D-Blog Week Day 6 – photos of diabetes

Posted on May 14, 2011 by janekdickinson

My assignment today is to post photos that relate to diabetes. I have chosen photos of a project my son and I tackled last weekend. We spent Mother’s Day moving all the rocks out of the front ditch, replacing the weed barrier and then putting the rocks back into the ditch.

I have decided that moving rocks is analogous to managing diabetes in that the small rocks/tasks are easier to handle; the large rocks/tasks are more of a hassle; but the end product is well worth the work!

Not to mention, we sometimes felt like we were doing the work of prisoners; however, diabetes is no longer the prison sentence it once was. We have more freedom now than ever, thanks to management techniques and tools that are available. And what’s even better is that diabetes management does NOT cause the aching muscles we experienced for a week after this project. Now for the ditch on the other side of the driveway…

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D-Blog Week Day 5 – Because of Diabetes

Posted on May 13, 2011 by janekdickinson

I’ve been looking forward to this day all week, because I get to tell you about what I’ve done because of diabetes, and that’s positive!

Because of diabetes I am a life-long camper. I attended Clara Barton Camp for years as a camper, counselor, student nurse, nurse, and Clinical Director. In between my Barton years as camper and counselor, I attended several other (non-diabetes) camps and had a blast! Now I am a camp nurse at Camp Calumet every summer and I LOVE IT!!

Because of diabetes camp I met many friends who I could never replace. They are the ones I call when I’m happy, sad, frustrated, perplexed, amazed (in a good or bad way), you get the idea. I call them about EVERYTHING – not just (and much less often) about diabetes. I would not trade these people for not having diabetes in a million years.

Because of diabetes I have had and continue to have a great career. I was the Director of Clinical Services and Education at The Barton Center, then I developed and ran a hospital based Diabetes Education Program, and now I am Program Coordinator/Faculty for a first-of-its-kind Master of Science in Diabetes Education and Management Program. I have met amazing campers, parents, staff, nurses, physicians, dietitians, patients, and now colleagues and students, who have taught me more than I could possibly teach them.

Because of diabetes I wrote a book, which I hope to get published soon.

Because of diabetes I started a blog and put myself out there, in a way I never thought imaginable.

Because of diabetes I am aware of my health, my body, my quality of life, what is important to me, what my priorities are, how I find balance. And I make it a point to accomplish all of it!

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D-Blog Week Day 4 – things we hate

Posted on May 12, 2011 by janekdickinson

Today I’m supposed to list ten things I hate about diabetes. I am being completely honest when I say that there is nothing I hate about diabetes, let alone ten things. I do, however, find a few things annoying, so I’ll tell you about those.

I drive three hours – each way – to see my endocrinologist (because that’s the closest I am to one). Although on nice days, the drive is beautiful, it is a hassle to go down and back in one day. My endocrinologist, on the other hand, is the bomb. I have the utmost respect for him, in fact, I call him the man who knows everything, so I don’t really mind going down to see him. And I recently found out (better late than never) that I can deduct 19 cents per mile for health care travel on my taxes!

I also drive three hours – each way – to see my opthalmologist. I am invariably heading home at sunset (going west in Colorado), with dilated eyes. This too, is a hassle. But it’s nothing that a little shopping – I mean time – can’t fix!

I have lipoatrophy in several of my injection sites. My theory is that it was originally caused by an allergic reaction to the animal-based insulin of my childhood (I have photos to prove that I had it as far back as fifth grade). When I use an insulin pump the atrophy gets significantly worse, even to the point where I have no sites in which to insert my infusion sets. So I stick with multiple daily injections. This is annoying because I don’t think it looks very good (my nice husband says he can’t tell) and because I would rather be on a pump!

Finally, I find hypoglycemia very annoying and a nuisance. It always seems to strike when I’m all geared up for a big housecleaning project or such. I have to treat the low blood glucose, hang out and do nothing for a while, then summon the enthusiasm to restart the project. This is also a hassle because I never leave enough time for these projects in the first place, and certainly can’t afford the time it takes to take care of a low!

As my mother always said, “hate is a very strong word.” I honestly don’t hate these things; I find them annoying, and then I move on. Sometimes I’m even organized enough to plan ahead so the hypoglycemia doesn’t happen, or so I can use my trip to the endo/optho to get other things done.

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D-Blog Week Day 3 – Diabetes Bloopers

Posted on May 11, 2011 by janekdickinson

Today I’m supposed to write about my diabetes bloopers. And they’re supposed to make you laugh. Unfortunately, I don’t really have much to write about, besides the usual low stories. Maybe I’ve just forgotten them!

During the summer when I was sixteen I had a run of severe hypoglycemia (low blood glucose) events. I think the blooper was that I was in the peak of puberty and hadn’t decreased my “school insulin dose” to my “summer insulin dose”, hence I ran low. Each of these “severe” lows found me unresponsive. In fact, I remember all of them (there were three), I just couldn’t talk at the time (unresponsive). Anyway, the third time I was a “mother’s helper” for a family on Cape Cod. I remember waking up, knowing I was low and making my way to the hallway, where I stood in front of the open bathroom door and stared at the dad who was shaving or brushing his teeth…in his underwear. I don’t know how long I stood there, trancelike, but eventually I went to the refrigerator and got some juice. More embarrassing than funny, I think.

The bloopers that I find much more funny (in retrospect) are those committed by innocent and uninformed people without diabetes. For instance, I once entered a shopping mall and saw a man slumped over on a half-wall. A security guard was next to him, and I just knew he was low. I ran over and asked, “Does he have diabetes? Is he low?” and the security guard said, “Yes, but don’t worry, we already got him some water.”

And my all-time favorite…I was on an airplane on my way to a diabetes conference. The woman I was traveling with and I got talking to a pair of venture capitalists in front of us. They were asking us about some diabetes equipment in which they were considering investing. I made a casual comment to the effect of, “I wear a pump and that doesn’t bother me,” to which one of them responded, “You have diabetes? I never would have known!! Is the diabetes what makes you look so young?”

I will continue to make it my mission to teach people the truth about diabetes, and clear up misunderstandings. But in the meantime, I think it’s ok to get a good laugh about some of the things people say!

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D-Blog Week Day 2 – a letter to my kids

Posted on May 10, 2011 by janekdickinson

Hello and welcome to Day 2 of D-Blog Week! Today I am supposed to write a letter to someone and share my feelings. I’ve decided to write to my kids, ages 10 and 9.

Dear Kids,

I’m writing to tell you how I feel about things. I don’t have to spend time telling you how much I love you, because you already know!! 🙂 I want to tell you about diabetes. We really don’t talk about diabetes a lot, and that’s ok with me because I truly believe that it’s not the most important thing about me or about our life together as a family. The most important thing is US. From the time you could understand, you have taken on the diabetes thing without even knowing it. My syringes have always been right out on the bathroom counter, yet you have never gotten into them. And so on.

We did go through the “googalose tablets” phase. You really liked those things that I think taste like chalk! Finally I started asking if you were low when you requested one. “Do you need to check your blood gluocse?” I’d ask, and funnily enough, you stopped asking for glucose tablets!

I’ll never forget the time when my eldest (probably 5 at the time) announced, “Mom, I know how you can get rid of diabetes. Take your kit and all your diabetes stuff and say, ‘I’m not going to do this anymore.’ And then throw away all the stuff in your office and say, ‘I’m getting a different job.'” You are brilliant!

And the most vivid diabetes-related memory for my youngest is how you inserted pump infusion sets into several of your Webkinz. Some have Quick-sets, some have Cleos, some have Insets, and some have Omnipods.

I love that you two take diabetes in stride. You know that I might get a little cranky when I need to eat something, but for the most part diabetes is not our focus. My plan is to keep it that way. I take care of myself so that I can take care of you! I love being with you, having conversations, playing, or just doing nothing. Our relationship does not revolve around diabetes – it revolves around us. I love your laughter and your individual (very different) personalities. I love the questions you ask (which are rarely, if ever, about diabetes). I have loved every stage in your development more than the stage before, and I am even looking forward to your adolescence!

Although I can’t just throw away my kit and get rid of diabetes, I can make sure to stay healthy and whole. I can take care of you two, because I take care of me and it is completely worth the effort! Thanks for all you give me every day – I love you!! (But you already knew that.)

Mom

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D-Blog Week Day 1 – we’re different yet we relate

Posted on May 9, 2011 by janekdickinson

I am participating in the D-Blog Week that starts today. This is my first time doing something like this, so bear with me! Many different Diabetes Bloggers will be participating in this week-long activity.

I am charged with writing about how D-Blogs that are different from mine are still helpful and interesting to me. I definitely feel this is true for a few reasons. I have struggled with finding my “place” in the diabetes blogging world, because I write about diabetes from both my professional and personal perspectives. As a result, I don’t feel I can be as “raw” as I might be if I didn’t have the professional thing going on. I enjoy reading blogs written by those with diabetes (and I admit, most that I’ve read so far are people with type 1, but I’m just getting started!) who aren’t healthcare professionals. They tend to hit on everyday topics – most relating to diabetes and some not. Although, let’s face it, everything relates to diabetes in some way!

The blogs I read by lay people with diabetes frequently make me laugh and often I can relate to what they write about. Many times I’ve learned something new that might benefit me or one of my patients! I enjoy seeing how people with diabetes find humor in their situations and circumstances. It’s refreshing to know that others are out there staying positive and finding balance in their lives with diabetes!

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Food Scrutiny

Posted on May 5, 2011 by janekdickinson

My last post was about food insecurity. Today I’m focusing on another food-related issue that plagues people with diabetes: food scrutiny. The more common term for this phenomenon is the food police. I am willing to bet that every person who lives with diabetes has dealt with food scrutiny at some point. If not, please let me know, because that would be exciting news! I believe that food scrutiny can actually lead to food insecurity.

Let’s say someone with diabetes is eating somewhere out of their comfort zone, and someone starts asking them about what they can and can’t eat, or questions what they have on their plate, or suggests there is “nothing they can eat” at that venue. Any of these scenarios can lead to feeling a loss of control or frustration (or anger) which can then lead to overeating, etc. Before I go any further, I want to give credit to the people out there (and there are many) who truly don’t know about food and diabetes; whose comments are completely innocent and driven by concern. Unfortunately, it’s often hard to separate that at the time the food scrutiny occurs.

I have countless stories about my encounters with food scrutiny. I’ve been interrogated at family reunion food tables; I’ve even had the contents of my grocery cart critiqued. I have just as many stories about situations where people mistook me for the food police (this happens when one is a diabetes educator, unfortunately). I have been stopped in the grocery store (“You caught me eating XYZ”), avoided in restaurants (If I don’t look at her, she won’t see me eating XYZ), you name it.  I assure you, I am not the food police.

My hope is that one day, with enough education, those who know someone with diabetes and even the general public will understand diabetes enough to know that they don’t need to scrutinize. Until that day comes, though, we can share our stories and continue to work on educating people.

Now I really want to hear your food scrutiny stories. I know you’ve got some good ones. And we share these so all people can learn and so we can relate to each other and not to criticize or make fun, especially of those who are just asking because they care.

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Food Insecurity

Posted on May 4, 2011 by janekdickinson

Food security is a real term, and it has to do with people’s access to food, and specifically healthy food. People with low food security have reduced dietary quality, variety or desirability, in other words, they tend to eat unhealthy foods because that’s what they can afford. Those with very low food security have reduced food intake because food is not available. They may be dependent on food from shelters, for instance. I’m teaching a Human Nutrition course and was reading student posts about food security today. This made me think of a parallel in the diabetes world. Because I in no way want to discount the critical nature of the situations I just described, I have decided to call the phenomenon I’m thinking of in people with diabetes, food insecurity.

For my purposes, food insecurity refers to situations where people with diabetes feel stressed because they don’t have control over their food (amount, type, source, etc.). Some examples are eating at someone else’s house, visiting a foreign country, staying in a place where meals are served cafeteria style (at certain times with no access to food in between), taking a standardized test where food is not allowed in the room, and I’m sure many others.

My observation is that in these cases of food insecurity, we have a tendency to get a little panicky and either overeat when we have access to food, or hoard food for later. I was recently in NYC, and I stayed in a residence hall room on a university campus. As a result, I did not have access to my kitchen! I found myself buying food at the local market and keeping it in my room – random things like bananas and dark chocolate. I also visited the dorm vending machine on one occasion. Talk about desperation!

The place I’ve observed this phenomenon the most is at diabetes camp. As much as I adore camp and my experiences there, I was always very sad to see staff members leaving camp every chance they got, and heading for Dunkin Donuts or Friendly’s or the nearest convenience store. It’s not necessarily because they are hungry – there is plenty to eat in the camp dining hall and the food is not all that bad. I feel strongly that the reason this happens is because there is a feeling of not being in control.

Have you experienced food insecurity? How did you handle it (or not)?

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Something’s Got to Give

Posted on April 28, 2011 by janekdickinson

Things have been a little busy lately. As I work to keep my head on straight and get everything done, I have to remember to keep diabetes management a priority. It’s so easy to let things slide – skip a blood glucose check and just estimate how much insulin you need; forget your pills; opt out of exercise; you know how it goes.

When my kids were very little (they are 17-and-a-half months apart) it was pretty crazy: diapers, teething, crying, napping, not napping, baby food, bottles, etc. I used to say that I would not have another baby because diabetes was my “third child”. I had to pack supplies for diabetes, take care of diabetes, and so on.

What saves me is that I made diabetes management a habit many years ago. I honestly think twice before taking insulin without checking my blood glucose first. In fact, I rarely do that. I don’t ever go to bed or start exercising without knowing what my blood glucose level is. I strongly recommend getting in the habit of making diabetes management a priority. Don’t they say it takes three days to make (or break) a habit? You can do it for three days and then ongoing! When things get busy, try not to let diabetes be the thing that gets overlooked.

Not too long ago I started taking some of my Lantus in the morning, and the rest at night (I had always taken the entire dose at night). It took me quite a while to get in the habit of taking that morning dose, but I’m just about there. I believe in using little tricks to help me along. My trick for the morning Lantus is to put the Lantus bottle right on the counter by my “kit” (blood glucose meter). When I see it there in the morning, I remember to take it. Eventually I won’t need to do this anymore.

What are your (healthy) diabetes habits and how did you establish them?

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Lag Effect

Posted on April 21, 2011 by janekdickinson

Have you heard of the lag effect? It’s a phenomenon where exercise causes low blood glucose levels up to several hours after the activity. We often teach people with type 1 diabetes about the lag effect. We warn people to be careful and watch for hypoglycemia (low blood glucose) even up to a day after they’ve been extra active. For instance, the first few times someone goes skiing for the season, or taking a run, or something else. The lag effect typically occurs when you’re doing something more than what you are used to.

One of the great things about New York City (I’m sure it’s true of other cities too!) is that one does a lot of walking. The part of NYC that I am currently staying in has a lot of hills (not like the “hills” in Northwestern Colorado, but hills, nonetheless). To get from A to B in NYC, you have to walk. If you take public transportation, you still have to walk to the subway station, bus stop, etc. I’ve been spending my days walking around (and up and down) the buildings of Teachers College, Columbia University. Not to mention to and from the room where I’m staying, nearby places for meals, etc. Lots of walking, and my blood glucose shows it!

I have definitely been experiencing the lag effect during this stay in NYC. I was thinking today about the lag effect and type 2 diabetes. We don’t usually teach people with type 2 about the lag effect and I think it’s because, unless they take a medication that causes low blood glucose (insulin or a sulfonylurea-containing drug), exercise is just a very good thing and we don’t worry about the lows. However, the lag effect can also be used to emphasize how good exercise is: if you have type 2 diabetes and you exercise more than your body is used to, the blood glucose lowering effects of the exercise will stay with you for several hours!

So the take-home on all this is to make exercise a regular part of your day. I’m realizing that I need to walk every day (not just four times a week), since I mostly work at home now and don’t walk city streets as a rule. In addition, be aware of the lag effect (if you take insulin or an SU drug) and watch for “late lows”. Enjoy the amazing feeling of getting/being in better shape!

What are your experiences with the lag effect?

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