Avoiding injury

Posted on October 24, 2011 by janekdickinson

I have a foot injury that is seriously cramping my exercise style (no pun intended). I haven’t been able to walk in several days, because it hurts, I don’t want to it get worse, and I do want it to heal. This has been a good reminder of two important things I always tell patients, but clearly forgot for myself:

1)      Stretch your muscles to avoid injury

2)      Wear good shoes to avoid injury

I am convinced that this foot injury happened because I walked far and fast in a pair of shoes that were not meant for walking far and fast. Totally bad planning (or no planning) on my part and now I’m paying the price.

Messages about stretching have varied over the years. I originally learned to stretch before exercising, but then it changed to after (when the muscles are warmed up and more flexible). I’ve been stretching after my walk as long as I can remember. But every now and then I hear someone say they stretch before, so maybe we should do a little of both. Here’s an article from the Mayo Clinic about stretching. I was happy to find out I’m doing most of what they suggest! I use the first five minutes of my walk as a “warm-up” and then I also “cool down” with five minutes at the end. I ran (most of) a 5K with my kids recently, and I seriously wondered how to do my warm up, when I was expected to just start running. I ended up parking a few blocks away from the race and walking to the registration area as my warm-up.

And don’t forget about footwear. It really is important. I was wearing a relatively new pair of slip-on snow clogs with my orthotics in them when I injured my foot. I had support, but not in all the right places. I think that because the shoes have no back, I used different muscles (or more likely tendons), which weren’t used to working so hard. In the future I will anticipate situations where I might have to walk a lot and then remember to wear (or at least change into) appropriate shoes.

If I’m injured, I can’t exercise. If I can’t exercise, my blood glucose is much harder to manage. My short- and long-term health depend on my exercising, so it’s my job to stay in good shape for doing that.

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Life Lessons Learned…on the bus

Posted on October 22, 2011 by janekdickinson

My kids take the school bus for many reasons, not the least of which is all the great life lessons they learn:

They learn to make room…for those they don’t know, those who are different from them, or those with whom they likely would never have had a conversation.

They learn time management…the bus comes on time!

They learn respect for adults who are in charge…three cheers for the bus-driver, the bus-driver, the bus-driver; three cheers for the bus-driver, who drove us today!

They learn that they have it good…especially when they hear about other bus drivers who are more strict!

They learn “bad words”…and then we have conversations where they learn about respect and what is acceptable in our family (and they learn that’s it’s about making choices).

They learn to be responsible for their belongings…and they keep track of their stuff!

They learn to be independent…they don’t need Mom and Dad for everything and one day they will be on their own!

They learn to say good-bye…which is part of being independent.

They learn that someone is always watching…and on the bus it’s a video tape!

They learn that there are consequences for poor choices…like having to sit alone in the front seat.

They learn that the world is made up of all kinds of kids/people…and sometimes we have to sit with them!

They learn that when people don’t pick up their trash, the bus gets messy, sticky and smelly…just like their bedrooms!

They learn that some kids have asthma or diabetes or something else…and that goes on the bus with them!

They learn that life is bumpy and crowded and fun and amazing…and new adventures are around every corner!

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Healthy Habits are Contagious

Posted on October 21, 2011 by janekdickinson

I find it very interesting and not all that surprising that a study revealed family members of those who’ve had bariatric surgery also lost weight. We tend to do what those around us do! The family member who had surgery got a kick start, so to speak, lost a bunch of weight, and then hopefully started making some healthy food choices to keep the weight off. The spouse and kids are most likely going to witness all of this, and may want to jump on the weight loss bandwagon. At the very least, if the person who had surgery is in charge of meal preparation, the rest of the family may have no choice but to eat healthier.

Here’s a little thing about me: I do not like to cook. Those who know me well know that if I won the lottery I would hire a personal chef long before I would hire someone to clean my house. How amazing would it be to come home to a healthy, well-balanced meal with fresh produce, etc., that I didn’t even have to think about? But I live in the real world, and I prepare breakfast, lunch and most suppers/dinners during a typical week because I feel responsible for my kids’ well-being. I hope my husband gets something out of it too! I also know that if I eat a home-cooked meal I am less likely to overeat and more likely to eat healthier food items.

I’ve often heard that kids will eat what you put in front of them, and I definitely find that’s true. Yes, they balk at most vegetables, but we deal with that and force feed on occasion. But snacks are the real problem. If I can find the time and energy to cut up some apples or carrots and put them out for a snack…that’s what they eat! So once again it comes down to being prepared. If I cut up the carrots as soon as I get home from the grocery store (would a personal chef do the shopping too?), I don’t have to think about it when we need a healthy snack.

So for me the take-home is just a reminder that I am setting an example every day, all the time. Not only do healthy habits keep me alive and well, but they do the same for my family.

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Seasonal Hypoglycemia Treatment

Posted on October 19, 2011 by janekdickinson

It’s fall, so I am currently treating lows with candy corn. In the spring I use jelly beans. This is not a joke; I really do this. (And in between I use glucose tablets or orange juice.) Here’s my rationale: I know that 8 Brach’s candy corn pieces equal 15 grams of carbohydrate. I also know that 1 Brach’s jelly bird egg raises my blood glucose approximately 10 mg/dL. Using this information I can pretty closely titrate my treatment to bring a low blood glucose into a safer range with a tasty treat! (PS You will have to figure out the math if you use a different brand of candy corn or jelly beans.)

It all began when I heard a story (still don’t know if it’s true) that a hospital in Maine uses twelve jelly beans instead of the glucose drink for glucose tolerance tests in pregnant women. When I heard this I vowed never to eat jelly beans again – I just couldn’t believe they were so lethal (I’m being dramatic). But then I remembered that I don’t even like jelly beans all that much, and since I wouldn’t find myself snacking on them, they really do make a good low treatment option. So I use jelly beans until I can’t find them in the store (usually by summer).

On the other hand, I really do have a candy corn problem. It’s a good thing they are only available in the fall. But if I count out eight of them, I can usually stick with that (if I just start eating out of the bag, however, it’s all over). I often suggest to patients not to think of a low as “yay, I get to eat (fill in the blank).” Instead, eat (fill in the blank) from time to time just because you want to (and work it into your eating plan), and treat lows with something that otherwise wouldn’t really appeal to you. The reason for this is that it’s easy to get into the “I want to be low” mindset if you get rewarded for being low.

I also avoid treating lows with (chocolate) candy bars. Since the beginning of time I have stuck to this because of the fat in candy bars, and I have found that fat slows down the action of the carbohydrate. This summer I attended a talk on carbs and was told emphatically that this is not the case; that fat does not slow down the action of carbs. I’m still struggling with this, because in my experience it does. And if it takes longer for my blood glucose to rise, I’m likely to eat more (basically until I feel better), which just means packing on the calories and feeling worse when I’m high later on.

So now for a poll: How do you treat lows? Do you find that if you treat a low with a high-fat item (for instance, a candy bar) that it takes longer for your blood glucose to come back up? Do you have a festive flare to your low treatment?

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Which Came First?

Posted on October 17, 2011 by janekdickinson

I’ve often wondered which comes first – one’s personality or diabetes. What I mean is, if someone is totally on top of their diabetes management – checks blood glucose levels frequently, takes medication on time, exercises routinely, etc., etc., would they have been like this anyway? Or did getting diabetes make them more attentive, obsessive, observant – whatever you want to call it?

On the other hand, if someone with diabetes doesn’t check blood glucose, doesn’t exercise, doesn’t pay attention to food choices, etc., are they responding to being angry at having the disease? Or would they have dealt with it this way no matter what?

I’m reading a great book called, “Succeed: How we can reach our goals” by Heidi Grant Halvorson. In it she talks about our innate ability to change. Many times we think we are born the way we are and cannot change aspects of our personality. Heidi dispels this myth and assures us that we can definitely change if we want to, and if we work at it. She also explains that we have certain types of beliefs. Some of us believe our personalities are fixed while others of us believe we can change, improve and grow. Our beliefs play a huge role in how we live.

I have to admit I’ve spent some time in the “fixed personality” belief group, but I’ve been working for a while to get into the other group. Believing we can change and improve can be especially important for people with a chronic condition like diabetes. And we don’t have to be perfect! Growing and improving involves falling down from time to time – and accepting ourselves despite all of it.

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Diabetes Story: Predicting the future

Posted on October 14, 2011 by janekdickinson

Question #9: If you could predict the future, how do you think you will do with diabetes? If the response is positive, add: How can you make this happen? If the response is negative, add: How can you avoid this?

I am very confident that I am going to do very well. I plan to live to be at least 85 years old and I have no idea what will take me, but I don’t think it will be diabetes-related. I do have worries about being in a nursing home, because I don’t want anyone “taking care” of me, but maybe I’ll just have to work hard and make sure I own the nursing home, and then I’ll be the boss :).

I can make this happen by continuing to work with providers who give me great information and direction when I need it; by staying positive and focused and motivated (at least most of the time); by staying connected with people who understand me and make me laugh; by being in charge of my life and my health and making my own choices every day. In addition, I can make this happen by maintaining balance in my life – between family, work, health, and enjoyment. And by taking advantage of quiet moments. And by remembering to enjoy “everything in moderation”…even moderation!

That’s my story. At least for now.

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Diabetes Story: Unhelpful

Posted on October 12, 2011 by janekdickinson

Question #8: What have other health professionals done that is not helpful?

I can’t think of any. I feel like I’ve raked the one internist over the coals enough in past posts, and I already admitted that good things came from his negative approach (as much I hate to admit it).

I have been fortunate to experience very skilled, kind, knowledgeable health professionals throughout my life. I know that many people cannot say the same. My hope for everyone out there is that you do whatever it takes to find a health professional(s) that is a good fit for you. Find someone who takes time with you, answers your questions, makes you feel like a person and not a lab value or disease, treats you with respect, and gives you autonomy. That’s what you deserve.

Today I drove three hours each way to visit my opthalmologist. It’s worth it for me to do what it takes to get the care I deserve.

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Diabetes Story: What have health professionals done?

Posted on October 10, 2011 by janekdickinson

Questions #7: What have health professionals done that is helpful?

My first pediatrician sent us to the hospital, and my nurse there, Sue, was kind to me and inspired me to eventually become a nurse.

My second pediatrician and first internist followed me through my college years and oversaw my health in a thorough and caring manner.

My Nurse Practitioner, Ruth, gave me strength and taught me to stay focused and positive.

My internist, although upsetting me terribly with scare tactics, indirectly helped me to take better care of myself.

My ophthalmologist gave me courage and made me feel good about myself and the work I put into my diabetes management. He showed me photos of my retinas and explained everything.

My endocrinologist takes time with me. He answers all of my questions including all the scientific rationale. He keeps me up to date with the latest in diabetes research and gadgets. He gives me respect, encouragement and positive reinforcement.

I have been fortunate to work with amazing health professionals throughout my life. I am also fortunate because I have good health insurance and I am able to choose providers who are a good fit for me. This is so important for anyone who lives with a chronic condition.

What have health professionals done for you that is helpful?

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Painfully Obvious?

Posted on October 7, 2011 by janekdickinson

Yesterday and today I received notice of articles reporting on diabetes research that appears to be painfully obvious. There’s one about kids who watch television having higher A1Cs. Ya think? That would be the lack of activity, folks. And another about decreases in A1C and blood pressure leading to lower risk of cardiovascular complications in people with type 2 diabetes. Ok, I admit that I left out the word “small” as in “small changes” leading to big rewards. And that really is a big deal.

These types of studies remind me of the DCCT. The Diabetes Control and Complications Trial began in 1984 with results published in 1993. They studied whether intensive management of type 1 diabetes lowered the risk of complications. Back then many people thought the study was a waste of time, energy and resources because we already knew all that. But the point was that enough providers did not believe it and teach their patients to manage their diabetes intensively, that scientists felt the study was necessary.

Almost twenty years after that landmark study (the DCCT), it is still talked about, and I don’t imagine there are many providers out there who are telling people with diabetes that it doesn’t matter if they keep their blood glucose level high all the time. I have to qualify that elderly people and those dealing with things like cancer are often encouraged to ease up on their diabetes management for a variety of reasons.

But back to the first two articles. The TV article actually starts with these words: “It’s not clear why this relationship exists” (TV watching leading to higher A1C, that is)! I was shocked. Kids who watch TV for four-plus hours a day are not getting enough exercise! There isn’t enough time between getting home from school and going to bed, if you include homework and reading time, to watch four hours of TV and get enough exercise. This is a set up for higher blood glucose levels, and therefore higher A1C. Am I missing something?

As far as the A1C and blood pressure research goes, it’s like the DCCT. Seems kind of obvious, but maybe providers in general needed proof to encourage patients that even small changes can make a big difference.

I’m excited for tomorrow’s headlines!

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Diabetes Story: What gets in the way?

Posted on October 5, 2011 by janekdickinson

Question #6: What gets in the way of you doing better with it?

PMS!!! Sorry guys, but it must be discussed. Pre-menstrual syndrome (PMS) and diabetes are a bad combination. For about one-third of women with diabetes, blood glucose levels rise during the 7 to 14 days prior to menstruation. Another third see their blood glucose levels fall and the final third don’t notice a difference. Things seem to settle in and normalize (if there’s such a thing as normal) once she gets her period.

I am in the first group. My blood glucose goes up – annoyingly – like clockwork at day 14 of my cycle. By day 18 or 19 I have to increase my basal insulin (Lantus) dose or I am left chasing blood glucose levels all day. When I give in to what I like to call “hormonal eating” my numbers are truly all over the place.

PMS is pretty well known for causing women to have mood swings and food cravings. Add diabetes to the mix and watch out! Food cravings can cause elevated blood glucose, which can cause mood swings (without even considering hormonal mood swings). Chasing high blood glucose with insulin can lead to low blood glucose levels. (This is called “stacking insulin,” where someone takes insulin to bring down a high blood glucose, but there was still insulin working. When all that insulin kicks in the blood glucose can plummet.) All that bouncing around of blood glucose levels can also cause mood swings – typically irritability!

I once asked a friend with diabetes how her blood glucose responds during PMS and she said, “I don’t know, because that would requiring checking it!” What a good point – during PMS, the last thing we feel like doing is checking blood glucose levels. Can you see how this is just a setup for disaster?

I have actually worked hard to figure out my blood glucose patterns during PMS, and I know for a fact that it goes up – even without extra food. It shows up most often after meals, so I need more insulin to cover carbs. I find that taking more basal insulin (again, Lantus for me) gives me a better starting point, so I don’t need quite as much rapid-acting insulin at mealtime. This is certainly easier to manage with an insulin pump – when I’ve used a pump, I always had a separate pattern or basal setting for “PMS.” I would just program my pump to deliver that basal rate for the 7-10 days before my period. It certainly helps if your cycle is regular, but it is possible to figure it out either way. If you wear a pump and don’t know how to program a separate basal rate like this, talk to your diabetes care professional.

So what gets in your way? Guys, if you stuck with it and read all the way through this, I’m impressed!

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