Sunday, June 22, 2008

Saluti Cahn discriminated against me because I was diabetic

In my last post, I talked about how forces are at work to strengthen the Americans with Disabilities Act. I also mentioned that I was once discriminated against on the job because of my diabetes, and promised that I'd tell that story in a future post. So here it is:

A few years ago, my employer at the time — Saluti Cahn, a small technical writing firm — tried to refuse to offer me the same health benefits as my non-diabetic coworkers. Since the company didn't have a group health insurance plan, we all had to get individual plans, which we were then reimbursed for. When I was offered the job and this was explained to me, I disclosed that I was diabetic, and that an individual health insurance plan might be expensive or even impossible for me to get. I was offered the job anyway.

As it turned out, I was right. No health insurance company would sell me an individual plan; the only way I was able to find coverage was by getting a conversion plan with the same company that had covered me under my parents' plan while I was in college. It was initially around $560 a month, but Dean Saluti and Marjorie Cahn told me they were going to pay it anyway, because it was the right thing to do.

They seemed to lose their interest in doing the right thing several months later, when I turned 25 and my premium increased to $690 a month. They told me then that they would pay a maximum of $600, leaving me to cover the remaining $90-something a month myself, while my non-diabetic coworkers enjoyed 100 percent reimbursement for their health benefits.

My doctor's office put me in touch with their contact at the American Diabetic Association, who then got me in touch with a lawyer. As I mentioned in my last post, the lawyer sent Dean Saluti a letter saying that he was in violation of Colorado law, and he needed to reimburse me for what I'd paid for out of my own pocket and resume paying my premiums in full. The letter worked, and two weeks later I had a check in hand for the amount I'd paid out-of-pocket (about two months' worth).

However, my experiences with Saluti Cahn threw into sharp relief the problems that I will face my entire life as a diabetic. To prevent employers and health insurance companies from discriminating against diabetics, two things need to happen:

1. Diabetics need to be explicitly included in the Americans with Disabilities Act, and
2. Our nation needs to offer universal health care.

Both of these things are equally important. With only one or the other, you might find diabetics with a job but no health insurance, or with health insurance but no job. I hope that Congress succeeds in passing the ADA Restoration Act, and that in the fall we succeed in electing a president who will ensure that all Americans get health care coverage.

Friday, June 20, 2008

Attempts to improve disability rights law

This story on NPR talks about attempts to revamp disability legislation.

The Americans with Diabilities Act is important to diabetics because it prohibits employers from discriminating against workers with diabetes — theoretically, at least. The story talks about how courts have been splitting hairs over who is disabled enough to qualify for protection under the ADA, which has eliminated protection for many people, such as diabetics.

I feel that this is a very important law, and I'm glad they are trying to improve it. A few years ago, I actually encountered some discrimination because I was diabetic, and quickly discovered that the ADA didn't cover me — the company I worked for was too small.

Luckily, in my case Colorado law stepped in and offered protection where the ADA didn't. The American Diabetic Association hooked me up with a lawyer, who wrote a letter to my boss and got the issue resolved. However, I remember him saying that if writing a letter didn't do the trick, it might not be worth going to court: Courts ruled in favor of diabetics under the ADA only some of the time, and a case with a diabetic had never even been brought to court under Colorado law.

In a later post, I'll explain what happened to me. For right now, suffice it to say that I'm glad to see they are attempting to strengthen the ADA by redefining what qualifies as a disability.

Wednesday, June 18, 2008

Which type of diabetes do you mean?

This morning on Colorado Public Radio, I heard a story about how diabetes and depression often cause one another. They didn't say which type of diabetes they meant, and although I knew they were most likely talking about type 2 diabetes (since the probability of depression causing an autoimmune response is pretty slim), it irritated me that they wouldn't say the words "type 2."

I couldn't find a link to the radio story on NPR, but I did find it on the Washington Post: Diabetes and Depression Go Hand-in-Hand. (Please note that this story does clearly state that they're talking about type 2 diabetics — it was only the NPR radio spot that did not specify which type they meant.)

It really annoys me when the media fails to specify which type of diabetes they're talking about. The two types of diabetes are actually very different — the diseases aren't related at all, even though the end result (too much sugar in the bloodstream) is the same. Type 1 diabetes is the inability to make insulin, because the body's immune system decided to go postal on its pancreas, while type 2 diabetes is the inability to use its own insulin, usually because age or obesity has caused insulin resistance in the body's cells.

In type 2 diabetes, a connection with depression makes sense, because depression typically makes people more sedentary and less willing to exercise, which in turn can exacerbate diabetes. And on the flip side, people who have been diagnosed and are being treated for type 2 diabetes could feasibly be more susceptible to depression, because of the stigma on diabetes in our society.

On the other hand, if the connection were with type 1 diabetes, it would have much more serious genetic and scientific implications. Right now we know that an autoimmune response is what triggers type 1 diabetes — the body's immune system decides to attack the insulin-producing cells of the pancreas, eventually killing enough of the cells that the organ can no longer keep up with the body's insulin needs. The autoimmune gene is hereditary; so far, though, scientists don't know what triggers the autoimmune response. If the study had been on type 1 diabetics, it would have meant that a possible trigger — depression — had been found.

But the study wasn't on type 1 diabetes. It had nothing to do with type 1 diabetes, but because that wasn't clearly stated in the story, some listeners could have drawn the wrong conclusion. So, when you're talking about something — such as depression — being connected to diabetes, you really need to specify which type of diabetes you are talking about, as the connection can have far different connotations for each type!

Sunday, June 15, 2008

Glucagon emergency kit: How-to video

A while back I blogged about the glucagon emergency kit, a treatment for hypoglycemia in diabetics. At the time I tried to find a video on YouTube that would demonstrate how to use it, but discovered there wasn't much information on the subjects — even the written instructions online are rather inadequate.

So I put a Google Alert out on it, and now I'm pleased to be able to show you a video of how to use a glucagon emergency kit. The woman doesn't actually insert the needle, mix the liquid, etc., but she does a pretty good job of imitating those actions on camera.

Friday, June 13, 2008

Recognizing hypoglycemia in others

The Washington Post published this health tip for today on hypoglycemia in diabetics. It's pretty basic, but I think it's interesting that most of the symptoms are ones that the person crashing will feel, rather than symptoms that those around him or her can learn to recognize.

One of the biggest problems with hypoglycemia is that the diabetic doesn't always recognize right away what the problem is. My first symptom is usually a lack of concentration. I have read the same paragraph or page over and over again without understanding it — sometimes staring at it for 10 minutes before realizing what was wrong.

My point is, diabetics don't always know right off the bat when their blood sugar is crashing. Sometimes they stop noticing at all (known as hypoglycemia unawareness). So the people a diabetic spends a lot of time with need to know what it looks like when a person is hypoglycemic.

* Acting "out of it" — My husband says one of the first ways he knows when I'm crashing is that I start acting "out of it" or not as alert. This goes along with the lack of concentration I talked about above — in other words, what I'm feeling also is noticeable in my behavior. I might also say things that don't make much sense, or demonstrate an inability to follow a simple conversation.

* Sudden, unexplainable anger — I've noticed that when I crash, I am much more prone to anger. I've also talked to people who have been around diabetics a lot, particularly diabetics with hypoglycemia unawareness, and often they pick up on the anger before the diabetic actually realizes they are crashing.

* Shaking or unsteadiness — I feel shaky, dizzy, and unsteady when I am crashing, and sometimes actually have a hard time with large and fine motor tasks (I stumble when walking, fumble while opening a bottle, etc.). This is all stuff that an observer should be able to pick up on.

* Pale or sweaty skin — When my blood sugar crashes I usually start feeling inexplicably hot and sweaty. Supposedly pale skin goes along with this. One of the things I do outwardly is to kick the covers off if I crash while sleeping.

If you are with a diabetic who starts showing outward symptoms of hypoglycemia, request nicely but firmly that they check their blood sugar. Sometimes someone who is crashing will actually resist being told to check their sugar, which makes it all the more important that they do it anyway. And of course, if they pass out or are near passing out, call 911 immediately and use their glucagon kit (if they have one on them).

Should type 2 diabetes be treated less aggressively?

The other day I blogged about the findings that hypoglycemia actually increases a type 2 diabetic's risk for heart attack. Since doctors have been operating under the assumption that lowering a type 2 diabetic's blood sugars would lower the risk for heart attack, now there's an article questioning whether the disease should be treated less agressively.

In my opinion, that depends on what your definition of "aggressive treatment" is. Too often, I think type 2 diabetes is treated with drugs — pills to make the body more sensitive to insulin, and sometimes insulin injections to supplement what the body makes on its own. Personally, I think an aggressive treatment for type 2 diabetes should attack the root of the problem: usually obesity, diet, and lack of exercise.

Many cases of type 2 diabetes can be reversed with proper diet and exercise — in other words, by losing weight and eating right. Since I think the chance of heart disease in diabetics is probably linked more to these factors than to high blood sugars, I doubt this kind of approach would make heart attacks more likely. I'm guessing it's the drugs that are causing the lows, which in turn are connected to a greater risk of heart attack.

Of course, not all cases of type 2 diabetes are caused by obesity, diet, and lack of exercise. Some people's bodies develop a resistance to insulin as they age that is unrelated to their lifestyle. However, in light of the epidemic that type 2 diabetes is becoming, I would say a large percentage of the cases are a result of America's couch potato trend.

Wednesday, June 11, 2008

Hypoglycemia connected with heart attack in diabetics

Today USA Today reported that hypoglycemia increases risk of heart attack in diabetics.

Remember my question in another blog post as to whether the risk of heart attack in diabetics affected all diabetics, or just type 2 diabetics? Well, this article says specifically that it applies to type 2 diabetics:

A recent event of hypoglycemia, or extremely low blood sugar, in type 2 diabetics was a major predictor of heart attack, stroke and death, a just-finished study by the Department of Veterans Affairs found.

Also, apparently in February another study found that tightly controlled sugars led to a greater chance of heart attack — perhaps because people with tightly controlled sugars tend to crash more often.

It's funny that this surprises people. I often tell people that the real danger is in my blood sugar going too low, not too high — high blood sugars cause problems over time, but lows can kill right then and there. So it doesn't surprise me that low sugars, not highs, are connected to heart attack.

Really, anyone who has felt the terrible heart-pounding feeling of a bad hypoglycemia episode won't be surprised by this finding.

Monday, June 9, 2008

My doctor's appointment

In my last post I talked about collecting overnight urine samples for my doctor's appointment. My appointment was Friday morning (and partly responsible for a very hectic day).

I always find out at my appointment what my A1c is, as my doctor's office (the Barbara Davis Center) has a little machine that tests it in 6 minutes. It was 7.4, down very slightly from 7.5 at my last appointment.

I had expected that my A1c would be a little high this visit. My brother-in-law and his family moved to Denver at the end of May, so the last month and a half have been kind of crazy and stressful — helping find them a place and preparing for them, and now helping them get settled and still trying to find enough time to get my own work done.

Of course, as my doctor reminded me (gently — he's not a mean doctor), keeping tight control of my diabetes is important, so I need to make sure I remember and/or find time to check my sugars when I am supposed to.

Thursday, June 5, 2008

Collecting overnight urine

I have one of my quarterly visits to the Barbara Davis Center coming up, and as a result I need to collect a couple of samples of my overnight liver for them. My doctor does these tests once a year or so to make sure my kidney is still functioning normally.

I was actually supposed to do this for my last doctor's appointment, but I forgot. Basically, I need to collect all my urine overnight and in the morning in one of those little plastic "hats" they use in the hospital to measure your urine. (For me, this means peeing in the hat just once in the morning, since I don't drink enough fluids to have to get up to pee in the middle of the night.) Then I pour a little bit of the urine into a little vial to take back to the doctor's office with me, and discard the rest.

Since my doctor wants two samples, I need to do this twice.

Kidney failure is a common problem for diabetics, presumably because the kidneys have to work harder in a person with diabetes: Any time the person's blood sugar is over 180, their kidneys kick into overdrive in order to filter out the excess sugar. However, this page about kidney disease claims that it can happen even in diabetics whose sugars are under tight control.