Diabetes and Depression

Posted on February 1, 2012 by janekdickinson

The link between diabetes and depression is interesting and important. Research now shows that diabetes can lead to depression (which we knew) and depression can lead to diabetes.

Although women tend to be affected more, everyone with diabetes is at higher risk for depression. Managing a chronic condition every day can be overwhelming and can tip the scale toward depression. In addition, those who have complications of diabetes are at risk for depression. Unfortunately, depression can decrease someone’s motivation to manage the disease, which can lead to further damage.

So how can depression lead to diabetes? I like how the article (link above) mentions that it’s all about stress. Stress causes the body to release hormones that raise the blood glucose and make the body less successful at regulating glucose levels. In addition, some antidepressants (medications for depression) cause elevated blood glucose levels. Finally, depression can cause people to overeat and not exercise, and this type of lifestyle can lead to type 2 diabetes.

It is crucial that those who have diabetes and depression take care of both conditions. Without managing the depression – with medication and/or counseling – the diabetes can suffer. Without managing diabetes, depression can develop. Another study looked at integrated care, where people with diabetes and depression received education sessions regarding medications, depression, diabetes, and the importance of taking both diabetes and depression medications. Results of this study showed a significant improvement in blood glucose (hemoglobin A1C) and a decrease in depression symptoms for those who received the intervention. This is evidence that it is possible to find ways to manage these two diseases successfully.

If you or someone you know is depressed and has diabetes, please ask your health care provider for help. Show them this study.

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Did you find everything you were looking for?

Posted on January 30, 2012 by janekdickinson

Why do cashiers ask this question if they have no intention of helping you find what you didn’t find? This happened to me today. I was asked the question and at first I was going to give my usual answer, “Yes.” But then something made me decide to tell the woman what I couldn’t find. She basically responded the same way she would have if I had said, “Yes.”

Do I do this with people I see in the office? Do I ask them a question and then not follow up on their answer? I’m sure I have done this at some point, and now I will be more aware of it (and work hard to not do it).

How do we do this to ourselves? Maybe we ask ourselves how we could do something differently in diabetes management and then we don’t follow up and make the change. Maybe we set goals and don’t work to achieve them. Maybe we get off to a great start with healthy eating and exercise, and then one low blood glucose makes us throw in the towel.

We can try again next time, though, and we can get back on track. The cashier will ask the next customer, “Did you find everything you were looking for?” and hopefully help them out if they didn’t. It can happen.

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We need snow like we need glucose

Posted on January 27, 2012 by janekdickinson

I admit that I am mostly motivated for wanting snow by the fact that I bought a very expensive ski pass and I want to use it. But more importantly, we need snow! I started thinking about how my community’s need for snow is a lot like our bodies’ need for glucose: ironic, but real.

Many people hate snow – they avoid being in snowy places at all costs. Other people visit the mountains for a dose of snow and winter activities once a year. Those of us who live here, know that snow is essential to life. Snow brings tourists and our community functions on tax dollars that come from tourists who spend their money here. Snow keeps our hospital in business, and therefore we have good, local health care options. Snow melts and runs off into our river and gives us much-needed water all summer long.

Glucose is a challenge for those with diabetes: we spend a lot of time and energy trying to manage the level of glucose in our blood. It would be wonderful if we didn’t have to deal with glucose, but we do, because our bodies need glucose for energy. Our brains can’t function without glucose and we can’t function without our brains. Our muscles use glucose to contract and we can’t move without muscle contractions.

Sometimes the things that drive us the most crazy are the things we can’t live without.

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To B(G) or Not to B(G)

Posted on January 25, 2012 by janekdickinson

Routine self-monitoring of blood glucose for people with type 2 diabetes who do not take insulin  has been a debate for many years (I’m guessing as long as blood glucose meters have been around).

Yet another article about this topic was published recently. This article discusses a review that was done on 12 studies looking at the value of blood glucose monitoring in people with diabetes who do not take insulin. This review showed that checking blood glucose had a modest effect on lowering A1C (that only lasted about 12 months), and had no effect on patients’ satisfaction, general well-being, or general health-related quality of life.

I have to admit that I recommend blood glucose monitoring for everyone I see – at least for a little while. For those who are diagnosed with type 2 diabetes and are not taking insulin I recommend checking before and after a different meal each day for the first few weeks after diagnosis. This can really help people see the effect of certain foods and beverages on the blood glucose level. It can also be extremely motivating to see the blood glucose level drop after exercise.

My rationale for encouraging blood glucose monitoring at least for a little while is that I feel everyone deserves to get the whole picture – all the information possible. There are, of course, special circumstances – often related to cost – where blood glucose monitoring is not recommended.

If you have diabetes and do not take insulin, please share your thoughts on monitoring blood glucose. Have you done it? Has it helped you? Has it made things worse? What was your experience?

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CGM Poll

Posted on January 23, 2012 by janekdickinson

With all this talk about artificial pancreases (closed-loop systems) and CGM, it’s time to take a poll. I just read an article about a CGM study in kids ages 4 to 9. This is an important study, because this age group might really benefit from CGM. Unfortunately the results showed that only 19% of those using CGM lowered their A1C by 0.5%. However, this could be directly related to the fact that the insulin dose guidelines study parents followed were developed to avoid severe hypoglycemia.

I am not including the link to the article here, because it is accessible in member-only databases. If you want to see the abstract for the research article, click here.

I really thought CGM would be a wonderful tool for parents who have been getting up or staying up to check overnight blood glucose levels. Are we finding it’s just not accurate enough to rely on yet? What else are we finding about CGM – is it helpful? Is it extra work?

Parents of kids with type 1 diabetes: what are your thoughts on CGM?

Others who are or are not using CGM at this point: what are your thoughts/impressions?

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Artificial Pancreas updates

Posted on January 20, 2012 by janekdickinson

I guess it just dawned on me that the race is really on for the artificial pancreas. I listened to a webinar the other day about one group’s work on it. Yesterday I was looking at a conference agenda, where another group’s artificial pancreas will be discussed. And I just read an article about a group in Minnesota (scroll down to the third section) that is working on one as well. There are probably several more.

When I’m living in my little world, going about my business and taking my insulin, I don’t really give a lot of thought to an artificial pancreas. All this information, though, makes it seem more real and maybe even possible (in my lifetime?).

Anyway, I was very impressed with the article I read today because they acknowledged that the artificial pancreas is not the complete answer and that it won’t be perfect. Just as CGM – which has many wonderful benefits – is not perfect. I truly appreciate the honesty and the fact that this person stated, “I don’t think any of us believe that these machine-based solutions and equations will ever be perfect,” Levine said. “What we’re trying to do is to close the gap between substantial imperfection and a better solution for real patients living in the real world.”

I just want to say THANK YOU for that statement, and for all the work these and other scientists are doing to improve life for those of us with diabetes. It’s good to know that while I’m not thinking about it, someone else is.

What are your thoughts on the artificial pancreas (closed-loop system)?

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Pigs are Precious

Posted on January 19, 2012 by janekdickinson

We used to say this at diabetes camp years ago: “pigs are precious.” That was because our “purified pork” insulin came from pigs. A long time ago, beef (cow) insulin was the best we had, but many people had physical reactions to it. When pork insulin came out, it was hailed as being so close to human insulin that we would no longer have reactions to it. Some still did. The human body can’t always be tricked! As I’ve mentioned before, my personal theory is that animal insulin is the reason I get lipoatrophy today.

I found it interesting to read this article about a group in Minnesota that is studying pig cells – once again – to see if they can be transplanted into humans and take over insulin production. I’m just not sure where I stand on this. My thoughts go in many directions – pig cells…cure…pig cells…total cure? partial cure?…pig cells…

What are your thoughts on having pig cells transplanted into you?

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Jumping on the PD Bandwagon

Posted on January 18, 2012 by janekdickinson

A friend (with diabetes) and I were discussing how so many people with diabetes get judged and blamed for not doing or doing certain things. As another friend would say, they get “should” on. This negative attention can really bring someone down. It can even lead people to give up trying to manage their diabetes.

The question, therefore, is not whether Paula Deen brought on the diabetes by following an unhealthy lifestyle. For me, the question is: did her health care professionals guide her appropriately? Did anyone ask her if diabetes ran in her family, or if she was engaging in regular physical activity? A celebrity like Paula Deen can certainly hire a personal chef (I know that sounds ludicrous, but she must get tired of cooking at some point) and a physical trainer. Did anyone encourage her to do that?

Paula raised some important points during her interview with Al Roker. She mentioned that not only lifestyle, but family history (genetics) and stress can lead to type 2 diabetes. I imagine a life of fame comes with some stress. Type 2 diabetes can be prevented or at least delayed with healthy choices. It does no good, however, to blame someone who’s been diagnosed and make them feel worse than they already do. No one wants to get diabetes and no one deserves to get diabetes.

Paula Deen now has an amazing opportunity to become an example to the TV-watching, social networking public by making healthy choices. She told Al Roker that she has always stressed everything in moderation, and she will likely continue to do that. Those of us who are health care and diabetes professionals can be reminded through Paula’s announcement that it doesn’t matter who we work with – everyone needs to know how to prevent diabetes.

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Meme

Posted on January 16, 2012 by janekdickinson

I’m intrigued by this concept of Internet memes. I first saw this word used in a blog post over a year ago, and am still somewhat perplexed when I see it now. Having taken many years of French, I will probably always pronounce it “mem.” In French, meme means “same,” which is somewhat related to the Internet meme meaning which comes from the Greek word mimeme (something imitated) and means a concept that is spread via the Internet.

At any rate, a meme is a good diversion from the usual posts, and I just saw this one that involves answering the following ten questions:

1. Describe yourself in seven words: Organized, driven, fair, positive, sensitive, routine, happy.

2. What keeps you awake at night? Worrying about my kids (and they’re not even teen-agers yet).

3. If you could be anyone for a day, who would you be and why? I don’t want to be anyone else.

4. What are you wearing right now? Cords and a sweater.

5. What scares you? Being someone else.

6. What are the best and worst things about blogging? Best: amazing forum for sharing thoughts and information. Worst: no idea what others are thinking.

7. What is the last website you looked at, aside from Twitter or Facebook? Khan Academy.

8. If you could change one thing about yourself, what would it be? The times when I second-guess myself.

9. Slankets, yes or no? Absolutely NO.

10. What’s your dream? To make sense.

 

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Omnipod and Freestyle

Posted on January 14, 2012 by janekdickinson

If you use an OmniPod by Insulet, there is important information out about blood glucose monitoring strips. For a while now there’s been quite some confusion about which strips can be used in the PDM (personal diabetes manager), which doubles as a blood glucose meter. The old Freestyle strips that were FDA approved for use with the OmniPod were becoming less and less available and the new Freestyle strips with ZipWik were not yet approved.

Now the FDA has approved the Freestyle strips with ZipWik for use with the OmniPod, so hopefully the confusion and fear of running out of strips is behind us. Please visit the OmniPod website for more information.

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