May 24, 2017
Am I unhappy about my hospital experiences? In a word, yes! Plus now it involves three hospitals. The first case is in this blog and it is by far the worst. The second case involved a doctor (not a hospitalist) ordering me to take more insulin than I knew I could handle and would be more than low. I told the doctor if that then he would be required to pay for my second day in the hospital, as I would otherwise leave against medical advice when I went below 70 mg/dl. Finally, the doctor relented and my AM reading was still below 70 mg/dl, but not enough for me to be concerned. Had I taken what the doctor ordered, I would have probably been below 40 mg/dl.
The third hospital was similar to the second hospital, but this time it was a hospitalist that gave the order and he was threatening to remove my diabetes supplies and my meter. I started to get out of bed and was having trouble because of the operation and he asked me what I was doing, and I said leaving against medical advice because of an overbearing and unreasonable doctor. My wife had started gathering my supplies and putting them in my briefcase. The hospitalist told me to stay in bed and he would see what my blood glucose was and called a nurse to use the hospital meter and test my blood glucose. When the reading came out 76 mg/dl, he said he would again have me tested in the morning. I said okay and went back to sleep.
In the morning, the hospitalist was there and asked the nurse to test my blood glucose again. This time it was 59 mg/dl and he was even surprised and said to use my meter, which when I used it was 58 mg/dl. Okay, he admitted, you were right and probably would have needed to stay in the hospital another day recovering from severe hypoglycemia. He said that after the operation, most people would have had a glucose reading over 140 mg/dl because of that alone. He said if he hadn't seen the results with his own eyes, he would not have believed it. He said you should be released about noon and he would be back to see me before I was released.
Breakfast arrived as he was leaving and he asked me to count the carbohydrates in the meal. I said after counting the foods I would eat and said 35 grams and pointed out the two items I would not be eating. The dietitian said I must eat them and I asked her if she wanted the whole tray thrown at her. The hospitalist told her to leave and when she wouldn't, he did escort her out of the room.
When he came back in, she was right behind him and told me she would feed me herself to see that I ate everything. I pick up the tray and told the doctor to duck. He told me to lower the tray and he would have someone take her back to the kitchen. She said he would not and she tried to get past him and I let the tray go in her direction. The food was all over her face and top and she became furious. It took two nurses to get her out of the room and the hospitalist called the administrator and he was there rather quickly. When he arrived, he asked what the problem was and when he saw me, he said what do I need to do. When the dietitian came back in, I said fire that bully. She still had food on her and said I would be brought another tray and she would force-feed me to see that I ate everything. The administrator said she would not have the chance as she could go to his office and wait for her final paycheck.
When she tried to appease him, he said told the hospitalist to call security and for them escort her from the premises and he would mail her the final check. With that, she left the room muttering to herself. Next, the administrator asked what other problems I was having. I said, because of my anger at the dietitian, I threw my breakfast at her. He asked me if the woman sitting at the foot of the bed was my wife and answered yes. He picked up my phone, dialed the kitchen, and asked them to send up two breakfasts as soon as possible. In ten minutes, we had them. The assistant dietitian and a nurse had them and the nurse asked what had happened to the head dietitian. The administrator asked the assistant if she felt up to doing the job. When she said yes, he told the nurse that the new head dietitian was standing next to her.
I was discharge at 12:30 PM and was happy to be out. My wife asked me how I had survived the problems and had everything go my way. I said because I know the administrator and you know what he asked and the hospitalist said. This was backed by the administrator and he likes his orders followed and knows that the dietitian was set on bullying me.
May 23, 2017
This is a continuation of part 1.
Milk thistle - Milk thistle is an herb that has been used since ancient times for many different ailments and is considered a tonic for the liver. The most studied extract from milk thistle is called silymarin, which is a compound that has antioxidant and anti-inflammatory properties. It is these properties that may make milk thistle a great herb for people with diabetes.
A review notes that many of the studies on silymarin are promising, but the research is not strong enough to begin recommending the herb or extract alone for diabetes care.
Many people may still find that it is an important part of a care routine, especially since the antioxidant and anti-inflammatory properties can help protect against further damage caused by diabetes. Milk thistle is most often taken as a supplement.
Fenugreek - Fenugreek is another seed with the potential to lower blood sugar levels. The seeds contain fibers and chemicals that help to slow down the digestion of carbohydrates like sugar. The seeds may also help delay or prevent the onset of type 2 diabetes.
A recent study found that people with prediabetes were less likely to be diagnosed with type 2 diabetes while taking powdered fenugreek seed. This was caused by the seed increasing the levels of insulin in the body, which also reduced the glucose in the blood.
Researchers found that the seed helped to lower cholesterol levels in patients as well. Fenugreek can be cooked into certain dishes, added to warm water, or ground into a powder. It can also be added to a capsule to be swallowed as a supplement.
Gymnema - Gymnema is a relatively new herb on the Western market. In the plant's native home of India, its name means, "sugar destroyer." A recent review noted that both type 1 and type 2 diabetes patients given gymnema have shown signs of improvement.
In people with type 1 diabetes who were given the leaf extract over a period of 18 months, fasting blood sugar levels were lowered significantly when compared to a group that received only insulin.
Other tests using gymnema found that people with type 2 diabetes responded well to taking both the leaf and its extract over various periods of time. Using gymnema lowered blood glucose levels and increased insulin levels in the body of some patients. Using either the ground leaf or leaf extract may be beneficial for many people with diabetes.
Ginger - Ginger is another herb that science is just discovering more about. It has been used for thousands of years in traditional medicine systems. Ginger is often used to help treat digestive and inflammatory issues. However, a recent review posted to shows that it may be helpful in treating diabetes symptoms as well.
In their review, researchers found that supplementing with ginger lowered blood glucose levels, but did not lower blood insulin levels. Because of this, they suggest that ginger may reduce insulin resistance in the body for type 2 diabetes.
It is important to note that the researchers were uncertain as to how ginger does this. More research is being called for to make the claims more certain. Ginger is often added to food raw or as a powdered herb, brewed into tea, or added to capsules as an oral supplement.
Important considerations for people with diabetes - It is always best to work with a healthcare professional before taking any new herb or supplement. Doctors usually have patients start out on a lower dose and gradually increase it until a comfortable dose is found.
Some herbs can interact with other medications that do the same job, such as blood thinners and high blood pressure medications. It is very important to be aware of any interactions before starting a new supplement.
It is also important for people to get herbs from a high-quality source. Herbs are not monitored by the United States Food and Drug Administration (FDA). Products may contain different herbs and fillers, recommend an incorrect dose, or even are contaminated with pesticides.
Herbs and supplements should be seen as a complementary treatment option, and should not replace medications. Working closely with a knowledgeable healthcare professional, herbs can be a great addition to many care programs for diabetes.
End of part 2 of 2 parts.
May 22, 2017
Diabetes is a widespread disease affecting the blood glucose and insulin levels in the body. Managing the long-term consequences and complications of diabetes are as much of a challenge as the disease itself.
There are two main types of diabetes. Type 1 diabetes is where the pancreas produces little to no insulin. Type 2 diabetes is more common. With type 2, the body either does not produce enough insulin or produces insulin that the body does not use properly. I will not be discussing gestational because doctors refuse to allow pregnant women many other medicines.
There are many treatment options for people with type 2 diabetes. Growing research suggests that some herbs and supplements may help with the condition. Useful herbs may be great to combine with more traditional methods to find relief from many type 2 diabetes symptoms.
Seven herbs and supplements: Here are seven herbs and supplements that may be of benefit to people with type 2 diabetes.
Aloe vera - Studies suggest an antidiabetic potential for aloe that may lower blood sugar levels. Aloe vera is a common plant with many different uses. Most people are aware of the plant being used to coat the skin and protect it from damage caused by too much sun exposure.
However, the plant has many lesser-known benefits as well. These range from helping digestive issues to possibly even relieving type 2 diabetes symptoms.
One review analyzed many studies using aloe vera to treat symptoms of diabetes. Their results strongly suggested an antidiabetic potential for aloe. Subjects given aloe showed lower blood sugar levels and higher insulin levels.
Further tests showed that aloe helps to increase how much insulin is produced by the pancreas. This could mean that aloe helps to restore bodies with type 2 diabetes or protect them from further damage. The researchers called for more studies to be done on aloe and its extracts to be certain of these effects.
There are many ways to take aloe. Juiced pulp is sold in many markets and added to drinks, and extracts are put into capsules to be taken as supplements.
Cinnamon - Cinnamon is a fragrant herb created from the bark of a tree and is commonly found in kitchens. It has a sweet and spicy fragrance and taste that can add sweetness without any additional sugar. It is popular with people with type 2 diabetes for this reason alone, but there is much more to cinnamon than just flavor.
A review found that subjects with metabolic syndrome and type 2 diabetes who were given cinnamon showed positive results in many different areas such as:
- blood glucose levels
- insulin levels
- insulin sensitivity
- blood fat levels
- antioxidant levels
- blood pressure
- body mass
- time to process food
These are important markers for people with diabetes. From this research, it may be said that cinnamon is important for everyone with type 2 diabetes to take.
The researchers did note that the type of cinnamon and the amount taken does have an effect on the results, however. Only the highest quality cinnamon or cinnamon extracts in capsule form should be used as a complementary treatment method. An experienced healthcare practitioner should always be consulted before starting to use cinnamon heavily as a supplement.
Bitter melon - Bitter melon is a traditional Chinese and Indian medicinal fruit. Research suggests that the seeds may help to reduce blood sugar levels.
Momordica charantia, also known as bitter melon, is a medicinal fruit. It has been used for centuries in the traditional medicine of China and India. The bitter fruit itself is cooked into many dishes, and the plant's medicinal properties are still being discovered.
One discovery being backed by science is that bitter melon may help with symptoms of diabetes. One review noted that many parts of the plant have been used to help treat diabetes patients.
Bitter melon seeds were given to both people with type 1 and type 2 diabetes to reduce their blood sugar levels. Blended vegetable pulp mixed with water also lowered blood sugar levels in 86 percent of the type 2 diabetes patients tested. The fruit juice of the bitter melon also helped to improved blood sugar tolerance in many cases. Eating or drinking the bitter melon can be an acquired taste. Luckily, similar effects were noted with extracts of the fruit taken as supplements as well.
There is not enough evidence to suggest that bitter melon could be used instead of insulin or medication for diabetes. However, it may help patients to rely less on those medications or lower their dosages.
Part 1 of 2 parts.
May 21, 2017
I have long suspected that many of the sugar substitutes were overrated. Now the word is out on one of them, sugar alcohol erythritol. This commonly used sugar replacement used in low-calorie foods that people eat to lose weight may actually have the opposite effect.
The sugar alcohol erythritol occurs naturally in foods like pears and watermelons but has been used as a sugar replacement in low-calorie foods. It is found in the sugar replacement products Zsweet, Zero and Sweet Simplicity. Truvia is a mix of erythritol and stevia.
The study was a collaboration of researchers at Cornell, Braunschweig University of Technology in Germany and the University of Luxembourg, on a discovery-based analysis to identify metabolomic markers linked to weight gain and increased fat mass in students transitioning to college life.
"About 75 percent of this population experiences weight gain during the transition," Patricia Cassano, professor in the Division of Nutritional Sciences at Cornell, said in a press release. "With this in mind, it is important to identify biomarkers of risk that could guide its understanding and prevention."
Researchers found that people who gained weight and abdominal fat over the course of a year had 15 times higher blood erythritol at the beginning of the year compared to those who were stable or had lost weight and fat mass.
The study was part of Cornell's ENHANCE project by the Division of Nutritional Sciences to understand how the transition to college affects changes in diet, weight and metabolism in students.
"With the finding of a previously unrecognized metabolism of glucose to erythritol and given the erythritol-weight gain association, further research is needed to understand whether and how this pathway contributes to weight-gain risk," Cassano said.
May 20, 2017
Diabetes is a disease that affects the way the body produces and uses insulin. Basal-bolus insulin therapy is a way of managing this condition. In type 2 diabetes, both the production and use of insulin are affected.
In people without diabetes, insulin is produced by the pancreas to keep the body's blood glucose levels under control throughout the day.
The pancreas produces enough insulin, whether the body is active, resting, eating, sick, or sleeping. This allows people without diabetes to eat food at any time of the day, without their blood sugar levels changing dramatically. For people with diabetes, this doesn't happen. However, a similar level of blood sugar control can be achieved by injecting insulin.
Injections can be used throughout the day to mimic the two types of insulin: basal and bolus. People without diabetes produce these throughout the day and at mealtimes, respectively
What is a basal-bolus insulin regimen? A basal-bolus insulin regimen involves a person with diabetes taking both basal and bolus insulin throughout the day. It offers them a way to control their blood sugar levels. It helps achieve levels similar to a person without diabetes.
There are several advantages to using a basal-bolus insulin regimen. These include:
- flexibility as to when to have meals
- control of blood sugar levels overnight
- they are helpful for people who do shift work
- they are helpful if traveling across different time zones
The downsides to a basal-bolus regimen are that:
- people may need to take up to 4 injections a day
- adapting to this routine can be challenging
- it can be hard to remember to take the injections
- it can be hard to time the injections
- it's necessary to keep a supply of insulin with you
These things can make it harder to manage diabetes well. To make it easier, some experts suggest introducing the regimen gradually. When this happens, bolus insulin is taken, beginning with just one meal at a time.
What is basal insulin? Basal insulin is also sometimes known as "background insulin." It is usually taken once or twice a day to keep blood sugar levels consistent. This is important when the body is releasing glucose to supply cells with energy, during fasting.
By keeping sugar levels steady during fasting, basal insulin allows the cells to change sugar into energy more easily. Basal insulin makes up about half of the total amount of daily insulin. It is sometimes called "long-acting insulin" because it needs to be effective for a long time.
Examples of long-acting basal insulin for people with diabetes include:
- glargine (Lantus)
- detemir (Levemir)
These insulins reach the bloodstream several hours after injection and are effective for up to 24 hours. However, people using these treatments will also need to use rapid-acting insulin when they eat. This applies for people with type 2 diabetes.
As well as using long-acting basal insulin, some people with type 2 diabetes may need to take oral medication. In addition, they may need a weekly injection of a medicine called a "GLP-1 agonist".
What is bolus insulin? People with diabetes take bolus insulin at meal times, to keep blood sugar levels under control after eating.
Bolus insulin needs to act quickly, and so is known as "short-acting" or "rapid-acting" insulin. It works in about 15 minutes, peaks in about 1 hour, and continues to work for 2 to 4 hours.
Brands of rapid-acting bolus insulins include:
Bolus insulin needs to reflect the amount of food eaten during a meal. So, carbohydrate counting and insulin-to-carbohydrate ratios are important tools for people with diabetes who use. However, some people find it easier to use an "insulin scale" instead.
An insulin scale is a list of how much insulin should be given before a meal. It takes into account both the pre-meal blood sugar level and the amount of carbohydrate that would usually be eaten at that meal.
However, it is still important for people using insulin scales to think about the dose of insulin they will take. They should compare it to the amount of food they are eating and what activities they have planned for after they eat.
This is because if they are going to eat more than usual then they may need more insulin than is listed on the scale. Or, they may need less insulin than is listed on the scale if they are planning on being more active than usual that day.
Insulin for people with diabetes is usually injected. However, in recent years, some alternatives to syringe injections have become available.
One alternative to injections is insertion aids, which are spring-loaded devices with a shielded needle. Insertion aids release insulin at the simple touch of a button.
Infusers are another option. An infuser is a device containing a needle or catheter (a flexible plastic tube) that remains under the skin for up to 72 hours.
When a person needs to administer insulin, they inject the insulin directly into the infuser, rather than into the skin. This method reduces the number of times they would need to insert a needle into their skin.
Yet, another method is the use of jet injectors. This does not use needles. Instead, a thin, high-pressure stream of insulin is forced through the skin.
Although jet injectors do not involve needles, the pressure can cause bruising.
Insulin can also be delivered using insulin pumps, if you can afford them. These are small, computerized devices that provide a steady, measured, and continuous dose of basal insulin, or a surge of bolus insulin at mealtimes. The insulin is delivered through a catheter that is taped in place on the skin.
May 19, 2017
I am adapting this discussion for people with type 2 diabetes. Long-acting insulin can help to stabilize blood glucose levels throughout the day, with only one or two shots.
Fast-acting insulin replaces the surge of insulin that a healthy pancreas would release at mealtime. In contrast, long-acting insulin mimics the low-level flow of insulin normally released between meals and overnight.
In this way, long-acting insulin works to establish a healthy baseline blood glucose level for the body to work around.
Long-acting insulin cannot be delivered in pill form because it would be broken down in the stomach. Instead, it must be injected into the fatty tissue under the skin. From here, it can be gradually released into the bloodstream.
According to the National Institute of Diabetes and Digestive and Kidney Diseases, there are a few ways to deliver long-acting insulin. These include:
- Needle and syringe: a dose of insulin is drawn from a vial into a syringe. Different types of insulin must not be mixed in the same syringe.
- Pen: this can be loaded with a cartridge containing a premeasured dose, or prefilled with insulin and discarded after use.
- Injection port: a short tube is inserted into the tissue beneath the skin. Insulin can be delivered using either a syringe or a pen. This only requires the skin to be punctured when the tube needs to be replaced.
Long-acting insulin can be injected into the abdomen, upper arms, or thighs.
Abdomen injections deliver insulin into the blood most quickly. The process takes a little more time from the upper arms, and it is even slower from the thighs.
It is important to stay consistent with the general injection area, but the exact injection site should be rotated frequently. Repeat injections at the same spot on the skin can cause lumps to develop under the skin, making it harder for the insulin to work.
Each type of long-acting insulin has its own suggested dose. These vary depending on whether the diabetes is type or for people who have never used insulin before. When a person is starting to use new insulin, it is recommended that they begin with a smaller percentage of the target dose. This is so that the body has time to adapt to the drug. That dosage is then gradually increased under the guidance of a doctor.
Long-acting insulin dosage may also be adjusted if diet or amount of daily physical activity changes, or if a person becomes ill. This is because these factors all affect blood sugar levels.
Adjustments can also be made to address any negative reactions to insulin, such as weight gain. Finding the ideal long-acting insulin regimen is a trial and error process that requires careful monitoring of blood sugar levels.
According to the American Diabetes Association, the periods that long-acting insulin works for differs from insulin that is faster-acting in three main ways:
- Onset: how quickly a dose of insulin begins to work. Short and rapid-acting insulin starts to lower blood sugar levels within 15 to 30 minutes. Long-acting insulin takes effect several hours after injection.
- Peak time: when a dose of insulin has its strongest effect. Rapid and short-acting insulin peaks at around one to three hours after injection. Long-acting insulin does not have a peak time. It works to lower blood sugar levels at a fairly stable rate throughout the day.
- Duration: how long the effects of an insulin injection last. Faster-acting insulin can control blood sugar levels for only a few hours. Long-acting insulin can work for around 24 hours or more, depending on drug type.
Long-acting insulin cannot stabilize post-meal blood sugar spikes.
When scientists create long-acting insulin, they change the structure of natural insulin. This is so that it can be absorbed into the bloodstream more gradually.
The United States Food and Drug Administration (FDA) explain that there are three forms of long-acting insulin currently on the market:
Below is a summary detailing how each of these work.
This insulin works over the course of the day. Here are some additional details about how it works:
- Duration: 18 to 24 hours.
- Administration: can be taken once or twice daily, at the same time each day.
- Brand name: Levemir.
When injected, insulin glargine forms clusters in the fatty tissue beneath the skin. These clusters break down slowly, so that small amounts of insulin are released into the bloodstream gradually.
- Duration: up to 24 hours.
- Administration: taken once daily, at the same time each day.
- Brand names: Lantus, Toujeo, and Basaglar.
This type of insulin works by slowing down the rate at which insulin molecules are absorbed into the bloodstream.
- Duration: up to 42 hours.
- Administration: taken once daily, and it can be at different times each day.
- Brand name: Tresiba.
Some research suggests that degludec works better than the older versions of long-acting insulin. However, because of pricing and health insurance coverage, insulin degludec is not very affordable.
According to an article recently published in Business Insider, Basaglar is currently the most affordable brand of degludec long-acting insulin.
May 18, 2017
I thought I had seen just about everything that medical writers can mess up, but this article just proves how wrong I was. These two women that wrote and checked the article obviously do not know diabetes equipment and I have some serious doubts about even diabetes.
They don't understand that many doctors do not recommend blood glucose testing and will not make any attempts to help them obtain additional test strips for the first three or four months to even come close to what they recommend.
“Read the manual for the blood glucose monitor and testing strips.” Yes, you should read the manual for your blood glucose meter and instructions that come with your test strips.
“In most cases, testing strips should only be inserted into the monitor immediately before a reading.” I could be in error, but I am familiar with using one test strip (not testing strips) at a time. Since we are talking test strips, I know that the equipment is a meter (not a monitor). The next problem I question is inserting immediately before a reading. Normally, you need to with most meters insert the test strip in the meter and insert the test strip in the meter into the blood your lancet has brought to the surface of your finger.
“Wash and dry hands.” Yes, you need to wash your hands with soap and water.
“Cleanse the testing area with an alcohol swab.” It is seldom advised to use an alcohol swab because this will not remove fruit sugars from the area you will test on. In the winter season, using alcohol swabs will cause dry and cracked skin, which will cause testing to be very painful.
“If testing on the finger, test on the side of the finger, and use different fingers with each test.” Most people I know do test on the side of the finger and use both sides of a finger and then move to the next finger. Many of us use the sides of our thumbs as well. Some of us also use the sole of our finger tips, but many cannot use all finger soles or any finger soles because of the many nerves there.
“Squeeze the finger while holding it at chest level, and allow a drop of blood to flow onto the test strip.” This is a totally bogus statement to me, as most meters require the test strip be inserted in the slot on the meter and then moved into the blood to be wicked into the test strip. There may be a meter that allows the blood to be flowed onto the test strip and then the test strip is inserted into the slot in the meter; however, I am not aware of any. The meters that I am aware of will return an error reading if operated this way. I don't like wasting money.
Sometimes known as A1c, this test provides a picture of blood sugar readings over several weeks. Several weeks is not 120 days or four months. The most current 30 days accounts for 50 percent of the test. The next 30 days accounts for 25 percent and the remaining 60 days account for the last 25 percent of the HbA1C test (A1C).
Part 3 of 3 parts
May 17, 2017
Diabetes cannot be diagnosed solely by home testing. People with unusual readings will need further testing by a doctor.
Tests might include fasting tests, plasma glucose test, tests following consumption of a glucose solution (or oral glucose tolerance test - OGTT), HbA1c tests, or a combination of these.
When deciding on a blood glucose meter to purchase, a few factors should be considered. A blood glucose meter, testing strips, and a lancet that holds the lances to draw the blood are all necessary for testing. Some testing kits offer all four, while others require purchasing each piece separately.
People should consider the cost of testing strips as well as the meter itself, since people with diabetes use many testing strips. Some other tips for buying a meter include:
- selecting one with automatic coding
- checking insurance plans to see if the insurer only covers certain meters
- looking at whether the unit stores previous data
- considering portability, since larger units can be harder to carry
- weighing blood sample size, particularly for people who do not like pricking themselves
Meters that use a smaller sample size will also use a less painful stick. Many people with diabetes have no symptoms at all. As a result, the absence of symptoms does not necessarily mean the absence of diabetes.
Many of the symptoms of type 1 and type 2 diabetes are the same, since both affect the body's ability to regulate blood glucose. Those symptoms include:
- increased hunger and thirst
- increased urination, particularly at night
- unexplained weight loss
- tiredness that is not well-explained by something else, such as sleep deprivation
- blurred vision
- slow-healing sores, or wounds that appear to heal and then reopen
- high blood pressure
Pregnant women who suddenly experience these symptoms should consider the possibility of diabetes. The placenta releases hormones during pregnancy that can make it more difficult for the body to control blood sugar. Left untreated, gestational diabetes can cause a range of pregnancy complications.
Diabetes is the seventh leading cause of death in the United States and can lead to a host of complications. These include:
- Increased hunger and thirst, as well as increased urination at night, may be symptoms of diabetes.
- cardiovascular problems, including stroke, heart attack, and blood clots
- wounds, numbness, tingling, and even loss of feet or limbs
- kidney failure
- nerve damage
- chronic headaches
Early interventions can reduce the risk of severe or fatal diabetes complications. The right combination of medication and lifestyle changes may even help reverse some cases of diabetes.
People performing home diabetes testing who have unusually high results, particularly more than once, should see their doctors. People with diabetes whose blood glucose is poorly controlled, or whose blood glucose suddenly changes, should also consult a doctor.
Changes in diet, medication, or both may be recommended. Diabetes can be well-controlled by managing carbohydrate intake, and exercising regularly,
People with prediabetes are at risk for developing diabetes if blood glucose is not managed. It's especially important for people with prediabetes to talk to their doctors, and to continue regular blood glucose testing.
Part 2 of 3 parts