Diabetes Rules

I may have mislead you all by the title of my post today. Opps! ;-) It's not meant to be "Diabetes Rules!" as in "Diabetes Rocks" but it's "Diabetes Rules" as in the rules to diabetes.

OK, so there aren't any "official" rules to diabetes, there are some very broad and general guidelines and there is a very good reason for this. It's because everybody is different and everybody's diabetes is different so too are the guidelines for each person.

So here are the rules I have come up with for myself, which are specific to when I'm having a bad day with Type 1 diabetes:

Always take your insulin.
No matter how you feel now, you will feel a thousand times worse if you don't take your insulin. Remember how ill you felt just before you were diagnosed. Yeah, that feeling will come back if you don't take your insulin.

Test your blood sugars regularly.
Now that you are taking your insulin like you should, it's time to look at how much you are taking. The best way to determine if you're taking sufficient amounts is to do some reconnaissance blood sugar testing. 

To check if you are taking the correct insulin dose for your meals and snacks, test your blood sugars before you eat and then again two hours after. If you want to check on how much basal insulin your body needs get some advise from your diabetes team. If they don't have enough advice for you, you can do some research on websites such as Diabetes Health or this website.

Use some form of carbohydrate counting.
There is quite a bit about diabetes management that you just cannot control or even measure, such as hormones, stress, illness. However, there are three elements of diabetes management that you can control and measure. They are insulin, food, and physical activity. If you know the quantities of insulin, food and physical activity then you can come up with some sort of system to work out how many grams of carbohydrate will be covered in a unit of insulin. My carb counting involves reading nutritional labels and weighting out the carbs.


And there you have it! Those three rules are my biggy's. Even if I'm feeling a little burnt out I make sure I don't waiver on these three rules for myself. I feel like if I just keep to my three "biggies" that I can keep from drowning in the diabetes doldrums and keep complications at bay.

After that, if I'm feeling a bit more positive, I troll through the many reliable diabetes websites and support forums for new information or a new way of saying something old that makes more sense. I also have my real life support group of people with type 1 diabetes who never fail to give me a kick-start. :-)

Updating to a new glucose meter:-)

Ahhh the glucose meter. What a wonderful invention! They've only been around since the 1970's but they have had such a huge impact on life with diabetes.

I remember my first one - I think it was a BD brand and it was about the size of an iPhone but twice as thick. I think I had that one for about 5 or 6 years. This is quiet a long time by today's standards.

Anyway, I have kept that trend up for almost 20 years - I very seldom change my meter. I know what I like and stick with what I know. Plus, it's really inconvenient to change.  In Ireland, people with diabetes receive all of their diabetes medications and supplies free from the Health Service Executive (HSE). The inconvenience comes from the paper work involved in changing your prescription for the test meter's strips and the lancet device's lancets (aka finger pricker).

However, I recently came across an ad for a glucose meter that had an interesting feature to me and decided I would change meter types after a gap of 6 years. I had the opportunity to have an upclose look at one at the Annual Diabetes Exhibition in Dublin last November and decided that it was worth the effort of changing.

I remember asking the sales rep how many strips came with the meter because I was probably not going to see my endocrinologist until March to get the prescription and I didn't to start using it until I had the supply established. She, helpfully, mentioned that my GP would be able to provide me with the script too. And yes, my GP is a little more convenient than my consultant but she seemed to assume that I would have a reason to visit him more often than my consultant. Truth is I haven't seen my GP since September when I had to bring one of the children in!

So, here we are at the end on January and my husband was heading into the GP, I gave him the note with the product information on it and he came home with a script for the strips.

Then within a couple of days, I sent the script with my Long Term Illness book to the Long Term Illness department of my local HSE offices. They update the book and a medical officer approves it and send it back to me. I got it back in the post within a week and a few more days later I had my new test strips and lancets.

It only took 3 months!

By the way, my new meter is the OneTouch VerioPro and I'll let you know how it does.

The media are coming...

World Diabetes Day is just over a month away. You may ask what is this day really all about? Well, in my opinion, it's main focus is to unite all those who have diabetes and all those who are involved in the care and treatment of people with diabetes and in unison we highlight the importance of being diabetes aware and raise some advocacy matters. "The campaign draws attention to issues of importance to the diabetes world and keeps diabetes firmly in the public spotlight." Source: (http://www.idf.org/worlddiabetesday/about)

As a result of this concentration of focus, there will be lots of media coverage on diabetes. Journalists will scurry to find people with diabetes to tell their stories and it will mostly focus on the hardships of living with diabetes of which there are quite a few. There will also be a lot of confusion that will result in people becoming annoyed because there will be failures to clarify diabetes types. Type 1 and type 2 diabetes will all be classified as diabetes.

Even though it's difficult not to get annoyed and frustrated with the media I urge people to express tolerance (afterall we didn't know a lot about diabetes ourselves before it came barging into our lives) - use this as an opportunity to educate the media about the differences. (Log onto this page for more information on the differences between type 1 and type 2, scroll to the bottom of the page). We, in Ireland, can use this opportunity to highlight the fact that with proper medical care and patient education people with diabetes can live better, healthier and longer than people without diabetes.

We can highlight the things that people with diabetes need but don't have in this country at the moment.

We can tell people that Irish children with diabetes deserve as much access to insulin pumps as those in the US or the UK and more diabetes education courses for their parents.

We can tell people that adults with diabetes need more efficient, better resourced clinics and more structured diabetes education.

We can let people know that all people with diabetes should get an annual eye screening to detect diabetic eye disease and prevent 1 person per week from going blind.

We can tell people that ALL pregnant women should be screened for gestational diabetes!

We can share our own stories.

 

Me-volunteer of the year???

Last week, I got a letter from Diabetes Ireland telling me that I have been nominated, along with 3 other people, for the Diabetes Ireland Volunteer of the Year award. I was quite taken aback and found myself getting a bit weepy.

 

I don't know who took the time to nominate me but I'm deeply grateful and humbled that you did.

 

I have so many emotions surrounding this nomination that it's taken me some time to identify them and to be able to articulate them.

 

Firstly, I'm overwhelmed that someone out there thinks kindly of me AND went to the effort of putting together a short essay on me!

 

I also feel a wee bit guilty for being nominated because I the personal reward for me has already been so great. Through volunteering, I have become a more confident person, very unlike the little mouse who sat at the back of the classroom hoping the teacher wouldn't notice me. I've learned that I'm capable of anything; all I need is an idea that I believe in, time and google.

 

I also feel a wee bit guilty because I originally got involved with Diabetes Ireland for selfish reasons. I wanted a diabetes support group for myself. The benefit of hearing other peoples diabetes stories has been ten-fold for me. They are my role models.

 

I'm a bit embarrassed because some of the things I've done in diabetes I only did because they needed to be done; kind of like emptying the dishwasher.

 

I think most people who volunteer don't do it to win awards, myself included, but every now and again it's nice to hear a "thank you". I look forward to meeting the other 3 nominees and hearing their diabetes stories.

 

The winner will be announced at Diabetes Ireland's Annual General Meeting which will be held in the Burlington Hotel, Dublin on Sunday 11th November at 12.15pm.

 

P.S. There are a lot of others in Ireland who volunteer to raise awareness about diabetes, fight for a better health service for us and who fund-raise like mad to make sure that Diabetes Ireland can keep up the fight. I thank you for your work.

Losing Faith!!

The Health Service Executive (HSE) is making headlines again but then what's new. It's so frustrating that nothing has changed in the six years since I moved back to Ireland.

The optimists among us would probably say that we just have to find a new way to show the rule makers that they need to change the way they do things. We, the advocates and activists, have to constantly change our methods yet the rule makers don't. Why can't we just launch a rolled up piece of paper from a rubber band into their faces and say "WAKE UP!' Oh yeah, that's been outlawed:-(

I'm exhausted from all the changing... and I don't even do that much to advocate apart from raise my voice or send an email when I'm asked. I can't imagine how frustrated the guys are that actually have to sit down and negotiate with this crowd and make nice with them.

I'm so fed up of hearing about how inefficient and under-resourced the health service is in Ireland. It's been that way for decades! I'm fed up of hearing how it's the minister's fault!  I'm fed up of the HSE blaming the department of Health! I'm fed up of the minister making promises and then being stonewalled when trying to deliver those promises. I'm fed up hearing about negotiations with unions when efforts are being made to improve working conditions; a better service means happier workers. I'm fed up hearing about how the HSE staff can't change anything because of the hiring freeze! All we hear from them is "I can't".

Well people, I think it's time some of you read "The little engine that could".

Is it really that difficult to straighten out a health service? Is it rocket science? Is it really about lack of money?

I'm not asking for a perfect system here, just one that works reasonable well.

People of the HSE, all of you, stop blaming each other and fighting with each other! GET THE JOB DONE AND STRAIGHTEN IT OUT!!!

Carb Counting

At our last Type 1 diabetes support group meeting we talked about carbohydrate counting, commonly referred to as carb counting.

The group was made up of people who practiced carb counting, people who kind of practiced, people who knew about it but didn't know where to start and some who never heard of it. We were a motley crew.

The topic was introduced by stating that carb counting has been around for a long time in one form or another. When I was diagnosed in 1993 I was introduced to the Exchange List. This was a list of commonly eaten foods such as bread, weetabix, that contained roughly the same amount of carb. For example 1 slice of bread contained approximately 15 grams of carb as did 1 weetabix. The idea was that if you had weetabix for breakfast in the mornings and fancied a change you could switch it for toast.

In today's world we can do carb counting by either weighing our food in grams or using the unit Carb Portion (CP). It's a bit more precise than the exchange list.

We, then, discussed today's methods of carb counting and what exactly it is. "Carbohydrate counting is a method of matching your insulin requirements with the amount of carbohydrate you eat and drink."

If you take insulin, you can use carbohydrate counting to decide how much insulin to take.

The benefits that carb counting can give you are:

· May lead to better blood glucose control and greater flexibility and freedom of lifestyle.

· May be able to predict your blood glucose response to eating different foods and drinks.

· Eat according to your appetite.

· Enjoy a wider variety of foods.

· Enjoy restaurant and takeaway meals.

 

The only disadvantage to carb counting the group came up with was that you really have to put great deal of time and effort to get those benefits.

Where do I learn more if you live in the Mid-West?
 

· The dietitian at your clinic or any registered dietitian who is knowledgable in Type 1 Diabetes.
 

· DAFNE (Dose Adjustment For Normal Eating) courses http://www.dafneonline.co.uk/DAFNE is a structured education course delivered in a five day intensive skills based education programme to people with Type 1 Diabetes. In this course, people learn how to adjust their insulin dosage to suit their free choice of food, rather than having to work their life around their insulin doses. DAFNE aims to encourage and equip people who have Type 1 diabetes to manage their insulin regimens actively and independently. This course is available only to patients who attend the Diabetes clinic in University Hospital Galway.
 

· BERGER course The Berger Programme is a comprehensive diabetes self-care skills course, named after Professor Michael Berger, the eminent Endocrinologist who recognised the value of teaching people how to adjust insulin to match their daily food intake. This programme is designed for people with Type 1 diabetes. People attending this course learn how to adjust their insulin dose depending on their food choice. The course also focuses on enhancing diabetes self-management skills. This course is run in St. John’s Hospital Limerick 061/462271
 

· BRUCIE - Better Regulation Using Carbohydrate and Insulin Education BRUCIE is an education programme aimed at providing adolescents over 12 years with diabetes the skills to understand the relationship between food, blood results and insulin dose adjustments. The workshop is based on developing practical skills and involves gaining a greater understanding of the effect of diet on their blood glucose levels. Education sessions on carbohydrate counting are also provided for parents of adolescents who attend BRUCIE. A joint session with adolescents and parents is provided at the yearly follow up. BRUCIE is delivered by the diabetes Dietitian and the Advanced Nurse Practitioner in diabetes. This course is available to patients who attend the Diabetes clinic in University Hospital Galway.
 

· Private Carb Counting Course by Kelly Johnson. The cost of the course is €150 for two full days. Contact information: mobile number: 086 8117676. She is hoping to run a course on 29^th Sept and the 6^thOctober.

 

If you don't live in the Mid West you can find out about carb counting courses from your diabetes clinic or from the DAFNE website.

 

Weighed down by weight issues

I'm getting old! Yep, I'm having that life crisis that happens to even the most optimistc of us as we approach those birthdays that end in zero.

Anyway, this summer when I was trying to squease into the seasonal outfits I thought to myself, "why not just tackle that stone or two once and for all". Wishing for it to happen doesn't make it happen, does it?

My diet is fairly decent; it does have some flaws but nothing catastrophic. I've always trimmed out the fat except for my little treat after my dinner every day which I will not give up! Never! So where the calorie intake is concerned I've decided to cut down on portion sizes and increase portions of salads and veggies.

My next step is to review my calorie output. Exercise! Auck! I already do a 30 minute brisk walk Monday through Friday. So in an effort to add to that I delved into "The I hate to exercise" book for people with diabetes to look for inspiration.

Now this book has been sitting on my shelf untouched for about 18 months. And if I'm honest the other reason I picked it up was because the previous book I read was so good that I would stay up until the wee hours reading (I needed some sleep).

I open it  and the first line is "well done, you've opened the book". At first, I laughed and patted myself on the back but when I thought about why I was reading it, I stopped laughing. I felt a bit ashamed but then I decided to laugh again. Why not?

So, well done me! I read the whole book. Surprise, surprise. there were no magic cures or quick fixes contained in it because there are none with weight loss. The book was really not targeted at me. It's really written for people who have not included exercise in their lives and may be more advanced in age.

My new next step is to carry on with my reduced carb portions and my 30 minute walk from now til December. Live life as best I can and not to get so weighed down (pun intended). I'll let you know if it works. I will say my blood sugar readings are looking very good with these reduced portions. One step/one day at a time:-)