Candid Diabetes

Two out of Five

I finally caught an episode of dLife this past Sunday (nights that, for me, are not conducive to TV) and all I have to say is, LOVE the JDRF commercial! All those cutie patootie little kids singing “Tomorrow”…I was saying to myself ‘ok I’ll take that one and that one and that one…’ It was the highlight of the show, IMHO!

As for the rest of it, well I can only say I was really disappointed. I wasn’t going to post anything that was overly negative about this show, but then I figured hell, these are my opinions, my site, and I can be as critical as I want. I felt like I wasted half an hour just to watch fifteen minutes of commercials (man, commercial central) and a bunch of fluff in between. The only hostess that was able to catch my attention was Mother Love (and even she had her moments); I found the rest to be very insincere and dry. Nicole Johnson totally overdoes it (sorry, but smiling Too much is just phony as hell) and the girl talks more than I do!! A little too much pretend Pollyanna Sunshine and Rainbows for my taste. I was so annoyed that I was telling my TV to shut up so that the Dietician could talk. Meanwhile the two male hosts hardly said a word. If it hadn’t been for the JDRF commercial, I probably would’ve watched Willy Wonka instead!! I want real, not a knock-off of Jerry Springer (without the fists/nudity of course lol).

On the flip side, there were a few things that I thought promising. I enjoyed Mother Love’s energy, and it seems like a there were some grains of knowledge to be had for anyone who is newly diagnosed (and I mean brand-spanking new). They showed a brief clip about future shows and it looks like there is going to be more human interest stories, although I’m sure there’s only so much they can do with 15 or so minutes of TV time. But if they can successfully incorporate some real stories, add some reality to the phony-baloney, I’d love to see it.

I’m always willing to give the benefit of the doubt, so I’ll probably catch another few episodes to see if it improves. But I’m definitely not going to deliberately change my schedule again for that.  The least they could’ve done was played the JDRF commercial twice just so I would’ve had a little bit of a warm fuzzy by the end. I just loved that commercial!!

All in all, I give dLife two kernels of popcorn out of five.

Top Ten

Kerri is paying a great "Top Five" game on her site Six Until Me. So I totally sponged and decided to put my own personal spin on something similar. People, get your thinking caps on and join in the fun!

Without further ado..........

(drumroll please, or hell just throw some money)

Top Ten Alternate Uses for an Insulin Pump

10. Exercised too much last night; sore muscles? Set the alarm on vibrate and press to offending area for instant relief!

9. Combination clip and underwear holder-upper.

8. Bad-date deterrent. Don’t like the guy across the table? Whip it out, play with the buttons, set alarms off, show him your infusion site. Tell him it makes sex interesting but it really wasn't your fault the last little soldier got choked!!

7. The tubing is much better for recreational chewing then say straws, pens or hoodie strings.

6. See #10, but place in pocket ;)  (is that a pump in your pocket, or are you GLAD to see me??)

5. Not only do you have a super padded bra – on one side anyway - but you also have a high-tech bra that vibrates and or beeps!! (may also apply to #8)

4. One minute it is an expensive medical device...next it’s a cheap paperweight!

3. Two words: Nunchuck Pump (hiiiiiiii-YA!)

2. The newest style in watches. (c’mon, admit it; you wear a watch but you still reach for your pump when someone asks for the time!)

Aaaaaaaaaaaaaaaaaaaaaaaaaaand………….

1. In a pinch, the tubing works great to cut off the air supply of anyone who asks you “should you really be eating that?!”

A Child's Gift

When I was in College, I supplemented my living costs working as a PCA (personal care aide) for a special needs child named Jordie. A (now) 12-year-old who was shaken by his father when he was three months old and who suffers blindness, seizures, scoliosis, pulmonary distress, is fed through a gastrostomy tube and has a colostomy bag. His mental capacity is frozen to that of a baby. He will never walk, never talk, never see the faces of his loved one’s, hold his own child and say I love you to a woman…

But he has a smile that lights up a room. That’s no cliché. To see Jordie smile is like standing before a splendid waterfall. There’s peace and happiness in the face of this beautiful child. He so rarely complains; I can count on the fingers of one hand the times that I saw him cry in pain or distress. His whole existence has revolved around fighting a battle for life and he’s done it with a will that most grown men don’t have.

Jordie is dying.

A month ago he was lifted improperly at school and broke his femur in two places. He was hospitalized, released and re-hospitalized not long afterward with RSV (Respiratory Syncytial Virus); which he most likely contracted during his first hospital stay. His right lung collapsed; due to his scoliosis (an abnormal curve of the spine) his rib compacted the lung and collapsed it. It couldn’t be reinflated because there just wasn’t enough room in his chest cavity. He now has lung disease, and it can’t be fixed.

He has coded several times and now has a DNR in place. About a week ago his vitals stabilized enough for him to be released (the team thought it better that he die at home). Before releasing him, they had to deliberately drop his O2 sats in order for the government to fund an at-home oxygen machine for him. I could easily rant and rave right now about the idiosyncrasies that are the government but I guess in the end it worked out and Jordie is where he needs to be.

This morning I went and saw him for the first time since this all happened. In some ways I wish I hadn’t, for reasons that are so hard to explain. He looked well, he looked like Jordie and not like a child with one foot on earth and one in heaven. It makes it hard to believe. But it’s not a reality that I can easily talk away. He coughed, once, briefly, while I was sitting beside him. I had to physically restrain myself from doing chest therapy and being, again, the person pounding on his chest and telling him “that’s it, big cough, get it all out”. I used to give him chest physio for hours, he with a big grin on his face while I pounded and sang along to whatever tune was on the radio. It was a ‘have-to’; in order to avoid Pneumonia, preserve the strength of his lungs, give him breath to live. And now it’s not allowed. If the mucus is loosened, if he tries to cough it up and can’t, it will block his air passages and literally choke him to death.

We’ve all hoped and prayed that he would fight his way out of this one just like he’s done every other obstacle that’s set itself in his path. But there won’t be any fighting this time. Nothing can magically cure his lungs, rid him of the pressure sores that have, for the first time, appeared on his skin. It’s just a matter of time now, an inevitable waiting game. I can only hope that he will go peacefully, that it will take him in his sleep while he’s dreaming, and that dream will become his reality.

And I will always be thankful for having legs that walk and eyes that see. For breath and for voice. For having a disease that lets me live. And for having known one of God’s true silver-tipped angels.

AACE Type 2 A1c Survey

Seems the American Association of Clinical Endocrinologists has released some horrifying statistics regarding Type 2’s in the USA and a purported lack of control in some 67% of these individuals, as shown by an inadequate A1c level.

To paraphrase the AACE media release, the combined results of 2003/2004 show that two of every three Type 2’s has an A1c above target (6.5%). 84% of those polled believed they were successfully managing their Diabetes, even though 61% didn’t know what the A1c is and half of those polled couldn’t remember their last test result.

It was stated that the average A1c was not calculated for this survey; whether or not that was because of a lack of substantial information is beyond me, but it seems (to me) a number that would’ve been important in this survey. (but of course, I don’t make those decisions)

While I was heartened by the fact that every article I’ve seen on this survey specifies Type 2 – rather than failing to specify the type and just lumping everyone as a Diabetic – I found myself wondering what questions this telephone study was comprised of. The bent of every article that I’ve read, even the release directly from the AACE’s website, seems to point the finger of blame for these statistics only at the Type 2’s surveyed.

So I’d like to know, were those polled asked questions about the quality of care that their Endo/GP’s had given them?? Did this survey critique the Healthcare Team as much as the Patient? I have heard so many Type 2’s repeat stories of slash-and-dash Diagnoses and Treatment plans. Newly diagnosed Type 2’s who don’t even know that they can self monitor their BG’s at home, who were never told what goals to set and strive for. Those who are fortunate enough to get instruction are told to self-monitor their BG’s on an infrequent basis; sometimes a couple of times a day, often a couple of times a week. Type 2’s who were initially Dx’ed by their GP’s and never referred to an Endocrinologist, let alone a multi-disciplinary team. And who were never told what an A1c is, let alone it’s importance.

And then there’s the financial side. From my understanding of the American Healthcare system, most that have supplemental health care insurance also have to have their physician pre-prescribe a specific amount of supplies per monthly basis (someone please correct or confirm this for me). Heck that’s if one is lucky enough to have supplemental insurance; if not you’re up Sh*t creek without a paddle! I’m not a Type 2, but I know that if I tested only a couple of times a day or a week my A1c would be catastrophic. Was the income level established in this survey, was there any correlation between those with higher A1c’s and lower income or lack of health insurance?

As far as I’ve been able to ascertain, the AACE didn’t publish the standard questions asked in this telephone assessment (at least I can’t find any mention of it, and I’ve searched). A campaign has been launched in which Type 2’s can take an oath to achieve better control; a list of 4 vague points that include taking meds as prescribed, setting goals and testing blood glucose levels, and speaking to his/her doctor about management plans. No mention of multidisciplinary teams that include CDE’s, Dieticians, Endocrinologists, etc. and no reference to Clinical Guidelines. But I suppose it's a place to start.

Acne Antibiotic for Retinopathy?

A study by the Penn State College of Medicine suggests that minocycline - an acne antibiotic - may slow or prevent Retinopathy by reducing the inflammatory component of cytokines and microglia and thus the death of retinal cells.

The study found that minocycline limits the destructive action of microglia (the immune cells of the Central Nervous System) by up to 50%. Microglia envelop damaged cells after the release of neurotoxins which, in turn, damage the delicate neurons of the retina. They are activated by the inflammatory action of cytokines within the retina. minocycline appears to decrease the neuroinflammation caused by cytokines in lab rats. Microglia are also suspected of playing a critical role in neurodegenerative disorders such as Alzheimer's and MS.

Seems like promising research to me!

D-Squared

Lately I've been contemplating the other "D" involved with Diabetes...Depression. I recently read an article entitled "Sweet Sorrow: The Relationship Between Depression and Diabetes Mellitus" that addresses the relationship between Diabetes and Depression, as well as its association with Diabetic complications.

But it's got me wondering...is there a line between chronic depression and the simple "down-and-outs" that anyone with a chronic disease feels? I know that there's a chemical correlation between Diabetes and Depression, that vicious cycle of one causing the excessiveness of the other. But how many of us are actually treated mentally as well as physically?

Now, don't get me wrong; I'm no psychiatrist, psychologist...psychwhosawhatsa with a PhD. But I can't ever recall a time when any doctor/CDE/health care worker ever asked me if I'm happy, if I feel I'm doing my best, if I'm satisfied with my best, if my self-confidence is intact and strong. And how many times do we just hear someone tell us "you're doing a Great job!"? I remember when I was a teenager and my principal wanted me to be checked for depression...I look back on that girl and I think to myself "was that clinical depression, or was it the scope of something much larger, a side-effect of Diabetes that isn't addressed?"

Self image. Self confidence. Self esteem. Who nurtures these things for us? Does Diabetes - or any chronic disease - set off a domino effect of debilitating our own self-image? As a kid, I was different than all the other kids, and different was bad. Separate. Oh, I was good at faking it; I walked around like I owned the world. But deep down inside, I just wasn't as good as everyone else. I was fortunate to have a mother who nurtured my self esteem and helped me to realize that I am strong and unbeatable...but if not for her, I would probably be caught in my own trap of believing that I'm just not worthy.

Not to mention that Diabetes is just plain HARD. It's a lot of frigging work. I'm a master at triaging and a self-proclaimed control freak. And it's expensive. And time-consuming. Stressful and scary. It's life amplified. Mortality acknowledged. And it has the ability to completely undermine one’s self confidence.

To me, knowledge is key. Knowing all that I can about every aspect of my disease then gives me power; an edge. But I wouldn't be privy to the in-depth knowledge that I have if not for my college education. Even the classes that I am required to take yearly at my local Diabetes Clinic don't offer that kind of learning. The internet seems to offer more than what should be attainable through our healthcare teams, our mandatory appointments and courses. And even those most have to ask for.

Add this all up and it begs the question (for me) of whether the issue then is not depression in a clinical sense, but a lack of belief in one’s self. A lack of workable information to supplement our sense of self control. In some ways, maybe even a (mistaken) concession to the futility of working against something that seems to be so powerful.

I don't suppose there will ever be a concrete answer to this, but it remains a compelling question and issue in my mind. How can one successfully cope with the rigors of Diabetes - of any chronic disease - if they don't truly believe that they are capable and deserve a 'normal' life? Could we be doing more for ourselves, demanding more? Could our healthcare providers be offering us more??

The Wonders of Modern Marketing

  I was watching the TBS channel last night and a commercial came on advertising an American Pharmacy; I believe it was called something like "Save-on".

  This couple walks into their kitchen carrying grocery bags. Buddy goes and opens the fridge door (me man...want food) and sees this ginormous slice of chocolate cake on the shelf. I am talking huge, Bigfoot could wear this sucker as a shoe (chocolate-toe-jam notwithstanding)!

  Anyway, hubby pulls this grossly overproportioned slice of cake out, big doofy grin on his face, ready to totally mooch out. Wifey sees the cake and says:

  "Did you forget - you're a DIABETIC!!"

  I cracked up. I threw popcorn at the screen (well I would've if I'd had popcorn). I yelled - in between snorts of laughter - "Riiiiiiiiight, he forgot he has Diabetes...I bet he also forgot to wipe his @$$ this morning!"

  The rest of the commercial was equally comically unbelievable; wifey does an impression of Mary Poppins disguised as Aunt Jemima and starts whipping display stands and Pharmacists out of paper bags. The farce ends with hubby having his cake taken away while the Pharmacist hands him an apple.

  And these kooks actually get paid for this.....

Oooh the Possibilities!!

I am feeling that verve, that excitement that comes from realizing that something actually might be obtainable sooner than later.

I’ve always wanted to be a Ped’s nurse, with my main goal being a CDE and even an Insulin Pump Trainer along with all that. I took my Unit Clerk degree as a stepping stone and a way to decide whether I would enjoy the nursing industry or not (if I didn’t, I would’ve wasted less time and money). I got out of college and worked in LTC (long-term care) and was not impressed. I did not work for a gov’t affiliated association, so it was very cliquey; it was also very difficult, as a young person, to work with geriatric patient’s day in and day out. Not to mention dementia clients, who are quick to anger and very difficult to deal with (not that I blame them, but it did make for some very harrowing experiences and a fear of growing old).

So I’ve let the Unit Clerk degree sit on the shelf and have been doing Admin work, boring as hell, non-challenging, but it doesn’t involve anyone screaming not to be touched or seeing monkey’s in their room.

But lately that old drive to be in there has come back three-fold. Unfortunately circumstances have made it very difficult for me; Canada Student loans f-ed up on my loan repayment and I am suffering for it (and we all know how hard it is to tell the government that they are wrong), to the point where it will be difficult for me to get funding to further my education.

And then, last night, I was talking with a great friend who offered me the simplest of solutions and perhaps a way to see my aspirations to the end.

We discussed my taking the RN course in the States. There is a huge difference in the educational Nursing structure of Canada and that of the States. I could take an accelerated BScN program here in Canada to become an RN, but it would cost more and one cannot become an RN in Canada without a Bachelor’s Degree. The entrance requirements for the American programs are less (although this isn’t a big concern for me what with my background) and one can specialize sooner.

This option appeals to me because not only would it be the greatest step towards fulfilling my dreams, but it also seems like a great chance to experience life outside of my own world. 

I found a list of nursing U's in the States and after looking at each, I'm impressed with the programs at Colorado State Uni., the University of Massachusets (boy is that ever a word to spell!!), and Georgetown University. I am still trying to find some sort of listing that rates the quality of the Universities in the States. So if anyone has any suggestions I could really use the help!

To go completely off my own topic (ahhh the liberties that I can take are so freeing!) I hate Sundays! It's 8 pm now and the day slipped by unnoticed....back to work tomorrow UGG!

The Hot Debate?

In the interest of becoming as Blog-savvy as I can be – and of course meeting my fellow D-Bloggers – I have been visiting every Diabetes Blog I can find. And I have to say, there are some amazing one’s out there; in particular I was very impressed with one called “Six until Me” (I have linked it on the left). Kerri, the writer, has a very distinct and frank style of writing and one that I found particularly refreshing.

It seemed to me that the hottest topic of many of the sites I visited was the distinction between the Types of Diabetes. So I decided to add my voice to this topic.

OK so my best effort at KISS’ing and getting rid of all the medical jargon:

-         Type 1 (formerly known as Juvenile Diabetes, IDDM) was broken into two Sub-types by the ADA (as I recall); Type 1A and Type 1B. Type 1A deals with the genetic and autoimmune mediated form of Type 1, while Type 1B deals with the more controversial aspect of Type 1. Type 1B is not autoimmune mediated, and presents with marked hyperglycemia but a normal glycosylated hemoglobin (A1c), and lack the markers for anti-islet cell autobodies.

Basically, the majority of Type 1’s are Type 1A. Without going into too much overwhelming detail, our immune systems destroy the B-cell, insulin producing islets in our pancreas.

-  Type 2, which is generally known as insulin resistance. Fat cells (particularly abdominal fat cells) actually inhibit the uptake of insulin, causing this resistance. The pancreas overcompensates by releasing producing more insulin and in many cases this leads to the complete burn-out of the B-cells. I recall reading that scientist have specified the genetic marker for this; while one person may have completely asymptomatic insulin resistance and an ample supply of endogenous insulin throughout their life time, only those with the genetic marker will become symptomatic Type 2 (or pre-) Diabetics.

-      Gestational Diabetes is another form of insulin resistance, thought to be caused by hormones from the placenta. The placental hormones block the action of the endogenous insulin.

-      With LADA (Type 1.5) the person is typically middle-aged and slender and has little or no resistance to insulin. They do, however, have the anti-B-cell antibodies. Type 1.5’s generally do not have to go on exogenous insulin right away because they have adequate insulin production. Sulfonylureas (which stimulate the production of endogenous insulin) can be used for LADA and are often successful in controlling blood glucose levels.

-      There is also Pre-Diabetes, Syndrome-X (the insulin resistance syndrome) and MODY (Mature onset Diabetes in Youth; neither Type 1 nor Type 2 it is a rare genetic defect inherited through the maternal x-chromosome, is diagnosed in those <25 years of age, and can often be controlled with diet alone).

I wonder if this isn’t the universal question that all Diabetics face? I meet someone new or get a new job and at some point I decide to tell them that I’m a Diabetic. That’s what I say. “I’m a Diabetic” or “I have Diabetes”. Nothing fancy, and I don’t give a flying hoot if it’s not specific. Unless or until someone says to me “Oh so you’re on those pills?” or “You don’t look like you need to be on a diet!” (once I had a very insensitive individual tell me that I wasn’t fat enough to have Diabetes). Do I like being perceived as lazy or irresponsible with my health? No, and I’m fairly certain that no Type 2 Diabetic does either. I believe that there is a reason that Type 2 is so well known while the other types lay in the shadows of mystery; Type 2 is an epidemic, it is a preventable chronic condition that is sweeping North America and that is big news. It’s also linked to obesity, and we live in a McDonald’s-Drive-Through-Every-Friday-Night world where, statistically, obesity is a big problem. Type 1 (and its sub-types), LADA and Gestational Diabetes are not preventable and a very small percentage of the population have these diseases. So really, it’s no wonder the general population is prominently aware of Type 2; it’s the media who needs to be educated. Just my 2 cents...

A Quick Thanks to My New Webpage Consultant

This one's for the girl...

Special thanks to Dewey for helping me immensely by taking a simple (and not at all specific lol) banner and creating my wonderful logo! Although I've stated in our contract that she is not for rent, I will allow her to give consults! ;)

The pump in the logo is the Paradigm 515. I am anxiously awaiting the upgrade here in Canada, but until then I'm all about my 512.

And now, since it's WAY past my bedtime....off I go!

*NOTE: Please be sure to sign the Guestbook while you visit!

The Inescapable Intro

Well, here it is. That ever-dreaded first post, the one in which I try to reach out through my computer and grab the attention of my readers. Get out the pink feathers and heeled boots 'cause here we go!

OK let's see here...I'm 25 (almost), 5'2" (according to my sister, almost), reddish-brown hair, I love long walks by the beach and candlelight dinners and all my friends call me Bunny...oh wait, that's my standard pin up for singles sites ;)

All kidding aside (and yes I am kidding, my friends do not call me Bunny!) I'm a newbie to the whole blog thing, and the help menu has become my best buddy. So apologies in advance if you visit and it crashes your computer!! (I'm innocent, officer!!)

Diabetes has been a part of my life for 14 years (as of April 23) and as such it is a main interest as well as what is ever-present in my mind daily. It has formed my character and made me into the person I am today, just as I'm sure it has done for any Diabetic. I have joined numerous Diabetes forums and subscribed to letters and advocacy groups and magazines because of my disease. And now I am going to share my thoughts with the www simply because I can. Because there is a large group of us who share the day-to-day trials of living with a chronic disease, and this is my way of "reaching out and touching someone".

Just don't expect greatness. In the words of Oscar Levant:

"There's a fine line between genius and insanity. I have erased this line."