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!