 are more susceptible and the odds go up every year. American Indians, Hispanics and African-Americans are more prone to develope type 2. Everyone should get checked for high blood pressure and blood fats as they age.

Quit smoking! That is something that's weighing heavily on my mind. With every puff, I'm increasing my risks of having heart attacks and strokes. Smokers are more likely to become diabetic than are non-smokers. Alcohol is bad. For healthy people, moderate drinking lowers blood sugar and improves glucose tolerance. There are alcohols diabetics should avoid, like beer and liqueurs. Anything with carbs and sugar. Diabetics who drink are at a much higher risk for eye and nerve damage in the form of neuropathy. No more than 2 drinks a day, if any at all.

Here are some nutritional supplements to take if you have diabetes:

•Alpha lipoic acid

•Chromium

•Evening primrose oil

•Magnesium

•Cinnamon

Always check with your primary care physician before you take any additional supplements. For one thing, there is a chance that something might interfere with other medications. I will continue to study this disease and report anything I find of interest, that I think is truly of benefit. I will not ever write something that could be questionable. I don't care what some of those quacks out there are spewing, there is no cure. It is a lot more controllable if diabetics take very good care of themselves.

A DIABETIC DIARY, Part Six

If you have followed my diabetes posts, you know I am now on 3 prescription medications:

GLIPIZIDE (Glucotrol) for diabetes

LISINOPRIL (Zestril, Prinivil) for blood pressure and, mainly, to protect my kidneys from disease

LOVASTATIN (Mevacor) to lower cholesterol and triglycerides

There are some rather interesting side effects associated with these drugs. If I forget what I'm writing or wander off somewhere, I might not remember why or when I did it. If I get cranky or START YELLING AT YOU, it means I now hate everyone and I want to run you off the road. To keep it simple, these drugs also have overlapping effects, but I will only list them once. Some, I have already experienced. I'm not going to tell you which ones, though, and if you ask, I might break into tears.

• Consipation or stomach pain
• Diarrhea (are these top two just so they can cover their butts?)
• Muscle pain and tenderness
• Weakness (duh... the diabetes made me feel that way)
• Severe fatigue
• Fever
• Yellowing eyes and urine
• Dark urine
• Persistent nausea
• Dizziness
• Headache
• Lightheadedness
• Dry cough
• Blurred vision (again, the disease has alredy caused that)
• Sore throat
• Fainting
• Decreased sexual ability (I don't want to talk about it)
• Rash, itching, swelling
• Trouble breathing
• Vomiting
• Loss of appetite (I wish)
• Easy bleeding or bruising
• Unusual or sudden weight gain (I wish)
• Hypoglycemia (low blood sugar)
• Confusion
• Mental/mood changes
• Chest pain
• Uneven heartbeats
• And, in very rare cases - suicide

In each case, there is a statement that says, "Remember that your doctor has prescribed this medication because the benefit to you is greater than the risk of side effects." I'm trying to explore macrobiotic options. One of the most important thiNs abot tHs florBl gogN roofn jmpofflin gor

A DIABETIC DIARY, Part Five

Last Thursday, I went to Quest Diagnotics to have blood drawn for a lipid panel and a serum glucose test. I also peed in a cup for a microalbumin/creatine ratio. Last night, I went to Shepherd's Hope for my final visit to receive the results of those tests.

For the past month or so I have made a concerted effort to alter my diet. For breakfast, I generally eat a veggie burger, an apple and a banana. The burger is not consumed as a substitute for meat. It is a source of protein, which diabetics must have at every meal, and it is easily heated up in a microwave oven. Very convenient. For lunch, I eat a mixed greens salad with fake lobster for protein. Fake crab is often referred to as "krab." I wonder what artificial lobster should be called? Lovster? I am a little more lax around dinner time, but I try not to venture outside of my dietetic parameters. I have been on Glipizide for a month now. I started to take chromium picolinate and magnesium. Of course, I'm taking Lisinopril for blood pressure to protect my kidneys. My blood glucose levels have fallen dramatically. Where I used to range from over 200-400 per day, my levels generally range between around 100-150. That is a very good thing. Remember, normal is 65-99. Interestingly, and in spite of my change in eating habits, my triglicerides went from 190 to 222 from my previous test a month or so ago. Normal is 150 or less. My total cholesterol remained about the same, 213 to 216. It should be less than 200. My HDL (good) cholesterol dropped from 41 to 37. My LDL (bad) remained about the same at 135. The normal number should be less than 130, but for diabetics, it should be below 100. The urine test was done to determine the shape of my liver. No problems there. Less than 30 is the ideal. Mine is 16. The serum glucose test is the same as what I take twice daily when I prick my finger. The first test was 182. Thursday it was 143. That is the fasting number and it must come down.

One thing I have noticed of importance is the way I feel. My strength is returning. Where, on most days I felt achy and weak, I am now the other way around. I'm not ever quite 100%, but clearly a whole lot better.

On my last visit to the clinic, I had the cold and abrupt Dr. Chan who insisted I didn't need Lisinopril. This time, I asked the attending nurse if I could see a different doctor because of what my pharmacist told me about the benefits of that drug in diabetes and that Dr. Chan would not write a new prescription. I got to see Dr. Velez.

Dr. Velez, it turns out, happens to be a diabetic. I found this out incidentally. I mentioned the Lisinopril and what Dr. Chan had told me. That's not really true, he said. I told him that my mother is diabetic and when she went to see her endocrinologist last week, she took my first test results with her. I wrote down the drugs and supplements I was taking. The drugs were fine and the chromium may help reduce sugar a few percentage points, he told her. Dr. Velez asked me who her endocrinologist is and I told him. "He's my doctor, too!" he responded.

Dr. Velez is a very kind and caring doctor. He is also aware of the benefits of chromium picolinate and magnesium. I asked him if they were absolutely safe to take and he responded positively. I asked him about cinnamon and he said he had never heard about that one. I told him my father's doctor told him it was good for the disease. Well, you can't expect every doctor to know everything about every drug and supplement, but I'm sure he'll look into it. I asked him if I would need to go on a cholesterol medication. Yup. No doubt about it. Mevacor 40mg. Knowing that this would be my final visit there and I would, henceforth, have to fend for myself, he wrote me 3 prescriptions, all for 90 day supplies. Through this clinic, for 90 days, I will save a lot of money on the Mevacor. It will cost me $7 per month for the first three months at the Central Florida Pharmacy Co-op. I checked with my pharmacy and their price is $65 for a 30 day supply. Big difference. $21 as opposed to $195. He also scheduled me for more tests to be done in April at the clinic's expense. This will also save me a tremendous amount of money and will include a Comprehensive Metabolic Panel, a Lipid Panel and a Hemoglobin A1C test. By then, I will have already established myself with a primary care physician who would make me take those same tests at my expense.

I really want to thank the dedicated volunteers at Shepherd's Hope for all they have done for me and the many others without health insurance. If not for them, where would I be today? I especially want to thank the doctor I spoke with last night, Dr. Carlos Velez-Munich, who would be my primary care physician if I had health insurance or could otherwise afford all that diabetes entails. He is a very good man.

If you have it in your heart, please contribute to Shepherd's Hope or any type of similar clinic that is there to help those in need who might not be able to afford quality care. They are out there. All I did was Google "free orlando clinics" and up it popped.

A DIABETIC DIARY, Part Four

Here is my brand new prized possession. It was my Christmas present to myself, thanks to the generosity of my siblings. It will be my friend for the rest of my life. Or whichever wears out first. Every morning, I will test my blood after a night of fasting, assuming that my last meal was eaten early in the evening. Then, I will test it again, just before I retire for the night. I have been using my mother's kit for the last month and a half. Those test strips run a buck a piece, so that's been $2 a day. Fortunately, Medicare pays for it, but I could not justify continuously using hers. One day, she would have to run out and that wouldn't be a good thing. Plus, when I am up for taking a trip somewhere, I would still have to test myself wherever I am.

I have been keeping a log of my blood glucose levels for the last 2 weeks. This is something I will have to do for the rest of my life, too. On Glipizide, my numbers have come down, although not to normal levels. Last Friday, I began taking 400mg of chromium picolinate (1)(2)(3)(4), an over the counter nutritional supplement. Since I began taking it, my numbers have come down, but I have no idea if it is strictly attributable to that. I will have to monitor my counts for a considerable length of time to make that determination and there is nothing scientific about it since my diet will vary from day to day. Anyone who considers it should talk to their physician first. Of course, I didn't, but I will when I go to my final visit at Shepherd's Hope clinic. Who knows, I may be told to stop taking it. In the meantime, life goes on and I have pretty much adjusted to my diabetes since the initial shock and denial has finally worn off.

A DIABETIC DIARY, Part Three

I just got back from one of my walks. I cannot stress enough the importance of daily exercise. Diabetes is such a debilitating disease. It begins to consume you. God knows how long I've had it. Certainly, it’s been a lot longer than when it was officially diagnosed last week and there’s no test to determine when it stealthily crept into my life. There are many out there who have no clue what may be lurking under the surface.

This morning, my arms were tingly from my elbows to the tips of my pinkies, all along the lower part. From my knees to my toes, I go from numb to exaggerated bouts of the same thing. Today is no exception. I've felt that way all morning and when I walked, my legs felt like they were made of lead. Sometimes, my toes feel like someone hooked up jumper cables and turned the juice on in quick, stabbing pulses. Then, it goes away. There isn't a day that goes by when I don't feel achy and fatigued. Some days, I have no energy at all. Today, I actually feel better than usual in spite of the numbness. One way to explain the ache is to try to imagine someone taking a knife and scraping the meat off your bones. Perhaps, that description is a little too harsh and I never really feel that bad, but it gives you an idea. At times, my heart pumps so strongly, it feels like it is going to explode out of my body.

Since I began taking the medication, my sugar has slowly dropped. I keep waiting for a small miracle to happen, that I will gain my strength again. I'm sure I will. Little things bother me. Lids on jars that, in the past, were so easy to remove are proving more difficult. Frustrating little things that gnaw at your very fiber. Sugar levels that ran in the 200-400 range are now down to 100-170. 170 is still too high, but it is an improvement. Last night, it was 136. This morning, it was 154. The closer in margin, the better. Saturday night, it was 276 and I have no idea why. That morning, it was 160. I don't think I ate anything wrong. Other diabetics have told me that's one of the strange things about it, that there's no rhyme or reason why your numbers can vary so much. You can eat something one day and repeat it the next and your numbers can be strikingly different.

Every night now, I have to get up about a half dozen times to relieve myself. That's a symptom. Of course, I drink lots of water now. I have to. Life as a diabetic must take on a very regimented structure. I should strive to eat at the same times every day, in spite of the fact that I am always hungry and sometimes nauseous. I should consume the same amount of calories per meal, per day, too. Food groups must be balanced, such as protein at every meal, especially in the morning. Proper sleep is of the utmost importance. Getting up to pee every hour is exasperating and disturbs the natural rhythm of the mind and body.

I can't take aspirin or ibuprofen any more, on account of the Glipizide. One of the warnings is to not take any over-the-counter pain medications without talking to your doctor. Instead, I asked the pharmacist if I could take Tylenol. Yes, you can. I think they know more about drugs, anyway. I also told her what Dr. Chang said about Lisinopril not helping the kidneys. She asked me if he knew what he was talking about. She told me to finish taking it and to demand a refill when I go back again. I said I don't go back for another month and I only have a 2 week supply. Take it every other day, she said. I don't know, maybe Dr. Chang has been in practice too long. Everyone else at Shepherd's Hope has been great, but he was not kind to me. The doctors and nurses there, and most of the other staff donate one night per month from their regular jobs. I don't think pharmacists would contradict a doctor unless they are pretty adamant about it. I started taking it the next day. Soon, I will have a primary care physician. That person will keep close tabs on me and will more than likely set me up with an endocrinologist, who will make sure I am put on the proper path. All diabetics react differently. All need special care.

When I was dealt this hand, it took me a while to adjust to altering my "set in his ways" lifestyle. I always played by my rules. No one ever wants to think they will get permanently sick. Where did I go wrong in life? What could I have done differently? Believe me, those are dumb questions and there is no truth to them. What is true is that I am sitting across the table from diabetes. I will play my cards right. I will keep a close watch on my opponent. I may not always win, but I will never fold. I will not be intimidated. So it must be true with any disease or disability. It's the game of life you're playing and you never let the one sitting across from you get the upper hand.

A DIABETIC DIARY, Part Two

Tuesday night, I went to the clinic for my blood test results and an official diagnosis on the diabetes. Gulp. I was not looking forward to the inevitable bad news. I sat patiently in one of those "holding" rooms the nurse stuffs you in to wait for the doctor. Why does it seem to last for hours before their grand entrance?

"Hello. I am Dr. Chan." That was as friendly as he got. He had the bedside manner of a Gestapo agent. Oh well, perhaps his manner was correct, given the somber news he was about to tell me. He scanned over the report and circled the (Comprehensive Metabolic Panel w/EGFR) glucose number. It was 182. That is the fasting number and 65-99 is what to aim for. He went to the second page and circled the Hemoglobin A1C number. Less than 6 is ideal. Mine is 8.0.

"You are a diabetic." He proceeded to give me strong directives. "You can eat all the fruits and vegetables you want. Do not eat coconut. No butter. Only poly and mono-unsaturated oil. NO SUGAR! Eat more fish. Avoid shellfish. Shrimp. Lobster. Cut all fat off beef. No chicken skin. Drink lots of water."

"What about cheese?"

"Follow this order," he said sternly. "Zero, zero, zero. That means you only eat things with 0% saturated fat, 0% trans fat and 0% cholesterol. Two egg yolks a week only. EXERCISE, EXERCISE, EXERCISE!!! You must eat 3 meals a day. You may have small snack in between." Protein is essential at each meal.

"What about salt?" I never put salt on anything, anyway.

"You don't worry about salt. Why you take Lisinopril?" Lisinopril is a BP med, an ACE inhibitor. "You don't need."

"Kelly, the Physician's Assistant wrote me the prescription two weeks ago when I was here. She told me it was to protect my kidneys from damage. She..."

"It does not help your kidneys. You don't need it."

"What should I do? Should I finish or stop taking it?"

"I don't care. You do what you want."

"But... but?"

"I don't care. You do what you want."

"She also told me I will have to go on a cholesterol drug."

"You may. We see when you come back. OK. Sit on table." He listened to my chest and heart. "We do another blood test. You wait here for nurse." And off he went. She came in a few minutes later and asked how things went.

"Well, he certainly laid it on the line. No messing around with Dr. Chan."

"Nope." She handed me the diagnostic test request for lipids and glucose. Oh, I have to pee when I go. He wants that, too. She gave me a prescription for Glucotrol. Typical doctor handwriting. I have no clue how pharmacists decipher that chicken scratch. Minus the skin, of course. I went across the hall to make an appointment a month from now for those results. It will be up to me to schedule the lab work. They only need a 24-48 hour turnover time. That will be my final visit to this clinic. I will need to find another doctor. For the rest of my life, I will need to take this medicine (or, eventually, insulin), test my sugar twice daily and have the A1C test done every 3 months. The test strips run about a buck apiece. This is not going to be a cheap disease, especially without insurance.

My platelet count is down. The normal range is 140-400. Mine is 102. He wasn't too concerned about that. He talked about my cholesterol level. The ideal number is below 200. Mine is 213. HDL (the good kind) is 41. That's good. LDL (the bad stuff) is 134. Not good. It's supposed to be less than 130. My triglycerides are high. 190. Less than 150 is best. My bilirubin is high. That's got something to do with the liver. Other than that, I checked out pretty good.

Last week, I was IMing with by best and oldest friend. He said it was from all those beers and pizza. Cheap women, too. I told him I haven't had a beer in a long time. Up until today, it was Bacardi & (DIET!) Coke. I typed in that it was from all those years working at the Weiner King, eating all those hot dogs, hamburgers and french fries. Who would think back then that all that junk would take its toll? How was I to know my mother and her sister would get it and be insulin-dependent? That's something we don't think about when we're young. We're going to live forever and never get old. I said it's also from all the trans fat that's in everything today, something food manufacturers have known will kill you for years.

This morning, I popped my first pill. I chose a generic brand because it's a lot cheaper. Glipizide ER 2.5mg. It is an anti-diabetic drug (sulfonylurea-type) used to control high blood sugar in patients with type 2 diabetes. It's meant to stimulate the release of natural insulin. With a proper diet and exercise, hopefully it will work. It's supposed to help prevent heart disease, strokes, kidney disease, blindness, and circulation problems, as well as sexual function problems (impotence). I'm waiting.

I would like to thank my family and friends for all the support they have given me. I also want to thank David W. Boles at Urban Semiotic and his dedicated legion of loyal readers and contributors, like Chris and Nicola. I especially want to thank fred for being such a caring person. He has helped me a lot by proffering some much needed advice. Many of the comments can be read here and here.

A DIABETIC DIARY, Part One

This is going to be a series of posts about my experiences with diabetes, at least, until I get it under control. It allows me to vent, but primarily, it is about educating people. There are millions out there who have Type II and don't know it. Hopefully, some will gain knowledge about themselves or someone they know and take the necessary steps to catch it before too much damage is done. Before you go on, please read my first post, titled I Never Liked Needles.

"Diabetes is not a disease!"

"Is it contagious?"

The first statement came arrogantly from a friend of mine who thinks I made it up. To him, I was probably trying to elicit sympathy from friends as I sipped on a Bacardi & Diet Coke, my new drink. I knew my days of bellying up to the bar with buddies were coming to an end. His statement was cynical, at best, and, quite obviously, he knows nothing about it. The second question was from an innocent bystander who stepped back upon my pronouncement. Yes - it is a disease and - no - it is not contagious. What I can tell you is that it is often hereditary. My mother has been diabetic for almost 20 years and takes insulin daily. Her older sister is, too. My father has onset. He takes an oral medication. I have researched it over the years because of my mother.

I have no health insurance. My mother tried to get me in to see her primary care physician for blood work and a proper diagnosis. She tried to make an appointment with her endocrinologist, who would not see me without a physician's referral. This was all going to be very expensive. To just peer through the door was going to cost me hundreds of dollars per office visit and a whole lot more for the blood tests. This is money I don't have readily available. I knew I had to do something. I went to a search engine and typed in these four words, "free medical clinics orlando" and came back with a very promising hit, Shepherd's Hope. I went to the website and called the number to explain my predicament. "Yes, we can help you," the woman at the other end told me. They only see those with no insurance.

I had been feeling rundown for some time, at about 93 percent, before that fateful morning I took my first glucose test. I showed many of the signs and symptoms, but was never willing to acknowledge why I was feeling so achy and fatigued. It's not unusual to have this state of denial. I lost 25 lbs in a 6 month period, but I had tried to lose weight anyway. For the next 2 weeks, I took this sugar test morning and night and ran anywhere from 200-370. Not good numbers, and it didn't take a doctor to figure out what my condition was. In the meantime, I've changed my diet and have started to exercise. Some days, I am too weak to. Today, I feel better. Soon, I will take a nice, brisk walk.

When I got to Shepherd's Hope, there were a handful of people waiting for it to open at 6PM. The staff are all volunteers there to help those who can't afford medical attention otherwise. Depending on location, the clinic may only be open one day a week. A woman came out and assigned us all numbers. Some had appointments. We were to write our names and what kind of problem we have. I put down diabetes. When my name was called, the first thing I was asked about was what made me think I had it. I explained. Then, I went into a private room and waited for a doctor. I guess most of the people who go to free clinics are there for the flu or other simple, treatable maladies. Diabetes? I'll bet I was the first one to do that. She knocked. "Come in," I said, "like, I was going to tell you to stay out?" She laughed.

We discussed everything about it. She asked me plenty of questions and I gave her plenty of answers. Do I feel numb here? Tingly there? I told her about the sharp pains I've been getting in my toes, a sign of neuropathy. Mostly, she talked of fatigue. She asked me, if I could, what I would pick my overall average blood sugar level to be during the period of my testing. I guessed around 225. The normal range is around 100 or below, give or take a few. I was well above that mark. She got her stethoscope out and listened to me. "Have you ever had pains here?" she asked, as she pointed to my chest. I had. She said nothing more.

"OK, I cannot tell you that you are, absolutely, diabetic. I am setting you up for some blood work and I can't properly say that until the results come in. I will say that we both know you are and I am going to start you right away on a blood pressure medication, not that it's too high right now, but borderline, yes. Diabetes will bring about all sorts of complications, such as strokes and heart attacks. This is to mostly protect your kidneys from damage. The previous generation of diabetics didn't get this and other drugs you're going to get. Once properly diagnosed, you will also go on cholesterol meds, on top of what your disease is treated with, and regardless of what your cholesterol level is." She wrote a prescription for Lisinopril, an ACE inhibitor. "We have [all donated] new drugs here I could prescribe free, but they are $100 a pop. If we run out, can you afford to stay on them?" No, I can't.

My mother has had a series of mini-strokes. Her kidneys are damaged. I asked her if she had taken any blood pressure meds when she was first diagnosed. She hadn't. This doctor (or Physician's Assistant) knows what she is talking about. I think you can call it preventive maintenance. She was very good, very caring and professional in appearance and demeanor. The next morning, I went to Quest Diagnostics where they drew lots of vials of blood for all kinds of tests, including A1C, which monitors sugar for the 2-3 previous months. I have an appointment with Shepherd's Hope on December 12 to find out the results. I will probably be given prescriptions then to get me on the right path. I will have to find a physician after that. The clinic is not there for continuous care. Right now, I'll take it one step at a time.

I have often read about the benefits of cinnamon in lowering blood sugar levels. My sister-in-law, Lindsay, bought me pills, along with dandelion root tea. So far, they haven't helped. I've always been a firm believer in alternative medicines, and I've been looking at other magic herbs, elixirs and anything else associated with "curing" diabetes. Online, I found out about the remarkable benefits of apple cider vinegar, which, at the same time, will eliminate warts. I read about chromium, the magic of bee pollen, how cranberries help and how just about every natural substance known to man will rid you of this dreadful disease. Cancer, too, probably. I wonder, if I switch to eating nothing but a combination of all of these wonderful things, will I be cured? I think, I'll stick with the conventional for now. Take that, Kevin Trudeau, you huckster, you.

This morning, my siblings told me the best Christmas present I could give them was no present at all, to take what I would have spent on them and apply it towards the medications I will need. They want to see me stick around for a long, long time. Their presents to me will be in the form of money, too. I protested to no avail, but they insisted.

Family, you gotta love them. I feel better already.

Please feel free to ask me any questions. If I don't know, I will do my best to find the answers.