Talk:Diabetes management

From Wikipedia, the free encyclopedia

"However, both Type 1 and Type 2 diabetics can see dramatic normalization of their blood sugars through controlling their diet. One diet in particular is "The Diabetic Diet" as described in the book of the same title as well as a more comprehensive book on blood glucose normalizations in the book Diabetes Solution [1] both of which are written by Dr. Richard K. Bernstein who has had Type 1 diabetes for the past 55 years (most Type 1's with diabetes diagnosed at this time are no longer alive). As diabetes can lead to many other complications as referenced below it is critical to maintain blood sugars as close to normal as possible and diet is the leading factor in this level of control. Dr. Bernstein shows through his own experiences and through research that lowering the amount of carbohydrates in a diabetics diet can reduce the amount of insulin required and improve the management of the disease signifigantly." This bit is obviously POV. There is a place for detailing Dr Bernstein's theories here but more wieght must be given to the moderate-carb, low-fat diet advocated by most diabetes professionals. I have edited to reflect this. Waifwaller 04:02, 17 February 2006 (UTC)

I am suprised the article doesn't discuss lower carbohydrate/moderate carbohydrate/complex carbohydrate method of managment more. Can someone more knowledgable please do this? --geekyßroad^{. meow?} 00:04, 3 March 2006 (UTC)

There is a point which is neither here nor in the main article on Diabetes Mellitus, on hypoglycemia. This article simply states that many diabetics can recognise signs of low blood sugar, and know that when this happens, it is time to eat or to drink something sweet which will increases blood glucose levels, such as sugar. I would like to suggest that some one with expertise on these matters also adds that after taking quick-acting carbohydrate (such as a sugary drink), diabetics should then follow this with a slow release, long-acting carbohydrate, such as rye bread or currant loaf. This is because, although quick-acting carbohydrates will raise blood sugars quickly, if they are not followed in this way blood sugars are likely to dip again, thereby increasing the likelihood of future hypoglycaemia. Perhaps a wiki-link to the article on the glycemic index would help to clarify how there are differences between long-acting and short-acting carbohydrates. ACEO 19:47, 25 February 2006 (UTC)

Contents 1 Diet for Diabetics 2 Tai Chi, qigong, relevance of a pilot study 3 Type 1 and 2 Confusion -- Talk needed 4 Article cleanup

[edit] Diet for Diabetics

There was not a lot of information here about the diet recommended for diabetics. This is rather a big topic - there are hordes of books on this subject, and plenty of material on the World-Wide Web - so I have started a new article on this topic, which I consider wide enough to justify its own article. For example, while the section on diet here merely seems to recommend carbohydrate counting, I have stressed the importance of dietary fibre in this newer article. ACEO 18:55, 24 August 2006 (UTC)

Can't locate the article - what is it called. "Diabetic diet" is term generally used in UK. David Ruben ^Talk 02:51, 25 August 2006 (UTC)

I have called the article "Diet_for_Diabetics", and it should be available on the website: http://en.wikipedia.org/wiki/Diet_for_Diabetics Alternatively, you could type "List of Diets" into your screen. This will take you to a list of diets, including a heading "Diet for Diabetics", and you could click on that. ACEO 19:05, 25 August 2006 (UTC)

Unfortunately article title actually created was misspelt as Diet for poeple with diabetes. As previously suggested, the more commonly known (at least in UK) is "Diabetic diet" (981,000 Google hits) vs "Diet for people with diabetes" (corrected spelling) 9,130 hits. I wondered about there being more than one recomendation, ie "Diabetic diets" and this has just 331,000 hits. I have therefore moved the article to Diabetic diet. David Ruben ^Talk 00:05, 26 August 2006 (UTC)

Thank you for doing this, and also for spotting the typing error in my original contribution. This is just to let you know that as the initiator of the article on diets for diabetics, yes, I am quite happy about the title change. I am based in the United Kingdom, too, and perhaps we should stick to conventional vocabulary. ACEO 19:01, 26 August 2006 (UTC)

[edit] Tai Chi, qigong, relevance of a pilot study

On 16 May 2006 I added this text:

Exercise is known to be helpful. A pilot study has also found evidence that [[Tai Chi]] and [[qigong]] are particularly effective in reducing the severity of [[diabetes]].[http://www.abc.net.au/pm/content/2005/s1535304.htm] <!--I'm not sure if the study uses controls who do other forms of exercise.-->

...and reference:

• Tai Chi a promising remedy for diabetes, Australian Broadcasting Corporation, 20 December, 2005 - Pilot study of qigong and T'ai Chi in diabetes sufferers.

It was quickly removed by Davidruben, with the comment Was a prev attempt add info/link to diabetes mellitus, but a positive pilot study is not verified proof (& shouldn't use to assert that 'particularly effective') - full published study might be.

It's acceptable to mention ongoing research, especially research that has received media attention. The information is not presented as verified proof, just as a pilot study. It's relevant to the article, so I am reinserting.

Re the expression "particularly effective," I've re-read the source and agree this is not justified, so I have removed that expression. --Singkong2005 ^talk 11:56, 31 August 2006 (UTC)

Whilst my preference/inclination would be to not include this ongoing research (see WP:NOT#Wikipedia is not an indiscriminate collection of information), you argue the case well and the revised version seems fine - I've worked up the ciation details a little and converted to cite.php footnotes with a citation template too :-) David Ruben ^Talk 15:14, 31 August 2006 (UTC)

Cool, that looks better.

btw, I'm surprised there isn't more info (especially sourced info) about the impact of exercise... I will have to resist the temptation to research this, seeing as it's 3:30 am, local time... --Singkong2005 ^talk 17:29, 31 August 2006 (UTC)

[edit] Type 1 and 2 Confusion -- Talk needed

I find this article to be very confused between T1 and T2. Both are mentioned, but the facts are often out of context.

I suggest we recognize that 90% of diabetics are T2, and that this article is intended for them. Perhaps in the intro, we should point management of T1 to conventional or intensive insulin therapy and then focus the rest of the article on management of T2 with diet, exercise, oral medications if needed, and lastly insulin if needed.

If not, then I suggest each subject is split into T1 and T2 specific information.

IMO this is the cleanup needed. Mbbradford 20:46, 26 November 2006 (UTC)

Disagree re making this about T2 with just redurect to T1, there already are separate articles for DM1 & DM2, this article seems to me on quick re-review to correctly indicate joint aspects (eg both DM1 & DM2 need observe dietary modifications and exercise, both need address cardiovascular risks and have BP & lipids controlled), and also highlights the differences. Many DM2 may eventually require insulin, at which point the issues about blood monitoring apply to them too. Which bits did you find confusing ? David Ruben ^Talk 00:18, 27 November 2006 (UTC)

The major sections (anti-dibetic drug therapy, other treatment, and monitoring) are clear between T1 and T2. But the sections on diet and home blood glucose monitoring, while trying to present both sides and saying nothing incorrect, are IMO going to be unclear to a reader unfamiliar with T1 and T2. It has more to do with emphasis. Specifically, diet for T2 is absolutely critical. Carbs must be limited to a reasonably small portion such as 40 grams per meal: for T1 however this is a bit outdated, as it is possible and more enjoyable to learn to adapt insulin regimen to the desired diet of the T1 person, as long as it is reasonable from a long term health point of view. Teenage T1 and athletic T1 persons can enjoy a lowfat 200g pasta meal and just cover it adequately, and a few hours later eat ice cream with another 100 grams of carbs. I find lay people are constantly undervaluing the importance of limiting the carbs for a T2, and then they overreact when a T1 eats candy or desserts. The home BG testing is the other section -- the second paragraph is very nice. The first paragraph says that BG testing is expensive, but this is more true for T2 (even though they are only using 30-40 strips per month?) than it is for T1 (where avoiding the occasional hospitalization due to DKA or extreem hypoglycemia is actually a cost savings, not to mention the cost in later years that can reasonably be expected to be avoided due to reduced complications and the T1 is often early onset). The third paragraph is specifically about T2, but it doesnt really say so until late in the paragraph. Again, its a nice article overall, I'm just suggesting. Perhaps we have a different point of view, you are writing for doctors while I am reading from a patients point of view.Mbbradford 06:00, 27 November 2006 (UTC)

[edit] Article cleanup

I've done a quick and tentative cleanup of the article structure, and tried to group information "Like with like" in sections, whereas some of it was scattered in other sections or in parallel points in different sections. I've made very few textual edits though, its almost entirely just restructure of existing content. Specifically:

1. Old section that just gave "early advances" seemed to lack a context. Expanded into a general overview section, briefly summarising the issues, complexities, early advances, and modern approaches, within diabetes management.
2. Logically next come the descriptions of blood sugar levels, hypo- and hyper-glycaemia, to explain about the sugar levels which diabetics are trying to manage (ie, explain the issue before describing the management methods)
3. Next, explain monitoring, how it's monitored, methods, and everything anbout the monitoring process. (I've put HbA1c and ongoing automated monitoring systems into subsections, since these can be easily itemised as subtopics within monitoring.)
4. Last, cover other aspects and approaches - diet, exercise, drugs etc.

I have made very few textual changes, and left the vast majority of existing text intact save a couple of places where obvious changes were visible. Hopefully it has helped, at least somewhat. There are two subsections marked "stub" if someone can add content for them They are brief summaries of "issues needing management", and "modern approaches". FT2 ^{(Talk | email)} 03:54, 6 December 2006 (UTC)