Compliance - It's Not Just For Bondage Night Anymore...

Like many people who grew up in the 60's and 70's, I'm not very good at discipline [you may have noticed fewer and fewer ships-in-a-bottle are made each year; I fear our American s-i-a-b resources may run out before the next decade ends]. I wanna do what I wanna do, when I wanna do it, and never mind the consequences.

Well, while that operating system should have done wonders for my self-esteem [it didn't, but I don't blame it on the 60's and 70's], it's very likely one of the main reasons I'm writing a blog on dealing with diabetes from a patient's perspective. I'll be honest; I was very aware that I was a likely candidate for type II diabetes from an early age:

-I was morbidly obese;

-There was a history of diabetes in my family

-I certainly didn't eat a very healthy diet; even when what I ate at home was okay, I had a tendency to supplement it with outrageously-bad snacks from the "junk food" aisle of my neighborhood's grocery store.

Put that all together, and it spells "T-y-p-e II".

So, here we are. I'm 51, still morbidly obese, adding to the history of diabetes in my family [it turns out both my brothers, in somewhat better shape than me, are type-II. As was my late mother...]. I'm eating better, but only by not carrying money most of the time [it does work, but it doesn't do wonders for the self-esteem (see above)]. Then again, I'm less morbidly obese than I was a couple of years ago, my blood sugars are mostly under control, and the quality of "junk food" I pick now is much healthier [usually].

This comes down to the discovery, over the years, that when I follow the treatments from my health professionals, I feel better. Not wonderful, but better [the more damage you do to yourself, the less wonderful it feels when you stop. Still, it's a good feeling].

The word most medical professionals use when a patient is properly following the treatment as planned is compliance. You can't imagine how I hate that word. It's not that I have issues with putting my life in the hands of another [I ride buses just about everywhere]. I don't have issues with taking medicine. My problems are eating what I shouldn't, and not exercising [if only Robo-Cop were available as a personal trainer...]. But those issues are part of the "C" word. My treatment, your treatment, is a package. You and I both need to follow all the instructions, as best we can.

(Of course, we don't need to be happy about it. Just as the right to Pursue Happiness is in many nations' Constitutions, so is the implied right to be miserable [if that makes you happy]. The older I get, though, the harder it is to follow after misery.)

All I know is, when I'm compliant with my health care team's treatment plan, I physically feel better. My brain is clearer. My mood improves. I actually believe that all the hassles of being compliant are worth it.

Make compliance your safety word...

-Mike Riley

Teamwork

The news that you're a diabetic can be more than a little overwhelming, especially if
you have little or no knowledge of the disease. But you don't have to face it alone. In fact, one of the first things you should do is put together a health care team to help you. This post looks at some of the key members of that team.

Primary Care Physician - your regular doctor. S/he may have diagnosed your diabetes during a regular visit [you do see your doctor at least once a year, don't you? You should...]. Your primary care physician will coordinate your health care, working with the other members of your team (That said, all your doctors should be aware of what the others are doing. Get each doctor's fax number, and ask that reports be shared).

Diabetes Treatment Specialist [usually an endocrinologist] - Most primary care physicians try to stay up-to-date with treatment for common illnesses. But some diseases, diabetes one of them, need specialized care. Hence the diabetes treatment specialist. These doctors are expert in diabetes care. And believe me, you WANT to keep your blood sugar levels under control! The better your blood sugars are controlled, the less havoc diabetes is likely to wreak on other parts of your body.

Nurse Educator - usually an R.N. with specialized training. They will show you how to handle day-to-day living with diabetes, teaching you such things as:
- how to check your blood sugar with a blood glucose monitor
- care for your feet
- how to treat your diabetes, with or without insulin.

(It's recommended that new diabetics take a brief course in self-care from a Diabetic Educator.)

Registered Dietitian - as the name implies, a nationally-certified expert on nutrition. The dietitian will work with you to create a meal plan that takes into account your diabetes, as well as other medical needs [weight loss, or high blood pressure, for instance], and frequently can steer you towards delicious foods and recipes.

Eye Doctor / Podiatrist - although diabetes can cause medical complications in many parts of the body, many issues come from the eyes and feet. The American Diabetes Association recommends annual visits to your eye doctor. It's probably a good idea to see your podiatrist three or four times a year for foot examination and, if necessary, removal of corns and calluses. Do not try to remove them yourself! Home treatments can lead to infection which, as you've probably guessed, are more difficult for diabetics to recover from.

Mental Health Professionals / Social Workers - Diabetes is a long-term disease. There is no shame, and a lot of good, in seeking help with emotional and personal issues relating to it. Social workers may be able to help with financial issues relating to your treatment.

Dentist - diabetics are somewhat more prone to gum disease, and may have more risk of tooth damage, due to high blood sugar. See your dentist at least every six months, and make sure s/he knows you're a diabetic.

Exercise Physiologist - regular exercise, at any level of exertion, helps control blood sugar levels. Make sure your exercise specialist is certified, and check with your primary care physician before beginning any exercise program.

This article, from the American Diabetes Association's website, expands on these points, as well as suggesting questions you can ask to make sure the team you construct has the skills you need. Because, at the end of the day, you are the most important member of your health-care team. It's up to you to follow the instructions of your health care providers. It's up to you to point out issues [medical and otherwise] relating to your diabetes. It's up to you to work on a positive attitude. Diabetes is a grinding, killing disease. The higher the quality at your back, the better for you.

-Mike Riley

Baseball, Football, and Diabetes

Before I get started, here's a classic routine from George Carlin:


One difference George missed: football teams usually play a short number of games [even the NFL's champions play, at most, 21]. Baseball teams, even in the minors, play 100 or more times a season. Thus, football coaches talk about getting their players "up" for a game, while wise baseball managers refer to getting their squads "down", that is, relaxed, into a groove, for their contests.

So it is, ideally, with diabetics. Yes, we need to be prepared. We need to keep vigilant about our blood sugar levels, our A1C's, our overall health [as noted, diabetes can throw wrenches into a wide swath of bodily functions]. But we also need to keep calm, cool, collected. To use another sporting analogy, diabetes is a marathon, not the 100-yard dash.There's no cure. Unless research finds a solution, we'll be dealing with the symptoms, side effects, and complications for the rest of our lives. Living in a constant state of anticipated disaster is not healthy for your mental state. [Of course, diabetes is also affected by stress; doesn't that just figure?].

The excesses many diabetics were part of before becoming diabetics have to be limited. The all-you-can-eat meals celebrating the fact that it was Thursday have to come to an end. But an occasional moment of ease, of eating something because you like it, not where it fits into your meal plan, is probably not only inevitable, it may be necessary for your state of mind [ideally, you should try to work it into that meal plan. But sometimes it just doesn't work].

And where do you get your meal plan, anyway? Well, it should come from a member of your health care team, a dietitian. Don't have a team in place yet? We'll look at who should be part of it in our next posting.

-Mike Riley

Diabetes: A Quick Overview

In this life, knowledge is power. The more we know about any problem that faces us, the better prepared we are to take on its challenge. This is very true of diabetes. So, here are some facts about the main types of diabetes.

-diabetes is a metabolism-related disorder. It's usually caused by a combination of heredity [some ethnic groups, including African-Americans and Native Americans, are particularly prone, although diabetes is reported in every ethnic group] and environmental factors [some polycarbons have been linked to type II diabetes, in particular. How a person lives is also important. The obese, for instance, are more likely to contract diabetes than those of normal weight].

-there are several types of diabetes. There are three main types: Type I, sometimes called "juvenile onset", is usually [but not always] found in children. It's caused by a lack of insulin production in the pancreas [Insulin helps the body use sugars, which come from the carbohydrates we eat, to make energy. Type I diabetes is usually treated by injections of insulin Type II, or "adult onset" [sadly, becoming an inaccurate term], is usually found in adults who did not show signs of diabetes as children. In recent years, though, an epidemic of childhood obesity has led to many cases of type II diabetes in children. Type II diabetes is caused by an inability of receptors in the body to use insulin, or a reduced production of insulin. Type II
diabetes is treated by oral medications and diet, but is also treated in long-term cases with insulin. Finally, gestational diabetes is faced by 2% - 5% of pregnant women. With proper treatment and preparations, women with gestational diabetes usually deliver healthy babies. It usually disappears after birth, but it's estimated that as many as half of women who have gestational diabetes will eventually suffer from type II diabetes. There are other forms of diabetes, but these three are the main types.

-there is no cure for diabetes. Research on all forms of diabetes is on-going, but no "cure" has been found. Those with types I or II diabetes will probably be diabetic for the rest of their lives. Diabetes will force you to make changes in the way you live, but it does not have to affect the quality of your life. More on this next time.

-Mike Riley

Coming Out Of The Candy Store

If someone told you there was a disease that afflicted millions of Americans, almost 8 % of the US population, nearly 25% of whom DIDN'T EVEN KNOW THEY HAD IT, would you be surprised? That disease is DIABETES. According to the American Diabetes Association, 23.6 million American men, women, and children suffer from one or another form of diabetes. 5.7 million of them have no idea they have it, despite the existence of simple tests to discover whether or not they have it.

Of course, no one wants to spend money unnecessarily. But if you have ANY of the following symptoms, you should see a doctor as soon as possible to be tested:

*frequent thirst

*frequent urination

*extreme hunger

*unusual weight loss

*increased fatigue

*irritability

*blurry vision.

If you have questions, or want more information immediately, click on the ADA or WebMD links to the left of this page. The next post will look at the principal types of diabetes, and the other health issues it can lead to [unfortunately, there are quite a few, and many are serious, even life-threatening]. This is YOUR health, YOUR life we're talking about. Don't leave yourself at risk!

-Mike Riley