Wednesday, October 28, 2009

Trick-or-treating for diabetics

With Halloween coming up, USA Today felt it necessary to run this article, about whether or not diabetic kids can celebrate Halloween:

Halloween still a treat for diabetic kids

There are two opposing viewpoints in this article: One set of experts says candy is okay, while the other says no candy, and recommends plotting with the neighbors to give your kid toys instead, or bribing them with iPod downloads to give up their candy.

WTF? When did bribing children become advisable, no matter what they've got?

Okay, let me make this quite clear: Diabetics can have candy. This isn't the 1980s. Our insulins and blood glucose monitoring systems are pretty efficient. There is no need to deprive your kid of candy on Halloween.

I like the first expert's advice:


"Sugar isn't the no-no it once was, but it's still never a good idea to sit down and just gorge on as much candy as you can. We recommend having a plan," says Debby Johnson, a nutrition and wellness coach for diabetes website Fit4D.com.

Johnson recommends getting your child involved in his or her health choices before the chocolate and Gummi worms come home.

"Do some exploring in the grocery store before Halloween. Look at different bags of candy to see how many carbohydrates are in each piece," Johnson says.


Basically, he's saying not to let diabetic kids graze mindlessly (not a good idea for anyone, actually), but to plan out how much candy they're going to have, know what is in each one, and take the correct amount of insulin.

I would also add that your diabetic kids need to be required to test their blood sugar every hour when eating candy, and correct as necessary. I find that candy and some foods, no matter how many carbs they are supposed to have in them, have a more significant impact on my blood sugar than I expect. I think it's because the super-processed sugar hits my bloodstream faster, upping my resistance to the insulin before it can take effect. (The higher your blood sugar levels are, the more resistant you are to insulin.)

They do say to be sure to moderate and not let them eat too much candy at once, but I have to say I don't think it does too much harm if they do. Just require that they keep checking their blood sugar every hour and correct as necessary. Honestly, the sooner the candy is gone, the sooner any spike in blood sugar can be brought back under control!

Tuesday, October 20, 2009

Rising support for public option

I haven't blogged on here in a while, but I heard some exciting news this morning that I just had to share: A recent poll found that support for the public option in health care reform is rising.

The article reports that 57 percent of people support there being a public option, up from 52 percent over the summer. And 76 percent of people support the public option if it is state-run and only available to people who can't get affordable private health insurance.

This last part is particularly exciting to me, since after all, that is my biggest reason for supporting the health reform bill and the public option: the belief that someone like me, with a condition that is life-threatening if it is not properly managed, should not have to become ill and possibly die because they can't get or afford health insurance.

I was disappointed to see that Obama's approval ratings have slipped, but perhaps he can recover, just as the popularity of the health reform has!

Tuesday, September 22, 2009

Sign a petition for better health care

This morning an email was waiting for me in my inbox: The American Diabetes Association is sponsoring an online petition, asking for health care reform for diabetics.

The current health care system needs to be changed. Health care reform needs to ensure:
- People are not denied coverage because they have diabetes or required to pay higher premiums because of they have a chronic disease
- Health insurance covers basic diabetes needs
- Access to the tools to prevent diabetes
- An end to the racial and ethnic disparities in how diabetes affects Americans


Please sign this petition and take a stand for better health care for diabetics!

Wednesday, September 16, 2009

Young invincibles, my @$$

An article ran today about how President Obama is going to require young adults under 30 to buy health insurance. The article talks about how young adults ages 19 to 29 are thought of as "young invincibles," and get away with not buying health insurance because this age group is generally pretty healthy. Of course, that hurts everyone else, because the whole idea of insurance is that the risks and costs of a small minority are borne by the whole population and therefore made more manageable for everyone.

There's only one problem with this.

Young invincibles, my @$$.

I was diagnosed with type 1 diabetes at age 22. I had spent a year or two without health insurance myself, but luckily the year before I'd gone back to school and therefore was covered again under my parents' insurance. I can only imagine how much trouble I'd have been in had I not been covered.

So actually, requiring this age group to buy health insurance will help more than just health care reform. It'll also help those young adults who have type 1 diabetes and other conditions lurking in their bodies, just waiting to make themselves known!

Tuesday, September 15, 2009

Are the insurance companies gearing up for health care reform?

And by "gearing up," I don't mean anything nice.

I wouldn't be surprised if the health insurance companies are a little bit worried about losing money when the reform bill passes. (Notice I said when, not if — I think something will pass, the only question is whether or not it will have a public option.) Something my mom told me about the other day certainly makes me wonder if this kind of thing is a preemptive strike, to lock in certain discriminatory policies before health care reform makes it impossible for them to makes these kinds of changes.

My mom was talking to someone at her work who has type 2 diabetes. Since it's a state job, they don't pay a very large portion of the employee's health insurance policy, so he has Kaiser — a health insurance company in Colorado that has all its own doctors, and is therefore usually cheaper than other insurance companies.

Anyway, they apparently decided they were losing too much money on him, so they cancelled his policy. Yep — just up and cancelled it. This is apparently a growing trend: A recent article talked about the growing number of rescissions, which is where insurance companies drop policyholders because they cost too much. The insurance companies, of course, claim it's because of fraud, but we know better.

In this man's case, however, they cancelled his policy, then told him to reapply. His new policy cost four or five times more than the old one, which seems to be why they cancelled his policy: so that they could raise his rates.

To add insult to injury, it turned out that he also had to make a deposit for the new policy to take effect — and they withdrew the money directly out of his account. This was, of course, hidden in the 30 pages of small print in the contract.

This seems to be the case with other insurance companies, as well. A survey was done that indicates health costs will be rising. It sounds like employers are coping with rising policy costs by passing on some of the price increases to their employees.

If you ask me, I think health insurance companies are concerned about the possibility that a health care reform bill will pass; I'm sure the thought of a public option particularly alarms them. To cope, I think they are raising costs across the board, and doing what they ccan now to dump (or overcharge) policyholders who cost them money. After all, when the legislation does pass, they may not be able to raise costs again (or discriminate against people) so easily, so they are probably trying to lock in as many of these changes as possible now!

Sunday, September 13, 2009

Good news!

I forgot to blog about my recent visit to my endocrinologist. You might remember that I've been monitoring my A1c pretty closely this year, due to a pretty high result earlier in the year. Well, during this recent visit my A1c was just 7.1 — just barely lower than the last time, and showing some signs of stabilizing.

Also, I talked to my doctor about my high TSH reading, and he said not to worry about it yet — it's not high enough to treat. We are going to test it again at my next visit, though. The doc said it may keep going up, but I'm hoping it was a fluke reading and will return to normal levels.

Friday, September 11, 2009

Maintaining your blood sugar when you're sick

I was recently sick with either a very severe cold or the flu, and spent most of the time sleeping and/or completely miserable. I find it to be rather challenging to check my blood sugar when I'm that sick, but of course it's pretty important that you do so.

Getting sick used to be much more dangerous for type 1 diabetics, because meals and snacks were planned around insulin regimens, and skipping a meal or a snack could cause you to crash. Of course, if you have the flu, this could be extremely challenging, because everything you eat tends to come right back up again!

Luckily, with modern insulin regimens — i.e., either Lantus and Humalog or the pump — it is much easier to maintain your blood sugar when you're sick. The only thing that I've found is that when I eat significantly less for a day or two, I tend to need less Lantus until my calorie intake picks back up again. To deal with this, I backed my nighttime dose off by a couple of units while I was at my sickest. And of course, I didn't take any Humalog unless I was correcting or eating something, so I didn't have any problems with crashing while I was sick.

I actually think that with modern insulin regimens, high blood sugars are more problematic than lows when you're sick. If you've got the flu, you're already in danger of dehydration — then add in further dehydration caused by high blood sugar, and you're really in trouble. And since (at least in my experience) my blood sugar tends to run higher when my body is under a lot of physical stress, this is something I really have to watch.

Here are some tips for remembering to check your blood sugar when you're sick:

* Set a timer
* Test every time you take medicine
* Enlist a family member to help remind you
* Keep a written record of all BG test results and insulin doses while you're sick

What about you? Any tricks you've learned for maintaining your blood sugar while you're sick?

Wednesday, September 9, 2009

Is President Obama's health care reform making a comeback?

After several months of disappointing headlines, it seems that health care reform might be making a comeback.

Despite Fears, Health Care Overhaul Is Moving Ahead

From the article:

Despite tensions between moderate and liberal Democrats, there is broad agreement within the party over most of what a package would look like. Four of the five Congressional committees considering health care legislation have already passed bills. Each would require all Americans to have insurance and provide government subsidies for those who cannot afford it. Each would bar insurance companies from refusing coverage for pre-existing conditions; imposing lifetime caps on coverage; or dropping people when they get sick.


This pretty much covers all the things that are important to me, except one: Any real health care reform really needs to regulate policy costs, particularly for people with pre-existing conditions. By forcing the insurance companies to cover pre-existing conditions but not setting any limits on policy costs, you're pretty much guaranteeing that the health insurance companies will respond by pricing these people's policies out of any normal person's reach.

President Obama is supposed to be making a speech tonight at 8 pm Eastern time. Like last time, I'll try to find the video afterward and post it to my blog. Let's hope this speech marks the beginning of renewed momentum on the issue!

Thursday, August 6, 2009

Dangers of diabetics driving

A top headline lately has been that of a diabetic woman who killed eight people in New York in a tragic car accident. It sounds like she may have been drunk and high on marijuana, although the family is insisting it was complications from her diabetes.

Regardless of which it is, this is a good example of why diabetics need to be careful about driving when they could be suffering from low blood sugar. My first doctor wanted me to always check my blood sugar before getting behind the wheel. He had a scary story about one of his patients passing out at the wheel and ending up being paralyzed in a terrible accident.

Although admittedly I don't do check my sugar every single time, I can also say with absolute certainty that I feel it when I'm crashing, and I check if I have any of the symptoms. Hypoglycemia unawareness is a real problem, and one I hope I never develop.

Anyway, it's better to be safe than sorry — if you have a track record of not feeling low sugars, or if you feel like you might be crashing, check your blood glucose first and don't get behind the wheel until it is safe to drive!

Tuesday, July 28, 2009

My latest lab results

A couple of weeks ago, I got the results of my latest lab test in the mail.

Remember a little over a year ago, when my doctor was concerned because my cholesterol on my last lab results was high? My LDL was 112, which was only a little higher than it "should" be for a diabetic, and well within the range for a non-diabetic.

At the time, I was thinking hubby and I would start trying for a baby soon, and had gotten off Lipitor in preparation for it. But even though we had decided to delay it a little, I decided I wasn't getting back on Lipitor in the meantime.

It seems I was right not to, as my LDL went down to 92 on its own (helped, probably, by a continuing healthy lifestyle). My triglycerides popped up a bit — to 173 from 128 — but my doctor write "OK" by that, so apparently he's not worried. My HDL is still about the same — 71 instead of 79 — which is good. My cholesterol to HDL ratio is still the same, 2.8.

While this is all good news, I find it interesting that my TSH has gone up to 5.64. This number should be between 0.40 and 4.50; a high number could indicate hypothyroidism. I find this very peculiar because I'd actually been losing weight before this test was taken, most likely because I was eating a bit less and riding my horse a bit more. Is it possible that my TSH could have gone up because my metabolism was slowing down, trying to compensate for the sudden change in eating and exercise habits?

In any case, I gained a few pounds briefly — we're talking for just a few weeks — and now I've been losing it again, so I'm not terribly concerned about having Hashimoto's disease. Next time I go in to see the doctor, I'll see what he thinks about my thyroid test results. Regardless, though, unless I really start struggling with my weight I'll insist that we simply keep tabs on my TSH — just like with the Lipitor, I will not go on medication that I don't fully need.

Thursday, July 23, 2009

President Obama's press conference on health care reform

Last night President Obama gave a press conference on health care reform to answer a lot of people's concerns. If you didn't watch the speech, I highly recommend you do now.



One of the biggest concerns that I've heard from conservatives I know is the fear that this is going to raise our taxes. In his press conference, Obama clearly states that he will not raise taxes on middle-class Americans. This means that for the vast majority of people, insuring the uninsured will NOT cost you anything.

Two-thirds of the plan is going to be completely paid for by reallocating tax dollars from other health programs that are not working. In other words, two-thirds of the funding for this plan is already being paid into the system, and is being essentially thrown away. It makes sense to redirect that funding into a program that will benefit Americans.

The other one-third of the funding is where the debate currently lies. Obama promises in the speech that he will absolutely not sign a bill that acquires funding by raising taxes on middle-class Americans. One proposal has been to raise taxes on people earning more than $1 million per year (which I don't see a problem with — if you have that much money you can afford to help the less fortunate), but there are also other options currently on the table that don't require raising taxes on anyone.

Obama also talks about how his plan will set in place some (much needed, in my opinion) regulation on the health insurance industry. For one thing, it will stop health insurance companies from denying you coverage for a pre-existing condition, and limit the amount of money that they can make you pay out-of-pocket. For a diabetic, this is extremely important, because not only will we be able to buy individual health insurance, but we will also be able to afford it.

Health care reform means more to me than almost any other issue. I don't think it's fair that in America, some people live in houses the size of small countries, while other people are dying from treatable conditions because they can't afford health insurance. That just should not happen in a country as great as ours.

Sunday, July 5, 2009

Diabetes and pregnancy

A headline I saw today, on expectant mothers with diabetes, reminded me of an important subject matter I haven't written on yet: diabetes and pregnancy.

Several years ago, when Michael and I were first contemplating marriage and the kids we wanted, I started looking into diabetes and pregnancy. I am a big-time advocate of keeping hospitals out of the birth process — or keeping laboring moms out of the hospital, I guess I should say — so I was interested in finding out more about diabetes and the possible complications of pregnancy.

What I found was both encouraging and discouraging. There are a lot of various problems that can arise from diabetic mothers giving birth, including birth defects, miscarriages, and oversized babies that require C-sections to be born. However, most of these complications seem to arise in cases where the mother's control over her sugars wasn't as good as it should have been.

Michael and I didn't start trying to get pregnant right away as we'd planned — we're now planning on starting to try later this year, when I'm done participating in a study at my doctor's office. Much of my research on the subject was therefore done quite a while ago, but I'm going to review it and write a few posts regarding diabetes and pregnancy. Although the article I linked to talks about both gestational and pregestational (i.e., type 1 or type 2 diabetes that existed pre-pregnancy) diabetes, my posts will have to do primarily with type 1 diabetes and how it affects pregnancy, labor, and the choices available to expectant moms.

Wednesday, July 1, 2009

Don't forget the underinsured

I've talked a lot in the past about politics and why I believe we need a health care program in this country to guarantee coverage for the uninsured. This recent article reminds us of why we need to also remember the plight of the underinsured.

Apparently, the majority of people who are forced into bankruptcy because of medical bills actually do have health insurance — they just found out the hard way that their policies had all kinds of loopholes that allowed the insurance companies to deny coverage.

The article has a good point — helping the uninsured is important, but we also need to control runaway health care costs and crack down on insurance companies dumping policyholders or denying coverage.

Diabetes and hard (physical) work

Today I spent about six hours working at the barn. As a type 1 diabetic, this is something I really have to be careful about, because the exercise makes my blood sugar drop.

I've been more active lately, so I've been having to tinker with my insulin doses a little. Usually when I become more active, my Lantus needs dip for a short while, then come back up and settle back where they were before. I think this is because the exercise changes my metabolism, which changes how my body processes sugar.

The other thing I have to make sure of is that I run my blood sugar a bit high before I go out to the barn. If my blood sugar is on the low or normal side, I'll eat a snack; if I'm eating a meal, I'll take a little less insulin than I normally would.

I also try to always bring my glucagon kit with me when I'm doing something that could make me crash. I didn't today, but I should have. For example, if I go for a bike ride I stick it in my handlebar bag.

It's important to remember that activities such as moving furniture — or, in my case, mucking manure and moving mulch at the barn — are just as active as going to the gym and working out, and therefore can have just as much of an effect on your blood sugar.

Friday, June 19, 2009

Will it pass?

The Obama health care reform situation is ongoing, and though I don't read every single article that comes out on the subject, I am waiting anxiously to find out what will happen.

A new article reports a step in the right direction:

Trying to regain momentum on a core issue of Barack Obama's presidency, House Democrats on Friday unveiled legislation they said would cover virtually all the nearly 50 million uninsured Americans. Major provisions of the draft bill would impose new responsibilities on individuals and employers to get coverage, end insurance company practices that deny coverage to the sick and create a new government-sponsored plan to compete with private companies.


I especially like the part where it says the plan will "end insurance company practices that deny coverage to the sick." That is a BIG deal to me, since health insurance companies can and do refuse to cover a diabetic under an individual plan.

The article also talks about whether the program is something we can afford to implement. Me personally, this is one piece of legislation that I'd be quite happy to pay higher taxes for. Heck yeah, I'll pay higher taxes in order to make sure I can always get health insurance!

Thursday, June 11, 2009

President Obama's health care reform

Lately there have been many headlines about President Obama's plans for health care reform. I admittedly haven't been following it very closely, but I've been noting the headlines. I'm glad he is pursuing this issue already, as I think it is very important for our nation's future that we rein in health care expenses and provide insurance to those who can't afford it.

There are a couple of important points that Obama is making that I personally support wholeheartedly.

The president promised that with his health care overhaul "if you like your doctor you'll be able to keep your doctor, if you like your health care plan, you'll be able to keep your health care plan."

"We're not going to make you change," he said.


And the other:

"Every plan should include an affordable, basic benefits package," he said. "And if you can't afford one of these we should give you assistance."


I think these are the elements to a strong health care system that protects all of our nation's citizens: allowing those who can keep their own plans, and to assist those who can't. Certainly, if I can afford to get a plan that provides me better coverage, there's no reason why I should be denied that. But if I can't afford health care, there's also no reason why I should die simply because I was unlucky enough to be born with the genes for a potentially lethal autoimmune disease.

Monday, June 1, 2009

Self-treatment requires flexibility

As a type 1 diabetic, a lot of your treatment is actually in your own hands. YOU are the one who lives with your diabetes, so technically you are more qualified to make small, daily adjustments in your insulin regimen than your doctor.

For example, since my doctor's appointment on Friday I've been pushing lows. Actually, it technically started last week, and I dropped my Lantus dose a bit then. Now I've had to drop it again.

My point is, as a type 1 diabetic you have to be able to recognize when your insulin regimen needs to be changed. You are the one checking your blood sugar every day, so you are the one who is most likely to notice trends in the numbers. And if you are constantly crashing or constantly going high, you are the one who will need to make a decision about your insulin doses. You can't wait until the next time you see the doctor, particularly if you are dealing with a lot of lows.

I'm happy to say that so far, my adjusted Lantus dose seems to be doing the trick. I didn't have any major lows or major highs today. It remains to be seen whether I'll be staying on this dose long-term or not — it's 2 units lower than what I take 99 percent of the time, and drops like this one are usually pretty temporary. But when my insulin needs go up again, I'll be watching for the signs!

Friday, May 29, 2009

An appointment with my endocrinologist

This morning I had an appointment with my endocrinologist. (As a type 1 diabetic, I have to see the doctor every three months, or four times a year.)

You might remember me being really concerned earlier this year because my A1c was 7.9. I was having some trouble with my blood sugar at that time, primarily because my nightly Lantus was wrong and because I had gotten out of the habit of checking my blood sugar often enough.

I requested that I be allowed to schedule my next doctor's appointment for 6 weeks out instead of 3 months. By the time I went in for my follow-up appointment, my A1c had dropped to 7.2.

This time it was exactly the same — 7.2 — but my doctor seemed pleased. I've been in there weekly lately for a study I am participating in, and I've had to do a ton of documentation for the study, so right now my doctor actually knows all of the intimate details of how I manage my diabetes. As a result, today's visit was fairly brief.

The one thing my doctor did suggest is that I use a different insulin-to-carb ratio at dinnertime. I take my Lantus dose in the evening, and on top of that I tend to eat big dinners (which I think tends to create some temporary insulin resistance or something), so my blood sugars have a nasty habit of popping up in the late evenings. To try to correct this, I'm going to start trying a 1 to 10 ratio at dinnertime, rather than the 1 to 15 I use the rest of the time.

Perhaps if the new dinnertime ratio does its job, I can get my A1c back down below 7 for my next visit!

Update

I almost forgot to post my update on the case where the 13-year-old boy and his mom were refusing medical treatment. I no longer have the link, but I saw a day or so later that they had returned to town and were accepting chemo. Crisis averted.

The article also noted that the boy's chances of survival with chemo were 90 percent, but only 5 percent without chemo. You'll remember (I hope) that I only agreed with his and his mom's actions if there wasn't going to be much difference in his chances if he went through the chemo; I don't see why anyone should be forced to go through a painful treatment if it's not very likely to help. Clearly, though, this was not the case here — so yeah, refusing chemo when it makes him 18 times more likely to live is pretty neglectful of a parent.

I still am somewhat uncomfortable with the government intervening in cases where the treatment has dubious benefits, though.

Thursday, May 28, 2009

Sonia Sotomayor is type 1 diabetic

I didn't know until a friend mentioned it to me tonight that Sonia Sotomayor, President Obama's Supreme Court nominee, is type 1 diabetic. As soon as I got home, I looked it up online, and found an astonishing range of good and bad articles on the subject.

This is one of the good ones: Sotomayor's Type 1 Diabetes is 'Non-Issue,' Says Docs

The article quotes a couple of doctors saying — rightfully so — that having diabetes doesn't necessarily mean a person is in poor health. It also has a very accurate description of type 1 diabetes and the risks that go along with it, such as hypoglycemia.

Type 1 diabetics can’t metabolize sugar because their disease has killed off the insulin-producing cells that normally perform that function. As a result, they must monitor their blood-sugar levels and take insulin several times a day to manage their conditions. By keeping their blood-sugar levels within an acceptable range, sufferers can decrease their risks for heart attacks and other side effects, say experts.

“There’s absolutely no reason why the fact that she has diabetes should be a factor in her longevity or should affect her ability to serve” on the Supreme Court, said Christopher Saudek, director of the Johns Hopkins Diabetes Center in Baltimore.

If sufferers exert themselves more strenuously than normal, or fail to eat enough, their glucose levels can drop too far, and they can feel disoriented or even faint. William Ahearn, a spokesman for the Juvenile Diabetes Research Foundation, said most patients can sense their blood-sugar levels plunging and sip some juice, nibble on a candy bar or drink soda to prevent an episode.


Unfortunately, not all of the articles are this positive or this accurate. Take this one, for example: Sotomayor's Diabetes: Will it Be a Handicap?

This article had a much more negative outlook not to mention several screaming inaccuracies. Not even the picture is accurate — how many diabetics inject into the vein these days, let alone with a needle that sign? Then you also have this paragraph, which contains two examples of the misconceptions often found in the media:

Once known as juvenile diabetes, Type 1 diabetes typically begins in childhood — Sotomayor was diagnosed at age 8 — eventually causing the body to slow production of insulin, the hormone necessary to break down sugars found in food. (In Type 2, or adult-onset, diabetes the pancreas continues to make insulin, but the body fails to respond properly to the hormone's signals.) While it is not yet clear what causes Type 1 diabetes, some experts believe that a patient's own immune system starts to attack insulin-producing cells in the pancreas, ultimately leading to a drop-off in hormone production.


The first inaccuracy in this paragraph is the statement that type 1 diabetes causes "the body to slow production of insulin." That's not exactly wrong, but it's not exactly right, either. Dead beta cells = NO insulin produced. Furthermore, as the beta cells are killed off, the remaining cells actually increase insulin production until there are no longer enough to keep up. The article makes it sound like the individual cells gradually produce less and less, rather than being completely snuffed out one at a time.

The last statement also pisses me off: "While it is not yet clearwhat causes Type 1 diabetes, some experts believe that a patient's own immune system starts to attack insulin-producing cells in the pancreas." Some experts believe, my a$$! Newsflash: We actually do know that type 1 diabetes is an autoimmune disease. It's the cause of the autoimmune response that we aren't sure of. Time, could you please get a writer next time who is actually capable of understanding medical science?

My little rant has unfortunately gotten me away from my original topic, which was Sonia Sotomayor being type 1 diabetic. Despite the media's misrepresentation of her condition, I have to say that I am thrilled at the thought of having a diabetic (not to mention a woman and a minority) being in such an influential position. Not only do I hope that she'll be able to make some decisions that result in better diabetes research, but I also hope that having a diabetic in the political spotlight will eventually help to end some of the misconceptions about type 1 diabetes.

Thursday, May 21, 2009

A fine line

I noticed headline on Google today about parents who are refusing medical care for their children in favor of their religious beliefs.

Now, I am not religious, and while I believe that the mind does have a lot of influence over the body, there are some things it just can't do. I can't make the islet cells in my pancreas come back to life just by believing they will, for instance.

So I don't think very highly of people who reject modern medicine for faith healing when the former is guaranteed to save the person's life. I do, however, support the right of the individual to choose not to go through — or not to put their child through — painful treatments if there is not guarantee they are going to work.

If you read the article, it mentions an 11-year-old girl who died of untreated type 1 diabetes. Her parents believed so strongly that their faith would heal her that they wouldn't even give her insulin — a medicine that is not only proven to work, but that type 1 diabetics will die without! In other words, there is absolutely no reason to refuse this medication, and every reason to take it.

The main focus of the story, on the other hand, is a mother who is refusing chemotherapy for her 13-year-old son. Of course, I don't know all of the details, but I do know that chemo causes a great deal of discomfort for the patient, and it doesn't always work. Chemo actually kills the body's natural defenses, and the doctors just hope that the cancer will die first. If the chances of it working in this boy's case aren't very good, I don't blame his mother at all for refusing it. If your son is going to die either way, wouldn't you rather he died a peaceful death?

Of course, that's not her thinking, and I do recognize that the government is trying to protect children. However, I still hold that parents have the right to choose whether or not to get certain treatments for their child, within reason. The difficult part is trying to determine what is reasonable and what is not.

Like I said, I think if the treatment is not very likely to work, and is almost certain to cause a great deal of discomfort for a very slim chance of recovery, then a parent has every right to refuse it. Refusing to give a diabetic child insulin, on the other hand, constitutes refusing a lifesaving treatment that does almost no harm.

Is it just me, or can you see the difference here too? What are your thoughts on the issue?

Wednesday, May 20, 2009

Afraid to take insulin in public?

The other day, I was at Barnes & Noble with my husband, someplace we go often. As I was ordering drinks and pastries at the café, the girl behind the counter — who knows us pretty well by now — said to me, "The other night I think I saw you taking insulin."

I was surprised; it's not very often people comment on this. "Oh, yeah, I'm diabetic," I responded.

"Type 1?" the girl asked, and I said yes.

"My boyfriend is type 1," she said. "But he's always afraid to take insulin in public, afraid someone will say something about it."

I laughed. "I've been diabetic for seven years, and I've never had anyone question my taking insulin in public."

Technically, that's not entirely true. I did have one girl, a classmate in college, freak out a little once. That was back when I carried a vial of Humalog and used syringes for every injection, rather than an insulin pen and pen needles, so I'm sure for someone who is afraid of needles it looked pretty freaky. She didn't make a scene or anything — just quickly looked away, and asked in a high-pitched tone, "What are you doing?"

But anyway, back to my story. After talking to the girl at the café, I thought — not for the first time — about how many diabetics are self conscious about taking insulin injections in public. I think it has a lot to do with the stigma that used to be associated with diabetes. A lot of people genuinely feel bad that they have diabetes, and don't want others to see them taking shots and comment on it.

Of ccourse, as you can tell by the name of this blog, I don't agree with that way of thinking at all. There is no reason we should feel ashamed of having diabetes, and certainly no reason why we should be inconvenienced — or even endangered — by not being able to take our insulin when we need it!

Sunday, May 17, 2009

Diabetic spit test?

There have been all kinds of headlines on diabetes lately! Here's a new one:

Spit test shows promise in diagnosing, monitoring diabetes

I know I've heard that diabetics have more sugar in their saliva whenever their blood sugar is high, which is why diabetics also have more problems with cavities. Or so I've been told — but it would make sense, because I had the most cavities right after I was diagnosed.

It'll be interesting to see whether they can make a blood sugar test using saliva instead of blood — but will it be as accurate and as convenient as blood glucose meters? Don't forget, home testing meters are tiny now — the Freestyle Flash, which I used up until very recently, is smaller than the mini mouse I use with my laptop. Will they be able to make a saliva test that small and portable?

The other question is whether the saliva test will measure current blood sugar. We don't want to go back into the dark ages of not knowing what our current blood sugar is, just what it was ten minutes or an hour or several hours ago. Diabetics used to have to test the sugar content in their urine, but of course that only told you what your blood sugar averaged since you last went to the bathroom — not a very good way of testing if you want to maintain any decent level of control.

Of course, I don't really see anything wrong with finger sticks. They rarely hurt, and they are pretty fast, making it easy to do wherever you are — if you can just remember to pull the meter out in the first place. And while I appreciate the need for continued research, I also personally think there is no reason to fix a system that is not really broken.

So I'm a little skeptical about how useful saliva testing will be — but on the flipside, I'm also pretty interested to see what they find out!

Friday, May 15, 2009

How to use a glucagon kit (video)

I've blogged before about how important it is for a diabetic to have a glucagon emergency kit on hand. Unfortunately, this is a pretty intimidating little contraption, with a big syringe full of liquid, a vial with a powder pill inside, and a very official-looking red case. It's so official-looking, in fact, that I think many people are afraid of using it.

So, first things first:

You can't hurt someone by giving them glucagon.

My old nutritionist said to tell friends and family to always give me the glucagon if I was passed out or unresponsive, even if they didn't know whether it was because I was crashing. Better safe than sorry, especially because hypoglycemia can kill if your blood sugar goes low enough without being treated.

All that being said, here is a rather corny, but extremely educational Rick Steves-style video of how to use a glucagon kit. It is by far the best video I've seen on the subject — much better than this one that I blogged about a while back.

Wednesday, May 13, 2009

Diabetic tattoo trend

I've considered before getting a tattoo that states I am diabetic. I happen to have a metal allergy that prevents me from wearing most jewelry, so I can't wear the cheap medic alert bracelets, and can't afford the ones I could wear.

It seems I'm not the only one who has considered having a medic alert tattooed on my body: Other people are already doing so. Check out this article:

Tattoos being used for medical alerts

I can't say that I would support tattooing children with a medic alert, just because they're children and they have more growing to do, for heaven's sake, which distorts tattoos. I know I'd be pretty pissed if I ended up with an unsightly blotch of color on my skin as an adult, no matter how well-meaning my parents had been. However, I strongly disagree with the logic here:

Some say they'd skip the body art, though. Sandra Miller's son Joseph, 13, has type 1 diabetes. "While I understand the reasons for doing this, it feels a little too much like 'branding' my child," Miller says.



The branding comment kind of annoys me. Diabetes is still misunderstood, sure, but it doesn't carry the same stigma it used to. However, we should still be careful not to say or do things that will make diabetic children feel ashamed of checking blood sugar and taking insulin in public.

As for me personally — well, someday I may consider getting a medic alert tattoo. The biggest problem I have is that my philosophy with tattoos (I already have two) is that they should be someplace discreet, so that you can hide them if necessary. A medic alert tattoo would be the complete opposite: In order to do its job, it would need to be as visible as possible. That will be a hard thing for me to get my head around!

Sunday, May 10, 2009

I'm not holding my breath

Tonight I saw this article in the top headlines on Google:

Health Groups Vow Cost Control

Supposedly, these health groups have promised President Obama that they'll cut back on the rapidly rising cost of health care in the United States. But you won't catch me holding my breath.

From the article:


Despite such heady predictions, many aspects of the plan remain unclear. The groups did not spell out yesterday how they plan to reach such a target, and in a letter to Obama they offer only a broad pledge, not an outright commitment.

In addition, White House officials said, there is no mechanism to ensure that the groups live up to their offer, only the implicit threat of public embarrassment. And it would be difficult to track whether they come up with the promised savings, other than the imprecise measure of comparing current projections of health-care cost increases with future actual costs.

Nonetheless, White House officials were optimistic about the offer from industry officials, who previously tried to put up obstacles to health-care reform.



Honestly, I think the change of heart (so to speak) these health groups are showing now is inspired only by the very real threat of government involvement under Obama. Besides the acknowledged problems with this promise, I can't help but be skeptical that our greedy health care industry will ever really change unless it is forced to with government-regulated reform.

Friday, May 8, 2009

Are you at risk for swine flu?

Today an article was published claiming that two groups of people are at risk for swine flu: young, healthy people, and people with chronic conditions such as diabetes and heart disease.

Okay, let me get this straight. You're saying that the people susceptible to swine flu are 1) anyone who is healthy and 2) anyone who is not?

Translation: Everyone is at risk for swine flu! Run! Run for your lives!!!

I'm kind of tired of seeing all the panic regarding swine flu — and of course, the media is behind most of it. At least 3 or 4 swine flu-related headlines make it into the top headlines on Google every day. They just won't let it go!

So let's put this into perspective. There have been around 2,500 cases of swine flu worldwide, with 44 deaths. That's a 1.7 percent chance of dying if you get it anywhere in the world. About 1,600 of those cases have been within the U.S., but only 2 have died here — which is only a 0.1 percent chance of dying of swine flu in the U.S.

Of course, many of the non-U.S. cases have been in Mexico, where the people are poor, cleanliness is not that great, and health care sucks. So is it safe to say that, just like anything else, swine flu is more likely to kill people who don't live in reasonably clean conditions or have access to good medical care?

Yesterday when I wasn't feeling well, I mentioned it to my parents and my dad immediately asked, "Do you have a high fever? Because that Mexican flu begins with a high fever." Uh, so do tons of illnesses! Hello — that's how your body fights a virus! (For the record, I did not, and I felt much better after a nap, so I think my super high blood sugar had something to do with it.)

Seriously, people. Stop. Panicking. This isn't the 1918 influenza epidemic. Our medical industry is far too advanced for that to happen again because of a simple flu virus. Just take reasonably good care of yourself, go to the doctor if you feel sick, and don't worry so freaking much.

Thursday, May 7, 2009

Under the weather

I woke up this morning feeling rather crappy: a bit of nausea, and just overall not feeling well.

When I checked my blood sugar, I found it was a whopping 311! I'm not sure what happened — it was about where it should have been at bedtime last night.

So the question is: Am I feeling sick because my blood sugar was so high, or is my blood sugar so high because I'm getting sick?

We'll see how I feel later before I decide which it is. In the meantime, I'm going to curl up on the couch with my computer and just take it easy today.

Saturday, May 2, 2009

What "diabetes" means to you

Diabetes is one of those words that carries a lot of negative connotations with it. I was reminded of that just this afternoon.

The grandmother of the kids I babysit for saw me checking my blood sugar, and commented, "Aren't you young to have diabetes?"

"I'm type 1," I said. Then I added, "It's juvenile diabetes." I know the term isn't really used anymore, but a lot of older people are more likely to understand if you explain it that way.

"Oh," she said.

After the exchange, I thought about what she's said: Aren't you young to have diabetes? The way she said it reminded me of the negative connotations of the word. Most people that don't know anything about diabetes perceive it as being a disease that affects only old or fat people. Heck, that's what I thought before I was diagnosed. There just isn't much understanding of the differences between type 1 and type 2 diabetes.

And of course, because many people think diabetes only happens to old or fat people, it's viewed as something that is the person's fault — a sign of bad hygiene, like bad breath or body odor.

Of course, type 2 diabetes can be caused by a person's lifestyle choices, but that doesn't mean they are deserving of this negative attitude. Not to mention, since the average person doesn't really understand what diabetes means, the negative connotations of the word are therefore applied to all diabetics, whether they had any control over their condition or not.

The only way we can change this is to educate people about diabetes. Here's something simple you can do to begin: Explain it to the people you see every day. Often diabetics don't like to talk about their condition, because of exactly the problem I'm discussing in this post. But by educating the people around you, you contribute to the efforts to create a better informed public.

Thursday, April 30, 2009

How preventative do diabetics really need to be?

Sometimes it seems to me like everyone assumes I'm on death's door just because I'm diabetic. My current doctor isn't bad about it, but my previous doctor went way overboard on the preventative stuff. I've mentioned before about all of the cholesterol drugs he had me on. He even had me get the first immunization for pneumonia! As if I'm even close to being at risk for it! Had I known better then, I would have said no.

Another thing I frequently hear is that diabetics should always get flu shots. Um... Why? If we're in good control of our diabetes, there's no reason why we'd be more susceptible than anyone else. And even those who aren't in good control may not benefit from it, according to this article on why the flu vaccine doesn't work.

Just because you are diabetic doesn't mean that 1) you are susceptible to every little bug floating around, or 2) you need to buy into every single preventative treatment available to you. Don't be afraid to question conventional wisdom. After all, it's your body and your diabetes, and you know both better than anyone else could!

Saturday, April 25, 2009

Keep your fingers crossed for health care

This is good news for diabetics and others in need of health care: President Obama is determined enough to get a guaranteed health insurance program in place to block a filibuster in the Senate.

I'm glad to see Obama taking action on this issue so quickly, and I am hopeful that his determination and skillful maneuvering bode well for the legislation. With the recession increasing the number of people without health insurance, this is now needed more than ever.

In my research for this blog post, I learned something I did not know. From Salon.com's article on the potential health care deal (emphasis added):

Because insurance is expensive, requiring people and businesses to pay for it is politically difficult. Most people now get insurance from their employers, but companies aren't required to offer it and as the economy skids more have cut back.


I didn't know that employers weren't required to offer health care. I thought they had to for full-time workers. So our current situation is even scarier than I thought it was, if even working full-time doesn't mean you will have health insurance.

According to the article about preventing a filibuster, there are 58 — perhaps 59 — senators who support health care legislation. Sixty are needed to break a filibuster. I don't know who the 41 or 42 dissenting senators are, but if you know yours is one, please write to him or her about supporting this important legislation!

Friday, April 24, 2009

Rising costs of individual health care plans

This is an OLD article — my apologies for not blogging about it sooner. It's been on my list since February, but I just kept forgetting.

For most diabetics, this won't even apply, since health insurance companies legally can and will decline us for individual health care plans — but in February the media reported vast increases in the cost of individual health care plans.

Look at the numbers in this article — some of those increases are almost criminal! Blue Cross of Michigan was trying to increase their rates by more than half, for heaven's sake! Does no one see how terrible it is that our country allows health insurance companies to put such a ridiculous price on its citizens' health?

Thursday, April 23, 2009

Diabetes and dementia

A week ago, a new study reported a connection between diabetes and dementia. Apparently type 2 diabetics who crash badly enough to go to the hospital are more likely to develop dementia later in life. It sounds like crashing that badly must do some kind of damage to the brain to increase the risk of dementia.

I'm not sure why type 1 diabetics aren't included, as I would think crashing would be just as badly for us as it would be for type 2 diabetics. However, I suspect the only reason is because the study was only done on type 2 diabetics, so they can only report the findings of the study. I hope someone does a similar study on type 1 diabetics or on all diabetics, but in the meantime I think it's safe to say that you should avoid hypoglycemic episodes.

Duh.

Studies like this one are good reminders that we don't know everything there is to know about diabetes — far from it. There could be many other complications that we still have yet to discover. To me, that just means that it's really important to keep my diabetes in good control. I don't want to "discover" a complication firsthand, thank you very much!

Tuesday, April 14, 2009

Why education and not health care?

The other day, my mom and I were discussing the subject of universal health care in the United States. If you've read other posts on my blog, you know that I fully support guaranteed health care for all Americans. In my opinion, I can't be a proud diabetic without supporting every diabetic's right to quality health care.

Just the other day, I blogged about the horrific choice facing many diabetics who have been laid off or otherwise impacted by the recession: Pay the rent or pay for medication. Forcing good, hard-working people into making life-threatening decisions like that is just not right.

I support a system that would guarantee basic health care for all Americans, but continue to allow people to pay for upgraded health insurance if they wish. I see it as similar to public education. The United States guarantees every one of us access to a government-funded education, but if you don't like the public schools you are welcome to pay for your child to attend a private school. Likewise, every American ought to be guaranteed the care and medications they require to maintain good health — but if you want to be able to, say, choose a doctor that's not in the network or get coverage for non-necessary procedures, you could pay for your own health insurance.

So why are we guaranteed an education yet allowed to suffer and die if we can't afford health care? Personally, I don't think this was our government's intent at all. When education was declared a human right in 1948, health care was much more affordable than it is today. I think that if those responsible for writing the Universal Declaration of Human Rights knew what would become of the health care industry in the next 60 years, they would have made access to health care a basic human right, too.

Sunday, April 12, 2009

Economic recession dangerous to diabetics

I blogged just the other day about free clinics providing services for diabetics. Today, though, there was a scarier article: A lot of diabetics aren't seeking out free or low-cost help, but are instead cutting back on their medications.

The article talks about how diabetics who have lost their jobs and/or health insurance due to the recession are cutting back on their medications in order to save money. The cost of medications for an uninsured diabetic is given as $350 to $900 per month, which blows my mind. That's nearly the equivalent of the rent or mortgage for many people.

To me, this article demonstrates why the United States so badly needs universal health care. Forcing someone to choose between having a place to live and staying alive at all is not right. Furthermore, not only does this type of thing hurt the people cutting back, it also hurts the rest of the people, whose health care costs go up in order to absorb the cost of hospitalizing these people when their health deteriorates.

It's in our best interests to ensure that everyone, especially people with chronic conditions such as diabetes, have guaranteed access to health care. I think our current administration understands that; but how many more will suffer because they can't afford their medications before something will be done about it?

Friday, April 10, 2009

Uninsured diabetic? Check out free clinics

Having diabetes, especially type 1 diabetes, is a big deal because without insurance, most of us would be unable to afford our medications. This just gives us another reason to worry in the current economy, with unemployment — and therefore the number of uninsured — rising.

If you don't have insurance and make too much to qualify for government aid, you should look into free clinics in your area to help you get medical care and medication. Community resources like these are lifesavers for diabetics and others who have to take expensive medications in order to survive, yet have low-end jobs that provide neither health insurance nor enough income to buy them on their own.

Do you know of free or low-cost clinics in your area that you could list here to help other diabetics? If so, please comment!

Monday, April 6, 2009

Raising future type 2 diabetics

...and I don't mean that in a nice way.

I just saw an article reporting that 1 in 5 preschoolers are obese. Really?! Have diets really gotten so bad in the United States that by the time kids are four years old, they have a 20 percent chance of being obese?

This is horrific for many reasons. One, research has shown that being obese in childhood dramatically increases the likelihood that someone will be obese as an adult. It seems that the body creates a sort of set point during childhood and adolescence, based on the individual's weight during these formative years.

Two, people's habits as adults tend to be sharply influenced by their childhood and adolescence. So if an individual doesn't get into a habit of being active and eating well during their youth, chances are not good that they will do so as an adult.

And of course, obese people are much more likely to suffer health problems as adults, such as heart disease and... you guessed it, type 2 diabetes. In fact, there has been a rise in recent years of children with type 2 diabetes. Now that's scary.

Type 2 diabetes, which stems from a resistance to the insulin the body produces (rather than an inability to make insulin, as in type 1 diabetics), is not always caused by lifestyle and obesity. I know several people who are pre-diabetic, and all of them are thin and reasonably active. Unfortunately, type 2 diabetes that IS caused by obesity and lifestyle problems is becoming much more common.

What all of this means is that if you are allowing your child to become overweight at age 4, you are potentially condemning them to a lifetime of health problems and struggling with their weight. Use common sense, people — get your kids outside, away from the TV and video games, and quit feeding them junk food!

Sunday, March 22, 2009

Mary Tyler Moore and type 1 diabetes

Mary Tyler Moore apparently has written a memoir about not only her life, but also about having type 1 diabetes.

Moore is a celebrity from my mom's generation, not mine, so in those days being diagnosed as diabetic meant something different than what it means today. Still, I am a little disappointed in the message she is sending to the world.

Moore says matter-of-factly and with no self-pity that with type 1 diabetes, there is little chance for spontaneity in life. She chooses not to use the newer glucose monitors and insulin pumps that can reduce the burden by taking automatic readings for the patient and deliver a dose without a syringe. Instead, she still prefers using finger pricks and test tapes to measure her blood sugar and a syringe of insulin whenever it's needed.

"You've got to always plan," she says. "It is a fact of life that if someone invites you out to dinner you have to think, 'What are they going to be doing when they serve you dinner? How quickly are they going to get it on the table from the time I arrive? When should I take my shot? What should I eat of what's available?' "

I think I must have a different disease than Moore, because I've never found being diabetic to be a hinderance to spontaneity. I don't find my diabetes to be something to worry about when I go out to eat or eat at a friend's house. I take a shot before dinner when I know what I'll be eating, and right after dinner or after each course if I don't, and then check my blood sugar an hour or two later to make sure it's coming down the way it should.

That may sound like a burden to a non-diabetic, but to me it's about as much of a burden as, say, stepping on the scale or brushing my teeth. In fact, as I may have mentioned before, sometimes when I watch a movie and the characters sit down to a meal, I actually think, Oh, she forgot her shot, before I remember that not everyone does that!

The other thing that annoys me in the above passage is the way it makes it sound like CGMs and insulin pumps are connected, and that Moore is refusing a miracle of modern medicine as some kind of act of nobility. Uh, sorry, but continuous glucose monitors do not automatically cause a pump to bump up your insulin. CGMs are not 100 percent accurate and need to be backed up with a finger stick before making any corrections.

But the article gets worse, as it goes on to talk about how she is nearly blind and recently got gangrene on her thumb after slamming it in the door. And this after the article has already painted her as a model diabetic. Finally it goes on to talk about how she didn't take care of herself when she was first diagnosed, but it doesn't make a clear connection between that and the problems she is having now. There's probably a whole bunch of readers who walked away thinking that diabetes is a debilitating disease and a death sentence.

I personally feel turned off from reading the book, after seeing the way this article has portrayed diabetes. Maybe I'll give her the benefit of the doubt and read the book anyway, but I can't help but think they've done diabetes a disservice in using its shock factor to try to sell her book.

Wednesday, March 18, 2009

Other travel considerations for diabetics

Going through security with your diabetic supplies might be one of the major concerns, but there are other things diabetics need to keep in mind when traveling. Here are a few others I found to be pertinent:

1) Insulin injection timing. If you take an injection at the same time every day, you will need to account for the time zone change where you are traveling. This doesn't need to be exact, but it should be close. For example, I always take my Lantus injection at about midnight, before I go to bed. In England, which was seven hours ahead before the United States changed for Daylight Savings, that meant I took my shot when I got up in the morning.

2) Changing insulin needs. Another problem is how your activities while on vacation can affect your insulin requirements. Being more active than usual can decrease your Lantus needs, but eating more than usual can increase your insulin needs. Also, don't forget you will be exposed to a lot more germs, and may get sick, which can have an impact as well. Your best bet is to check your blood sugar frequently and be sensitive to changes in your insulin needs.

3) Extra vigilance checking blood sugars. I also find that I need to be extra vigilant about checking blood sugars while traveling. It is far too easy to forget about checking it, which of course usually ends up with your sugars being sky-high.

What do you find that you have to keep in mind when traveling as (or with) a diabetic?

Monday, March 16, 2009

Traveling with diabetic supplies

My husband and I just got back from a trip to England. It was my first time traveling out of the continental United States, but not my first time flying with diabetic supplies. Interestingly it seemed no different than the domestic flights I've been on.

Even though no one has ever said boo about my diabetic supplies, even going through security, I always take certain precautions when traveling with my syringes and lancets. This trip, for example, I

* carried a letter from my doctor's office stating that I have type 1 diabetes and need my insulin and needles with me at all times,
* kept as much of the original packaging as was practical, in order to help someone quickly identify the supplies, and
* put all of my insulin and needles together in a gallon-sized ziplock bag.

The one thing I didn't do was to keep my Lantus chilled. From personal experience, I happen to know that Lantus lasts about two weeks if it is not refrigerated, and I always keep at least one extra bottle on hand, so I just opened a brand new bottle for the trip with the intention of tossing it as soon as we got home.

What precautions do you take when you travel with your diabetic supplies?

Saturday, March 7, 2009

Expensive diabetic prescriptions strike again!

I remember when I got on my husband's health insurance, and I thought how nice it was to be paying $100 every three months for prescriptions rather than the $200 and up my other insurance company charged.

Now, since our insurance company changed the copays for diabetic prescriptions, it seems I'm right back where I was before. I reordered my prescriptions the other day, and I will now be paying more than twice what I was before. It all amounts to about $500 additional per year, which may not seem like a lot; but when you have to come up with $200 or more all at once instead of just $100, you really do feel the pinch!

Things like this demonstrate just how badly we need health care reform. Without health insurance, these life-saving medications would cost me probably three times more. How many people out there are slowly dying because our country thinks it's a good idea to model the health care industry after the free market system?

Tuesday, March 3, 2009

Follow-up endocrinologist appointment

Last month I blogged about how disappointed I was in my A1c results at my quarterly endocrinologist appointment. My follow-up appointment was on Friday, and good news: My A1c dropped from 7.9 to 7.2!

I was surprised but extraordinarily pleased to see it change so much. The Navigator really did help by getting me on the correct dosage almost right away. Being able to see what my blood sugar was doing overnight really helped me to fine tune my Lantus dose.

Interestingly, though, I think my insulin needs have dropped again. I haven't been feeling as hungry or — apparently — eating as much, and as a result I've been losing weight slowly but steadily over the last few months. That usually causes my body to reset my metabolism, which always causes in my insulin needs.

Hopefully I won't need to beg for another sensor in order to figure out the correct Lantus dose this time!

Tuesday, February 17, 2009

Health insurance prescription coverage changes

I just got a letter from our health insurance company today stating that their special program for diabetic prescriptions is ending. This program made prescriptions really affordable by putting all diabetic prescriptions in the tier with the cheapest copay.

The change is most likely due to the fact that another, bigger health insurance company recently took over our original provider. I'm sure this is only the first of many ways they'll find to wring a little extra money out of us.

I know from experience that many of my medications will not be in the generic tier once they end the program on March 1. Instead I'm willing to bet my bill for three months' worth of prescriptions is going to double. The expense was difficult enough to cover some quarters — do they have any concept of how this is going to affect many people?

Of course, they don't care. As my husband said sarcastically when I told him, "Oh, but people with chronic medical conditions always have tons of money laying around. That's why they have to charge you more."

Thursday, February 5, 2009

Campaign against reusing syringes

Apparently, there's enough of a problem with nurses reusing plastic syringes — just snapping on a new needle — that there is a campaign forming to speak out against the problem.

The problem is that some nurses thing that as long as you use a sterile needle every time, there is no problem of transmitting disease. This simply is not true. The plastic syringe can transmit disease just as easily as the needle.

This shows how important it is to be in charge of your own diabetes management if you are ever in the hospital. You can — and should — request that you control your insulin regimen. After all, you know more about your body and how it reacts to insulin, sugar, etc. than some doctor who has never met you before!

If you can't be the one in charge of your insulin shots, be sure to confirm with every nurse, every time, that the entire syringe is sterile. It's sad that we have to think about these things while we're in the hospital, but honestly, it's better to harass a few nurses than to wind up with hepatitis C — or worse!

Monday, February 2, 2009

Diagnosing diabetes using an A1c

This article made top headlines today: Doctors are beginning to use the A1c test to diagnose type 2 diabetes.

I think it makes sense to use this test as a diagnostic test. After all, the usual diagnostic tests for diabetes only tell you what the person's blood glucose is doing at that time, while an A1c test effectively tells you what it's been doing for the past three months.

In fact, this makes so much sense that I can't help but wonder why doctors just now thought of it!

Of course, the article fails to mention that A1c test results tend to vary in what they actually mean, depending on the lab your doctor's office uses. The same A1c from two different labs may translate into different average blood glucose levels, in other words. So a 7 from one lab might be the same as a 6 from another — a fact the article ignored with its blanket statement, "People who don't have diabetes typically have about a 6 or less reading."

What I found especially interesting about the article is that it mentions there are no clear standards for diagnosing type 2 diabetes. What exactly does that mean? That we don't understand the disease as well as we would like? That the whole "prediabetic" thing is a bunch of hooey? Or does it simply mean that the fasting blood glucose and the oral glucose tolerance test simply aren't very good at indicating whether a person has type 2 diabetes — and therefore why the A1c test is needed to help diagnose the condition?

Friday, January 23, 2009

Obama health care reform seems promising

If you're like me, you've been watching Obama with interest, particularly to see whether he will follow through on his health care reform promises.

It certainly seems he will. This article on Obama's stance on the issue of health care reform indicates that his campaign promises were serious statements of intent. Even once he was elected, Obama continued to set the stage for his plan to make some major changes in the health care industry. And now he's pressing for health care to be a significant issue in the economic stimulus bill he and Congress are working on.

Obama has been amazing, in my opinion. Even before he took his oath, he was acting like the president, talking to foreign leaders and addressing the public's concerns. And after he was sworn in on Tuesday, he hit the ground running: In his first full day as president, Obama accomplished more (in my opinion) than Bush has in the last six months.

All of this seems to indicate that President Obama will also keep his promises regarding health care. Good news for those of us with preexisting conditions such as diabetes!

Tuesday, January 20, 2009

A happy day for diabetics everywhere

Happy Inauguration Day! Today Barack Obama was inaugurated as the 44th president of the United States. Since part of his campaign platform was health care for all Americans, an issue I feel very strongly about, I am excited to see what change he will bring to our nation's health care industry.

Although in his auguration address, President Obama (doesn't that sound wonderful!) didn't refer specifically to his plans regarding health care, he did hint at the change he intends to bring about in this area:

The question we ask today is not whether our government is too big or too small, but whether it works — whether it helps families find jobs at a decent wage, care they can afford, a retirement that is dignified. Where the answer is yes, we intend to move forward. Where the answer is no, programs will end.

It doesn't take a genius to know that the current health care setup is NOT working, so I'm sure that's part of the change he is referring to here. I'm looking forward to seeing what he will accomplish as president!

Sunday, January 18, 2009

Coping without the Navigator

My life is returning to normal somewhat since I've been without the Navigator again. I don't have to worry about keeping the monitor within range at all times, or be careful not to inadvertently scrape the sensor off my belly.

On the other hand, I really miss having that graph of my blood sugar over time. It's so amazing to see the curve of my blood sugar as food and insulin take effect!

I do seem to have found the correct nightly dose of Lantus, however, as my sugars are easier to control, more often in the normal range, and are much more manageable in the mornings when I get up. Also, as I was hoping would happen, my week with the Navigator has inspired me to check my blood sugar a little more frequently, and take a little better control of my diabetes. Amazing what just a week of using a continuous glucose monitor has done for my understanding of my diabetes!

Wednesday, January 14, 2009

Making the Navigator sensor last longer

I have a confession to make: I kept the Navigator sensor in for two extra days — for a total of seven days instead of five.

The sensor adhesive was sticking so well, I was pretty sure I could get away with it. And I didn't have any problems with the accuracy, either. In fact, I'm not really sure why they want you to only use the sensor for five days.

To get the extra couple of days, I stuck my thumbnail into the back of the sensor and popped the catch that keeps the transmitter locked onto it. You have to be very careful when you do this, so that you don't wreck the adhesive or pull the sensor out of your skin. You might want to look at how the sensor and transmitter fit together sometime when you removed a used sensor, so you know what I am talking about.

Anyway, when you do this you really only get an extra day and a half, because you have to go through the 10-hour initializing period again. But in my case, I wasn't as concerned about my daytime sugars — I wanted to fine-tune my Lantus dose by looking at my nighttime sugars — so I just restarted the sensor shortly after I woke up on Monday.

I ended up being glad I did it. I was able to tell quite a bit by looking at my sugars Monday and Tuesday nights, and I think I've hit on the correct Lantus dose. It was going so well, in fact, that I was really tempted to leave the sensor in for longer — but not knowing what would happen, I reluctantly removed it this afternoon.

Sunday, January 11, 2009

Making the Navigator sensor stick

In my last post I talked about the Navigator sensor adhesive problems I had when I participated in a CGM study back in July.

This time, luckily, I haven't had the same problems. I think this is because of one or more of three possible reasons:

1) It's the middle of winter and I'm not as active as I was over the summer. At the time of the study, I was cleaning stalls at the barn in exchange for free board, and I was riding my horse frequently.

2) I'm not sweating as much. I think sweaty skin was the primarily reason why the Navigator sensor's adhesive seemed to have so many problems over the summer. Even had I not been so active, it was hot! This would also explain why the combination of a bandage underneath and the Skin Tac (which I described in my last post) worked so well.

3) I've lost some weight. My tummy is flatter and doesn't curve as much when I sit down.

4) I haven't put an over-bandage on at all. I think putting a bandage over the top pulls at the adhesive ring around the base of the sensor, and loosens it, so I decided not to put any extra adhesive or tape on unless it actually started coming off.

In any case, this time I used IV Prep instead of Skin Tac. We had tried that once over the summer, and it didn't work then, but it's working pretty well now! It wasn't until the fourth day that the adhesive finally started to loosen the slightest bit at the edges. I had forgotten to put a bandage underneath the sensor (which a hole in it for the entry point), but I don't seem to have needed it this time — though I suspect the nickel will start making me itch soon!

We'll see if the adhesive makes it to Day 5!

Saturday, January 10, 2009

Navigator sensor adhesive problems

Back when I did the CGM study in July, I (and everyone else) had a lot of problems with the adhesive on the Navigator sensor. I had a sensor actually pop out, and two out of the three times, by the time we got to the end of the 5-day period I had to hold the sensor on with tons of tape for fear of losing it.

The one time I didn't have any problems with it, some mystery lady — a pump rep, I think, who didn't work at my doctor's office but was helping out — used Skin Tac wipes to make it stick. This is what she did:

1) Put Skin Tac on my skin. She said it was okay for the sensor to go through it, though I've heard differently since then.

2) Cut a hole in a clear, rectangular bandage, just a little larger than the size of the sensor and its surrounding adhesive. The hole was for the sensor wire to go through into my skin, so she made sure it lined up correctly.

3) Put the bandage on my skin, over the Skin Tac. This was actually to prevent the little spot of nickel on the transmitter from touching my skin (I'm allergic to nickel), but as it turned out it also helped to prevent the sensor adhesive from losing its stickiness when I got sweaty.

4) Put the sensor over the bandage, making sure the entry point lined up with the hole in the bandage.

Out of the four sensors I wore during the study, this one stuck the best, without me having to tape it down as the 5-day period wore on.

This time I've had a little better success, as I will explain in my next post.

Friday, January 9, 2009

First night of Navigator readings and nighttime insulin resistance?

Last night was my first real night of Navigator readings, since Wednesday night the meter was having so many problems.

The meter was about 30 points on the low side last night, but I did check my blood sugar and the difference was consistent. In any case, the meter did reveal that my sugars held steady throughout most of the night.

The one thing that did baffle me was a little bit of apparent insulin resistance that I experienced between late last night. Around 10pm I checked my blood sugar and found it was a little over 200. It had been several hours since my last meal and insulin dose, so I took a couple of units of Humalog to bring it down.

Between 10pm and midnight, my blood sugar didn't move it all — it stayed right at about 230 the entire time. So at midnight, when I figured the Humalog would have run its course (short-acting insulin takes 2-3 hours, but with me I usually find it takes only 2), I took two more units.

I was up for nearly another two hours, and when I went to bed at nearly 2am my blood sugar had dropped to around 135. I figured that was high enough to prevent crashing during the night (usually I aim for 150).

Unfortunately, my blood sugar continued to drop until about 4am. I woke up several times with the Navigator beeping at me. Since it was reading about 30 points low, it was telling me I was around 40, when I was actually around 70. However, after 4am it stayed consistent for the rest of the morning, so I can only assume my new nighttime Lantus dose of 16 is pretty much perfect.

I am going to watch the next three nights for signs of insulin resistance late at night, and I will be careful not to take two shots so close together again at bedtime. I came pretty close to crashing, even if I didn't!

Day 1 on the Navigator again

I mentioned in my last blog post, about Wednesday's appointment with my endocrinologist, that my doctor's office gave me a Navigator sensor to help me find out what my blood sugars are doing overnight. The hope is that the 5 days I get on the sensor will help me regain control over my diabetes.

The unit is mine — back in July, I participated in a comparison study on continuous glucose monitors, and at the end of the study I got to keep the CGM of my choice. I chose the Navigator, because despite the sensor adhesive problems and the size of the transmitter, I felt it was more accurate at lower levels — something that is important for me at the barn.

Unfortunately, I have been unable to get my insurance company to approve the sensors, so I haven't used the CGM since then. Yesterday was therefore my first full day back on the Navigator in almost six months.

When I first inserted the sensor on Wednesday, I had a little bit of trouble getting used to having it on me again — though I adapted faster than I did my very first time. For the rest of Wednesday I was worried about bumping it, rubbing it, etc. However, by the time I woke up yesterday morning, it felt much more natural to move around without worrying about the sensor coming off.

Because the Navigator waits 10 hours before the first calibration, it wasn't until Wednesday evening that I started getting any readings. Unfortunately, the meter wouldn't accept my second calibration late Wednesday night, so I had to get up every two hours throughout the night when the CGM beeped at me to recalibrate.

Because of the calibration problems, the meter wasn't very accurate overnight, so I couldn't determine anything based on the night's readings. However, during the day yesterday I very quickly was able to assume much tighter control over my sugars, same as what happened when I first started using the CGM back in July.

It's so nice to be using the Navigator again, even if it's only for 5 days!

Thursday, January 8, 2009

The purpose of frequent endocrinologist appointments

I haven't had very good control over my diabetes lately. My blood sugars have been quite high, and I haven't been checking very often. As a result, yesterday's appointment with my endocrinologist was a bit discouraging.

Of course, though, that's the point of seeing your endocrinologist frequently: to get you back on track when you start to stray.

One of the reasons why I was having problems was because I've been afraid to bump up by nighttime dose of Lantus by too much. The CGM study I did back in July (which I still need to blog about — sorry!) verified that I don't wake up when I crash at night. I've tried a couple of times to bump up my nighttime Lantus dose (it's been at 15 for several months now), but every time I felt like I was pushing lows all the next day, so I reverted back for fear of what my sugars were doing while I was sleeping.

Unfortunately, when combined with my recent trend toward less frequent testing, my sugars were getting quite out of control. It's easy to ignore that when you want to, so I really needed the reality check of yesterday's doctor's appointment.

My doctor's appointment gave me several things to help me out:

1) A free Navigator sensor (I was able to keep the Navigator unit after the study ended in July) so that I can find out what my sugars are doing overnight
2) Guidelines for changing my Lantus dose
3) Another appointment in six weeks, instead of the usual three months, to check my progress

So far I am really very excited about being wired up to the Navigator again, even if it's only for five days. I'll blog about that in my next post. However, the real thing that saved me here was the doctor's appointment, as it gave me fresh resolve to keep better control of my diabetes.