To pump or not to pump – that is a choice

Posted on April 2, 2011 by janekdickinson

I love insulin pumps. I frequently say they are the best way to mimic a functioning pancreas (for those without a functioning pancreas)*. Currently, I am not on a pump. I went on a pump in 1996 because my friend and colleague had one and loved it. I wore it for one year (almost to the day) and then went off. My endocrinologist was shocked and said he had only known one other person who ever willingly went off their pump.

In 2003 I had two kids: 3 and 2 years old. I was on a plane with the two of them one day, when I decided taking injections was just not convenient with two little kids (and on an airplane). I went back on an insulin pump. I wore that pump for three years and then went back to injections again. I haven’t been back on a pump since.

The reason for all this on and off stuff is because I experience a rare situation called “lipoatrophy” or “atrophy” for short. Because no one can tell me definitively what causes atrophy, I’ve developed my own theory. I believe it is caused by an allergic reaction I had to the animal-based insulin that I injected for years as a child. Now, when I don’t inject into a site (legs, buttocks, arms, abdomen), I get indentations in the fatty tissue (this is atrophy). When this happened in 1996, I was actively dating and felt the “holes” in my legs, etc. were especially hideous looking. I used to say, “I’m too vain for the pump”. Then in 1998 I got married, no longer had to date, and so in 2003 I was ready to try again.

My second time on the pump I lasted a lot longer, until, in fact, I had no sites left in which to put the infusion sets. I finally gave up and went off again in 2006. When I am not on an insulin pump, I actually inject insulin all around the areas of atrophy and build them up with hypertrophy (raised areas usually caused by overuse). And the sites look normal again, by the way.

I’m ok with injections. I can achieve almost the same level of blood glucose management with injections as I can with a pump. But it’s more work. You never know what you can do with diabetes management until you go off the pump. Just try to draw up 2.475 units in a syringe. Can’t be done! There’s no such thing as a dual-wave/extended bolus or a temporary basal rate with injections. These pump features just can’t be matched. I strongly believe that insulin pumps are the way to go, if someone wants to be on one. I also believe that by paying attention and putting in the effort, diabetes can be successfully managed with injections.

Which did you choose (and why)?

*Most people with diabetes really do have a functioning pancreas, it’s just that the 1% of pancreatic cells that make insulin don’t work as well as they need to or at all. The pancreas has another very important function: producing digestive enzymes!

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Get our act together

Posted on March 26, 2011 by janekdickinson

About two months ago I got a call from a pregnant woman. She told me that her OB had informed her that her blood glucose was high and that she had “one week to get her act together”. It’s probably a good thing I waited this long to write about it, because I was pretty upset at the time.

Let me explain. Gestational diabetes mellitus (GDM) is a situation where a pregnant woman’s body cannot keep up with the demand for insulin. The insulin requirement increases drastically during pregnancy because the hormones of pregnancy counteract the work of insulin. Many women get GDM. None of them want to get it. Most of them panic when they are told about it. The reason for the panic is because these women feel they have done something wrong and it will hurt their baby. I don’t think I’ve ever met with a woman with GDM who wasn’t completely stressed out.

Imagine getting this scary diagnosis (anything is scary when you’re pregnant, let alone having a disease that can affect your baby). Now imagine being told you have to “get your act together”. If you are reading this and you have or have had GDM, please be assured that you did not do anything wrong. For whatever reason your body could not make enough insulin during pregnancy. Making healthy food choices and exercising can certainly help manage blood glucose, and for some women these are enough to keep blood glucose levels stable and safe throughout pregnancy. However, for other women, medication is required. This still doesn’t mean you’re a failure.

The most important things about managing GDM are the following: 1) keep blood glucose levels in a safe range for you and your baby (see your health care provider and a diabetes educator for guidelines and recommendations) 2) don’t stress: be well-informed, take deep breaths, surround yourself with a good support network, tell yourself that you are doing a good job and 3) stay active and healthy after your pregnancy to prevent getting type 2 diabetes later on. Women with GDM have an increased risk for type 2 diabetes later in life, so it’s important to take off that “pregnancy weight”. Taking baby for walks is good for the whole family and you can be a role model in preventing type 2 diabetes.

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Just choices

Posted on March 10, 2011 by janekdickinson

I saw a bumper sticker the other day that said, “No excuses; just choices”. I love that! I decided to alter it slightly to, “No limits; just choices”, which is how I would describe life with diabetes. It’s all about choices (and balance, of course).

People with diabetes have to make choices all day every day – but then again, so does everyone else! People with diabetes often get bogged down thinking they have certain limits (food being the number one thing that comes to mind), but in reality everything we do, say, and put in our mouths is a choice.

The key is to make healthy choices as often as possible. We do this by arming ourselves with the latest information about managing diabetes. We improve our knowledge base by reading current and reliable sources (for instance, the American Diabetes Association or the National Institutes of Health). Websites sponsored by universities or the government are typically reliable. We also need to advocate for ourselves and our health by finding a health care provider who is knowledgeable and a good fit. Seriously, if you have a health care provider who is not a good fit, your health can suffer.

Physicians who specialize in diabetes are called endocrinologists (specifically, diabetologists). There are not enough endocrinologists out there for all the people with diabetes, so many of us meet with primary care physicians (internists or family practice doctors). In this case it is important to find a primary care physician who has current knowledge about diabetes. There are also nurse practitioners and physician assistants who specialize in diabetes care.

In addition, it’s good to have a certified diabetes educator (CDE) that you meet with regularly. A CDE can be a nurse, dietitian, social worker, pharmacist, exercise physiologist, physical therapist, physician assistant, or physician. You can find the nearest diabetes educator by calling 1-800-TEAM-UP4 (832-6874). A diabetes educator can help you find a good diabetes provider (physician, nurse practitioner or physician assistant). This may sound tedious, but it’s a very important step in managing your diabetes and your long-term health. And once again, it’s a choice!

What are some choices you’ve made lately?

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What we say and what we hear

Posted on February 28, 2011 by janekdickinson

Something that I experience often in my diabetes education practice is patients not knowing they have diabetes. I realize that this sounds kind of crazy, but it really is a pattern. I get a referral from a health care provider, I call the patient to set up an appointment, and they say, “I don’t really have diabetes.”

Because I don’t want someone to have an unnecessary appointment, and because I don’t want them to end up paying for it (health insurance won’t pay without a diagnosis of diabetes), my next step is to call the health care provider and confirm whether or not the patient really has diabetes. Chances are, the provider will tell me that the person’s A1C (3-month average blood glucose) is elevated and they have been started on Metformin (type 2 diabetes medication) and, yes, they definitely have diabetes.

For a long time I honestly thought that providers avoided coming right out and telling people they have diabetes because they don’t want to be the “bad guy”. I still have a “bad guy” theory, but I’ve come to realize that this is not what is always happening. Now I realize that it is actually a combination of providers not clearly stating that the person has diabetes and the person not hearing them say it. In other words, some people are told, “your A1C is high and I’m going to recommend that you start taking this medication for diabetes” and what they hear is “your blood glucose is slightly elevated, so you need to take this medication to bring it down.”

Although I wish health care providers would be clear and confirm that people hear what they say (and understand it), I can’t really blame someone for interpreting the words the way they want to. Nobody wants to be told they have diabetes. It’s much easier to digest another version of it – maybe one that sounds better or nicer or easier to handle.

For many years, people used the term “borderline diabetes”. Today we, in the diabetes professional community, use “pre-diabetes” because “borderline diabetes” was (is) too easy to dismiss. Many people have said, “Oh, I’m just borderline. I don’t have to worry about it.” On the other hand, pre-diabetes basically implies that it’s about to happen. And that’s the truth – if you have pre-diabetes, it’s just a matter of time before it becomes full-blown type 2 diabetes (unless you do something to prevent it).

I fully believe that ignorance is bliss, and I’m guilty of living that way from time to time. I do believe, however, that when it comes to our health we need to be fully aware and in charge. No room for ignorance if we want bliss (health). So how can we help patients and providers improve the lines of communication? Ideas, anyone? Have you had a personal experience with this sort of thing?

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Stress and Diabetes

Posted on February 19, 2011 by janekdickinson

How’s your stress level? Mine’s actually a little high right now. Anyway, stress has a big effect on blood glucose. There’s a long, drawn out scientific explanation for why stress tends to raise the blood glucose level, and it mostly has to do with hormones that are released during stress. At any rate, the typical effect of stress on blood glucose is that it causes it to go up.

Stress can be emotional (you get in an argument with someone, you lose a loved one, you get fired from your job, etc.). Stress can be physical (pain, infection, illness, surgery). Stress can be hormonal (a cortisone injection, PMS, menopause, pregnancy).

Because stress has an effect on blood glucose, the first step is to manage stress. This really is considered one of the four aspects of diabetes management: exercise, nutrition, medication, and stress management. Managing stress is very easy for some people – usually the ones with little stress in their lives. For others it’s much more challenging. The first thing to do is to figure out if you are stressed out or not. If things tend to roll off of you – you don’t let things bother you – chances are you are a low-stress person. If you get pretty worked up about just about everything, you are probably a high-stress person. And from time to time low-stress people get hit with a major stress.

Managing stress means different things to different people. It could be going for a walk or calling a friend. Perhaps you like to listen to music or write in a journal. Notice none of these suggestions include eating. Stress triggers eating binges for many people. Since stress alone tends to raise the blood glucose, eating will just raise it more, so it’s a good idea to avoid managing stressful situations with food. Exercising is a great alternative since it not only relieves stress, but gets your mind off eating (it also lowers blood glucose and blood pressure).

How do you manage stress?

PS It’s important to know how stress affects your blood glucose. Pay attention next time you are experiencing stress. Check your blood glucose more frequently, if possible, and see if you notice any trends. Occasionally I meet someone whose blood glucose actually goes low from stress, so it is possible.

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Why Should I Care?

Posted on February 9, 2011 by janekdickinson

Last night I put on a Diabetes Exhibit at our local hospital. We had reps from companies that make diabetes gadgets and supplies. One gentleman who came through the exhibit said that he was visiting from another state and thought he would stop by because he was recently diagnosed with diabetes. I have no idea how old this man was, but I’m guessing mid-seventies. He looked me straight in the eye and said, “Why should I care? No one has told me why I should care.”

My first response was, “You don’t have to care. It is your choice to care.” Then I went on to explain that people with diabetes tend to care because they want to prevent the complications of diabetes. That is why we manage this chronic condition.

I care because I have a lot of things I want to accomplish in my life. I have two children and a husband with whom I still want to spend a lot of time. Most importantly, though, I want to have a quality life – regardless of how long I’m around. I want to be able to see and pee, walk and be active, be productive and successful and so on.

Someone who still considers themself having a lot of time left, may feel similar to the way I do. Perhaps someone who is much older than me would feel differently. For those who are diagnosed at an older age, the chances of long-term complications (blindness, kidney failure, amputation) are much lower. The immediate effects of unmanaged blood glucose, however, can still have a negative impact. High blood glucose can lead to blurred vision, lethargy, depression, mood swings, dry mouth and frequent urination. Low blood glucose increases the risk of falling, passing out, seizures, headaches, blurred vision and lack of energy. Both of these situations can interfere with one’s daily activities and can be extremely frustrating.

In order to avoid both long-term and short-term complications of diabetes, we care. And we are the ones who benefit from our caring. Do you care? If so, why?

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The Quest for 117

Posted on February 4, 2011 by janekdickinson

I have a long history with the Clara Barton Camp for Girls with Diabetes. Those of us who attended as campers or staff call each other “Barton Girls” and we have many great memories and some inside jokes. One joke is about the number “117”. Back in the 80s, a staff member from the boys camp (Elliott P. Joslin Camp for Boys with Diabetes) was interviewed by a reporter. She had him check his blood glucose on camera and it came out 117, to which she replied, “Fantastic!” For the past 20-something years any one who has a blood glucose of 117 gets a rousing round of “Fantastic!” from anyone who understands. The great thing is that it really never gets old.

The other day I was driving with my daughter and I saw a vehicle with a license plate that simply said “117”. I just about flipped out. My daughter, believe it or not, had a camera with her and tried to take a picture at the stop light, but it didn’t come out. I lost the car when I turned to go to the grocery store. When we came out of the store I decided to go looking for the car. Crazy, but true. And would you believe I saw it again, going in the opposite direction on a nearby street. I watched it turn in my rear-view mirror, and then proceeded to turn around and try to find it.

Although I never did find the car, it got me thinking about people with diabetes and the quest for 117, in other words, “happy” blood glucose levels. We can work really hard at it and sometimes get the results we’re after, while other times we don’t. How often do we just give up? I know there have been times when I have just said, “forget it”, but luckily, I get myself back on track at some point (usually the next morning). It’s easy to want to throw in the towel when things (blood glucose levels) are not going the way you want them to. With diabetes it’s critical that we don’t beat ourselves up when this happens. We need to stay calm and focused and remind ourselves that we are good people and we can start again tomorrow.

Don’t give up on your quest for 117. And remember that no matter what your number, you are truly fantastic!

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Temperature and Blood Glucose

Posted on February 1, 2011 by janekdickinson

I had grand visions of my first blog post, but what I’ve decided to write about is the weather. The entire country seems to be dealing with freakishly cold or snowy or icy weather right now (except for the part of Florida where my parents are staying, which is sunny and 80s). Here in Steamboat Springs, Colorado, it is negative 25 degrees at the moment. It was so cold this morning that school was cancelled for the second (or third) time in 25 years.

This cold thing got me thinking about the effect of extreme cold and heat on blood glucose levels. I did a quick search and did not find a whole lot, but there are some interesting anecdotes. One person found that they tended to have more hypoglycemia unawareness (lack of low blood glucose symptoms) during extreme cold weather. We know that hot showers and hot tubs/hot springs can cause low blood glucose. This is related to the dilation of blood vessels that occurs in very hot water. On the other hand, sitting on the beach in the hot sun can cause high blood glucose.

Probably the biggest frustration with extreme temperature and diabetes, however, is the fact that the blood glucose meter itself can malfunction. If we can’t accurately measure blood glucose in extreme temperatures, we’ll never really know the effect on our blood glucose level! At any rate, I hope you are staying warm tonight.

What is your experience with extreme temperatures and your blood glucose levels? Please share!

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