insulin

Numeracy

Unconscionable Numeracy

Last week at the 6th Annual Education Forum on Diabetes Prevention & Management conference, I witnessed clinical healthcare professionals learning and sharing about the impact of diabetes, issues from the patient perspective, issues from the healthcare professional perspective, and enough data and PowerPoint slides to make Bill Gates proud.

Two presentations really stood out to me. As a person with type 1 diabetes, or a type 1 diabetic if you prefer (you say “noo-tella,” I say “nuh-tella”), I gravitated toward those portions of the conference that I could identify with the most. I like hearing various perspectives of my particular flavor of diabetes, especially from the side of people who work with and deal with diabetes without having the disease themselves.

First, there was a presentation about numeracy.

Numeracy: adjective; able to use or understand numerical techniques of mathematics.

In other words, numeracy is the ability to understand and use numbers in our day-to-day lives. Those of us with diabetes, especially type 1 diabetes, do it all the time, seemingly without thinking because we’ve done it for so long that it has become almost habit. We can do carb and blood sugar math like it’s nobody’s business! For example, I know that my insulin to carb ratio is 1:8. That means if I have a meal or a snack with 20 grams of carbs, I’m going to have to take 2.5 units of insulin to cover it so that my blood sugar doesn’t spike and make my head explode. (Not really, but my blood sugar will go high, and I hate, hate, HATE being high.)

I loved this presentation because the presenter really linked it to the patient perspective of living with diabetes. She highlighted the fear of all the numbers that sometimes paralyze us to take action. That applies no matter what type of diabetes you have. She said, “Something that healthcare providers have to realize is that if we make a mistake in math in our checkbook, it’s really no big deal, but if a type 1 makes a diabetes math mistake, they can die.” There is not a lot of room for mathematical forgiveness with type 1 diabetes.

Numeracy

The next presentation I went to was awesome because the presenter was my endo. I love my endo, so pardon me a minute while I gush. I really appreciate him because, even though he doesn’t have diabetes himself, he gets what it is like to live with diabetes as well as anyone I have ever met. He was sharing with the room some of his experiences with helping children and parents adjust and learn to live life with type 1 diabetes. Having grown up with diabetes myself, since age 2, I could appreciate a lot of the stories he had to share; many of them could have been about me.

He opened his presentation by telling every single diabetes and healthcare professional in the room that “it is absolutely unconscionable what we ask people with type 1 diabetes to do to stay alive.”

Unconsionable: adjective; not in accordance with what is just or reasonable.

Yes, yes, and more YES! I’m paraphrasing here, but he explained that sustaining the constant counting and checking and pricking and poking and dosing and everything else it takes to live with diabetes is really not reasonable or realistic. He said, “Albert Einstein said that doing the same thing twice and expecting different results is the definition of insanity,” then added, “…except with diabetes.” A person with diabetes can do the same exact thing and eat the same exact foods for two days in a row and get totally different results. The best that can be hoped is that people with diabetes will do as much as they can.

Something that I’ve always appreciated about him, and the reason he is still my endo even though I am 32 years old (still a kid at heart people, don’t get it twisted!), is because of the perspective he shared at the end of his presentation. He said that in his practice, he refuses to tell a person with diabetes to “test” a blood sugar. A test you can pass or fail. A blood sugar check is just a check, returning a number that is neither good or bad, just possibly something that needs to be addressed. All these numbers that come with diabetes are just data. Just. Data.

What we have to do to live with diabetes may sometimes be unconscionable, but the numbers that we see staring back at us should never be that. We have to learn to use all of these numbers in our diabetes world to make decisions, and react to the best of our abilities.

That has to be enough.

Lying Sweet Potatoes

Never Trust A Sweet Potato

Wednesday was one of the hardest days with diabetes I’ve had in awhile. Well, at least since this day, which actually wasn’t that long ago. But anywho…

This episode began on Tuesday night, when I noticed that my blood sugar was stubbornly high after having dosed enough insulin to take down a small rhino. I thought I had dosed correctly for the sweet potato that I had for dinner, but apparently sweet potatoes put on a good show, with their sweet and seductive scent, but they are actually full of lies and half-truths when it comes to their nutritional info.

Lying Sweet Potatoes

This is a Public Service Announcement: Sweet potatoes are not to be trusted!

I woke up with a BG of 235 mg/dl on Wednesday morning, which I attributed to the fact that I probably didn’t dose enough before bed. Not a huge deal, go-go-gadget correction bolus, and it was off to work I went.

The correction bolus should have done the trick. Instead, my BG wavered a little, but mostly it just hovered in the mid 200’s all morning. For some, that isn’t that high and they can go all day long in that range and not be out of sorts. For me, it made me want to dig a hole and throw myself into it. I’m accustomed to numbers closer to the 90-100 range. I had a headache, I was nauseous, I felt like someone had replaced my blood with syrup, my insides ached, I had no energy, I wanted to go lay down, and all I could focus on was how awful I physically felt.

After giving the insulin plenty of time to work, and still being high, I corrected again. I wondered if maybe the morning BG spike had also included the dawn phenomenon, along with the errant sweet potato bolus, so maybe that was why my BG was being stubborn and not dropping down to normal.

I tried to get into working and distract myself from the awfulness I was feeling, and give the whole situation a little time to work itself out. Apparently it worked too well, because by lunch I had dropped down to 45, after ignoring my CGM alarm and then getting busy and forgetting about it. For future reference to you CGM-ers out there, don’t do that.

Lately I’ve been working through lunch, only to look up at the clock and realize it is mid-afternoon and I haven’t stopped to eat yet. Since I was at 45 and low brain had kicked in with full force, I quickly grabbed some chicken nachos for lunch. I figured there would be enough carbs in that to cover the 45, but not so many that I couldn’t easily manage a proper insulin dose for it.

I thought I dosed properly for it. I even looked up the nutritional info online. Still, I was back up to 245 by the end of the workday, and also back to feeling like someone had replaced my insides and physical well-being with frustration flavored Jell-O.

I remained sky high for the rest of the afternoon and well into the evening. By 8 o’clock that evening, I was physically ill. I thought I was dropping at one point, and that it was safe to eat and dose for dinner, so I had one serving of eggplant parmesan so I didn’t skip a meal and end up low again. Unfortunately, the eggplant parmesan had much more of an effect on my blood sugar than the insulin I had dosed to cover it.

I can’t say for sure, but I really think I spent all night and day dealing with insulin that had lost its mojo, its libido, its life force, its essence, its right stuff. What the French call a certain… I don’t know what.

Once I got home, I cracked open a cold one (a new vial of insulin, that is), refilled my pump, and my BG’s since then have been rock solid and right where they are supposed to be.

Moral of the story: Beware of skunky insulin. And never trust a sweet potato.

Diabetes Art Day 2011 - Family

The Big & Small of Diabetes

Diabetes is sometimes larger than life.

Big Prescriptions

There are all these really BIG prescriptions, written with really BIG pens.

Big Fingersticks

Then you've got all these BIG tests you have to take.

Big Pizza

Sometimes you get to eat really BIG food.

Big Shots

But then you have to take really BIG shots.

Big Success

And if you do it right, you end up a BIG success.

All the BIG things that go along with diabetes are important, but it helps to remember the small stuff too.

As A-Flizzle reports…

I think most people would consider me creative, but not artistic. I love crafts, but I also like detailed instructions on how to get it “just like the picture.” What can I say? I have OCD and am a type A personality to a tee. Nevertheless, I was very excited when Martin asked me to participate in Diabetes Art Day and make something that expressed how I feel about being a Type Awesome. I feel like the whole undertaking of the craft project brought us closer together and, of course, was so much fun!

Diabetes Art Day 2011 - Family
This is what I consider my “family” (featuring Martin’s dog, Hopper, but absent my dog, Bindi and Martin’s cat, Squirt) and how sometimes I feel like Martin is in a bubble with his diabetes, where he takes on too much all on his own and no matter how supportive I am (as evidenced by my “Good Job” ribbons) there will be some things I just can’t and don’t “get.” This is perfectly okay, but a hard pill for me to swallow, as I am a fixer and like to take care of people. In the end, I think we are both continuously working to pop the bubble and find a greater understanding that while it’s his disease, we are in this together.

Imagine - photo courtesy of Allison Blass

Imagine

Every Thursday night Diabetes Social Media Advocacy Live (DSMA Live) comes online, where various topics relating to diabetes are discussed. Last week, the special guest was Professor Jean Claude Mbanya, President of the International Diabetes Federation (IDF). He spoke about many diabetes advocacy and global diabetes initiatives that are going on worldwide, the most pressing of which include:

  • O is for Outrage
    The topic of the United Nation’s 2nd summit on global health issues is non-communicable diseases (NCDs), of which diabetes is one. Create a postcard right now to send to United States President Barack Obama, and ask him to represent us at the UN Summit on September 19-20, 2011. The IDF is taking care of all of the shipping costs. (P.S. – I don’t care what political affiliation you are or whether or not you approve of President Obama. This isn’t political. This is necessary.)
  • I Agree
    Do this now. Just click the “I Agree” link above. Just by doing that, you are telling the IDF, the UN, and the world that you support essential care for people with diabetes. People should not have to choose between starvation and living life with diabetes. Not anywhere.
  • Life For A Child
    Saving the lives of children in the developing world. As Professor Mbanya said in his time with us on DSMA Life, “No child should die from diabetes.”
  • World Diabetes Day
    November 14 is World Diabetes Day. Wear blue on this day, attend or host an event, and increase awareness of diabetes worldwide.

Something that really jumped out at me was what he shared about the stigma of diabetes, especially in less fortunate countries where oppression, starvation, corruption, overpopulation, and poverty reign.

Professor Mbanya shared with us the story of a man whom he met in a hospital that had four children, one of which was a daughter who had type 1 diabetes. Despite what help he could get from the hospital, the man was always sad and never smiled. One day Professor Mbanya went away on a trip, and when he returned and happen to run into the man, he was happy, and had a smile on his face. Professor Mbanya asked him, “Why are you so happy?” The man answered that his daughter with type 1 diabetes had died. Professor Mbanya, unable to understand why the death of a child would bring a smile to the father’s face, asked, “Then why are you smiling?” The man answered, “Professor, it was better that my daughter should die, so that the rest of the family can live, for when she was alive we couldn’t eat, the other children had to drop out of school, and now I have changed and put on weight because we are able to eat.”

Imagine.

Among some tribal people in the undeveloped world, diabetes is not viewed as a medical condition, or a sickness, or even a disease. It is viewed as a curse. Professor Mbanya explained to us that in those cultures, the family of a child with diabetes is viewed as having the disease as much as the child, where parents take their children and commit suicide or infanticide because of the profound negative stigma of diabetes.

Imagine.

In 1979, Chinese leader Deng Xiaoping enacted the One Child Law for urban areas of China in an effort to control population. The basic premise of the law states that couples are limited to only one child per family. However, if that one child develops type 1 diabetes, then an exemption is allowed so that the parents may essentially try again, because the expectation is that the child with diabetes will die.

Imagine.

Professor Mbanya said it, and I couldn’t agree with him more: “No child should die of diabetes. All children should have adequate access to insulin, monitors, supplies, and education needed to have a happy and quality life.”

Imagine.

Imagine - photo courtesy of Allison Blass

Photo courtesy of Allison Blass