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.