You’re Fat and it’s Your Fault!

Posted by on Feb 23, 2016 in Exercise & Lifestyle, General |

Got your attention, didn’t I? Before anyone gets all tied up in knots ready to behead me for my apparent rudeness and lack of sympathy, I don’t agree with what the title says. This was just my attempt at click-bait because I feel that this subject needs to be addressed from another point of view.

The website Upworthy recently posted a link to an article that talks about a study that was done at the University of Pennsylvania funded, in most part, by the National Institute on Aging. This study looked at the idea of “fining” fat people if they didn’t exercise. Wow. Apparently the study was trying to look for ways to motivate people to become healthier and thinner. But here’s the thing: weight isn’t the best indicator of health. There are many overweight individuals who are otherwise healthy and many thin people who are horribly ill. The idea that we can tell someone’s health by just looking at them is ludicrous and yet that is what most people will do, including many doctors.

While this subject isn’t specific to those of us with type 2 diabetes, it is certainly closely related. We all know of the stigma that is attached to our disease and it is continually perpetuated in the media and medical communities. The fact that this study was even done is very telling. You want to fine fat people for failing to exercise? Really?

Now let’s look at this from another perspective. Lack of added exercise is a HUGE problem in our society (and that pun was not intended. Lack of exercise is a problem for everyone, not just the overweight). Our hectic lives, jobs that require us to sit for hours a day, cities that are designed for cars and not people, the Internet and exhaustion have all made it easier to just not exercise. But we should exercise, in fact I’ll go further and say that we must exercise! Really! I’ve posted on my personal blog before about how exercise has benefitted me. I also know how difficult it is to keep it up when life gets in the way. I’m not here to say that it’s easy but it is worth doing.

Here’s what gets under my skin about this study and what it implies. Quit pointing at fat people and saying that they’re a problem! (I should have used caps.) People who are overweight are vilified as being lazy and saying that we should fine them for not exercising is indicating that they’re stupid and need to be tricked into walking like some toddler who won’t pick up their toys. YES, overweight people should exercise. YES, it will benefit their lives. NO, they’re not the only ones who should be moving. I’m not implying that overweight people should be coddled and patted on the head while telling them that it’s not their fault. Maybe it is and maybe it isn’t. Exercise is hard. Exercise is even harder when you’re heavy. Should we condemn people who are struggling with this? I don’t think so. Another very important thing to consider is that there are many medical reasons that people are overweight; insulin resistance has been shown to encourage fat storage, thyroid issues, medications can cause weight gain and the realization that processed carbs are addicting is rarely discussed in the mainstream.

So, what should we as a nation do to fix this issue? How about figuring out a way to re-teach our society about the importance of eating real food as opposed to processed junk? How about subsidizing vegetable farmers (other than the corn growers) in order to decrease the cost of vegetables? Community cooking classes and vegetable gardens sound awesome. Why can’t communities put some bucks into making it easier to walk instead of drive? What about having employers put programs in place that encourage their employees to exercise while at work, you know like a room with a few treadmills like you see at hotels or a mandatory 20 minute stretch or walk break with extra kudos for taking the stairs? People don’t need to be bullied or shamed in order to improve their lives, that doesn’t work! People need to be shown what a healthy life looks like and be given the opportunities and information to make it possible for them to achieve that health. Yes, overweight people should be exercising and so should everyone else. The reward will be healthier individuals who are happier with their lives. That is worth much more than a few pennies in their pocket and it can be done without shaming. Quit pointing at the overweight as the problem and begin solving the real problems facing all of us: lack of real opportunities to improve everyone’s health. Let’s find ways to encourage each other instead of blaming and shaming. I can get behind that.

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Let’s Talk About Complications

Posted by on Dec 30, 2015 in Management & Care | 2 comments

diabetes07A couple of years ago I had the opportunity to participate in a virtual summit with some members of the DOC. When I received the invitation from Scott Johnson to join him and some people involved in Pharma and social media, at first I wasn’t sure I would fit in the group; there was to be a discussion about Diabetic Neuropathy and my reaction was “Well, I don’t have that… What kind of input could I possibly give?” —But I said yes, anyway; the conversation was eye-opening and it left me with a lot of bittersweet feelings.

I was rather grateful to be able to say that I’m free of complications, and then it hit me. Just because I’m complication-free now, it doesn’t mean the future doesn’t hold any challenges. And how well informed am I about these complications? I wouldn’t put myself in the completely ignorant category, but I’m definitely very close to it. What I know is very vague, very superficial, and usually tainted by the sensationalism of the media. Nobody wants to learn about diabetes and what it can do to your body when the first thing you see is a horrendous photo of a sick foot that most probably needs to be amputated. That’s fear-education and I avoid it like the plague. The sad part is that at some point I end up avoiding it ALL.

How many of us can say that, unless we get diagnosed with something, we actively go and look for information on a certain condition, especially a complication from diabetes? I certainly can’t! I go for my eye exam every year and I’m all happy when the doctor tells me my retina is the most beautiful thing he’s ever seen, and I leave it at that. I don’t worry about it for another year because I’m almost convinced that I’m doing all the right things to control my diabetes. After all, no complications means good control. Ummm… No, not really. We all have different bodies and this is what we were talking about last night. Some people can spend years without paying attention to their blood sugars and develop no complications. Some others can pay attention to every single thing they do and still get them.

And that is why we all should be open to:

1) learn about complications
2) talk about complications
3) approach it from an educational point of view
4) discuss it like patients, not like pharma, doctors or the media

How do complications of diabetes make us feel? What would happen if we got one? Are we prepared? Do we know how to recognize symptoms? Let’s put neuropathy as an example. I was one of those people who thought neuropathy = pain. I was wrong. It turns out I could have diabetic neuropathy as of this very moment and be completely unaware of it. Why? Because the symptoms are vague and can be related to many other conditions. Orthostatic hypotension? I have that… and it’s a symptom! Yes, quite shocking. It may not be neuropathy, but at least now I know I should pay more attention to the things my body tells me.

So, the same way we advocate for finding a cure and talk about our rights, we should be working on discussing complications openly to get rid of the stigma created by the media and other misconceptions. Knowledge is power. Shared knowledge is power.

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BG Testing… 1, 2, 3

Posted by on Dec 29, 2015 in Management & Care |

Originally posted on Diabetes Daily.

getty_rf_photo_of_woman_checking_blood_sugarThe first time my endocrinologist told me I was doing so well managing my blood glucose levels, I only needed to test them 2-3 times a week, I laughed… hard… I looked at him with a big “REALLY?” stamped on my forehead. He assured me it was okay, so I thought it was okay.

Guess what? It isn’t okay!

In 2008, I worked for a company that sold diabetes supplies and delivered them in the mail. While I tried to appreciate the experience for what it was, and did my best to keep my compassionate and caring attitude toward the customers, I got burned out pretty quickly. Among the many things that made me unhappy about that job was the absurd insurance companies’ policies when it came to the limit on test strips.

Insurance companies in general oversimplify something that isn’t simple at all. Their perfect equation goes something like this: you use insulin, you test 3 times a day; you don’t use insulin, you test 1 time a day. And good luck with that! Forget the highs and the lows during the day, and just guess what your food can do to your glucose levels before you put it in your mouth. Easy, right? No.

I speak from the perspective of a person with type 2 diabetes who doesn’t use insulin. Most of the time, I’m just praying to the gland gods to behave when I eat. Many times I don’t even pay attention and have the negative thought train about dying any day, anyway, so why bother? And you know why that is? Because I was told it was OK to test only 2-3 times a week… so the rest of the time I’m completely oblivious.

It’s really hard to get into a blood glucose testing routine when you’re advised to do it so randomly. If you choose to stick to that necessary routine and use more test strips, good luck paying for them out of your pocket. I’ve gone without testing for long periods of time, mostly as a personal choice (irresponsible choice, I may add), and let me tell you that not knowing your numbers isn’t a good thing. Especially when you rely on food choices; sometimes even the healthy stuff may play a bad trick.

So, how do you know? By testing your blood sugar more often!

If you’re not testing often because you believe that people with type 2 diabetes shouldn’t test that often, consider talking to your doctor about increasing the amount of test strips in that prescription. Knowledge is power. It’s frustrating not to know where you’re going to land when you jump. And testing often does help you make better choices.

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We All Hate the Word “Compliance”

Posted by on Dec 28, 2015 in Diabetes & Emotions, General, Management & Care |

Compliance
noun  |  com·pli·ance  | 
:  the act or process of doing what you have been asked or ordered to do
:  conformity in fulfilling official requirements
:  a disposition to yield to others

Keyword being ordered. Really? You gave me an order? Do doctors give us orders or recommendations? I prefer recommendations. Maybe I’m a rebel, maybe I question authority more than I should, maybe I’m adult and I only follow orders from my boss—and sometimes from my Mother. Who knows… but the word compliance has been thrown at me so many times by my primary care doctor, and it only adds to another fancy word we love in the diabetes world: guilt. I don’t like the word compliance when it comes to my diabetes; the doctor tells me I’m not compliant and I feel like I’m going through disciplinary action.

But why do we hate the word compliance so much? A few guesses for me…

  • Managing diabetes involves so much more than following a bunch of instructions from your doctor. Of course they know what you’re supposed to do, they went to school for that crap! I respect my doctor, and her knowledge, but when she talks to me like I’m a robot… that is not cool. I’m not a kid, stop telling me I didn’t do my homework correctly.
  • If you deal with not only one, but two or three (or more!) chronic conditions that require day to day tasks, it can get pretty overwhelming. Sometimes you forget your medication, sometimes your life is so hectic you don’t prioritize too well, sometimes you just want to say eff it. Or at least that’s what happens to me. Is it good? Nope, but hey… sh*t happens.
  • Depression, especially the clinical one, makes you not care… not one single bit. You’re down in the dumps and taking care of yourself is at the bottom of your priority list. You feel like you’re going to die anyway, so why bother. So asking about mental health should be the first thing any doctor should do with a patient that requires a constant regime for any kind of condition.
  • It’s not that we don’t want to do the right thing. DIABETES JUST SUCKS! So the doctor telling me I’m not compliant leaves out the fact that 1) I’m a human being, not a machine; 2) I’m not perfect; 3) I’m freaking tired of poking myself; 4) I just want to feel normal without all the hocus-pocus.

So no, it’s not only about following orders, or fulfilling requirements. The emotional component of diabetes makes it way more complicated than that. And like my good friend Bennet would say, your diabetes may vary. A set of rules and regulations for conformity, which I associate with the word compliance, is not what we need. We won’t conform… it’s not that easy. I want my doctor to work with me on a plan that works for me. I want my doctor to ask me how she can help me achieve my goals, not hers.

Because I don’t want to be compliant… I want to be successful!

 

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Type No Type

Posted by on Aug 22, 2015 in General |

(C) Diabetes Ramblings

(Originally posted at Diabetes Ramblings.)

There are times in diabetes advocacy that it feels like we’re fighting ourselves. “That’s the other kind of diabetes” should not ever come between us and diabetes advocacy.

During last month’s MasterLab, I heard several times the sentiment that we need to put the “types” aside and focus on *everyone* with diabetes.

We need to take that energy that is wasted in arguing amongst ourselves and channel it in helpful ways.

We need to work together for better access to the treatment and supplies each of us needs to manage our diabetes. Even people with the same type have different needs. I may only need a glucose meter at this time, but my mom needs a meter and medication. We both have Type 2, but our needs are different.
Even if we get the tools we need, like a glucose meter, we may not receive necessary supplies to go with it. Giving someone only one test strip per day does not give him/her the ability to adequately use that meter for diabetes management.
When my doctor prescribes what I need to manage my diabetes, the insurance company shouldn’t be asking what type I am. They only need to know that I have diabetes and this is what I need to manage my disease. Why shouldn’t a Type 2 diet and exercise controlled elementary school teacher who can’t stop to test while teaching six and seven year old children receive a CGM (continuous glucose monitor)?

Since each person’s diabetes management is unique, it really doesn’t matter what type the person is when determining what is needed for successful diabetes management. Let’s look at the person and the needs, not the type. This is not a one size fits all disease. Not for diet, not for test strips, not for medication.

To borrow from a made for TV movie, “We’re all in this together!”

Thank you to Mike at My Diabetic Heart for designing this No Type image and Lizmari at The Angry Type 2 Diabetic for artistic input.

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The Endo Encounter

Posted by on Jul 21, 2015 in Diabetes & Emotions, General, Management & Care, Treatment & Medication |

(Originally posted at My Diabetic Heart.)

So, last week I had my first appointment with an endocrinologist.  For the last six and a half years, my diabetes care has been overseen by my primary care doctor, but due to some struggles I’ve had and changes that I wanted to make, we agreed it was time for a referral to an Endo.  Initially, I was excited about the change, but as the appointment grew nearer, my nerves got the better of me and panic set in.  I was Expecting the Inquisition.

Well, I survived that appointment.  In fact, it went much better than I feared it might.  I do have some reservations about it, but I’ll get to those in a bit.  First, the good parts.

Doc D. is a young guy, maybe 34 years old at most.  I’m 31, so we’re close in age.  He was attentive, listened, and took the time to get to know me and my situation.  He asked a lot of questions and documented my responses as we went along.  I appreciated how thorough he was, and the fact that he took the time to process my information and put his recommendations in writing before he tried to explain his thinking behind them.

He revised my meal time insulin regimen, giving me a coverage plan that is more logical and better suited to my needs.  That should help a lot.  He left my Lantus and Victoza doses alone.   He also prescribed the oral type 2 drug Jardiance for me to try, and suggested that I add a coenzyme Q10 supplement to help strengthen my heart and increase my energy levels.

Doc D. also said he wants to check my pancreas output with a c-peptide test.  He was a bit surprised that I’d never had one.  And since he was ordering tests, I requested that he order GAD65, IA-2, and insulin auto-antibody tests while he was at it.  I practically begged my PCP to run those tests, but they were never done.  Now, they will be.  So, I have that bloodwork to look forward in two months.

He took his time and didn’t rush through the appointment.  That was huge in my mind.

And…. AND…. There was no mention of my weight at all.  Let that sink in for a second… The doctor did NOT focus on my weight at all.  I’m really not use to that.  I was honestly kind of shocked.

His focus was more on nutrition.  Eat better, the benefits will follow.  Hey, I agree with that logic.  I know it works.  But the means of getting there are where some of my reservations begin.

Doc D. is something of a paleo diet evangelist and strongly “encouraged” me to adopt that diet and to severely restrict my carb intake.  He wants me to give up a lot of things that I’m just not sure I’m willing to ditch completely.  I have a real problem with having to deprive myself of the things I love, and I have no desire to go back to starving myself like I did for months after I was diagnosed.  While the results at that point may have been beneficial for a while, it ultimately lead to a major crash and burnout.  I don’t need that again.  I’m willing and wanting to make some changes, but I’m not sure the paleo diet bible is one that I’m willing to thump.  And I’m certainly not going to be beaten over the head with it.

The other major reservation that I have concerns the drug Jardiance that I mentioned above.  I had never heard of it, but through some research I’ve learned that it’s basically Lilly’s version of Invokana.  It’s an oral type 2 drug that is supposed to help my body dump excess sugar when I take a leak.   I’ve heard mixed things about that class of drugs and I’m incredibly leery about starting it.

I have two issues with this.  One, yeast infections are listed as common side effect of this medication.  If you’ve read my story, you know that’s what lead to my diagnosis in December 2008.  It’s understandable that I wouldn’t want to venture down that road again.  Secondly, do I really need another medication on top of what I’m already taking to treat my diabetes?  I’m already taking Victoza, Humalog and Lantus.   I think that’s enough. And I’ll spare you a rant about the additional monthly cost of that medication and the CoQ10 supplement.

So overall, the appointment went well.  I have some strong reservations about some things, but there were some really positive things that came out of it.  I’ve got some clearly defined goals to work on as far as my A1C goes, a better insulin regimen, a new supplement that seems to be helping to boost my energy, and hopefully a doctor who will be the same at the next visit as he was at the first.  He listened, he was thorough, and didn’t leave me feeling judged.  I see him again in September.

Time will tell.

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Diabetes Advocacy Has an Easy Button

Posted by on Jul 16, 2015 in General | 2 comments

(Originally posted at Diabetes Ramblings.)

Do you want to get involved with diabetes advocacy but just don’t have the time?

As a busy mom of five, teacher, and recent masters graduate, I understand this completely!

Please let me introduce you to Diabetes Patient Advocacy Coalition! This is the diabetes advocacy easy button.

As stated on their site, “Join Diabetes Patient Advocacy Coalition to easily help keep policy makers’ attention on people with diabetes. Once you’ve joined, we’ll keep track of issues, opportunities, and how to contact officials. We make it easy to for you to advocate while giving you the opportunity to tell your own story.”

It doesn’t matter what type you are. Type 1? Type 2? LADA? MODY? Diabetes issues affects us all. This site makes finding the issues and who to write to easy. Add a little personalization to the letter and hit send.

As a famous office supply store likes to say, “Well that was easy!”

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