New Doctor Blues

Posted by on Aug 14, 2013 in Management & Care | 2 comments

This is one song I think most people with diabetes know.

My primary care physician, who I really worked well with, left the clinic at which I saw her. My understanding is that she’s looking to start a new clinic, but in the meantime I have to see another doctor at the same clinic. If I like him, I’ll probably stay with the clinic, which is a good fit for me in several ways.

My first appointment is tomorrow morning. I’m somewhat nervous. In fact, I’m double-nervous: I have diabetes-checkup nerves AND new doctor nerves.

I’ve got the normal pre-appointment jitters about the normal stuff. What will my numbers be like? Will I need a change in treatment plan? Has all the walking I’ve done helped with the HDL cholesterol? Will I get a good answer to the question I hope to ask?

But the new doctor brings a different set of worries. Will I like him, and will he like me? Will I feel like his next appointment is more important to him than I am? Will I be judged for my obesity? Will I be judged because I don’t test often enough? Will he be open to my desire to participate in treatment decisions?

To be honest, the new-doctor worries actually weigh more heavily upon me than the pre-appointment worries. If the appointment goes well, I’ll feel good about staying with that clinic. If it goes badly, I may be on the hunt for a new clinic to go to.

I don’t much care for “The New Doctor Blues”. I sure seem to know the words, though.

 

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Cookbooks and Care Plans

Posted by on Aug 3, 2013 in Exercise & Lifestyle | 2 comments

Cookbooks and care plans are both very individual things.

I own quite a few cookbooks, and I’ve looked at many, many more. Most of the cookbooks I’ve seen, even the good ones, aren’t a good fit for me. Even cookbooks with well-written recipes may not match my skill level, or important ingredients would be pricey or hard to get, or I just don’t particularly want to cook eat the food?

Plans we make to maintain or improve our health are the same way. There are some basics, such as actually being healthy. You don’t want food plans that aren’t good for you or exercises likely to injure you. But our circumstances vary so much that plans have to fit us, or they just won’t work. A good example from my life is exercise. I’ve tried many things to increase the exercise I do, and most of them have failed. My strong distaste for changing clothes in a locker room make gyms impractical. I can’t make myself do calisthenics for more than a few days. Playing a competitive game like volleyball or basketball leaves me feeling inadequate and ashamed of my lack of athleticism, even just playing among friends.

In fact, the only physical activity I know that I enjoy doing is walking. So, a few years ago, I began walking to and from work each day: the round trip takes me about half an hour. That made for a good start, but the various goals I’ve set to go beyond that just haven’t gone anywhere.

If you’ve read other recent posts, you may know that this has changed for me. In recent months, some of my friends have been talking about a pedometer that syncs online. (I’m not naming it because the tool I chose isn’t the point here.) The ability to work towards both daily and cumulative goals appealed to the gamer in me, especially since it didn’t require manual logging. This particular gizmo has proved thus far to be very helpful for me, and I’m now waking between 60 and 90 minutes every day. I could accomplish the same thing with a cheap pedometer and a notebook … but I haven’t. That’s like a recipe that’s great in every way except that I just don’t want to cook the dish it describes.

So, having found one plan that’s working for me right now, I’m looking for the next step. I want to establish a short daily stretching routine, and I’d like to add just a little bit of strength training. I need to remember to keep the goals small: if my plan feels like a burden, the plan isn’t sustainable. I also have to be willing to adjust a plan that’s not working rather than stopping completely. A plan for exercise or eating that I don’t follow is as pointless as a recipe I never make.

Whatever you choose to do, be it a care plan or a cookbook, your plan has to fit you.

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Bob’s Diagnosis Story

Posted by on Jul 26, 2013 in Diagnosis Stories | 2 comments

This is an edited version of a post that appeared on my on blog in 2010.

I almost always find diagnosis stories to be interesting. For many people, diagnosis results from some sort of crisis, whether it be a life-threatening high, the onset of complications, or just a doctor’s visit resulting from persistent fatigue or other early symptoms. I was a little luckier.

About six months before I was diagnosed, I began experiencing the classic symptoms of thirst and frequent urination. Like many folks, though, I didn’t really think of the thirst as being unusual – it was the bathrooms trips that kinda bothered me. Did I secretly suspect the truth, down in my heart of hearts? Yes — or, rather, no: the ‘truth’ I was hiding from was my suspicion that I was developing prostate problems. The thought scared me, though – my dad had had prostate surgery – and I took no action.

A couple of months before diagnosis, I had an opportunity to join a weight loss program at my workplace. I made some pretty big changes: I quit drinking sugared soda (boy, had I been guzzling that!), generally ate more sensibly, did some exercising, and lost about 20 pounds. (Alas — they didn’t stay lost.) Guess what? I also quit living in the bathroom, and I now know that I pretty much stopped having symptoms. So, when I went in for my physical, I just expected a pat on the back and encouragement to keep going.

Perhaps because I had a type 2 father, the doctor must ordered an A1c as part of my blood work. (The prostate was fine.) A couple of weeks later, when I got home from work on a Friday, I had a letter (!) informing me that I had diabetes and that I needed to make an appointment for a follow-up. (I learned later that my A1c had been 9.5.)

At that time, I had no idea as to the changes that letter would bring into my life.

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Guest Post: When Metformin Can’t Do It Alone Anymore

Posted by on Jul 20, 2013 in Guest Posts, Treatment & Medication | 3 comments

Our first guest post has been supplied by my cousin Christy, who writes hare about a recent medication change. — Bob

I’ve been T2 diabetic for a long, long time. I’m sure I was “pre-diabetic” for several years before an appendectomy and subsequent post-operative infection threw me over the edge into full blown Type 2 diabetes. I was sent to diabetes education classes and put on metformin. That was around 12 years ago. Metformin did a fine job taking care of my diabetes for me with very little effort on my part. My A1C was always in the 6.0 range, fasting sugars were in the 120-130 range, blood pressure, cholesterol, triglycerides all near normal (with applicable medications doing their job).

A few months ago, my blood pressure began creeping up, and my blood sugars, fasting or not, began to creep higher and higher, and I began to gain weight. My A1C jumped to 7.1 in less than 6 months. Exercise didn’t help. I felt so sad, knowing that I have not done everything I could do to control my diabetes (let’s be honest – not much at all), instead, depending on the metformin to do it all for me. I met with my doctor, and he advised that not only is diabetes progressive, but that metformin eventually loses its effectiveness. He said most people get 2-3 years before they have to add another medication to their metformin regimen. He started me on Victoza along with the metformin. I am amazed how fast Victoza has brought down my fasting sugars, and I can’t wait to see what my next A1C is. If I overdo it on the carbs, the next morning glucose numbers are noticeably higher, but not like they were before.

The lesson? Even though Victoza seems to be the new answer for me, I don’t want to take it for granted like I did metformin. I’m extremely grateful for the number of years metformin worked well. I’m hoping with the addition of Victoza, better diet control, exercise and going to the monthly diabetes support group, I won’t have to go through this kind of frustrating scare again.

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Motivation and Effort

Posted by on Jun 21, 2013 in Diabetes & Emotions |

Life is full of ideas that most of us just accept without examining them or even being aware of them. Here’s one:

“You can do anything if you want to badly enough.”

This idea is what leads some doctors to try to instill fear in their patients. The approach would even seem to have some merit, because some people do respond to a disease diagnosis or serious warning by making significant and lasting changes.

Before we look at whether this idea is really true, let’s flip it around:

“If you can’t do something, it’s because you don’t want to badly enough.”

Here is where our idea starts to become dangerous. I’ve spent a lot of time over the years either feeling guilty that I wasn’t sufficiently motivated to lose weight, trying to psychoanalyze myself to figure out why I wasn’t sufficiently motivated, or trying to artificially pump myself up to a higher level of motivation. None of this has helped in the least.

It seems to me to be useful to break our idea into two ideas:

“Greater motivation produces greater effort.”

and

“Greater effort produces better results.”

Both of these statements are suspect, but let’s concentrate on the first one. Does greater motivation lead to greater effort?

There are at least two things that can get in the way of motivation producing effort. The first is when we either do not know what action we could take to move us forward, or we don’t believe that the possible actions we know about would be effective. The other is that though strong desire can spur us to action, it can also paralyze us.

People differ in how they respond to crises. I myself too often responds to a crisis with both mind and body seeming to shut down. Even in a situation that is not a crisis, strong feelings about something that I want to do seem to strangle clear and creative thinking. I have to find a way to view the situation more coolly before I can make progress. This is part of why I think it is dangerous to try to use fear to motivate others.

I once read a friend’s concern for a relative that had been recently diagnosed with type 2 diabetes. This relative was not testing his blood, was not making needed changes in his diet, and was not doing the exercise which would have benefited him. It may indeed have been, as my friend assumed, that the relative did not understand his situation and was therefore unmotivated. But, it may also have been that he did understand his situation but was frightened past the point where he could take effective action.

If there are changes that we want to make in your self-care that we can’t seem to pull off, it may not be that we don’t want to change badly enough but that there are other barriers we need to find our way around.

 

 

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