Make your own medical journal

I have been a caretaker all my life. I learn how to give a shot when I was 17 years old. What I've learned over time is that you do have to listen to what your doctor says but you need to read up on the conditions of the person that you're taking care of. This last year I have been taking care of an older diabetic person. The person has a mild cognitive disorder and bad kidneys and diabetes 2. By reading up on person's condition, it also makes what the doctor says more sense it allows you to know when to call the doctor and when not to also allows you to set up protocols that I make sense to you also it helps you understand what is going on

The problem with the Internet is that many articles just do not make sense or there too academic. Even worse they come and go. I have found several websites that made it easier to explain to my friends the situation that I'm going through however over time they disappear. One was called: My Aging Parents.

Many blog sites will cut and paste different websites. I wish I could since the information was helpful to me. I believe it would be helpful for others.

However, in the United States, we have to deal with Copyright our laws. Even under the theory of fair use, I have already learned the hard way about justice sometimes is a matter of how has a better lawyer. When I say that, I do not claim victimhood.

My recommendation is that you decide on a notebook such as OneNote and copy and paste the information so that it will always be there and is available to you. I am choosing OneNote because when push comes to shove when it counts, I turn to Microsoft Office. I do use other Office Suites such as Google Docs, just that Microsoft Office is a lot less frustrating.

I hope that over the year, I can synthesize the information that I find so it can be available to me and hopefully useful to you.

Show Respect

A lot harder than than it should be.

“Show respect to people who don’t even deserve it; not as a reflection of their character, but as a reflection of yours.

—Dave Willis

Titration

Warning

I am not a doctor. Only purpose of this post is to show how Excel may be helpful. Do your own homework, read at own risk. I take no repsoncibilities

Note

I do not have dieabietes. I just know people who do.

I have moved from Google Sheets to Microsoft Excel for doing Insulin titration for my mother. I am an Android, Linux, Windows shop and felt that Google sheets would be better for being able to move between Windows and my Samsung tablet and phone. From past experience, Google Docs is excellent in collaboration. The issue that I noticed was that sometimes the data that I entered in did not prorogate between devices. I know that SAAS spreadsheets are a hub and spoke. What I think was happening was that the cached version was not being uploaded to the central server. When it was, uploaded, it became the older version because it was changed elsewhere. The issue may have been my work offline settings or how I move from device to device or wifi to wifi. In the end, it does not matter to me. For my well being and mother’s health, it just has to work.

Before I show an HTML table representation of my spreadsheet, here are my sources:

The spreadsheet that I created looks like this:

Date

Blood Sugar

Move Average

Insulin

Comments

10/29/2018

53

10/30/2018

60

10/31/2018

138

84

102

Started Tresiba

11/1/2018

198

132

100

11/2/2018

107

148

100

11/3/2018

150

152

100

11/4/2018

64

107

90

11/5/2018

69

94

82

11/6/2018

81

71

82

Underlying cell formulas look like:

Date

Blood Sugar

Move Average

43402

53

43403

60

43404

138

=IF(ISBLANK(B7),,ROUND(AVERAGE(B5:B7),0))

43405

198

=IF(ISBLANK(B8),"",ROUND(AVERAGE(B6:B8),0))

43406

107

=IF(ISBLANK(B9),"",ROUND(AVERAGE(B7:B9),0))

43407

150

=IF(ISBLANK(B10),"",ROUND(AVERAGE(B8:B10),0))

43408

64

=IF(ISBLANK(B11),"",ROUND(AVERAGE(B9:B11),0))

43409

69

=IF(ISBLANK(B12),"",ROUND(AVERAGE(B10:B12),0))

43410

81

=IF(ISBLANK(B13),"",ROUND(AVERAGE(B11:B13),0))

I am using the round function for the moving average because there is no such thing as decimal numbers on the blood glucose monitor.

The current Insulin titration looks like:

=IF(ISBLANK(B31),"",IF(COUNTIF(D27:D30,D30)>=4,IF(C31<70,MROUND(D30*0.9,2),D30+LOOKUP(C31,$H$6:$H$10,$I$6:$I$10)),D30))

The titration uses the fasting simple moving average. From what I understand about Tresiba, does change should happen every 3 to 4 days. The countif function checks to see if the last 4 doses were the same. If they are the same, titrate. Also, if the simple moving average is under 70, reduce dosage by 10%.

Look Up table:

Titration Lookup

min value

Change

0

-2

80

0

110

2

161

4

180

6

Important

As I said, this is a laypersons interpretation. This post is to give you ideas. However, please do your own homework.

You can't walk enough to eat pizza

Today, I hit obese body fat or 25.1 based on my Garmin Index Scale. I look at BMI as a benchmark, but my goals are not by body weight percentage. I had promised I would never be obese again, but here I am.

Read an MFP blog post. I liked it because it sums up how I feel about dieting. It was simply called: You Can't Outrun a Bad Diet. I laughed at it because when I first started dieting my hour lunch walk did not burn up enough calories so that I could eat a piece of pizza. It is worth reading. Over this week I had burned a lot of active calories biking, sailing and running. I still put on the pounds.

My current problem with dieting is I like to eat and drink with friends. Also, my stress level is a little high. I eat when I am stressed out.

Well to the highlights:

The first paragraph made me laugh since I allowed myself to get mugged by chocolate cake:

It's a huge battle which I suck at some days. I don't know about you, but even though I am not afraid of being mugged my a chocolate cake with vanilla icing (is this profiling), this effing food thing is tough. It does not care how fit you are, or what you do; when you consume more calories than you burn, you gain weight

This sums what it is about dieting. I do believe that food is a lot more complex that the calorie in, calorie out mantra. Just that calorie in, calorie out works. I do not know how, but I have already put on my most feared ten-holiday pounds. I have to work to get them off.

The next part is that one just has to work the program. My program is three parts: Calorie counting, exercise, sleep. If I do not record my food, I tend to eat more. Exercise makes me feel good and allows me to be active. Without good sleep, it seems that the other two do not matter.

The last statement is important. I have been giving myself permission to cheat on my diet.

One of the things I know about failing is that we give ourselves permission to do it. We make excuses. "It's only once", "it's vacation", "it's OK to start over tomorrow", "it's just a stressful time" and the hits keep on coming. In 7 years on MFP I have seen a lot of people come and go - a lot - thousands in fact!

In my family, it was always Monday to start a diet. Maybe even eat enough food that it would take a month to work off the bing. When it comes to dieting, there is no time like the present.

I am a big fan of statistics. They make order out of chaos. The summation hit home. I am currently in the 55% of those who do not keep all my weight off. I am terrified of being the 40% who gain their weight back or even more. I want to be the 5% who make there goal of weight loss and keep it off.

I admit, I will will always be a recovering overweight person.

Percent weight Loss Success 20423.70399677156774104.9943468764167820496.4490673881045328.880653123583255127.57594353127936357.911597572844245274.673998375693769.21540979582369Percent weight Loss SuccessGained back we…Gained back weight lossGain back weig…Gain back weight and then someDo not keep of…Do not keep off all weight lossKept weight off

Healthy BMI Reboot

January 1st, 2016, I looked into the mirror and told myself: “Michael you are fat.” I know that it is not PC, but problems cannot be solved without stating the problem. I started what I called my Quest for a Healthy BMI. Target weight was for a BMI of 25 or 175. Since that time my lowest weight was167 pounds. What I discovered, is that keeping the weight off is hard. I allowed myself to gain weight back up to 195. My current seven-day moving average weight is 186.5. My current goal is 170.

Some of the reasons that I am doing this again are:

  • Vanity: I liked the way I looked.

  • Makes it easier to sail, dance and be active.

  • I do not have support for the damage that overweight causes later in life. I do not want to be a burden to my family, friends or society.

This time around, I am not looking at BMI as the goal target. I am going to use the body fat percentage. Currently, I am 23.8% or average. I would like to be at 17% or at the fit level. The number is based on the chart from American Council on Excerse:

Description

Women

Men

Essential Fat

10-13%

2-5%

Athletes

14-20%

6-13%

Fitness

21-24%

14-17%

Acceptable

25-31%

18-24%

Obesity

>32%

>25%

To my body acceptance friends (yes I have been called anorexic because I wanted to be healthy). From experience and observation, nature does not care about my feelings. These two paragraphs from Rising Obesity in the United States Is a Public Health Crisis is scary enough to get motivated again:

Obesity is a grave public health threat, more serious even than the opioid epidemic. It is linked to chronic diseases including type 2 diabetes, hyperlipidemia, high blood pressure, cardiovascular disease, and cancer. Obesity accounts for 18 percent of deaths among Americans ages 40 to 85, according to a 2013 study challenging the prevailing wisdom among scientists, which had placed the rate at around 5 percent. This means obesity is comparable to cigarette smoking as a public health hazard; smoking kills one of five Americans and is the leading preventable cause of death in the United States.

The obesity crisis may be less dramatic than the opioid epidemic now gripping the nation, but it is just as deadly. Opioids accounted for around two-thirds of the 64,000 deaths related to drug overdose in 2016. Excess body weight leading to cancer causes about 7 percent of cancer-related deaths, or 40,000 deaths each year. This number doesn’t include deaths from the many other medical conditions associated with obesity. Obese people are between 1.5 to 2.5 times more likely to die of heart disease than people with normal body mass indices (BMIs).

Automation is not always good customer support

Yesterday, I had to spend half my day dealing with cable television. I had called Cox Customer support. I had already done most of the general debugging: Turning off the television off then back on. Turning the TiVo off ten back on. By the time I called Cox I was quite sure it was not on my side.

I had the choice of the virtual debugger or and agent. I chose ‘Agent’. I still got the virtual tech support. A very calming automatic voice (condescending) started walking through all the steps again. It was like a combination of the IT Crowd and H.A.L. If cable was not important to the household at this moment, I would have canceled.

Problem with automation, is that it is decided to make a customer give up in frustration. What is so unfair to the person customer service person, and to me, is that the survey after words is designed to rank her performance. The virtual help got a bye.

I will say this; Cox live people are great. The virtual needs work.