Blessed Assurance: Success Despite the Odds

by Jacquie Lewis-Kemp, Author & Health Coach for Living life with diabetes and organ transplants, rather than limiting life because of them.

Browsing Posts tagged type 2 diabetes

Actor Anthony Anderson, Spokesperson for the Eli Lilly’s F.A.C.E. program.

African Americans are diagnosed with diabetes more than 2.5 times the rate of whites. I had the opportunity to interview Anthony Anderson about his ambassador role as national spokesperson for Eli Lilly’s F.A.C.E. program. The Fearless African Americans Connected and Empowered (F.A.C.E.) program is designed specifically to reach African Americans and inform us about how to prevent or manage the epidemic diabetes diagnoses in our community.
Listen to our hilarious interview:

This is part one, stay tuned for part 2.

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Jacquie diagnosed with T1D at age 7

Many people tend to categorize Type 1 diabetes as a “worse” case of diabetes than Type 2.  The fact of the matter is that while they are both diabetes–an endocrine disorder whereby the body cannot move glucose from the blood stream to feed the cells–the reasons for the disorder are different. Because the reasons are different, the treatment is often different.

 

People with Type 1 diabetes always take insulin injections because the reason for their inability to move glucose to the cells is because their pancreas doesn’t produce insulin at all. Therefore the only way to complete the digestive process is with insulin injections.

 

People with Type 2 diabetes develop it for a number of different reasons. Some suffer from insulin resistance, meaning that their pancreas’ produce insulin, however their bodies have become resistant to the insulin and oral medication is needed to make the insulin work or work more efficiently.

 

Others with Type 2 diabetes have undergone a major change (weight gain, stress etc.) that increases the amount of insulin required for digestion. Sometimes the pancreas can be stimulated with oral medications to produce more insulin, however in other cases insulin injection therapy is needed.

 

So as you can see, there is no “worse” case of diabetes, just differences in how they are treated.

 

To  answer to my own question, I do have an opinion about which type is easier to manage. Type 1 diabetes is typically diagnosed in children, hence the earlier description “juvenile diabetes”. Type 2 often occurs in older adults. Managing diabetes is a lifestyle change, and for children, it is creating a lifestyle–not changing it.

 

Many people have difficulty managing Type 2 Diabetes because it is a lifestyle change more than adding a pill a day, but includes blood testing, weight management, exercise for more than just pleasure and following a diet.  I believe that people managing Type 1 diabetes have it easier because they created a lifestyle as a child that they have adapted to their routine as they grew older.

 

For example, I was diagnosed with Type 1 Diabetes at the age of 7.  It was August, two months after my baby brother was born and a month before second grade started. In fact I missed a few weeks of the start of school because in 1969, patients with diabetes were hospitalized while they learned to manage, and doctors determined what dose of insulin to prescribe (Boy was this old school). In 1969, there was no such thing as a glucometer and patients were prescribed an insulin dose to take for six months until the next doctor’s visit and a blood glucose test could be done.

 

It wasn’t until my junior year of high school that I participated in a study with a new machine called a glucometer. It was the size of an old cassette tape machine and weighed about 40 pounds. The machine had to be calibrated with synthetic blood anytime the machine was turned off–oh yeah, it had to be plugged in. While this doesn’t sound convenient or conducive to anyone’s lifestyle, it was a major step in managing diabetes. Once I graduated from college, glucometers became pocket sized and much more portable. With this new technology, I was “able” to do nearly anything.

 

One of the most important things my parents taught me when I was diagnosed with diabetes, was that I can do anything that I wanted to do as long as I was willing to work hard at it. While technology made it possible to manage a busy lifestyle, it was my parent’s words that continue to ring in my ears and hopefully have been passed on to my son’s ears. With that mantra, it was relatively easy to modify my regimen from high school cheerleading, to walking the campus to class; from school to work and the impact on my blood sugar of emotions during meetings or public speaking. Adding marriage, childbirth and a young family to the mix was more an organizational feat than it was a procedural change.

 

So the next time you see a child with diabetes, don’t hang your head in sorrow because of her diabetes. Know that she is preparing for a busy life ahead.

 

Wife, Mom & CEO managing T1D

 

 

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Join me and learn how my coaching program works with you to take your doctor’s instructions and create a routine that fits into YOUR lifestyle.

When:

Wednesday, June 26, 2013 at 7 PM (Eastern Time)

Topic:

This will be an online conference that demonstrates my Diabetes Lifestyle Coaching Program. REGISTER HERE

Description:

Life for people with diabetes is not one simple lifestyle, and so no one’s diabetes should be treated the same. We are as individual as snowflakes and that is why coaching to create a plan to tailor your diabetes maintenance to your current lifestyle is a better option than using one set of procedures for prescribed for everyone. I will show you how my program works.

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DATING WITH DIABETES

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The scenario: The waiter arrives. He places the entrees in front of you and your date. You look at the food. You glance towards the bathrooms. What do you do? Do you check your blood glucose at the table or do you politely excuse yourself and hope he or she doesn’t think something is wrong?

Dating can be hard enough. Dating with diabetes puts another twist to things. In addition to the “Where are you from?” and “What do you do?” conversations, should you initiate the “I have diabetes” conversation? If so, when do you bring it up? Before the appetizers? After the third date? On your wedding night?

Let Life Happen

On top of the “I have diabetes” conversation, there is the rest of the Diabetes 101 syllabus that you could offer your date (maybe wait until the plates are cleared). Bolusing. Carb counting. Hypoglycemia. The list could go on and on.

One approach to dating and diabetes is to let life happen and explain as needed. “I find that the majority of people are quite uneducated about diabetes and that when they see how nonchalant I am about everything, it piques their curiosity. They want to ask more questions,” shared Karen, a fifty-something from Wisconsin. “The way I look at it, I should manage my life, including my relationships, versus letting diabetes manage them. If they can’t handle that, they’re not the kind of person I want to be with anyway, so it wasn’t meant to be.”


 

From the Other Side: Tips on Dating a Person with Diabetes

Written by Howie, a thirty-something from Washington, DC, the significant other of a person with diabetes

  1. Learn as much as you can. The more you know, the better you can understand the physical and emotional experiences of your partner. It helps to share that common bond and provides comfort to your partner in discussing his/her feelings if they are going through extreme shifts in their blood sugar levels for example.
  2. Offer to become involved. Gauging how involved you should become in your partner’s blood glucose and meal planning can be difficult. Some partners might not want that much involvement, and others do. However, offering that support shows you care and can provide your partner an emotional lift. Sometimes I inquire about what my girlfriend’s glucose reading is after a test. If it is low, then I will offer to help her find something to eat or drink. If it is too high, then I know not to suggest having a meal right away.
  3. Be flexible surrounding meals. I generally eat on a structured schedule – breakfast before going to work, lunch around 11:30 and dinner when I get home from work. However, one with diabetes might not always be able to eat on such a structured schedule; it may depend on his/her blood glucose level at the particular time. In my relationship I have learned to be more flexible in my meal/snack schedule, but we have also communicated that to each other that if one person is hungry and the other isn’t (or can’t eat at that particular time), then it is acceptable to go our separate ways.

 

“When I watched Karen so casually measure out her dosage and poke her arm right through her clothing, I thought she’s one tough cookie!” Karen’s new fiancé Rob commented. “I had always hated shots. The idea of piercing the skin with a needle would make me cringe. But I found her more attractive as a result of the experience.”

Twenty-something Dayle from Washington, D.C., brought her boyfriend along for the ride of day-to-day living with diabetes. “When I first went on the pump in college, my boyfriend accompanied me to the training sessions. My diabetes educator found a loaner pump for my boyfriend so we spent the first few days pumping saline solution together. I think it helped him to develop understanding and empathy for my diabetes lifestyle.”

“Diabetes is not something that should be kept secret,” advised twenty-something Dana from Alabama, “unless you would rather say you’re just part of a not-so-secret international club that subscribes to rigorous blood glucose testing, reverence of A1C numbers, and a lifelong addiction to insulin!” jokes Dana.

By being open about your diabetes, you can help to make the other person feel more comfortable. Jim, a former boyfriend of a person with diabetes weighed in, “If the fact that she had diabetes made me feel uncomfortable, educating me on the various aspects simply resolved that problem.”

No big deal?

Let’s face it — diabetes is serious. But if you look healthy and act healthy, then it can be easy for your partner to forget it takes a lot of effort to maintain this level of good management.

“There is a downside to my openness and matter-of-fact attitude. My boyfriends have often assumed that because I’m always testing and bolusing — and because they’ve never seen me have a bad reaction, get sick, or lose consciousness — that diabetes is ‘no big deal,'” shared Miriam, a forty-something from Maryland.

“The guy I’m currently dating said that to me recently, adding that he thought I was ‘doing really well’ with my diabetes. I was surprised, because I often complain to him about my frequent high blood sugars and try to explain the destructive long-term consequences of less-than-optimally controlled diabetes.”

On the other hand, diabetes is not an automatic death sentence — for you or your love life. “When I was diagnosed with diabetes 3 years ago, I thought my love life was over,” commented Keith, from Indiana. “Who would knowingly date a ‘diabetic,’ right? But on a blind date, I made a short comment about my diabetes while I was reading the menu. I found out that my date had been diagnosed with diabetes when she was 15! We ended up talking for hours… and we even put a friendly wager on which one of us had the better A1C result at our next doctor’s appointment! I can only say that having diabetes actually helped me get that part of my life back.”

Love and Understanding

Finding someone who is compassionate can make a big difference when dealing with difficult situations. Having a sense of humor also helps!

“My guy’s ‘no big deal’ attitude did come in handy when I went on the pump last December,” Miriam said. “I was really worried that he would be turned off by the whole ‘medical-ness’ of it, but it doesn’t bother him at all. I, on the other hand, am still struggling with the logistics when it comes to sex and the pump!”

Recently, twenty-something Allison from Virginia was preparing for her wedding and contemplating the switch to a continuous glucose monitoring (CGM) system at the same time. “With the thought of having a family in the next five to ten years, my fiancé Ross became my biggest cheerleader and advocate when we decided I should try a CGM. Unfortunately, it wasn’t in the pre-wedding budget!”

But Ross had different plans. Two days before the wedding, he presented Allison with a CGM starter kit as an early wedding gift. “I joked with Allison that I wanted to have an additional life insurance policy for the person I loved the most,” quipped Ross.

Needless to say, the wedding gift was a hit. “As Ross was taking off my garter at the reception, he checked the CGM that was stuck in my thigh holster to make sure everything was going smoothly,” said Allison. “Naturally, that made our guests cheer all the more!”

For more information or assistance, contact the American Diabetes Association National Call Center at 1-800-DIABETES.

 REPRINTED FROM THE AMERICAN DIABETES ASSOCIATION WEBSITE
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When you decide not to listen to your doctor’s advice and eat whenever you want to or miss doses of critical medication, what’s the big deal? You’re only hurting yourself, right? Wrong! YOUR NONCOMPLIANCE AFFECTS EVERYONE AROUND YOU!

 

A woman living in the sandwich generation (sandwiched by needing to take care of college students and aging parents) was perplexed because her mother complained that she never visited her father. The woman’s parents were both in their eighties and somehow Stephanie found it difficult between work and immediate family commitments to visit her parents.

 

Stephanie’s father suffered from insulin-dependent Type 2 diabetes and found it difficult to walk and to see due to the onset of neuropathy and retinopathy, complications of uncontrolled diabetes. He especially felt bad when Stephanie would abruptly end a phone call needing to return to work, and forgetting to return the call.

 

One day after receiving a tongue lashing from her mother about not visiting them and her father in particular, Stephanie decided to confide in a close friend about the situation. Stephanie’s friend listened intently and explained,

 

“Stephanie, I know you well and I know how much you love your parents. I also know that you find conflict challenging. Diabetes, left uncontrolled can lead to very debilitating illnesses. I believe that the reason that you haven’t made time for your father is because you have watched him ignore advice from his doctor, refuse to monitor his glucose and eat regularly. As a result, he walks with a cane and is losing his sight. He has passed out requiring EMS to treat ailments that wouldn’t occur if he better managed his diabetes.

 

What happens when people see an accident about to happen? When two trains are barreling down the track toward one another? They look away don’t they? No one wants to watch something bad happen. And so I think you subconsciously don’t visit your parents to avoid seeing the train wreck about to happen–what will likely happen to your father if he doesn’t get serious about controlling his diabetes.”

 

This holiday season, if you don’t take care of yourself for you, do it for someone who loves you.

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When first diagnosed with diabetes it is likely that you have to develop a new routine and change some bad habits. While many young people with Type 1 diabetes haven’t established a routine and so the prescribed routine from their doctor easily becomes their routine, often people newly diagnosed with Type 2, Gestational or Pre diabetes have a more difficult time making change to their established routines and habits.

Much like fad dieting, biting the bullet and deciding to try to eat the right food and  test like a robot three times a day, doesn’t create a routine and you are likely to slip back into old habits. On the other hand, understanding the reasons for eating certain foods and testing glucose levels with a purpose in mind will bring about permanent change.

According to author of Changing for Good, James Prochaska, PhD, there are six stages of change that a person has to go through in order to make permanent change and they are

  1. PRE CONTEMPLATION- recognizing that a change or routine is necessary.

  2. CONTEMPLATION – thinking about what that new routine might look like.

  3. PREPARATION – organizing thoughts and supplies necessary to begin the new routine.

  4. ACTION – Beginning to eat, test and exercise according to the new routine.

  5. MAINTENANCE – the action steps are now a daily routine with seamless modifications for schedule changes,

  6. TERMINATION – for some types of change like smoking cessation, the maintenance phase may no longer be necessary, however for Diabetes Control, the maintenance routine never ends and provides a very healthy lifestyle whether a person has diabetes or not.

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The following study from the Thomas Jefferson University Hospital describes diabetes as “a self managed disease whereby the patient provides 95% of the daily care”. It continues that education is the prerequisite and ongoing contact (coaching) maintains compliance and saves lives as well as health care cost.

 

HealthWorks – Achieving Balance with Diabetes

A Diabetes Self-Management Education Program

of Thomas Jefferson University Hospital

 

Diabetes is a common, serious, and costly disease that affects an estimated 16million people in the United States. It impacts many aspects of the lives of diagnosed patients and their families, the health system, and society. People with diabetes are more likely than their non-diabetic peers to have heart attacks, strokes, amputations, kidney failure, and blindness. As a result, they have a more frequent and intensive visits within the health care system. A great number of hospitalizations are for acute problems such as foot ulcers, acute myocardial infarction, circulatory and nerve problems, and pneumonia.1 As evidenced by the Diabetes Control and Complications Trial (DCCT), many of these complications can be prevented with better glucose control.2

 

Because diabetes is a self-managed disease with the patient providing more than 95% of the daily care, patient education is the fundamental prerequisite for diabetes Self-management.3 Diabetes education is viewed by many as a “process” whereby a patient develops his/her knowledge base and improves his/her skills related to compliance with the recommended treatment plan. Modern diabetes self-management education programs emphasize patient empowerment rather than strict adherence to a regimen.4 HealthWorks at TJUH has been designed to support the current model of self-management education. In order to accomplish this, the program places emphasis not only on one’s knowledge and skill level, but most importantly on improving one’s self-confidence by helping them to:

 

• Identify and set realistic goals;

• Problem-solve

• Manage stress caused by living with diabetes;

• Identify and obtain social support; and

• Develop a plan for changing behavior

References

1. Patient-reported outcomes measurement to be featured in diabetes management

study. UHC Clinical Practice Alert. June 1997.

2. Implications of the Diabetes Control and Complications Trial. Diabetes Care 1998;21; Suppl.1:88-90.

3. Anderson RM, Fitzgerald JT, Oh MS. The relationship of diabetes-related attitudes

and patients’ self-reported adherence. Diabetes Educator 1993; 19: 287-292.

4. Anderson RM, Funnell MM, Butler PM, Arnold MS, Fitzgerald JT, Feste CC. Patient

empowerment. Diabetes Care 1995; 18(7): 943-949.

 

 

Read more of this article at http://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1100&context=hpn

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The final leg of our 3 Legged stool of glucose control is diet. Our diet or the food we consume is the source of the glucose our bodies use to fuel our cells. Therefore the more we focus on the ultimate purpose for the food we eat, the more efficiently our bodies can use the fuel and function best.

According to the National Institutes of Health, “It [The diabetic diet] should take into account your weight, medicines, lifestyle, and other health problems you have.

Healthy diabetic eating includes

  • Limiting foods that are high in sugar

  • Eating smaller portions, spread out over the day

  • Being careful about when and how many carbohydrates you eat

  • Eating a variety of whole-grain foods, fruits and vegetables every day

  • Eating less fat

  • Limiting your use of alcohol

  • Using less salt

With these parameters, The American Diabetes Association recommends a “meal plan” which it describes as “a guide that tells you how much and what kinds of food you can choose to eat at meals and snack times. A good meal plan should fit in with your schedule and eating habits. Some meal planning tools include the plate method, carb counting, and glycemic index. The right meal plan will help you improve your blood glucose, blood pressure, and cholesterol numbers and also help keep your weight on track. Whether you need to lose weight or stay where you are, your meal plan can help”.

The Exchange Method

Medicinenet.com gives a detailed account of the food pyramid and how to incorporate each of the food groups into a daily meal plan. It also details the serving sizes in order to comply to the appropriate calorie limits prescribed by your doctor.

http://www.medicinenet.com/diabetic_diet/page4.htm#tocf

Carb Counting

TheJoslinDiabetesCentersuggests the following steps for Carbohydrate Counting.

1.     The first step in carb counting is to have a meal plan.  A meal plan is a guide that helps you figure out how much carb, protein and fat to eat at meals and snacks each day.  If you don’t have a meal plan, meet with a registered dietitian.

2.      Step two involves learning which foods contain carbohydrate. Most people know that starchy foods, such as bread, pasta and cereal contain carbs.  But other food   groups, such as fruit, milk and desserts and sweets, have carbs, too.
There are three main ways to learn about carbs in foods:

o       Ask for a food choice list from your dietitian.

o       Learn how to read the Nutrition Facts Label

o       Purchase a food counts book that provides the number of grams of carb in various foods.

3.      Measuring tools.  In order to accurately count carbs, you’ll need to be accurate with the portion sizes of foods that you eat.  Invest in a food scale to weigh foods such as fruit and bread.  Use measuring cups to measure cereal, pasta and rice, and use liquid measuring cups for carb-containing beverages such as milk, juice and energy drinks.

The Glycemic Index

Web MD defines,  “The glycemic index is a ranking that attempts to measure the influence that each particular food has on blood sugar levels. It takes into account the type of carbohydrates in a meal and its effect on blood sugar.

Foods that are low on the glycemic index appear to have less of an impact on blood sugar levels after meals. People who eat a lot of low glycemic index foods tend to have lower total body fat levels. High glycemic index foods generally make blood sugar levels higher. People who eat a lot of high glycemic index foods often have higher levels of body fat, as measured by the body mass index (BMI).

Talk to your doctor, a registered dietitian, or a diabetes educator and ask if the glycemic index might work to help gain better control of your blood sugar levels”.

The Plating Method

Here’s a quick video from the American Diabetes Association on how the Plating Method works.

Ask your doctor to prescribe or refer you to a dietician to prescribe a meal plan or daily calorie count, and also ask which diet method is best for you.

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Managing a chronic illness like diabetes is more an issue of behavioral change than it is a medical treatment. Sure for insulin dependent diabetics, management requires not only learning to administer the injection, but how to manipulate the doses. But the majority of diabetes management involves understanding how various foods and exercise affects blood sugar levels, and learning to orchestrate a routine that keeps a relative flat line of glucose levels within the normal range

The same is true of living on dialysis or transplant living. Other than being compliant with the doctor’s orders, most of the activity while on dialysis or maintaining a healthy transplant, involves a behavioral change.

Many times, dietary restrictions like low sodium, low fat, low glycemic, means that people need to learn to eat and cook differently. Often times this means a change not only for the person afflicted with the chronic condition, but the entire family. For instance, my husband has a condition unrelated to diabetes or transplant that requires him to eat a low sodium diet. Since I prepare about 99.99% of the meals in our house, that means that after a life of no sugar and low carbohydrate diets, I now add to our meals, low sodium! But it doesn’t work if I prepare his meals separately. In a world of processed foods with lots of added salt, eating low sodium is healthy for everyone.

Since a lot of chronic conditions are aided and best managed by lifestyle changes and establishing a routine, I’ve started a health coaching practice which works is concert with your doctor’s care plan. Once your doctor has prescribed the necessary activities, I work with the patient to develop a regimen that makes those changes fall in concert with your current life.

Perhaps the busiest and most difficult to manage time in my life was when I was a dialysis patient. I was CEO of a manufacturing company, married with a son in elementary school. My job was an hour away from my son’s school. He played soccer and went Kumon twice a week after school. Peritoneal dialysis required that I did one midday exchange and connected to a Cycler at night to perform the dialysis as I slept. My diabetes required glucose monitoring four times a day and insulin injections twice a day. Because dialysis can cause the blood pressure to fluctuate to dangerous levels, I also needed to monitor my weight daily and blood pressure several times a day.  At that time I was sodium restricted as well as on a diabetic diet, and so the best way to control sodium and sugar was to prepare meals myself. As a busy wife, mother and CEO, that was more than a notion, but necessary and therefore not impossible.

All of those requirements—medical, occupational and familial could be summarized like this:

  • Eating out had to be a rare treat

  • I needed diabetic and dialysis medication and testing supplies handy at home and at work

  • In order to cook healthy meals and eat at reasonable times, I had to have them prepped to the point of spending an hour to finalize them for dinner.

  • In order to attend my son’s sporting events and participate in the snack schedule or take him to Kumon even when I would normally work late, meant I had to have business resources at home (computer, fax, printer, binding equipment, presentation folders, etc.).

When I finally got my Ultimate Multitasking Routine in swing, this is how it ran…typically.

  • My workday began at 5:30 am in order to disconnect from my cycler, do all of my testing (weight, glucose, blood pressure), take my insulin plan and prep dinner, prepare lunches for everyone to take to school or work, prepare a light breakfast, and if necessary complete any last minute items for work.

  • Our routine was that my husband usually took my son to school and I usually picked him up from school. As they left, I dressed and left for work. My commute was about 45 minutes which allowed me time to clear voicemail and not walk into any surprises.

  • I kept a three drawer plastic storage cabinet under my desk to store a glucometer, testing supplies, dialysis fluid, blood pressure cuff and supplies, an extra pair of pantyhose and nail polish remover—for other emergencies. The key to being compliant with doctor’s orders is to make the process easy to do and have all of the necessary items available. So at midday, I was ready to test and do my midday dialysis exchange. I kept my stock of dialysis fluid replenished by loading up the car on Sunday night and bringing it into the office each Monday morning.

  • If my son had an after school activity, I would also load up the car the night before with the team snack or whatever was necessary so that I could leave work, pick him up from school and be ready with whatever supplies.

  • Because dinner had been prepped that morning, it was usually within an hour of being done, if not crock pot ready. While completing dinner, I supervised my son while doing homework and was available for questions.

  • In the evening, I completed bedtime testing, took medications, and finished any job related work and prepared for the next day.

 

While of course, things didn’t always work out this smoothly, it was my home base, and when things like illness or other family functions got in the way of this routine, I knew where to return.

I would like to help others with chronic conditions to develop the routine that works best for them to be compliant to their doctors orders and live healthy lives without making overwhelming changes to their current lifestyle.

FOR MORE INFORMATION ON HEALTH COACHING, click on the Health Coaching Tab above.

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