The Saturday Share #11

Did you know that health topics are the number one internet search item, outstripping even porn? Uh… pardon the Freudian slip there...

So to do my part in trying to keep internet health information correct I’ve been two-timing my blog by writing over at Sharecare were I am one of their “Experts” answering diabetes questions posted by readers.

I’m having a blast, and I’ve decided that every week I’m going to share one of my favorite questions with you here.


Sharecare Question: What does Sliding scale refers to in context of insulin?


My “Expert” answer: A sliding scale is a slightly old fashioned (but functional) approach to fixing high blood sugars. The scale has two columns, the first shows ranges of blood sugar; and the second shows units of insulin. So for instance—and I just pulled these numbers out of thin air so for Peat’s sake, don’t use them—the scale might look like this:

• For blood sugar of 151 to 200 take 2 units of insulin
• For blood sugar of 201 to 250 take 3 units of insulin
• For blood sugar of 251 to 300 take 4 units of insulin

It’s called a sliding scale because as the blood sugar numbers increase, so too do the units of insulin. The amount of insulin you need is variable—it slides—depending on your blood sugar.

Everyone needs a different, personalized scale that takes into account both their insulin sensitivity and insulin resistance. The bigger problem with sliding scale is that it is trying to close the gate after the horse has gotten out of the barn and the barn has burnt to the ground. It is a reactive therapy, trying to fix problems after they happen. More modern approaches focus on trying to calculate insulin needs beforehand. Key to this modern approach is “carb counting,” a method of estimating the blood sugar impact of a meal proactively and taking insulin to cover the meal before the first bite.

You can check out other Expert’s answers to this question, and my answers to many more questions by going here:

http://www.sharecare.com/user/william-lee-dubois

Then select the “Answers” tab near the top left.

The Saturday Share #10

Did you know that health topics are the number one internet search item, outstripping even porn? Uh… pardon the Freudian slip there...

So to do my part in trying to keep internet health information correct I’ve been two-timing my blog by writing over at Sharecare were I am one of their “Experts” answering diabetes questions posted by readers.

I’m having a blast, and I’ve decided that every week I’m going to share one of my favorite questions with you here.


Sharecare Question: Where on my body can I do the diabetes test?


My “Expert” answer: Many meters are FDA approved for “alternate site” testing, commonly on the forearm. The idea is that this type of testing is less painful than lancing fingertips.

However, they are not approved by yours truly. :-(

And to explain why, we have to talk about cops. It used to be that when police cadets were trained to use their guns they lined up in a nice neat row, standing straight and tall, drew their pistols, and fired at paper targets. They were taught to “pocket” their expended cartridges when reloading to keep the shooting range nice and neat.

Or at least that’s how they were trained up until a notorious shootout about three decades ago when an armed felon gunned down four cops. One of the deceased was found with empty shells in his pocket. In a life and death shoot out he seemly took time to put his expended cartridges in his pocket; a delay that may well have cost him his life.

In the aftermath of the incident, studies of how people react under stress were undertaken in earnest. It turns out that when the you-know-what hits the fan people fall back on their training and habits. Even when they should know better.

Now, strange bit of blood sugar trivia. The blood in the tips of your fingers carries the most accurate and up-to-date information. Blood sugar in your forearm is old news, sometimes as much as 20 minutes out-of-date. If you use alternate sites to test your blood sugar, you are getting old news. Much of the time this does not matter.

Unless your blood sugar is dropping quickly, which can possibly be life threatening. The folks that make the meters will warn you not to test on your arm if you suspect you are dropping, but guess what? Under stress, with dropping blood sugar (which tends to make us less mentally sharp anyway), what do you think you are going to do? Yep.

You’ll resort to your training. Your ingrained habits. My feeling is, don’t get into bad habits under sunny skies and you won’t resort to them in stormy weather. You don’t want to be putting shell casings in your pocket when a low blood sugar is gunning for you.

You can check out other Expert’s answers to this question, and my answers to many more questions by going here:

http://www.sharecare.com/user/william-lee-dubois

Then select the “Answers” tab near the top left.

The Saturday Share #9

Did you know that health topics are the number one internet search item, outstripping even porn? Uh… pardon the Freudian slip there...

So to do my part in trying to keep internet health information correct I’ve been two-timing my blog by writing over at Sharecare were I am one of their “Experts” answering diabetes questions posted by readers.

I’m having a blast, and I’ve decided that every week I’m going to share one of my favorite questions with you here.


Sharecare Question: Why is my A1C high when my blood glucose levels are in my target range?


My “Expert” answer: I want you to picture a freshly fried doughnut hole, just out of the deep fryer. Steam wafts from its surface. Still gleaming wet with oil, it’s sent spinning across a tray of powdered sugar. As it tumbles, sugar sticks to the wet oil, coating it, covering it as it rolls and bounces along.

Well, the same thing happens to your red blood cells. As they tumble and spin and roll through your blood vessels, sugar molecules stick to their skins. Or another way to think of it is to picture a windshield of a truck after driving through a swarm of mosquitoes. Splat-Splat-Splat-Splat-Splat! (OK, I just threw that in so you wouldn’t log off and drive straight to Dunkin Doughnuts.)

So an A1C test is a measure of how much of the skins of your red blood cells are splattered with sugar, which in turn gives as a picture of the blood sugar environment in which the cells lived, which in turn gives us a notion of your average blood sugar over the last several months.

So the A1C test looks at average blood sugar, while your fingersticks look at moments in time. The most common cause of a difference between A1C and fingersticks is that the fingersticks are not frequent enough, or are not at the right times to catch the elevated blood sugars that are jacking your A1C to higher levels.

For instance, if you are only testing in the morning, you are missing possible elevations after meals or overnight while you are sleeping. The A1C test is not perfect. For instance, if your sugar was ranging scary low to scary high you might get a number that looked pretty good. That said, most “false reads” are good looking numbers that mask troublesome variability. Additionally, if you are anemic, you can also get a false low, as your blood cells don’t last as long as typical.

But if your A1C is high, there are some high blood sugars lurking somewhere. And that is exactly why we do both fingerstick testing a A1Cs. They serve as checks and balances against each other.

You can check out other Expert’s answers to this question, and my answers to many more questions by going here:

http://www.sharecare.com/user/william-lee-dubois

Then select the “Answers” tab near the top left.

To-do list

Using my sexy new Fisher Space Pen (with medical caduceus laser engraved into the barrel) I was able to scratch another of the WHO’s top ten off my list. A bold black line through the word “Italy.”

Taming the Tiger: Your first year with Diabetes was translated into Spanish in 2009.

A German language version is in the works.

Now I’ve hooked up with a translator for Italian. Hoo-raw!

Next on the hit list:

Hindi, the Official language of India. Maybe I need Bengali too?

Japanese.

Chinese.

Russian.

Come on people. I’ll bet I’ve got readers who can speak and write all of these languages. Don’t be shy.

Don’t force me to buy the following classified ad:

Wanted: Diabetics or Persons with Diabetes fluent in Hindi, Japanese, Chinese, Russian, or any other language on the planet for diabetes education translation project. No pay. Lots of glory. Satisfaction of doing the right thing for your fellow humans. Great working environment (your home). Short job, only 6,000 words. Word-for-word translation not needed, I’m seeking people who can translate spirit and intent. Contact Wil at LifeAfterDx. Sorry, the English, Spanish, German, and Italian positions have already been filled.

The Saturday Share #8

Did you know that health topics are the number one internet search item, outstripping even porn? Uh… pardon the Freudian slip there...

So to do my part in trying to keep internet health information correct I’ve been two-timing my blog by writing over at Sharecare were I am one of their “Experts” answering diabetes questions posted by readers.

I’m having a blast, and I’ve decided that every week I’m going to share one of my favorite questions with you here.


Sharecare Question: I have diabetes, should I be concerned about a small red foot blister?


My “Expert” answer: Absofreakinlutely. Not to scare you, but we D-folk account for over half of the amputations in the US, all of which start with something simple like a blister.

For what it’s worth, that’s around 90,000 amputations every year, a popular club, but not one you want to join.

For a whole host of reasons, those of us with diabetes heal more slowly than other people, and we are also a risk from suffering from reduced sensation in our feet. That’s important because it means you might injure the bottom of your foot and not even know it.

But the great news is that you are aware of your blister. That tells me you are paying attention. Taking care of any foot injury early on is the key to keeping your toes, feet, and legs attached to your body until you die at the age of 114 after being hit by a FedEx truck while out for your early morning jog.

Two tips for everyone: buy slippers. Yeah, I know, I know. It is a hard habit to get into, but you should never be wandering around barefoot. Keep slippers by your bed so if you get up at night to answer a call of nature you don’t step on something sharp the cat drug in or stub your toe on a wall in the dark. (I’ve been preaching this to my patients for years but had to break a toe twice to actually start doing it myself.)

Second tip: kiss your feet goodnight every night. That simply means stop, look, and feel. Check in with your feet as you slip under the covers. Make sure everything is A-OK. No cuts. No splinters. No blisters. No odd color. If you have a hard time seeing the bottoms of your feet, get a hand mirror.

You can check out other Expert’s answers to this question, and my answers to many more questions by going here:

http://www.sharecare.com/user/william-lee-dubois

Then select the “Answers” tab near the top left.

The Saturday Share #7

Did you know that health topics are the number one internet search item, outstripping even porn? Uh… pardon the Freudian slip there...

So to do my part in trying to keep internet health information correct I’ve been two-timing my blog by writing over at Sharecare were I am one of their “Experts” answering diabetes questions posted by readers.

I’m having a blast, and I’ve decided that every week I’m going to share one of my favorite questions with you here.


Sharecare Question: Can I take OTC drugs instead of levothyroxine as I cannot afford it?


My “Expert” answer: Yikes! Breaks my heart when I hear stories like this, but I have good news, levothyroxine is a generic thyroid hormone replacement medication, and as such, is on the $4 list at Wal-Mart. Surely you can swing $4 a month? That’s cheaper than most OTC meds, after all.

Your thyroid med is not optional. If your doc prescribed this medication, you are hypothyroid, and that funky little organ in your neck is under producing the chemicals that drive your metabolism for the whole day. Without your pills at best you’ll be dragging through the day, and at worst will fall asleep at the wheel driving.

Oh, and be sure to take it in the morning with a nice glass of water quite a bit before you eat, and without any other pills. Like a spoiled toddler, levothyroxine does not play nice with others.

But there are lots of other needed meds for which there are no generic alternatives, and at first glance that may seem pretty hopeless, so I want to spend a quick moment on that. Some frontline drugs can be $200, $300, $400 a month or more.

If you have no health insurance, or if you are in Medicare Part D’s “doughnut hole” you will probably qualify for Patient Assistance. The big pharma companies all give hundreds of thousands of dollars of drugs away every month. Check the website of the medication you need, or contact your local community health center. In addition to Patient Assistance, many Federally Qualified Health Centers have what are called 340B pharmacies. The 340B is a non-profit cash only pharmacy that sells meds at the price the Veteran’s Administration pays, plus a very small administrative fee.

The prices can range from fair to amazing, sometimes literally pennies on the dollar.

You can check out other Expert’s answers to this question, and my answers to many more questions by going here:

http://www.sharecare.com/user/william-lee-dubois

Then select the “Answers” tab near the top left.

Another year, another copyright

© 2011 William “Lee” Dubois