Rural Diabetes

Posted on November 18, 2011 by janekdickinson

Happy Belated National Rural Health Day (it was yesterday)! Since I live in a rural area, this actually has meaning for me. Having diabetes and living in a rural area can be empowering and intimidating.

Some people live in a metropolitan area, yet choose to drive many miles or even take a train or fly to see their health care providers. Others live in rural areas and have no choice. The closest endocrinologist (medical doctor who specializes in diabetes) may be three hours away, as in my case. It’s still a choice. I choose to take a day out of my life every three to six months and drive to Denver for my diabetes “check-ups.”

When I was pregnant the first time, I was advised by a friend who is a nurse-midwife to only deliver in my rural town if they typically deliver at least three hundred babies per year. Our hospital wasn’t up to that number at that point (they’re past it now), but I decided to stick it out because my OB was really good about staying in close communication with my endocrinologist. I did have to go to Denver for a fetal echocardiogram, so that in the event that the baby’s heart was in danger I would deliver in Denver. Luckily, that was not the case and I delivered right here in our little 29-bed hospital, twice!

It’s important to get the care you need and deserve regardless of where you live. You can find the nearest diabetes educator by calling 1-800-TEAMUP4 and entering your address. One drawback to living in a rural location is that you may not have too many providers to choose from. It’s a good idea to have a general provider (family practitioner, nurse practitioner, physician’s assistant, or internist) who you can go to for regular physical exams, screenings, or if you are sick.

Some rural areas have top-notch health care. And there are amazing people all over the country who are working to improve care for those in rural places. Certainly the internet can provide information and answers to questions; just make sure you are getting your information/answers from reputable sources. Rural places are not as likely to have the numbers of people with diabetes that are found in cities. It’s less likely to find “meet-ups” and such, and support groups may not be as plentiful. Not to worry – you can find lots of friends with diabetes through social media. There are countless opportunities to meet people, compare experiences, share stories and suggestions, and support each other through diabetes-related websites. A quick Google seach will lead you to these resources.

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Managing Diabetes While Treating Your Cancer

Posted on November 16, 2011 by janekdickinson

Today I would like to share a guest post by Jackie Clark. Jackie joined the Mesothelioma Cancer Alliance in 2009 as a research assistant after graduating with a bachelor’s degree in English and a minor in fitness and nutrition. Jackie’s experience in technical and medical research has allowed her to assist in the development of medical content and outreach efforts, with specializations in alternative care, cancer support programs, and social media campaigns.

Cancer and diabetes are each difficult diseases to manage. Each can be frustrating enough to deal with on their own but managing both simultaneously can be extremely problematic and stressful.

Doctors have known for some time that cancer and its various treatments can cause or aggravate symptoms of diabetes. A recent Reuters Article published on May 12, 2011 reported, “Based on a telephone survey of nearly 400,000 adults, the study – whose findings appear in “Diabetes Care” – found that 16 out of every 100 diabetic men and 17 out of every 100 diabetic women said they had cancer.”

There are differing opinions as to why this happens and what needs to be done to manage both diseases simultaneously. What patients need to know is briefly discussed herein.

According to Dr. Pankaj Shah, assistant professor in the Department of Endocrine Neoplasia and Hormonal Disorders at the MD Anderson Cancer center as reported on the MD Anderson website:

“Certain treatments and certain cancers, particularly pancreatic, adrenal and lung, can produce diabetes. Sometimes diabetes appears a few years after chemotherapy.”

This is because “cancer or (cancer) treatment can bring about metabolic changes that cause or worsen diabetes. For example, you can lose muscle and not be able to exercise.”

As soon as they are diagnosed, cancer patients, whether they have a severe form such as mesothelioma or a common form such as breast cancer, should do two things. First, educate themselves about the risk factors for diabetes. Second, evaluate his or her risk based on this information. Doing so may increase your life expectancy.

Risk factors include:

• Family History

• Obesity

• Stress

• Race

• Medical history

• Tobacco use

• Gestational diabetes

If you already have diabetes, become more proactive:

• Discuss your additional issues with your doctor

• Consult your dietitian about any dietary changes that might be beneficial

• Know the blood glucose levels you need to maintain

• Know what medicines you are taking and how they affect your diabetes

• Be prepared at all times with healthy snacks

• Wear diabetes ID

Managing your blood sugar levels will help insure a better outcome and help prevent infection during treatment. Since everyone is different, patients should consult their physicians about appropriate levels.

While nausea is a common side effect of cancer treatment, it is especially important for people who have cancer and diabetes to eat.

• Take advantage of the times when you are hungry

• Try to eat frequent small meals

• Avoid fatty, fried, or spicy foods

• Do not lie down right after eating

• Sip liquids between meals but do not drink too much fluid with meals

By: Jackie Clark

I would also add that sometimes cancer treatment (chemotherapy drugs, and prednisone, in particular), can cause elevated blood glucose levels. For people who were predisposed to diabetes before ever getting cancer (for example, those with a family history of diabetes and those who were overweight or had an elevated fasting blood glucose) the scales may be tipped and diabetes may rear its ugly head at this most inopportune time. For most people, dealing with cancer is the priority and managing diabetes may mean simply taking additional medication (often insulin) in order to keep blood glucose levels in a safe range without having to make other changes. As Jackie mentioned, those who are being treated for cancer need to eat when they feel they are able to, so worrying about food and diabetes does not have to be a focus. Taking insulin requires being educated about the possibility of low blood glucose. If you are dealing with cancer and diabetes simultaneously, ask your provider for the name of the nearest diabetes educator.

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Stating the Obvious

Posted on November 14, 2011 by janekdickinson

Today is World Diabetes Day (the diabetes-related festivities are going to keep happening all month long). The purpose of World Diabetes Day is to increase global awareness about diabetes, and in honor of today I found some very humorous (in a weird, twisted way) titles on today’s list of diabetes articles. Talk about stating the obvious:

Poor Diet in High School Raises later Risk of Diabetes

Sugary Drinks Raise Risk of Metabolic Syndrome in Women

Overweight Fathers Increase Risk of Obesity in Children

Chewing Gum Doesn’t Affect Weight Loss

Despite the complete overuse of this saying in American dialogue, I just have to say, “Really??” Today I’m thankful for diabetes educators who are out there pounding the pavement (well, the clinics anyway), teaching Americans that healthy habits will help prevent or manage diabetes. Hopefully we are getting the message across so that headlines like these will just be redundant and unnecessary.

Now for the big one: Insulin is not a cure. In 1922 people honestly thought insulin was the cure, but quickly realized that insulin is just a way to manage diabetes. The campaign slogan for World Diabetes Day 2011 is “Act on Diabetes. Now.” Yes, insulin is not a cure, and we are dependent on research scientists to find the cure. We are also dependent on those who donate funds to pay for the cure.

In the meantime, those of us who live with diabetes can act on diabetes now by taking care of ourselves: we can make healthy choices, take medications, be active, eat well, stay positive. This way the next obvious statement will be “I’m doing great, thank you!”

 

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11/11/11 Salute

Posted on November 11, 2011 by janekdickinson

Today I am thinking about all the veterans who have served our country in the armed forces (and those who are still serving). Thank you for your dedication to ensuring that my family and I are safe and free. Diabetes is hard enough in the U.S.; I can’t imagine living with diabetes in a country where freedom does not ring.

I attended my kids’ Veterans Day assembly, which was on Tuesday (no school today). It was a wonderful celebration of those who have served – we learned about some people’s experiences in the different branches of the military. And of course, the kids sang some great, patriotic songs (and one tear-jerker called, “Thank You, Soldiers”).

After the assembly I was interested to find out if anything has changed in the world of diabetes in the military. One thing I once fantasized about doing in my life, and was not able to pursue due to diabetes, was being a Navy Nurse. This was not a lifelong dream or anything, but something that really intrigued me earlier in my career.

I learned that having type 1 diabetes still limits someone from entering the military. I can’t quite tell if there are some military jobs that would allow someone with type 1 diabetes, or if it is an across-the-board ruling. I also did not see anything definitive on type 2 diabetes. I was intrigued by a story about an Army Sgt who developed type 1 diabetes while in the Army, fought to stay in, and won. He was deployed to Iraq, insulin pump and all. Here’s an interesting blog post related to this topic (be sure to read the comments too).

I have mixed feelings about all this. Although I don’t think diabetes should limit anyone from doing things in life, I personally would not want to deal with diabetes during a war or any other military operation. I have great respect for the people who are working so hard to manage their diabetes in a way that keeps them safe in dangerous and high-stress situations (and these are not just in the military). At any rate, thanks again to all veterans with or without diabetes.

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Smoke diabetes, not cigarettes

Posted on November 9, 2011 by janekdickinson

Monday the 14th is World Diabetes Day and Thursday the 17th is the Great American Smokeout. What do these two things have in common? They can both wreak havoc on the human body!

The purpose of managing diabetes with lifestyle changes and medications is to avoid the devastating and sometimes deadly complications that can result from elevated blood glucose of prolonged duration. Smoking also causes deadly health problems, and, in fact, the same ones! Diabetes and smoking both contribute to poor circulation, heart disease, stroke, eye disease and kidney disease (and I’m sure nerve disease isn’t helped by smoking).

While the rate of cigarette smoking in adults without diabetes has declined over the past ten years, for those with diabetes it has stayed the same. In fact, adults with diabetes now smoke more than adults without. People with diabetes who smoke put themselves at a much higher risk for complications. Smoking is dangerous regardless, but if you have diabetes and you smoke, give yourself the gift of health this year and work toward quitting.  Cigarette smoking can also contribute to type 2 diabetes, if you don’t already have it. Can you imagine what it does to the blood glucose of someone with diabetes?

Sorry to go all diabetes educator on you, but smoking and diabetes really is a deadly combination and it’s my job to let everyone know that. Especially during Diabetes Awareness Month!

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Why I’m a diabetes educator

Posted on November 7, 2011 by janekdickinson

Happy Diabetes Education Week! The American Association of Diabetes Educators asked us to write about why we are diabetes educators. It’s a good question, I think.

Although I’ve shared in the past how my experience at diagnosis originally inspired me to be a nurse (and perhaps a diabetes educator?), I kind of came around to it in an interesting way. I’m sure most diabetes educators would say the same thing! I got my nursing degree through a 3-year RN to MSN program. I had my bachelors in biology and went directly on to get my masters in nursing. My specialty was Pediatric Clinical Nurse Specialist. As a Ped. CNS I could choose the disease state I would work in and my first job out of school was in a Hematology and Oncology Department. I worked with kids who had blood disorders and cancer.

Despite the fact that I loved working with these kids and their families, some challenges at work drove me to realize that what I truly wanted to be doing was working with kids who have diabetes. It was a 16-year-old with cancer who told me, as I taught her to inject herself with blood cell stimulating medicine by having her inject my insulin, “this would really help kids with diabetes, because they could relate to you.” (She then went on to say that it would really help her if her nurse would take chemotherapy.)

I entered the profession of diabetes education in 1995, and have never looked back. I’ve been fortunate to experience a variety of roles within diabetes education and I have enjoyed them all. I am very excited to be a part of the Teachers College Masters in Diabetes Education and Management program, where we are growing the next generation of diabetes education leaders.

Although I would be happy to change careers should diabetes be eradicated, I must admit I can’t imagine what I would do (ok, yes, I could figure it out). I’m honored to work with people who have diabetes: I learn more from them than I could teach, and the same goes for my students at Teachers College. My job is never boring and always fulfilling. That’s why I’m a diabetes educator.

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Fear vs. Respect

Posted on November 4, 2011 by janekdickinson

My husband was telling me about the girl who was “disciplined” by her father and got it on video. I guess it’s all over the internet now. It got me thinking about how as parents we want our kids to respect us, but do we really want them to fear us?

This, of course, made me think of diabetes. We live with this chronic disease, its frustrations and sometimes devastations. We may fear complications, but do we fear the disease? Or do we respect the disease?

I think it’s healthier and safer to respect diabetes. Respectfully we can manage the disease, do the tasks we need to do, think about what we’re putting in our bodies and how it will affect our blood glucose, be active and take our medications. Respect can lead to motivation, direction and commitment.

Fear, on the other hand, can to lead to anxiety and anger. This response is likely to trigger “counter-regulatory” hormones that just raise the blood glucose level higher and higher (it’s called the stress response). Stress can sap our motivation and cause a downward spiral.

While fear can also motivate (fear of complications), I’m going to stick with respect.

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Living in the dark

Posted on November 2, 2011 by janekdickinson

Monday night was Halloween. It was also the night that a fiber optic line was cut about 90 miles from where we live, knocking out cell towers and therefore cell service all over northwestern Colorado. Not a big deal, right? Wrong. I found out that night how dependent we really are on technology.

Our town has a wonderful tradition of trick-or-treating in our “downtown.” It’s a typical western town with a wide “main” street and store fronts. For two hours on the evening of Halloween, kids and families stroll up and down the street while merchants hand out candy. It really is a fun and quaint tradition.

This year my husband and I decided that our kids were old enough to trick-or-treat with their friends, so once they were all squared away and off to collect candy, we went to a restaurant and hung out with friends. About an hour and a half later our friend went and retrieved the boys, but came back without our girl. My husband went out to look for her, but came back alone. After a few more laps (by this time all the businesses were closed and the street had been reopened to through traffic), we finally found her in a restaurant with her friends and one of their dads. If only we had had cell service, we could have avoided a lot of stress and worry.

This experience made me think about how much technology does for us in terms of diabetes. Without technology we really are in the dark. Without blood glucose meters we have no guide for how much insulin to take or food to eat. Without computers we can’t download our results and see patterns and make adjustments. For those whose lives have been changed due to CGM (continuous glucose monitoring), it would be hard to imagine not seeing your “number” at any moment of the day.

And then there’s the insulin pump, the treadmill or elliptical, the iPod you wear when you’re exercising. What about the computer you use to read the blog posts on the DOC? Diabetes would be a completely different experience without technology, and I, for one, wouldn’t want to go back to living in the dark.

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Finally, Good News

Posted on October 28, 2011 by janekdickinson

I’ve waited for this for a long time. Several years ago (I believe it was 2004), I was a facilitator at an education program for families of kids with newly diagnosed type 1 diabetes. I will never forget listening to a physician give a talk on kidney disease. She presented horrifying statistics about how many kids with diabetes would grow up to be adults with kidney disease. Someone asked if those stats weren’t decreasing since intensive diabetes management had become the norm and she said NO. I couldn’t believe it.

Now there are at least two studies that show the numbers are actually decreasing. Unfortunately, one has to be a member of a health professions database in order to read the article I saw today, so I will sum it up here.

Over 1600 adolescents were studied for eye (retina) changes, kidney function, and nerve function. The researchers found that retinopathy and kidney damage decreased in those who either took multiple daily injections or used an insulin pump.

Here’s the conclusion: “The decline in retinopathy supports contemporary guidelines that recommend lower glycemic targets and use of MDI/CSII in children and adolescents with type 1 diabetes” (Downie, et al., 2011, abstract).

It makes sense that using intensive, or physiologic, diabetes management (doing for ourselves what our bodies would be doing if they could) would actually pay off. Now the results are coming in. This study looks at kids/adolescents, so we might have to wait longer to get results for adults. Those of us who lived through the animal-insulin-1-or-2-shots-a-day period, have to live with the damage that approach may have caused. We can work hard to do good things for our bodies going forward, though.

And here’s the reference: Downie, E., Craig, M.E., Hing, Stephen, Cusumano, J., Chan, Alfred K.F., & Donaghue, K. (20110). Continued reduction in prevalence of retinopathy in adolescents with type 1 diabetes: Role of insulin therapy and glycemic control. Diabetes Care, 34(11), 2368-2373.

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Age and Weight

Posted on October 26, 2011 by janekdickinson

I recently read a conversation on facebook about how we are only as old as we feel or, more importantly, as we act. I believe this is true, and I have been known to say, “age is an attitude.” Unfortunately, one thing doesn’t seem to get easier as we get older: our weight.

I have worked with many people who have struggled to take off extra pounds as they have gotten older. I always make sure they have confirmed with their primary health care provider that their thyroid is working properly (nothing as frustrating as fighting the thyroid when it comes to weight loss!). We also discuss calories in vs. calories out (we all know how that goes – eat less, exercise more).

But something about aging makes weight loss harder, and recently there was an article about this. The title caught my eye, because I can now add myself to the group of people who are working harder to lose weight as we age. I was always one of those people who could take off extra weight easily and quickly, but these days I’m finding it a lot more difficult.

With diabetes insulin can be an extra challenge (and some other medications, such as sulfonylureas). When we take insulin we have to eat. So if we just start exercising and decreasing calories, but don’t change our medication doses, we risk being low all the time.

If we take the proper amount of insulin for our bodies, and we eat the proper amount of food (and we exercise), it should all balance out. Taking too much insulin leads to eating too much food (because of treating lows, or just plain feeling more hungry). On the flip side, eating too much leads to taking too much insulin. The insulin allows all those extra calories to get stored as fat.

So taking less insulin (again, working toward the right amount for your body) can lead to weight loss, if you are eating fewer calories (again, the right amount of food for your body). Keep in mind that not taking enough insulin can be a dangerous (even deadly) situation. If you are planning to lose a significant amount of weight, work closely with your health care providers to make sure your insulin doses and food intake are appropriate.

If you have diabetes and need to lose weight, but you don’t take insulin, you need to check with your provider to make sure you don’t take another medication that could cause low blood glucose. If not, you are pretty much free to decrease your calories and exercise to your heart’s content (but speaking of your heart, be sure to clear it with your provider before you start exercising too hard). It’s a good idea to meet with a registered dietitian if you haven’t in a while. He or she can give you some suggestions on how to safely reduce calories and still get the healthy foods you need in your eating plan.

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