Trying to contain the epidemic on the eve of Diabetes Awareness Month
I could be snide and say, "Well, that only took a million years" or I could be thankful and say a lot of patients should now live longer with less complications.
In an article, "New Major Changes in Recommendations for the Treatment of Type 2 Diabetes by ADA and EASD" that appeared in DiabetesInControl, an online newsletter for health professionals, the ADA has issued new recommendations for treating type 2 diabetes more aggressively.
What motivates the change appears to be the conclusion, "that much of the morbidity associated with long-term microvascular and neuropathic complications can be substantially reduced by interventions that achieve glucose levels close to the non-diabetic range. Although new classes of medications and numerous combinations have been demonstrated to lower glycemia, current-day management has failed to achieve and maintain the glycemic levels most likely to provide optimal healthcare status for people with diabetes."
Translation: Yea, we got new medicines to keep blood sugar in control but most people's blood sugar still isn't in control.
So new ADA health-care providers therapeutic recommendations are to speed the introduction of insulin:
Step 1 -- Lifestyle intervention and use of metformin because of its effect on glycemia, absence of weight gain or hypoglycemia, good tolerability profile and relatively low cost.
Step 2 -- Add another medication, either insulin or a sulfonylurea, within 2 to 3 months of starting step 1 or at any time when target hemoglobin A1c level is not achieved or if metformin is contraindicated or poorly tolerated. For patients who have hemoglobin A1c level of more than 8.5% or symptoms secondary to hyperglycemia, insulin is preferred, typically a basal (intermediate- or long-acting) insulin.
Step 3 -- Further adjustments by starting or intensifying insulin therapy with additional injections that might include a short- or rapid-acting insulin given before selected meals to curtail postprandial hyperglycemia.
David M. Nathan, MD, from the Diabetes Center of Massachusetts General Hospital in Boston says, "The epidemic of type 2 diabetes and the recognition that achieving specific glycemic goals can substantially reduce morbidity, have made the effective treatment of hyperglycemia a top priority." Hmmm...it wasn't before? Oops, there goes my snide side. Hard for a type 1 to fathom the laxity in treating type 2 diabetes. "Maintaining glycemic levels as close to the non-diabetic range as possible," continued Nathan, "has been demonstrated to have a powerful beneficial effect on diabetes-specific microvascular complications, including retinopathy, nephropathy, and neuropathy, in the setting of type 1 diabetes; in type 2 diabetes, more intensive treatment strategies have likewise been demonstrated to reduce microvascular complications."
We can only hope physicians will know the new recommendations and patients will get effective treatment. If I were a type 2 I'd ask my health care provider for the best treatment to control my blood sugar to normal levels, whether it's with a pill or a syringe. For most of us, it'll mean more years on the planet and spending them happier and healthier.
This past Saturday the Diabetes Research Institute Foundation (DRIF), the premier organization seeking a cure for diabetes, had a one day conference in Manhattan that I attended. The day consisted of presentations and workshops providing an overview of research findings on islet cell transplantation and regeneration, and tools and treatments and psychosocial support for living with type 1 diabetes.
While some of the morning's scientific talk admittedly went over my head, and no one's promising a cure anytime soon, I know those of us with type 1 are in a better place than we've ever been before and closer to the brass ring. I particularly enjoyed an informative lunch moderated by Amy Tenderich, award-winning blogger of DiabetesMine. On the panel of experts were Dr. Jay Skyler, researcher and Dr. Norma Kenyon, research scientist both with DRIF, Wendy Satin Rapaport, clinical psychologist who works with the DRIF and University of Miami, Fran Carpentier, editor of Parade magazine and type 1 diabetic for 39 years and Jeff Hitchcock, father of a daughter with type 1 diabetes and founder of Children with Diabetes, an online community for young people and families.
Beside the camaraderie of the day, including meeting my wonderful lunch buddy, a grandmother from Albany, here are a few tidbits I took away.
While progress in curing diabetes has not yet visibly translated into any giant leaps, the details behind the scenes have progressed enormously, like how we get islet cells to last longer without immunosuppression drugs. Research, techniques and discoveries are progressing speedily, but the stage from what's found in the lab to works in a mice to gets tested in humans is not speedy.
Islet cell transplantation is also making progress but major obstacles include: 1) not enough cells available 2) immune rejection. Scientists are now harvesting other cells, like liver cells, and turning them into islet cells. This is showing early success.
In trials, those using continuous glucose monitors over the age of 25 improved their A1C on average by .53%. Doesn't sound like much, does it, but it translates into a drop in A1C from, for instance, 7.4% to 6.9%. Those between the ages of 15 and 24 showed relatively no improvement. No surprise, largely because only 33% of participants in the trial actually wore the darn thing most of the time.
An artificial pancreas is very near. The technology is there and much of what's needed now are safety protections: putting alarms and breakers in the system, preventing malfunctions and safely letting patients go home with the system making sure they won't administer too much insulin.
The self-care diabetes demands is NOT easy and lapses are not failures. Life gets in the way. Set achievable goals and if you lapse, don't blame yourself, use it as information and continue forward.
Hope for a bright outcome, not only does it feel good, but it changes your immune system for the better.
"Choose" to live well with diabetes. If you don't do something well you'll quit doing it altogether.
Expect, but don't fear burn-out.
Expect your teen with diabetes to swing like a seesaw between adult and child-like behavior. Don't accost them with, "What's your number?" every time they walk in the house. Talk about normal things before diabetes.
To learn more about the conference, click here. And don't forget, a portion of the proceeds from the sale of my book, The ABCs Of Loving Yourself With Diabetes, is being donated to DRIF at the end of the year. Your purchase will make a difference.
Showing up in the moment changes the next one
I recently read this quote and put it where I see it often:
"Everyone stands alone on the heart of the earth transfixed by a sun ray and suddenly it is evening."
In other words:
What are you doing with the substance of your life?
What will you want to have accomplished when it's over?
What do you want to be remembered for?
What could you do today that would add something to your life or that of others?
What will you do today that matters; that honors that you're here?
...for so suddenly it is evening.
I would gladly credit the author of this quote but do not know who it was.
The other morning I heard on the Today show someone with type 1 diabetes say, "Any moment I could die," referring to a low from taking too much insulin. Yes, it's possible, but how many times do you ever think it could really happen to you? Ten times a week? Once a day? Ever? Never? People die of diabetes every day, but usually due to something that's been brewing for years, like heart disease, stroke or kidney disease. Yet anyone using insulin can die any minute, any day, by erring with their dose.
So how is it that we can get up every day, go about our business, take our medicine and never think about this? I was musing about this because of a book I'm now reading, The Unthinkable: Who Survives When Disaster Strikes - and Why by Amanda Riply. It's about how our brains work when we're in dire circumstances: a fire, plane crash, kidnapping, 9/11. People don't react and respond at all the way we expect. Our brain shuts down and it both heightens and blocks certain senses. People become temporarily blind or deaf, unable to see or hear--obviously blocking the horror of the event. Time appears to slow down for most, while it speeds up for some. People freeze, they literally go limp and lifeless, probably an adaptation of how we escaped predatory animals eons ago. We move into a space of denial and disassociation during the event.
Is this denial and disassociation at work when you take insulin, a life-giving and life-threatening medicine? I go far to protect myself living with diabetes: I'm enormously educated about diabetes, how it works, how to care for myself, I know how to prevent hypoglycemia (low blood sugar) and how to treat it if it should occur. Yet in 31 years of using insulin I've never had a Glucagon kit (injectible glucose if you lose consciousness) in the house and when I take my injection three to seven times a day I never fear or panic. In fact, I'm more likely to take a little too much insulin rather than a little too little, preferring to tolerate a low rather than long-term complications. I see insulin only as protecting me against complications, not the damage it can do.
Just like any thought of the "unthinkable," who ever thinks something awful will happen to them? There's almost a kind of arrogance in this thinking. "Hubris" as a dear friend and I used to say, using the word often just because we loved how it sounded. If the brain blocks us from thinking something horrible can happen to us ordinarily, maybe it's doing the same every day when it comes to taking insulin. I guess it's a good thing or we'd run screaming every time we had to pick up that syringe or press buttons on our pump.
The Unthinkable is a fascinating read. You won't find anything about diabetes in it, but then again, you might just get something about diabetes out of it.
1 4 oz juicy red apple
12 oz. baked potato
1/2 cup cooked = 1 cup raw
1 cheeseburger with bun
5 oz French Fries
Since it's Columbus Day and Columbus was in search of spices (or so I think I remember) it seems fitting to have a little food quiz today.
Whether you use the Exchange System or Carbohydrate Counting to measure your meds against your carb intake, here's a little quiz by virtue of Accu Check and their cute, bite-size refrigerator magnets to see if you know your carbs.
Before you look at the answers posted on the graphics to the right (and if you already did come back tomorrow and try this again. If you're my age you won't remember what you just saw), ask yourself how many exchanges or carbs you think are in the foods below:
1. 1 small apple
2. 1 large baked potato
3. 1/2 cup cooked broccoli, same as 1 cup raw
4. 1 cheeseburger with bun
5. 1 cup of French Fries
Since I still have 15 more magnets, I imagine we may go through this exercise again in the near future with different foods.
By the way, I got these magnets at the American Association of Diabetes Educators conference this summer, so I can't tell you whether they're available anywhere. But I imagine if you'd like a set, it couldn't hurt to contact Accu-Chek and find out.
Call me "Pollyanna" but life is better looking for the upside
You can't connect the "diabetes dots" until you look backward. Allow me to explain.
The other day I took my usual walk from my apartment about 40 minutes away to do some specialty grocery shopping. While I typically follow the same route, this time I walked down a different street: the lovely fall foliage was beckoning me. Half-way down the block I realized this change would cost me walking a few extra blocks and I immediately thought, darn, I wish I hadn't done that.
A few minutes later, however, I saw looming down this new street, a Key Food supermarket. Key Food is the only supermarket chain in my area that carries Dreamfields pasta, my favorite new incredibly low-carb pasta (most of its carbs never get digested.) Just two days earlier I had been searching for it in the Key Food nearer my house but they were entirely out of stock, and I was sorely disappointed. Yet now, choosing a new route, I was delighted with my serendipitous find. I walked into the store and straight to the pasta aisle to discover shelves full with Dreamfields pasta. By making what looked initially like a mistake--taking the "wrong" street--I actually found something I'd been searching for and was benefitted.
I thought immediately of Steve Jobs' commencement address to Stanford University graduates in 2005. He said, "You can't connect the dots looking forward; you can only connect them looking backwards. You have to trust that the dots (what you do now) will somehow connect in your future." Jobs was referring to his dropping out of college which led him to drop in on some calligraphy courses which ten years later came into play designing the Mac's graphics and applications. Sure, a box of pasta may not be life-changing, but something good may be before you because you took a "wrong" turn, so take a look rather than cursing where you are.
So, is there a bigger point here than being able to enjoy my favorite penne in olive oil tonight? Sure there is. Drum roll please: You've got diabetes, somehow your body took a wrong turn and this is where you are. Now what are you going to do about it? Curse the fact that you have diabetes or look up and see what advantage or new opportunity might be in front of you now because of it. I see diabetes' gifts everyday: I'm thinner, fitter, healthier, eat better, get more exercise than I ever would had my body not taken that "wrong" diabetes turn thirty-seven years ago.
'A' is for Appreciating All the Special Things You Are and Have
Last Saturday at the American Diabetes Association’s Expo in the Jacob Javitz Center here in New York City I stood beside Kevin, the CEO of Eat Right America, at their booth. Kevin had been given a copy of my book, The ABCs Of Loving Yourself With Diabetes, by someone who may do some publicity for the book next year as there are some tie-ins with Eat Right America.
Eat Right America offers a nutrient-dense diet created by Dr. Joel Fuhrman and if Oprah ever gets a hold of him, he may be her next Dr. Oz. The diet has great impact for living with diabetes: it emphasizes making most of your diet vegetables, beans and legumes with some fruits, whole grains, and lesser amounts of lean meats, low-fat dairy and healthy fats. As a result, people lose weight, blood sugars go down and related conditions improve or disappear. My book brings to the party the ability to grab a healthy handle on your emotions to weather the daily trials of diabetes; it helps you rev up your emotional strength, stamina and resilience which leads to better management and a happier, more productive life. The first thing Kevin told me upon meeting me was that he’d given away his copy of my book to a neighbor whose daughter just got type 1 diabetes at age 10. He told me how grateful the woman was and how good it made him feel watching her thumb through the book. She was like a camel who'd been dying of thirst and led to water he said.
Later at the Expo I ran into Ralph, a sales rep from Sanofi-Aventis, manufacturer of Lantus and Apidra insulins, who has attended several of my Sanofi-sponsored A1c Champion presentations in Brooklyn. Since I still had a few of my books in hand I gave him one with the directive, “Ralph, see what you can do to get Sanofi to buy my books and distribute them to patients. It wouldn’t hurt either to get medical staff to read them.” I chuckled and Ralph said he would do his best.
Ralph called me this morning and said he gave my book away at the Expo. Two give-aways in one day! A woman came up to him and began looking at the book and was so taken with it he felt compelled to give it to her. Funny, as he was apologizing I thought, how great. Now someone who can use my book actually has it in her hands, and he got to witness a demonstration of the book’s ability to touch and move people. As a writer you so rarely get to know whether anything you do really impacts people, to learn that it does is its own reward.
What actually prompts this story is it follows a phone call I received just the other day from Nico, a sales rep from Edgepark, a medical supplies company--they supply meters, test strips, syringes and lancets. I'd met Nico at the American Association of Diabetes Educators (AADE) conference in August and asked whether Edgepark covered lancet discs for the Pelikan Sun lancing device. Along with updating me whether Edgepark covers the discs (not yet as my health insurer, Empire, is reviewing the device) he asked if I was acting as a diabetes resource in the community as he often encounters medical professionals who might have need of me, particularly to talk to patients about the emotional aspect of managing diabetes, and, what made him think to ask was shortly after meeting me a woman came up to him at the AADE conference with my book in her hands.
So no matter how this book gets around, the mere fact that it does, is a gift--not just to those whose hands it falls into (or so I hope)--but to me. Like the camel I’m still drinking it in.