I haven't been posting much on this blog as I've been very busy with other things over the past few months. Now that I have a bit more time, I am going to be looking over the various pages on the main Blood Sugar 101 web site and bringing them up to date.
I post all significant changes to the main web site on the Changes to Blood Sugar 101 blog, which makes it easy to keep up with them.
If you have any ideas about how to improve the main web site, or any topics you feel should get more coverage, please mention them in a comment on this post. However, keep in mind that there are already over 100,000 words posted on this site and its blog so the challenge with this web site is to keep it from becoming so overwhelming that the people who come to it for the first time don't miss the important information I'd like them to take away from it.
The focus needs to remain on explaining to people what blood sugar levels are normal, what levels cause diabetic complications, and what strategies safely lower blood sugar and prevent complications.
My web stats show me what pages on the site people actually visit, and for now, it is the pages that stick to that core mission that receive the heaviest traffic. The rest of the site, as fascinating as it might be, rarely gets visited. So the only changes I'm really interested in making are those that will make the pages that convey this vital information even more useful.
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24 comments:
I think it's important that URLs don't change when you update. Or if that is unavoidable, to make sure proper redirects from the old URLs to the new page are setup. I know I have personally posted various URLs of yours hundreds of times and would hate for those links to all be broken now!
The URLS will never change! I'm only revising the text. Changing the text would lose the Google placement of the page, and these pages rank too high for me to mess with them.
The content is spectacular and does not need to be changed. Cosmetically if it were cleaned up with a better color scheme your choice of course. I love the color scheme of this blog. So I'm partial to whites greens blues as a background. Looking forward to your choice...Jenny, thank you
I love your site. I wonder if you think there is any need to provide even more explanation that would specifically help people get their head around not listening to their doctor. I know that personally it threw me for a loop that the recommendations of both my doctor the entire medical community at large were directly detrimental to my health. I also know people who are of the mentality that what the doc says rules.
Anna,
I have put up that new page explaining why lowering A1c isn't dangerous, which does fly in the face of what many people's doctors tell them.
But most people come to the site from a Google search, and if the first impression they get is that I'm hostile to doctors on principle, they are likely to leave right away. That's why I stick to pages that answer common questions and fill them with documented facts. After that, it's up to people to draw their own conclusions.
My impression is that the very fact that someone is searching online often means that they aren't 100% comfortable with their doctors. People who are never get to the site.
I suppose I'd suggest some new updates on the 5% club article... In general when I'm reading testimonies about something, I like to see the older ones (evidence that the site has been around for a longer period of time) and newer ones (evidence that the advice has continued to be beneficial). Ideally, there are updates to original posters' stories.
I love your site and have gotten some fantastic information from it. I like the picture icons that hit the highlights of what someone wants to know.
What would be great is a chart with the normal blood sugar readings at fasting, 1 hr postprandial, 2 hr post prandial from both the Diabetes Association and what the research has told you (the REAL facts). I like that you have the research as backup and have told about it but sometimes I can't seem to pull the relevant numbers out in a simplified form.
Thanks so much for all your hard work! This is an amazing resource site and SO HELPFUL!
Hugs, Joy
Good point about the 5% club updates. Unfortunately, the original postings were public postings made to newsgroup where they could be looked up by anyone interested. The newsgroup is no longer active and the reports I get now (which I get often) are in emails, so I can't post them online.
Perhaps I should put a data collection box on the 5% club page where people could contribute new accounts understanding that they would be posted publicly. That would require a bit of programming but I enjoy programming. I'll definitely consider that for the future.
Good idea for a graphic showing blood sugars, too. Thanks! Keep the suggestions coming.
I'm a member of a diabetes forum, and there is definitely a very steady stream of newbies asking all of those basic questions. Many of them get referred to your site, as it has some of the best explanations around.
My suggestion would be to give the "Read this first!" section a different title and/or graphic. I clicked on that link today, and I was surprised to see that it actually had a substantial amount of important information. I had always just assumed that it had the stuff like the legal disclaimers and maybe a broad, general overview that wasn't going to be of much actual use.
Danae,
That's an excellent idea. I always wondered why that page had so little traffic.
I an unable to care much about color schemes, BUT... I like that your site and blogs are so uncluttered.
Some sites are just ridiculously hard to read.
You've done a great job of discussing bariatric surgery on your blog. I'd like to see an article in Blood Sugar 101. It's needed, because I've seen a real spike in popular-media articles which tout bariatric surgery as a cure for diabetes.
There's a kernal of truth in these claims, wrapped in a lot of misinformation.
- Very low calorie diets (VLCD, 400-800 kCal/d) do sharply improve FBG numbers, and eventually restore first phase insulin response.
- The benefit dissipates when patients go on a maintenance diet; in some reports the numbers are worse than for patients who lost the weight more slowly.
- Even before the operation, bariatric surgery patients are put on VLCD, in order to shrink their livers (which makes operating easier.)
- In the month or so after the operation, the patients are kept on a VLCD. SURPRISE! they get the same benefits as patients with no surgery, who are on VLCD.
I've seen lots of articles in the medical-press and popular-press articles on the supposed benefits of bariatric surgery. *NONE* of them have even mentioned the contribution of the VLCD.
Adam, That's a good suggestion, except that analyzing the paths people take through (and to) the site and blog make me think that no one would be likely to find a page about WLS and diabetes.
I get almost no traffic to the blog page on the topic, because Google won't rank my page on the appropriate search. And people who come into the site mostly do come in on Google searches about blood sugar.
My usual policy is only to move a topic from the blog to the site if a) it gets a lot of traffic and generates onging comment or b) I get a ton of email from people asking about the topic.
I never get emails about WLS and the WLS-related pages on the blog get very little traffic. So my guess is that the kinds of people who fall for the WLS-cures-diabetes line aren't the kind of people who do the sort of research that would bring them to Blood Sugar 101.
That's a shame, but I have learned there are many topics which I have put on the site that no one ever visits, and so I have tried to optimize the site to highlight the ones they do, which are fortunately the ones about normal blood sugar and lowering blood sugar.
Hi Jenny,
I'd be interested in learning more about the relationship between diabetes and oral health.
- BS levels impact to oral health
- Common oral ailments for diabetics and how oral conditions might impact the ability to manage their diabetes (if that's the case)
- How to know if your dentist is knowledgeable about this disease and staying healthy, conversely when to think about getting a new dentist.
It seems like such an important aspect of diabetic health, but I've rarely heard much conversation on the topic.
Another excellent suggestion. Thanks!
Hi Jenny, I've been trying to find good credible information about the impact of menopause on blood sugar control in general, prediabetes and diabetic conditions. And incidentally, NOT ONCE has my doctor ever been up for a discussion in any depth on this either. Given our aging population, I thought this might be another possible topic to add to your website (if that's too gender specific, perhaps more broadly the hormonal changes in aging for both genders.) I read recently that the loss of ovarian hormone production when in menopause promotes increased insulin resistance (according to The Endocrinology Journal), but I'd sure like to know the details of how and why.
Sand_Al,
There is very little to no research connecting women's hormones and/or menopause with blood sugar in any useful way. I've looked into the question in the past and never found anything substantive.
My own experience is that supplementing with about 1/4 of the usual dose of estrogen in the form of Menest (a non-horse origin pharmaceutical) has a very positive effect on my blood sugar. But all studies of HRT use doses that I believe are far too high, hence the bad effects.
After hearing all the hype about bioidentical hormones, I tried Tri-est and immediately saw my blood sugar skyrocket to truly frightening heights. My own experience with progesterone was very negative too, but all these simply tell us what works for ME. Every woman is different.
But as is the case in all the situations where mainstream medicine has abandoned people with real needs, a huge unregulated industry has arisen taking advantage of menopausal women and selling them faddy supplements for which huge claims are made that don't check out on the rare occasions when they are tested.
As is the case with so much, women with diabetes have to try various things, measure their blood sugars, and see what works for them.
Hi Jenny,
I had been toying with the idea of bariatric surgery for a long time, looking at it, coming back to it, and just not able to make up my mind.
Your comments on it (and also Sandy at Junkfoodscience.com) definitely turned me against it.
I am pleased to report that I am now a member of the 5% club. A1c in June was 8.9%. My endo read me the Riot Act, added Bydureon to my metformin, I started LCHF, and last check it was 5.3%, thanks to you and Dr. Bernstein.
Thank you.
id like to second sand_als comment. even before i got to the question about hormonal supplementation, it took me ages to find anything to indicate that other women experience fluctuations in blood sugar during different times in their cycles - and that those fluctuations would be exacerbated as one goes into peri/menopause. still not figured out how to mitigate... it may seem pretty basic, but i've had little luck chasing even anecdotal information down.
JoBlue, I don't think there is anything solid on this topic. So much of what you read about menopause is funded and promoted by people selling dubious supplements who sometimes pay for vanity research studies that don't hold up.
From what I can tell, women vary greatly in how they respond to hormones and, for that matter, how they go through menopause. Be very suspicious of anyone who claims they have a one-size fits all solution. For example, people push natural progesterone and bioidentical estrogen, both of which really mess up my blood sugar.
Hi Jenny,
I love your books and blog! After discovering your blog and books I have put my diabetic husband on strict diet and we were able to bring his glucose levels down from upper 200s and low 300s to 117 average. Your writing made sense and so did Dr. Bernstein's. Husband's average carb intake that worked perfectly with his medication (glipizide 25mg a day, and 2000mg metformin) was 70-80g a day. Now yesterday we went to see 1st endocrinologist since he was diagnosed with diabetes. Checking his meter readings, dr asked "what has been different since XY date, because his glucose levels improved dramatically" and I simply said "Low carb diet". While she liked the idea of low carb diet, she doesn't want it to be that low. She wants him to eat 130g a day, take Amaryl and Januvia. I've read your books, website and blog, and I'd rather not have him on Januvia but he doesn't want to self inject Byetta. We have had great meter readings for couple of weeks and he is feeling great. I'm very confused whether I should up his carbs or keep it as is and see how it goes?
Did the doctor give any reason for raising carbs and adding a very expensive possibly dangerous drug? My guess is not--because there isn't any. Very outdated theory suggested that the brain wouldn't function on under 130 g of carbs. However, research has proven that simply isn't true. The less medication he takes the safer your husband is. Plus Januvia and Amaryl together is a very questionable combination as both drugs stimulate the beta cell in a very similar way, raising the risk of hypo. If your husband isn't experiencing hypos on his current regimen you should demand the doctor give you a good reason to change what is obviously working.
You're spot on- no reasons given for amaryl+Januvia combo. She said given his family history of kidney failures, he shouldn't be on ketogenic diet and according to her 80g is considered ketogenic. Today's a first day for him to take amaryl, and after the nutritionist suggested meal that left him more hungry and dissatisfied than my low carb meals from last week, we have no doubt about ditching Januvia and just sticking to low carb diet and amaryl. Thanks for your opinion Jenny
Desi,
The belief that a ketogenic diet harms the kidneys has been dismissed by solid research. At the bottom of the following page you'll find the journal articles addressing this subject: http://www.phlaunt.com/diabetes/16351841.php.
Amaryl is a very bad choice given the research connecting it with a raised risk of heart attack. You can read the study documenting that that here: http://www.phlaunt.com/diabetes/25311847.php .
Unfortunately, doctors get most of their "education" about drugs from the drug reps and the "thought leaders" they pay huge honorariums to in return for these doctors giving talks at professional conferences plugging the drugs. Doctors in private practice rarely keep up with the newly discovered side effects of any drug. There is a black box warning on Amaryl and you can discuss the issue with your pharmacist, too.
Besides heart risk, amaryl can cause dramatic hypos (and hunger) as blood sugars continue to normalize, so do keep a watch on blood sugars 4 or 5 hours after eating and if you see them dropping below 80 it may be time to adjust the dose down.
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