Ending my sweet life the second part

Dear Bloggers,

I was asked a couple of times by fellow blog writers to make a part two on my sweet life is ending. It took me a while to produce a sequel on this story. I am now pretty experienced if it comes to my own case.. In the beginning it scared the hell out of me. And yes I probably will not get very old but that doesn’t bather me. I have it pretty much under control and my life is full of imperfections but I am not much of a cry baby and sit in a corner whining. I have a future to live for and I hope one day to play with my grandchildren. Both my my wife and me have health issues and climbing stairs is getting us into trouble. We decided to put our family home on the market and look for something with everything on ground level. My next move after this one will be in a wooden coffin. Let us hope that we have a couple of great years left with the kids at home and if they fly out that they come and see us frequently with their kids.

Hard reality

Once you know the facts, it is hard not to care about diabetes. In the Netherlands alone, 1 million people have diabetes. Approximately 71000 Dutch are diagnosed each year, and a third of all the people with diabetes are unaware they have it. WHO (World Health Organization) has declared that there is an epidemic of diabetes. Worldwide, there are 200 million diabetes patients, not including those who still do not know that they have it. In the next decade, the projected number of known diabetics is expected to reach over 250 million. Because of the small amount of attention that has been paid to the disease despite these alarming numbers, the rise in diabetes has often been called the “Silent Epidemic”. A possible cause for this epidemic has been attributed to changes in modern lifestyle:

• The type of food consumed contains higher numbers of calories and purified sugars;
• The typical meal size has increased; • People are not exercising adequately;
• Higher stress levels, and;
 • An increase in the elderly population.

What exactly is diabetes? There are several definitions of diabetes, but the most commonly agreed upon definition is that diabetes is a condition when a person's ability to metabolize carbohydrates (sugar) is impaired. Basically, blood sugar does not get burned inside the muscles and tissues, but rather stays in the blood. This results in high blood sugar levels. A person with a sugar level above 150 ml/dl in the blood in the morning is diagnosed as ‘diabetic'. Insulin allows the body to convert sugar in the blood into energy. It is secreted by ß (beta) cells in the pancreas. So, in a diabetic, either no insulin or inadequate levels of insulin are being produced. Furthermore, even if insulin is produced in a diabetic, it is highly unlikely that it will be properly utilized.

How can having high blood glucose affect me?
Diabetes is much more than just a relative lack of insulin. In one sense, it is a disease that affects the blood vessels, or capillaries. A high concentration of sugar in the blood from relative lack or sensitivity of insulin is still not completely understood. However, it has detrimental effects on the blood vessels and they gradually cease to function properly. Since every organ or tissue in the body depends upon capillary flow to transmit oxygen and glucose and remove waste products, this eventually leads to end-organ damage. Yes in the end we are all going to die.

 Diabetes can make your vision blurred

As every cell is dependant to a large degree on glucose for its fuel, any impairment in its supply or being able to properly metabolize that glucose will lead to impairment in the function of those cells and organs. Consequently, the tissues that have the highest demand for proper blood flow and utilization are most susceptible to the damage of impaired flow or metabolism, e.g., the kidneys, heart, nerves, retina. A lack of blood flow and oxygen to the tissues can also result in many infections, and often the only treatment left is amputation. A high concentration of sugar can also cause increased fatigue and weight gain. It does not kill instantly, but causes long-term, permanent damage over many years with lethal complications. That is why we often take a lax attitude: slow and gradual but certain and fatal.

What related complications can result from diabetes?
Diabetes is not only the leading cause of kidney failure, but it is also the leading cause of blindness, particularly among patients between the ages of 25 and 70. It also increases the chance of having and dying from cardiovascular disease and stroke. The probability of dying from stroke and cardiovascular disease is increased by 400% in people with diabetes, and 2 out of 3 people with diabetes die from heart disease and stroke. Diabetes also damages the nervous system. Approximately 60%-70% of diabetics have some form of nervous system damage. This is especially a concern for diabetic males because they usually have trouble functioning sexually. Erections involve blood flow and nerves.

Because diabetes causes nerve damage and affects blood flow, many males struggle with sexual dysfunction. The first question doctors ask when a patient complains of erectile dysfunction is, “Do you have diabetes?” According to statistics, more than half of sexual dysfunctions among males come from diabetes. In addition, diabetes is a major risk factor for heart attacks and amputations. Sixty percent of amputations occur among people with diabetes. This means that each year, 82,000 amputations are performed on people with diabetes.

Long John Silver did not loose a leg to diabetes

What is the relationship between diabetes and obesity?
Diabetes basically involves an inherent metabolism problem. Because of the inability to absorb and process blood sugar in the muscles, the muscles are constantly experiencing malnutrition. Insulin that has been produced may not be efficiently used. Coupled with lack of exercise, excess glucose eventually becomes fat. We also know that this abnormal blood sugar metabolism affects appetite. All of these lead to weight problems. Between 70%-80% of people with obesity have diabetes. Likewise, 70%-80% of diabetics have difficulty controlling their weight.

I don’t have diabetes, why should I be concerned?
Diabetes is the “silent killer”. Often people who have diabetes do not know it because they cannot feel it. People must take a direct measurement of their blood glucose levels to know if they have diabetes. Even more alarming, when a person is diagnosed with diabetes, the actual development of the disease actually started on the average of seven years prior. Once the active symptoms and complications are observed, diabetes has already entered the later stages. Early detection is good, but prevention is even better. A yearly blood test is essential, even if you feel healthy.

What is Pre-Diabetes?

Pre-diabetes is when a person has a higher than normal blood glucose levels (hyperglycemic) but the level is not high enough to be diagnosed as diabetic or they are unable to secrete enough extra insulin in response to a glucose challenge. This is a cause for concern, especially when 700000 people in the Netherlands have “Pre-diabetes”. At this point, long term damage to the body is already occurring and often leads to Type II diabetes. If the blood glucose is controlled at an early stage, the development into Type II diabetes can be prevented. Often, diabetes is referred to as the “Silent Killer” due to the unobvious symptoms of diabetes. People who have diabetes or are pre-diabetic initially do not feel pain or feel any symptoms. It is only when the diabetes has reached a serious stage when all the complications, pain and symptoms surface. As previously mentioned, according to statistics, once a person is diagnosed as diabetic, it is likely that the onset of the diabetes actually started seven years ago. On average, every 10 years afterward, there is a rise in blood sugar of 100 milligrams per deciliter. Diabetes is a progressive disease.

Treatment Goals
The main goal for diabetes management is good blood glucose control. Your doctor will recommend a desirable range for you. Keeping your blood glucose as close to your target range as possible will help keep you healthy. Other important health goals for people with diabetes are lowering high blood pressure and decreasing cholesterol and triglyceride (blood fat) levels. If these are high, you may be more at risk for heart disease and stroke. A big goal for anyone who smokes is to stop! Smoking accelerates all of the problems associated with diabetes, because it cuts blood flow and oxygen to the cells. Good Nutrition Matters Your food choices will affect your diabetes control. Foods that contain natural or added sugar or starch (carbohydrates) will affect your blood glucose more than foods that are mainly protein or fat. A registered dietitian can help you plan a healthy meal plan using a variety of your favorite foods. Controlling calories is important for diabetes control. A weight loss of just 10 to 20 pounds can make a big difference in your blood glucose and blood pressure control. Drinking plenty of water, eating higher fiber foods, and eating less fat will help. Watching your sodium intake is also helpful if you have high blood pressure. Limiting solid fats will help control your cholesterol level.

Eating less fat so next time eat only half of it.

Most people find that eating the same amount of food at about the same time each day helps them control their blood glucose. Skipping meals is a bad idea, especially if you take diabetes medicine. Missing a meal also makes you more likely to overeat later. 2 You do not need to buy special food for your diabetes. The diabetic meal plan is good for both you and your family. Getting Active Is Important Blood glucose and weight control are very difficult to achieve without regular physical activity. Activity may include merely moving around more during the day, driving less, taking the stairs more often, doing yard work, or walking the dog, all of which increase caloric use.

Regularly scheduled exercise is also good. For weight loss, exercise that gets the heart rate up helps the most. Good choices are brisk walking, swimming laps, water aerobics, and biking. If you have not exercised regularly lately, have a doctor’s exam before you start. The results of this checkup will help you choose the activity that is best for you. The main goal is to do more of something you enjoy. You should exercise 5 to 7 days a week. Exercising with a partner or group may help you better stick to your program. Exercising at the same time each day may make your blood glucose levels more predictable.

Blood Glucose Monitoring is the only way to tell how well you have your diabetes under control. Your medical team will tell you how often to check. These blood glucose readings will help you see patterns in your diabetes control. If you have three values at the same time each day that are above or below your target range, you may need to change your eating, exercise, or medication habits. Recording your blood glucose readings, what you ate, what you did that day, and how much medicine you took will help you see those patterns. There are many monitors available. A diabetes educator or a pharmacist can help you decide which one is best for you. Always take your monitor and blood glucose records with you when you see your medical team. They can test to be sure your monitor is working correctly and that you are checking it properly.

Obese and diabetic a deadly combination

Medication Choices
New medicines for diabetes seem to appear every day. Your doctor will decide which medication is right for you. Some people with type 2 diabetes may only require better eating habits and more physical activity to control their diabetes. Medication needs often change over time, so you may switch diabetes medicines or add medicine more than once. Blood glucose monitoring is essential in deciding the correct amount of diabetes medicine for you. Diabetes pills work in different ways. They are not insulin. Some pills cause your pancreas to produce more insulin. Some make your liver produce less blood glucose after meals. Others slow the absorption of carbohydrate. Another type makes you more sensitive to insulin. You may need one or more of these medicines to control your diabetes. You may need insulin shots. Some people need insulin along with diabetes pills. How often you take insulin depends on how much insulin your body still produces and how closely your doctor wants to control your diabetes. Different types of insulin last different amounts of time. Your medical team will tell you how much of each kind you need to take and how often.

 In the beginning your overwhelmed by all the information and medication

Don’t Be Overwhelmed
Diabetes is a complex disease, and it takes time to develop the skills needed to control it. A certified diabetes educator can help. Ask your doctor to refer you to an educator for diabetes education. A diabetes support group may also help.
  

You will be surprised how much you will learn and how much easier it is to adjust your diabetes care so that it fits your lifestyle.

The Old Sailor,

Sweet times are here, Holidaytime as a Diabetic

Dear Bloggers,

As we all know the hard times are coming if you’re loving the sweet life. The candy that we got for Saint Martin (Same kind of thing as Halloween.) and now Sinterklaas is in the country and he is bringing sweets and chocolate. Next things in line are Christmas and New Year. Huge eating, drinking and social snacking events. I can only call it hell on earth if you need to loose weight, count calories and eat a lot of low carbs, veggies and fibres.

For diabetics, the holiday season is filled with temptations. Candy is everywhere. Your well-meaning co-workers bring in plates of cookies, chocolates and other thickmaking happy food made of sugar that taunt you from the break room. You've got invitations to partys where it seems like the foods were chosen by people that either try to test your will or hope that you will have regrets.

But before you decide to give everyone a piece of coal or a chunk of carrot and hibernate through the holidays, you should know that being diabetic doesn't mean you have to give up your favorite seasonal foods. But of course you can do something different with your old habits by simply changing some ingredients.

What About Other Holiday Food?

Holiday Appetizers:

·        Substitute low-fat or fat-free versions of mayonnaise, yogurt and sour cream to make dips.

·        Serve plenty of raw vegetables to accompany your dips.

·        Make for example a fresh salsa and serve with home-baked tortilla chips.

·        Use fat-free cream cheese and lean cuts of turkey or ham in pinwheels and roll-ups.

·        In soups, use fat-free and low sodium broths as your base. Use pureed root vegetables or beans to thicken them instead of cream.

Holiday Dinner:

·        Serve lean cuts of meat, such as pork or beef tenderloin. If a ham is your centerpiece, be sure to trim the fat. And if turkey is making a comeback at your table, remove the skin and choose white meat over dark if you can.

·        Provide plenty of vegetables. Steam, braise or roast them. Glaze with a very small amount of butter if you like, or use broth and herbs for flavor instead. If you are serving mashed potatoes, substitute reduced-fat or fat-free sour cream or half and half for the full-fat versions.

Holiday Desserts:

·        If you are serving a holiday pie, consider using phyllo dough as a base or topping. Phyllo dough is light and flaky, and virtually fat free. Enjoy fruit cobblers or crisps with less butter and use oats for added fiber. Top with fat-free whip or low fat frozen yogurt instead of ice cream or heavy cream.

·        Use reduced-fat and fat-free cream cheeses for cheesecakes

·        Serve poached or baked seasonal fruits such as apples or pears, again topping with low-fat or fat-free frozen yogurt or whip.

These are just a few ideas about how to reduce fat in your Christmas feast.

Joining in the Fun

Although sweets are often considered a diabetic's worst enemy, managing diabetes is more complicated than simply avoiding sugar. For instanace, other carbohydrates -- like a serving of mashed potatoes -- can cause a surge in blood sugar just like a candy bar. It's the total number of carbohydrates that counts and not the form you're eating them in. Fat, which abounds in holiday cooking, should also be kept to a minimum.

So what should you be eating during the holidays? "As at any time of the year, you should be eating a healthy, balanced diet low in saturated fat," And of course that you should be getting a good amount of fiber and complex carbohydrates. Easier said than done, I can imagine that it is hard to change your ways.

This can be pretty tricky during the holidays. But there is no need to eliminate foods, since a good meal plan balances different types of foods and outlaws none.

Planning Ahead

While the holidays are a time when you have less control over what food is put in front of you, you've still got control over what you actually choose to eat. Don't allow the usual high-fat and high-sugar holiday party fare to take you by surprise. If you're going to a party or a holiday meal, go prepared.

·        Know your own limits. "Every diabetic is different," and that is the tricky part, "and you need to figure out the balance of different foods that will work for you." Although counting grams every day may be difficult, you should have a general sense of what combinations of carbohydrates, fats, and fiber will work.

·        Try to anticipate the kind of food that you'll encounter at a party. For instance, if you know that your mom is making a favorite pie for dessert, plan your meals and medication during the day accordingly so that you can have a slice. You don't have to deny yourself if you think ahead.

·        If you're really concerned that there won't be food at a party that you can eat, consider eating a snack beforehand.

·        Another good alternative is to bring a dish with you that you know you can eat. Given that there are many diabetics in our society, there are a number of recipes and cookbooks for people with diabetes. In general, consider reducing sugar or using a sugar replacement in sweets and use pureed fruit as a substitute for fat in baked goods. Your host will surely appreciate the gesture, and you'll be able to relax knowing that you won't go hungry.

Sensible Enjoying the Holidays

Once you're at a holiday meal or party, overeating is pretty easy to do, especially since the rest of the guests are often overindulging. However, you are the one in charge and you shouldn't let yourself lose control.

Beware of what you can call "unconscious eating," the tendency we all have to absent-mindedly take a cookie or a piece of candy from a dish as we pass by. A little here and there can add up quickly. (in my case nearly 130 kilograms.

Say "no" to seconds, and pay attention to the details. "Remember, you can control how much gravy someone's putting on your plate, or whether you're getting turkey skin or not."

Avoid or limit alcohol. In addition to raising your blood sugar, yhe most difficult part for me, as alcohol can interact with diabetes medications.

Test yourself. "If ever there is a time to be religious about taking your blood sugars, it's during the holidays." Because you may be eating more and eating foods that you don't normally have, it's especially important to keep track of your levels.

For a lot of people during the holidays, lounging in front of a gameshow or a good movie on TV is about as close as they get to physical fitness. That's not good for anyone, and it's especially bad for diabetics. I suggest making exercise social during the holidays. "Grab your favorite familymember or a friend and go out for a walk," it is relaxing and "It's a great way to catch up." Or what about a game of bowling or games at home on the games machine that you might have.

Mistakes happen, and you may wind up eating in a way that you shouldn't. But don't let one instance of overeating cause you to give up and indulge in a lost weekend of excess. If you've fallen off the wagon, you've just got to pick yourself up quickly and get back to your plan.

Sticking to the Plan

Staying in control may be difficult and exhausting during the holidays, especially when no one else is. Holidays are trying times for many, and the extra hassle of having to always be so careful about what you eat may get you down, or make you feel cut off from others. However, using some of the tips above will help you enjoy the holidays along with everyone else.

In addition, it's worth remembering that the consequences of going off your meal plan are often not only long-term, but immediate. "When diabetics are off their program, whether their blood sugar is up or down, they know it. They feel sick."

So even though planning ahead may sometimes be a chore, having a healthy holiday is the best way to assure a festive one.

I hope this might be some good ideas for the days to come.

The Old Sailor,