Type 2 Diabetes

Type 2 Diabetes

What Schedule?

Type 2 Diabetes Blog

July 11, 2010

Once I began injecting insulin in 2004, I learned very quickly that staying on a schedule of monitoring my blood sugar level was in my best interest.  Knowing my blood sugar number and then counting my carbs accurately, usually means I take the right dose of insulin and thus keep my blood sugar fairly stable throughout the day.

So for the last 5 years, I have tried to check my blood sugar at the ADA (American Diabetes Association) recommended times of before each meal, 2 hours after beginning to eat each meal and just before bed.  That’s 7 times a day.  Of course, there are days when I test more such as when I am sick, traveling, or eating foods that are not normally in my daily diet.  And there are days when I test less for varied reasons such as leaving the meter at home, being so hungry or so involved in a conversation I just begin to eat without checking or I decide to skip it.  But for most of the time, I test at the appointed 7 times during the day.  It’s become a habit.

Well, that schedule seems to go out the window whenever I am with our grandson, who is 1 year old this month!  Edward and his parents visited with us this weekend, and I doubt I did a finger stick more than twice each day.  How can one adorable little boy create such havoc with my schedule?  His parents were very active in his care so it wasn’t like I had sole responsibility for him.

Yet I didn’t want to miss any opportunity to interact with him.  We only see him every 3 months since he lives about 3 hours away.   So many new skills can be learned in a short time at this age, and this grandmother didn’t want to miss any of his “new tricks.”  I can happily report he waves “Hi” and “Bye.”  He wields a mean hammer on his workbench and loves to cruise around the coffee table.  No electronic remote control is safe from him.  How could I miss watching this on- the- move bundle of energy?  Especially when he turns his heart- melting smile on me, inviting approval of what he is doing. 

OK, so my focus was not on managing my diabetes. Missing a finger stick reading is one thing, but not taking your bolus!  How could that happen?  I just know that it did.  I forgot at least one bolus each day!  I was busy putting food on the table for all of us or getting us out the door on time or feeling exhausted or simply enjoying Edward.  None of these is an excuse.  I know that.  And I am thankful that as PWD T2, the end result of not taking the bolus was not off the charts.  While my blood sugar was not <180 as recommended by the ADA two hours after eating, it did not soar into the high 200 or 300mg/dls like it may for others with diabetes, especially those with type 1.

I now have greater respect, and empathy, for mothers with diabetes and with young children who demand so much time and energy.  I applaud you for the herculean effort you put forth in taking care of YOURSELF and understand how things can fall a part in the midst of family demands and hectic schedules.  Sometimes we moms think we need to take care of everyone else, and then if time is left, we will take care of ourselves.  I saw very clearly this weekend how that line of thinking is counterproductive.  I make better choices and generally feel better when I follow my “normal” routine of checking my blood sugar and taking my bolus.

Flight attendants tell us if we are traveling with a young child and the oxygen mask is deployed, we should put the mask on ourselves before putting it on the child.  The first time I heard this, I thought, “Yeah, right.  I’ll take care of my child first.”  But in doing so, I may truly put my child at risk of not having me to care for him later on. 

I will work on applying that knowledge to future times with Edward.  I will respect that I need to care for myself so that I may continue to be healthy and can care for him and the rest of my family hopefully for years to come.  Putting my diabetes management first is not selfish; it is in the best interest of my family for me to manage my diabetes well.  I hope you put your diabetes management as a top priority too.

 

Lesson Learned

Type 2 Diabetes Blog

July 4, 2010 

When I began injecting insulin, I would experiment with different foods to learn if they would increase my blood sugar.  For instance, I learned that a half cup of white rice will raise my blood sugar significantly.  Being armed with this information, I now know that if I choose to eat a half cup of white rice as part of a meal, then I can choose to increase my insulin bolus or to engage in physical activity shortly after eating the meal to help reduce this increase.

 Recently a slip in my morning routine created an opportunity for me to experiment with my breakfast food choices.   First, I do a fasting blood sugar check, then fix breakfast, take my insulin bolus, and eat.  But this fateful morning I simply forgot to take my bolus before eating my breakfast.   No problem, you say, just take it during or right after eating.

Well, I didn’t realize I had missed my bolus until 3 hours later!  Too late for a bolus but I might need a correction dose of insulin to reduce that high I just knew I would see on my meter.  Off I went to stick my finger and wait the few seconds for my reading.

To my surprise, I really did not need a correction dose because my meter reading was 139.  My breakfast is a very high carb affair:  a bowl of high fiber, high carb cereal, with 2% milk, fruit, and a few walnuts thrown in.  Um, about 75 carbs or more if I am heavy handed with the cereal and fruit.  Since my early mornings are not usually high activity times, I give myself a bolus of 5 to 8 units depending on my morning blood sugar reading.   My two hour after meal reading is usually at the lower end of my target range, but I often have found that my before lunch reading is at or below 100.

I believe that numbers are information, and the information from this event made me wonder did I really need a bolus each morning I ate this same high carb breakfast?  Or just a smaller bolus?  To find the answer, I decided to experiment each morning for the next 4 days to see if my two hour after eating blood sugar reading would be < 180, which is the ADA recommendation, without taking a bolus of insulin.

The result, I am happy to report, is I was well under 180 each morning 2 hours after eating this high carb breakfast, but it was not in my desired target range.  Of course, I did not achieve the same number each day because of variations in my fasting blood sugar number and in the level of morning activity. 

Now I have decided to think about my morning routine first, and if there will be little or no real physical activity after breakfast, I will give myself a smaller bolus than I previously did.  If I plan on being “on the go” that morning, I may skip the bolus entirely or reduce it even more.  Reducing the amount of my bolus at breakfast will help prevent the dip in energy and blood sugar just before lunch and will keep my after breakfast blood sugar in my target range.

I will continue monitoring this new morning routine and will adjust my bolus to ensure that my two hour after meal blood sugar reading is not only < 180 but in my personal target range.  I am all about taking less insulin, but not at the expense of higher blood sugar.  Yes, I could change the foods I eat, but I enjoy this breakfast fare.  It is quick to fix, and I believe that it is a healthy way to start the day for me.

This lapse in routine and subsequent experiment taught me that no matter what I think I know about carb counting, I should stay open to opportunities to learn more about the foods I eat and their effect on my blood sugar.  Knowing, rather than assuming, the effect of a food on my blood sugar will help me do better at portion control and determining my insulin bolus.

 

 

Perfection

Type 2 Diabetes Blog

6-27-2010

How important is body image to you?  Are you OK with your size 4? 12?  24?  Or are you embarrassed and believe you should do more to reach that elusive perfect size.

Sunday afternoon of the Weekend for Women sponsored by DiabatesSisters and TCOYD, I listened as Rhonda Merwin, PhD, Assistant Professor in the Department of Psychiatry and Behavioral Sciences at Duke University Medical Center,  had us reflect on our body image and the fact that many women would give up 10 years of their lives to be at “their ideal weight.”  Gasp – 10 years!  To bring home the importance of this statistic, we were asked to take any 10 years of our lives and list the most important events during those years.

My last 10 years quickly spilled onto the paper as I listed my retirement, becoming a peer mentor, gaining a daughter-in-law and then a grandson, losing my dearest aunt and my only sister, traveling frequently, starting insulin, getting an insulin pump, and so much more.

Yes, a smaller, well, several smaller dress size is a constant dream of mine, but at what cost?   Except for the loss of my aunt and my sister, these events have brought such joy into my life. How could weighing less ever take the place of being with my grandson or being retired and having more time to read or travel?  Too often our sense of self worth is connected to pants size and a body image that someone has told us is the “perfect” size/shape to be.  I would not give up 10 years of my life to fit into the smaller sized pair of jeans still hanging in my closet.

This discussion of body image caused me to think about our diabetes image. Much of what we do to manage diabetes is driven by trying to meet certain numbers that are often touted as “the standard or gold standard of care.” How often have we heard the words “not compliant” in managing our diabetes, meaning we have not reached the standards set by the medical community?

Like those seeking the “perfect body image”, I strive to reach a subjective ideal number for my blood sugar readings,  A1c results, BMI, blood pressure, and cholesterol, as well as including daily physical activity and counting carbs.  All of this number chasing is very stressful and time consuming.  I feel successful when the numbers are in my target range and often feel anxious and concerned when the numbers are not.

But numbers are just ….numbers, information that can be used to better manage this disease.  Obsessing about each number is too exhausting and counterproductive.   A meter reading of 205 mg/dl is information that tells me my blood sugar is high and I should seek to lower it through whatever treatment plan I have established with my healthcare professionals such as my insulin injection or some physical activity.  It does not mean I have failed or that I am less worthy because at this moment I am not at an acceptable number.

There is value in these numbers, but they do not define who I am.  My life is rich in family, friends, work, travel and hobbies, and I am a person with diabetes who struggles sometimes to maintain a balance among all areas of my life. So when I realize I am too focused on chasing the numbers associated with managing my diabetes, I stop, take in a deep breath and release it slowly.  And then I remind myself that “diabetes perfection”, like the “perfect pants size”, is a myth, and an illusion, and that my life, with all its imperfections, is a great life.

 

 

Welcome to North Carolina

Type 2 Diabetes Blog

May 17, 2010

I want to welcome all my DiabetesSisters who will be traveling to North Carolina this weekend. I am not a native daughter of this great state, but most certainly have adopted her as my own.

As a member of class XVII of Leadership NC, I had the distinct pleasure of traveling to all corners of this beautiful land and met some of the finest people one could ever know.  I know between the TCOYD Conference on Saturday and the Weekend for Women Conference afterwards, your weekend is pretty much full.  But, if there is a way for you to come a little early or stay a little later, I would highly recommend it.  Of the countless wonderful things wer have going on here in the Tar Heel state- we are just the right size for a day of travel.  You can get from one end of our state to another in a day's drive with time to spare.  Although I could never choose a favorite city, I will tell you that you can literally step outside your hotel and onto the streets of one of the most dynamic cities around: Raleigh, NC. 

If you find yourself with more than a couple of hours of time on your hands, you could be sitting on the sands of one of our beautiful beaches, touring our iconic lighthouses, strolling the world renowned gardens of the Biltmore House, or celebrating the 75th anniversary of the Blue Ridge Parkway with a leisurely drive or even a hike. We can offer you a glimpse into past with our many historical sites and museums unless of course you prefer to peek at the future and explore some of most technologically advanced medical centers in the world. Sports buff? We got you covered: Tar Heels, Devils, Wolfpack, Deacons, Panthers, Bobcats, need I say more?  Is music more your thing?  Many an American Idol has Carolina on their mind.

I wouldn’t be much of a blogger for women with diabetes if I didn’t at least touch on that subject just a little bit. North Carolina is ranked number 17 in the nation with regard to the number of diabetic residents. There are nearly 650000 adults in our state diagnosed with diabetes. - when combined with the estimated number of adults living with diabetes but have not been diagnosed our numbers soar to about 1.25 million adults. I have always considered myself fortunate to know I have diabetes and to have access to premier medical services and institutions like Wake Forest, UNC Medical Centers, and Duke. I could not talk about North Carolina, diabetes, and health care without giving a special acknowledgment and thanks to Dr. John Buse, MD. If you are not familiar with him by name, I assure you we are all benefactors of his work. His accomplishments are too numerous to list; what stands out for me is his work with and for the ADA locally and nationally as ADA President 2008, and his research with diabetes and specifically diabetes and cardiovascular risks. You will find out more about this wonderful doctor and his link to TCOYD and Diabetessisters.Enjoy your time here and come back soon!?

Now what?

Type 2 Diabetes Blog

May 5, 2010

Have you ever just thrown your hands up in the air and asked “now what“? Either literally or figuratively? I have had a few days like that lately that have turned themselves into a few weeks.

Several weeks ago, I noticed a minor irritation on my eyelid. Little red, little sore, more of a distraction than a major medical event. Probably a sty I thought. Rather than running to my doctors office, I ran over to my laptop for a quick appointment with one of the more reputable medical advice sites. I was completely shocked when I got to the information about risk factors for a sty, low and behold diabetes was listed first. Several hot compresses later, it went away; or so I thought.

About ten days later, I woke up with horrible frightening pain in the same eye. Completely freaked out when I could not open my eye because of the major swelling. There is nothing like starting your day thinking you have gone partially blind. All I could think of was the many complications listed on my friendly cyber doctor’s website. Needless to say, I ran to my ophthalmologist office that day just as soon as they could take me. As a person with diabetes, I do everything I can to ensure my eye health remains in tact and have a wonderful ophthalmologist. It took him all of two seconds to diagnose my problem: a chalazion - basically a cyst under the eyelid. Nice…..right? Well, it gets better. Among risk factors for these horrible little things - diabetes.

I supposed I have gotten used to needing a flu shot because I have diabetes, not taking certain over the counter medications because I have diabetes - or at least “consulting with my physician” before taking these seemingly innocuous medications for menstrual cramps or muscle aches. I have generally accepted that diabetes - even well controlled diabetes can cause complications with other, seemingly unrelated conditions. Every now and again I guess we are entitled to have that moment when we just have to ask (our bodies, our diabetes) NOW WHAT?

Diabetes Role Model

Type 2 Diabetes Blog

April 21, 2010

There have been very few days in the last 28 years that I have not thought of my mother. Like most mothers she was a role model to me, even when it comes to diabetes, she was my role model. My mother was diagnosed with type II diabetes sometime around my tenth birthday.

Although I remember the time of year very well, near the Christmas holiday, I can not remember the exact year. The holiday time sticks out in my memory because like most families we were in the thick of the season, which included lots of baking and candy making. What we had not planned on that holiday was that she would slip away from us into a coma like state that resulted in several days of hospital inpatient care.

In the days, weeks, months, and years after that time our family life changed dramatically. There was an extreme focus on healthier eating, more exercise, and heightened sense of awareness of our health as a family unit. My mother was the picture perfect type II diabetic. She always took her meds, ate small meals counting each item against her “exchange” list, her daily checks of urine with “keto sticks”-meters had not yet hit the market for patient use at home, and the many laps she swam, miles she walked or pedaled on her bike nearly everyday are a constant in my memory.

It was only recently that I truly allowed myself to reflect upon my mother as more of a peer, more of a diabetes sister, if you will. It really hit me back in January of this year a producer and film crew from the CNBC show dLife came to Greensboro NC to interview me and film a segment for dLife about me - living well and overcoming many obstacles. During the course of this interview the subject of family history and diabetes came up and along with that, a lot of emotional stuff came out, most of which I had pushed down and chocked back for far too many years. After shock and fear, one of the things that was toughest for me to get over when I was diagnosed with diabetes was the guilt….guilt of “knowing better”, guilt of “letting my family down” by not taking better care of myself, and guilt of feeling I had somehow shamed my mother and her efforts to keep me healthy and teach me lifelong habits of good health - I had failed her.

This morning I attended an ADA breakfast to kick off this years Step Out Walk in Raleigh NC. I was looking forward to seeing old friends, meeting some new ones, and bonding with other people with a common goal to stop diabetes. I had also been dreading it, every time I glanced at the invitation on my bulletin board, looked at my calendar, got my pop up reminder because today is also the 28th anniversary of my mother’s death. It was not diabetes that took her from me too soon but rather a tragic car accident. As I sat there listening to the speakers and taking it all in, I kept reflecting on just how far we have come in this fight against diabetes, how much has changed and improved with regard to treatment and research, and most of all how proud my mother would be of me, the woman I have become, the woman living well with diabetes.

In loving memory of Marci E. Nash, November 15, 1943 to April 21, 1982

Historic women with diabetes

Type 2 Diabetes Blog

April 11, 2010

I just watched one of the most amazing 30 minutes of television I have seen in a long time.  On the dLife program which airs on CNBC, I saw an episode about the history of insulin.  Last year when I attended my first TCOYD conference here in Raleigh NC, I got my first lesson on the history of treatment of diabetes. 

To be honest, it was more accurately the history of the non treatment of diabetes which until the 1920’s consisted of little more than slowly starving patients to death in an attempt to lengthen their lives.  But tonight, I was introduced to two women who are no longer with us, but are surely Diabetessisters none the less.  Please allow me to introduce you to Elizabeth Hughes-Gossett and Marie Krogh.Elizabeth Hughes was born to politician Charles Hughes, the governor of New York at the time of her birth in 1907.  Elizabeth was diagnosed with type I diabetes at age 11.  At the time of her diagnosis she was treated with the only known treatment at the time, severe caloric restriction – as in under about 400 calories on most days.  Weighing only about 52 pounds at age 14 her mother contacted Dr. Frederick Banting of Canada who had been working on development of insulin suitable for use in humans.  Elizabeth was taken to Toronto Canada in the summer of 1922 and was one of the first humans to be injected with insulin.  The work of Dr. Banting was taken up by Eli Lilly and replicated in mass production making insulin more readily available in North America – improving and saving the lives of countless people.  Elizabeth Hughes went on to finish her education, marry, have children and grandchildren – living until age 73.Marie Krogh was one of the first female physicians in Denmark.  She was married to world renowned physician August Krogh, a Nobel Prize winner for his work and discovery of how capillaries carry oxygen.  Marie Krogh was diagnosed with type II diabetes in 1921 and like Elizabeth Hughes and countless others with diabetes back then, the only treatment was severe caloric restriction.  Upon hearing of the groundbreaking research being done in Canada, Marie and her husband August traveled to Canada to meet with Dr. John Macleod a collaborator of Dr. Banting.  With Macleod’s permission Marie and August Krogh returned to Copenhagen and began to manufacture insulin in a laboratory that is now known as Novo Nordisk.  Not only did this endeavor change Marie’s life but also the lives of countless others.  Sadly, Marie lost her life to breast cancer in 1943 – but all accounts indicate that insulin enabled her to live without complications of diabetes throughout her life.I know that a mini history lesson is not typical for most blogs, but I found myself very drawn and endeared to these two women and the stories of their pivotal role in the history of diabetes treatments.  I have used insulin products from both Eli Lilly and Novo Nordisk at different times of my life, and I am sure many reading this have as well.  Maybe that’s why I felt so compelled to share their stories with you.  Or maybe it’s the little voice inside that tells me although Elizabeth and Marie have left this world long ago, they will always be Diabetessisters in my heart.

Hair Band to Hero

Type 2 Diabetes Blog

March 14, 2010

Once upon a time ago, long before I was anyone’s grandma, I was a BIG fan of 80’s metal bands.  As many of my fellow children of the 60’s who were coming of age in the 80’s; we just could not get enough of bands of men with bleached big hair, who wore mascara, ripped belly shirts, and lycra-spandex leggings in various shades of metallic or animal print.  If you are reading this, and just don’t get it – guess you had to be there…..

Bret Michaels of Poison was among my very favorites back in the day, for a much different reason than why is still one of my very favorites today.  I don’t even watch Celebrity Apprentice – but I know that a significant number of the some 18 million Americans diagnosed with diabetes are considering tuning in!  I am completely thrilled that he has chosen the American Diabetes Association as his charity of choice.  And the reason he cited for this personal connection, ADA sponsored camps for children, is even more touching to me. If timing is everything, his timing could not be better.  A week from today, Tuesday March 23rd to be exact, is Alert Day – brought to you by the American Diabetes Association.  If you are not familiar with this, I encourage you to go to www.diabetes.org and find out how you can become involved.  It’s all about getting the word out to the over 7 million Americans who have diabetes, but sadly don’t know it. Big thanks to Bret Michaels for his generosity of himself for always being so open and advocating for diabetics and generosity of his treasure as well.  Who says every rose has it’s torn?

Love your Heart

Type 2 Diabetes Blog

February 20, 2010

Most of us can not escape February without thoughts of hearts….usually, hearts, flowers, romance, and chocolate.  I want all of my diabetessisters to come to think of February a little differently.  

Each of us needs to be aware of our increased risk for heart disease.  As women, we are at an increased risk for heart disease and as women with diabetes, our risk is even higher.I am not a health care professional, but I am an avid volunteer for the American Heart Association, and the information I am sharing can very save your life.  Also, a large part of my personal life story is attributed to a no nonsense cardiologist.  His intervention and treatment plan not only helped me to better control my diabetes, it quite literally saved my life.In America today heart disease is the number one killer of women.  More women loose their lives to heart disease than to all forms of cancers combined.  Statistically one in three women have cardiovascular disease and one in three women will die from the same.  That means that one woman is lost to heart disease roughly every sixty seconds.  Even more than all of the mind numbing statistics, please know this one important fact:  heart disease is largely preventable.There are many things that none of us can control, our sex, our genes, our ethnicity…for all of the things we can not control there are at least as many things we can affect.  We can start by being informed and engaged about our health, knowing our numbers – A1C, blood pressure, and cholesterol – ensuring we get daily physical activity, and participating as the center of our health care team.  We must understand and accept that diabetes and heart disease are undeniably linked.  So sisters, Love your Heart!

Diabetes Here, There, Everywhere

Type 2 Diabetes Blog

February 7, 2010

For many of us, it is impossible to escape the reality of diabetes on any given day.  Between daily testing, meal planning, carb counting, exercising with the specific intent to improve our blood sugars, it’s not much of a surprise that diabetes is top of the mind for most of us – and often times our families.  Agree?

Would it surprise you to know that during my most recent Leadership North Carolina session, which happened to be the Health and Human Services, all but one speaker spoke of type 2 diabetes as the most daunting health challenge facing our state and our nation? In fairness to the one speaker who did not talk about diabetes, her particular area of concentration was mental health.  All the other speakers which included subject matter experts ranging from doctors, insurance professionals, a well as leaders of non-profits from around our state were consistent in their message:  type 2 diabetes poses the largest threat to our children and our medical infrastructure that we have ever known.  Of course, the solution to this imminent crisis is not a secret – we must be more aggressive about prevention and in that respect all roads point to reducing overweight and obesity.  The multi billion, maybe even trillion dollar question is:  How? While I was away in Charlotte for this three day session, I read about the Oprah show about diabetes.  I immediately called my family to have them record it for me so I could watch when I returned home.  As I watched it last night, it was such a surreal experience for me in that I felt like someone on her show must have tapped into the previous three days of my life.  The subject matter and conclusions represented were EXACTLY those of the speakers I had the privilege of hearing earlier in the week.There are so many layers of this monumental onion; there are only two things I see for certain is this.  First, as a nation, we can not continue to do the same things, the same ways, and expect a different outcome.  The second is:  there is no time to waste, there is no time to waste, we must act swiftly and aggressively – and further, we ALL must become part of the solution as everyone of us has a stake in this.I understand that Diabetessisters is an international organization, and this may seem like something only important to the U.S., I promise you that is not the case.  It is very true that what hurts one, hurts us all when it comes to an issue of this magnitude.  My challenge to all who read this week is:  what are you doing to help stop diabetes?