Vacation

Posted on July 26, 2011 by janekdickinson

Although there is no vacation from diabetes, it is possible to take a vacation from work, home routine, etc. I’m on one of those. Be back later.

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Diabetes Terminology Part 2

Posted on July 14, 2011 by janekdickinson

Are you ready for the next installment? I started the conversation about diabetes terminology a while back. There are a few more words I like to avoid using, for instance, “good” and “bad” when referring to blood glucose levels, people with diabetes (I especially loathe hearing someone say, “I’m a bad diabetic”), food, etc.

Blood glucose readings are just numbers. They help us make decisions. They are not good or bad. If you have chosen a target range where you’d like to see your blood glucose level hang out, you may refer to the numbers that aren’t in that range as “out of range”, “off my target” or something to that effect. I sometimes refer to blood glucose readings that I like to see as “happy” numbers. Using “good” and “bad” to describe blood glucose levels implies that the person is good or bad depending on what their number is. And this simply isn’t true.

There are definitely foods that are less healthy for us than others. I like to refer to these as healthy or unhealthy foods, rather than “good” or “bad” foods. Food has gotten a really bad rap and many people say, “diabetes means you can’t eat anything you like.” In addition, people often think “good” (good-for-you) foods are “bad” (taste bad). So if we strike “good” and “bad” from our food discussions, maybe we can help people understand that foods that are good for us can actually taste good too!!

That brings me to “cheat”. If someone without diabetes chooses to eat something that is high in calories or generally known to be unhealthy, no one really comments. Often when someone with diabetes eats that same food it’s considered “cheating.” How is that fair? Both people made a choice. They didn’t falsify anything or copy anyone’s work. They made a choice.

It’s easier to get these messages across to the general public if we avoid using terms like these on ourselves (and others). You really aren’t a “bad diabetic”, so don’t call yourself that. You aren’t a cheater (well, I guess I don’t know that for sure, but not as far as diabetes goes anyway…), so don’t call yourself one.

Ok, once again, stepping down from my soap box. Thanks.

 

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We all make mistakes

Posted on July 13, 2011 by janekdickinson

Last night I really messed up. I’ve witnessed insulin mistakes at diabetes camp, and I’ve heard stories from many parents of/people with diabetes who have taken wrong doses. It’s never an under-dosing we hear about, because we could always just add more. It’s the over-dosing that’s really scary.

Last night was a set-up for a mistake. I was extremely tired and I was talking on the phone as I was drawing up my Lantus. I finished injecting the “Lantus” into my leg when I realized it was actually Novolog. Sixteen extra units of Novolog, which is a fast-acting insulin that starts working in about 15 minutes and peaks in about 90 minutes. You can’t fix that with an ice cream sundae!! (Too much fat – fat takes hours to break down and doesn’t raise the blood glucose level significantly.)

To make matters worse I had just taken a correction dose of 3 units about 30 minutes earlier, so I had 19 units in me and about to work hard. The only thing going in my favor was that my blood glucose was 223, so I had a little time. I stayed calm (important first step) and thought about what I could eat/drink with the most bang for the buck, because I knew I would get full quickly. I ended up drinking approximately 3.5 cups of orange juice, which is 7 carb servings (4 oz. of orange juice is 15 grams of carb, or a carb serving). I also had a whole banana and some peanut butter. The fat was to ensure that the effect of the carb would stick around for at least a couple hours.

I also took my 16 units of Lantus, which was a little scary, but I knew I still needed the long-term coverage throughout the night and next day. Finally, I told my sister what was going on. I’m currently up in New Hampshire and she is my roommate.

I went to bed feeling good about how I had “pre-treated” because I also knew that I had had some high fat items prior to the whole insulin ordeal (these would give me a buffer and keep my blood glucose level up for a while). I woke up at 4 am and checked: 131! Then this morning at 8am I was 119!

What I learned from this experience:

  1. we are all human and humans make mistakes
  2. stay calm, think through the options, and come up with a plan (quickly when dealing with fast-acting insulin)
  3. take enough “treatment” (food or beverage) to account for all the insulin taken
  4. let someone know what is going on, so they can help out, if necessary
  5. stay focused when drawing up/administering insulin – avoid distractions like talking on the phone, especially when extremely tired
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Observations from the road

Posted on July 12, 2011 by janekdickinson

I made some observations while driving from Colorado to New Hampshire over the past five days. First of all, and probably most important, we have a beautiful country. From the vast, open farmland of the midwest to the green mountains of Vermont and the lakes of New Hampshire, this is quite a place. I saw several mile markers and exit signs with “117”, which always made me smile.

I noticed that the stops along route 80 through Nebraska are getting cleaner and more modern. There are a few more choices in food and lodging now than there were years ago. The rest areas in Iowa have been completely redone and are very nice! We had picnic lunches at many of these places. Rest areas on highways throughout our trip even had wi-fi!

The most significant observation, though, is that when I practice what I preach it really works. I’m always coaching patients to keep up their healthy habits when traveling – check blood glucose levels, take walks, eat well, etc., – and then they can enjoy their experiences more. Well, folks, it’s true. I actually packed a cooler with veggies and fruit, sandwich supplies, cereal and milk. When it came time for lunches, not only did we save time (and money), I didn’t eat roadside junk/fast food that makes me feel tired and gross. I also walked every morning and this combination of exercise and healthy eating gave me the energy to get through five long days of driving. I highly recommend it!

I definitely acknowledge that it’s easy to throw in the towel while away from home and routine. It’s more convenient (and tasty) to just eat the junk, slack off on the exercise, maybe even the blood glucose monitoring. But if you stick with it, the payoff is worth it: more energy and a better attitude for enjoying the sights and people you are visiting.

Any other tips for traveling with diabetes?

 

 

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Freedom and Diabetes

Posted on July 4, 2011 by janekdickinson

Happy 4th of July! Happy Independence Day! To me, this holiday is a celebration of freedom. Of course, I started thinking about how this could possibly relate to diabetes, and I believe it does. Despite many people’s struggles with diabetes, those of us who live with this condition really do have much more freedom than our predecessors did.

In 2011 we have medications that address all different aspects of type 2 diabetes. We have much more effective types of insulin that are made in a lab and no longer from animals. We have the tiniest needles imaginable. We have blood glucose meters that require a teeny drop of blood and take just a few seconds to give a result.

We can pursue our dreams, have babies, run marathons, compete in the Olympics or on professional sports teams, participate in extreme sports, perform in movies or on stage, go to school, become executives, and so on.

We have the freedom to treat our bodies well, to exercise, eat healthy foods in healthy amounts, get good sleep, say no to smoking, find balance in life. We can learn about diabetes from countless resources and we can share correct information with others so they gain a better understanding of what diabetes is and what it is not.

We have the freedom to make choices and live well. Let freedom ring!

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Critical Thinking

Posted on July 2, 2011 by janekdickinson

I define critical thinking as being able to handle life as it comes. Critical thinking is drawing on our past experiences to make decisions about present situations. Critical thinking is more than a reaction; it’s a thoughtful, deliberate process.

Does that sound like diabetes management? It does to me! I listened to a talk not too long ago, where the presenter mentioned that it takes 10 years to become experienced at something (teaching, being a nurse, etc.). Although this person was specifically speaking about teaching, I kept thinking about how his points directly related to living with (and teaching people about) diabetes as well. There is no doubt that I am a lot better at managing my diabetes now than I was ten years ago, or ten years before that.

I once worked with a nurse at diabetes camp, who had her carb ratio down to the point that she knew exactly how much insulin to take for each food she ate – and for the most part it worked. Of course, it helped that she basically ate the same foods all the time. But we all have ways of handling this thing! Anyway, during this talk, I kept wondering how we could shorten that ten year experience rule. How could I, as a diabetes educator, help patients with newly diagnosed diabetes (and/or their family) to take it on, know how to respond to a variety of situations, and keep their head straight?

The presenter said that we can’t anticipate all the situations that will occur, because the human experience is dynamic, or always changing/moving. Just like diabetes – always changing! What matters is that we teach the essentials and count on people to apply those essentials in their lives (and they learn how to do that through experience). In diabetes education, we teach “survival skills”, which are the essentials: blood glucose monitoring, medications/insulin administration, hyper/hypoglycemia and how to treat it. If people leave us with a good knowledge of those basic topics/skills, they can go into the world and start experiencing. It is also our job to assure them that they can do this, and to give them ongoing support, encouragement and positive feedback.

The other day I wrote about conditioned responses, for example, teaching myself to stop eating after I’ve had my two Dove Promises. Although I believe there’s a place for a more black and white approach, I also believe that most things in life are gray, and therefore, we need the ability to think critically. There is no way for us to know what’s coming around the next corner, or what our next blood glucose level will be, but we can develop the ability to respond appropriately to whatever it is.

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Pavlovian diabetes management

Posted on June 29, 2011 by janekdickinson

Sometimes it’s good to be a dog. Actually, we have a dog (see personal profile), and I rarely, if ever, envy his life. It’s way too boring for me.

However, there were some dogs, a long time ago, who were studied by a famous scientist named Pavlov. Pavlov and his research assistant, Tolochinov, coined the term “conditioned reflex.” Over one hundred years later, we think of “conditioning” as an “automatic form of learning.” We also think of a “Pavlov’s dog” as “someone who merely reacts to a situation rather than using critical thinking.” In order to keep this as simple as possible, I got the above information from our good friend, Wikipedia, and you can read more about it here.

Although in most situations, I think critical thinking is much more important than “merely reacting”, sometimes it works to be a Pavlov’s dog. In my last post I mentioned that I have trained myself to stop eating when I have my (two) Dove Promises. This is something I’ve been doing for a few years now. I started eating dark chocolate after having given up chocolate altogether for 14 years. Dark chocolate, in moderation, can actually be healthy! This article does a great, and concise, job of explaining. Please note that even healthy foods (especially healthy fats) in excess can cause weight gain and other health problems. That’s why I stick with two Dove Promises. I typically do this at lunch and supper.

There are certainly times when Dove Promises are not available, and I have to deal with that. Sometimes I find another type of dark chocolate, other times I go without. I have even been known to bring a bag of Dove Promises with me when I travel. Whatever works, right?

What works for you? Do you have a way to condition yourself to stop eating or perform some other part of your diabetes management?

 

 

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An interesting coincidence…

Posted on June 27, 2011 by janekdickinson

Check this out. We spent the last week on the farm in Iowa with my husband’s family. On our drive back to Colorado, we stopped for gas and a potty break at a random gas station in Nebraska. Here is a picture of the sign over the door:

Shortly after arriving at this establishment, I had my Dove Promises (like Pavlov’s dogs, I have trained myself to finish a meal {i.e., stop eating} with two Dove Promises – more on that in another post). Here is what the wrapper on the second one said:

Is that just ironic?! I would try to get all philosophical about this, but it’s probably that I was meant to be on my way back to Colorado. A stop in Nowhere, Nebraska, was just part of the journey. But honestly, isn’t that hilarious?

 

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Random Typing

Posted on June 23, 2011 by janekdickinson

I was going to post “Diabetes Terminology Part 2”, but something else has come up tonight. I have a new laptop, and when I type it randomly moves the cursor to random places and continues typing there. Somewhat annoying and time-consuming, but I’m chalking it up to user error and figure I’ll get the hang of it at some point. (By the way, if anyone knows what I’m doing wrong, be sure to comment and let me know!!!)

So this random typing thing made me think about random diabetes things. For instance, “gushers”, which may be when you poke your finger and the blood squirts across the room, or when you remove a pump infusion set and blood gushes everywhere. Or perhaps a low blood glucose event that makes absolutely no sense (just ate, didn’t take too much medication/insulin, didn’t exercise). Maybe it’s high blood glucose readings after exercise (although that one can usually be explained, but in another post).

I’ve mentioned before that I once heard one out of four blood glucose readings are unexplainable. That goes into the random category for me. Unexplainable does not have to be unacceptable, however. These blood glucose readings actually give us something – the ability to be flexible and to move on without letting it get us down. Let’s face it, life as a human being is pretty random.

Ok, now for some more random diabetes things: how about all the random places we find blood glucose monitoring strips? Or the random bruises from injections (there was absolutely no pain or bleeding, yet a bruise shows up a day later)? Random food cravings? Random blog posts? Feel free to comment and add something random to this list.

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Elderly with diabetes

Posted on June 17, 2011 by janekdickinson

My grandmother turned 102 on Tuesday (Happy Birthday, Grandma; you rock!!), which, of course, has me thinking about old age. And that, in turn, makes me think of being elderly with diabetes. For many years I have said that I want to live to be 85. I’m not sure when or how I came up with that number, but it’s kind of stuck in my head. I have to admit, though, there are times now when I think that 85 is really not all that old and maybe I could go a little longer.

The one thing that really bugs me, however, is the thought of someone else taking care of me. I worked in a nursing home during the summer between college years, and I took care of several elderly people who had diabetes. I saw the nurses doing everything for them, and I decided then that I couldn’t accept that. Someone else giving me my shots or programming my pump or poking my fingers? I don’t think so. By the way, when I was in the hospital having babies, my OB wrote in my orders, “diabetes management per patient”, which meant that I did it all myself. Thank you very much.

Another aspect to being elderly and having diabetes is that it really makes sense to ease up on the intensity of management. In other words, higher A1Cs are not only acceptable, but safer. Elderly people are at increased risk for falling, and those who live alone really need to be careful. I have had some 80-plus-year-old patients who managed their diabetes extremely tightly and had a somewhat difficult time accepting “slacking off” a bit, but they came around. Even more, I’ve had family members of elderly people with diabetes who had trouble understanding that it’s ok for Mom, Dad, or whoever, to run numbers in a higher range than they had been.

My philosophy is that if you’ve lived 85 years, for example, you’ve done something right and you deserve to enjoy the time you have left here on earth. As long as your blood glucose levels are in a range that allows you the energy and health you are accustomed to (too high of blood glucose levels can lead to infection, lethargy, etc., and too low we already discussed), I encourage the elderly with diabetes to enjoy eating the foods they like, check blood glucose levels less frequently, and get the most out of what they love to do in life.

Although I have a lot to do before that time comes, I’m looking forward to kicking back a little and enjoying my “golden years.” I’ll take good care of myself now so I have the luxury to relax more later on!

 

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