Today marks the end of Diabetes Awareness Month. What did you learn? Of course the notion of naming a month 'Diabetes Awareness' is in part to draw the public's attention to diabetes. Yet, ask yourself what you learned this month, or this year, that you didn’t know before?
Did you know that approximately 21 million people in the U.S. – 1 in 16 – have diabetes and one-third of them don’t even know it? Out of those 21 million, 19 million have type 2 and 2 million have type 1. Did you know that 54 million more people have pre-diabetes? That means their blood sugar is slightly elevated, yet not enough to be considered diabetes. However most of them, if they don’t change their ways, will get diabetes within five years. Did you know it’s predicted that one in three people born in 2000 will get diabetes? Did you know that every 10 seconds someone in the world dies of diabetes, and two more people get it? Did you know that diabetes is the fifth leading cause of death?
What did you learn about taking better care of yourself? Did you know that insulin controls blood sugar more effectively than pills, even if you have type 2 diabetes? Did you learn doctors hesitate to prescribe insulin because of patient resistance, and that it takes more of their time to educate patients and because of their own ignorance? Did you learn that taking care of your diabetes is up to you, not your doctor? I guarantee you, he or she is not the one who’s going to wake up with complications down the road. Did you know that there’s a new insulin pump called Omnipod that has no plastic tubing and it's controlled via a remote control? Did you know that if you have type 2 diabetes and you’re overweight losing just 10 – 15 pounds or 7% of your body weight could eliminate your need for medication? I have two friends with type 2 who just lost weight and both no longer require their pills. Did you know that exercise is as important as diet to control diabetes because exercise not only burns sugar but makes you more insulin sensitive. This is particularly important for type 2s almost all of whom have insulin resistance. Did you know that?
Did you learn something about managing your head? For instance, it’s normal to feel overwhelmed, frustrated, fearful and crazed at times with all there is to do managing diabetes. You may also feel like your life's falling apart at times taking care of a child with diabetes, but there is help.Did you learn that you can do exactly the same thing two days in a row: eat the same foods at the same time, get the same exercise, take the same amount of medication and get completely different blood sugar numbers? Why? Hormone interaction, variable rate of insulin absorption, getting sick, lasting affect of exercise yadayadayada…Big message: it’s not your fault! Did you learn that it’s actually advisable to take “diabetes vacations” from time to time – skip a blood sugar test or allow yourself dessert here and there, just make sure you prepare and don't put yourself in peril. Did you learn – and this is my personal favorite – that if you shift your focus from the tiresome tasks of diabetes to why you’re doing them – to have more energy, be able to travel in your retirement years, continue a hobby you love or still be here to dance at your grandson’s wedding – that you’ll have more motivation, resolve and pleasure as you go through every day?
Here's a big one: did you learn that diabetes is not a death sentence? That today, unlike decades ago, we have incredible research going on, and the tools, information and know-how to control diabetes, and that if you keep your blood sugars as close to normal as possible much of the time, (an A1c < 6.5) that you can prevent or significantly reduce your risk of complications? Did you learn that this is within your control by getting educated at your local hospital, at a support group, online, joining a diabetes organization, or subscribing to a diabetes magazine. In other words, step up to the plate. Oops, you may also need to step away from the plate. Try controlling portions by using smaller plates, upping your physical activity in small everyday ways like climbing a flight of stairs, parking further away, dancing to the radio, and a big way -- get busy on living your dream.
I hope you learned a lot this month. Finally, did you learn that you have to put what you learned into action for it to make a difference? And that if you do, it will.
If you read my post below you know I’m big on walking and that I think using a pedometer is a tremendous motivational tool. While we know the obvious, walking is healthy, you’d naturally think having a tool that marks your steps would be motivational. However, I just learned, that’s not entirely true. The real motivation comes from having a "step-goal" – deciding how many steps you will walk.
In 26 studies (eight randomized controlled trials and 18 observational studies) conducted by Dena M. Bravata, M.D., M.S., of Stanford University, Calif. and colleagues, among 2,767 participants, pedometer users logged between 2,183 and 2,491 steps per day more than control participants. Whew! I got that right. Overall, pedometer users increased their physical activity by 26.9%. However, and here's the news, having a step-goal was identified as the predictor for increased physical activity. In the three studies that did not include a step-goal, participants had no significant improvement in physical activity -- even with their pedometer! The participants who were clocking in 2,000 steps more per day had a 10,000-step-per-day goal, or other goal.*
Who woulda thought? So, in light of this information, decide how many steps you want to cover today and then strap on that pedometer. One note of caution: If you’ve been laying about the house lately don’t pick 10,000 steps as your goal today. Shoot for 2,000 and up it every few days. Keep it up and by New Year’s Eve, you may just be a 10,000 a day stepper – and yes jitterbugging, walking down the aisle and strolling through windmills count too!
*JAMA. Nov. 21,2007;298 (19):2296-2304.
My Omron pedometer
As I sail from Thanksgiving into the merriment of Christmas, Hanukah, Kwanzaa and New Year's Eve, counting how many sweet potatoes and marshmallows I just devoured and how many cookies and glasses of champagne await me, I have one eye on threatening extra calories. But I have my other eye on a different set of numbers.
Diabetes comes with so many numbers. Our pre-meal blood sugars should be between 90 and 130, our 1-2 hour post meal blood sugars should be between 120 and 140, our A1cs should be below 7, our HDL over 45, LDL under 100, oops no, for us it's under 70, our triglycerides under 150... you get the idea. But here’s one measurement I find truly encouraging, rather than discouraging. Counting my steps.
I know how I eat and how I move affect and create all the numbers above, but here’s one value I feel I have immediate, visceral control over; how many times I lift my foot, stretch it forward and put it down again. And, I am rewarded (not just with my blood sugar going down, my insulin sensitivity going up, my calories going away,) but with the instant knowledge and immediate gratification of seeing the results of my labor.
These 9,183 steps on my pedometer are yesterday’s count from a one hour and 15 minute walk. On this late fall day I was strolling through a nearby neighborhood peering into new restaurants and kicking the leafy foliage underfoot. Since these 9,000 plus steps occurred between 11:30 AM and 1 PM, I know my ambling around my apartment before and after certainly put me over the 10,000 steps a day recommendation for physical activity.
There’s something truly motivating in seeing such immediate results of your efforts. Every time I give a diabetes presentation and show my pedometer someone will ask me where they can get one. Maybe they like the "gadget-ness" of it, but seeing things in black and white makes a big difference -- it gives you a feeling of control. And as we all know, diabetes feels pretty uncontrollable a lot of the time.
So while you’re counting how many holiday parties you’re going to, slices of pumpkin pie you just ate, mini hot dogs and mushroom tartlettes you'll be sidling up to at the buffet tables yet to come, remember, you can always count your steps. Getting them up to 10,000 a day, I guarantee you will put a holiday smile on your tiramisu-stained face.
My 44 seconds of fame
In recognition of Diabetes Month ABC TV is showing up to 45 second videos sent from people using insulin. What strikes me is the typical sad to somber arc of so many people's stories. How about sad to glad?
Sure, upon diagnosis we're reeling, grieving, feeling loss, shock, confused, pissed-off. And, learning to live with diabetes is a process over time, as you get better educated and build your diabetes-muscle through education and repetition.
But there is also another view of living with diabetes if you look from the other side. Diabetes can be an asset. I'm not saying I'd go out and chose it, but if you've got it, use it.
Diabetes can motivate you to eat better and get on that exercise bike you now hang your clothes on. I will go so far as to say if you take care of it, diabetes can actually make you healthier - you'll lose some weight, attend to your blood pressure and cholesterol.
Also, realizing the fragility of life, diabetes is a wake-up call to get going on your dream. My fellow A1c Champions are an overwhelmingly joyful bunch as they go around the country helping others manage their diabetes. And, emotionally, while many fall into denial, depression and a victim stance, taking good care of your diabetes can develop an inner strength and confidence, a sense of mastery, an appreciation for your stamina, and pride. Well c'mon, you just knew that's what I was going to say, didn't you? Hear for yourself.
It’s been a busy week with Diabetes Day having fallen this past Wednesday. I’ve been involved in various activities around town, and like my fellow A1c Champions, been giving our motivational presentation to fellow diabetics. Yesterday, not far from my home, I spoke to a roomful of type 2 patients. The good news was almost everyone knew this is Diabetes Awareness Month. The bad news was very few knew what an A1c is. You’d be amazed to know just how few people with diabetes know how to manage it.
I was speaking at a medical center in Bedford Stuyvesant, a lower economic area of Brooklyn with signs of gentrification spiritedly popping up amidst the shuttered buildings and bodegas. Most of the patients who attended have had diabetes for several years and one patient was a newbie - diagnosed just two days ago, and he was reeling. While I know full well the initial response to a diagnosis of diabetes: shock, loss, grief, anger, shame, fear…he felt he'd lost his life. I acknowledged his feelings and then said, “You know, there's another way to look at this. You didn’t just hear a doctor say you have terminal cancer. Diabetes is manageable once you know how. Now it’s your job to find out how and take the steps necessary.”
I wish I had also remembered to tell him, and all of them, about a news story I had seen some months ago on TV. It was about a one-legged black skier training for the Special Olympics. His story is remarkable, not only because he has become a masterful skiier, but because he came from the neighborhood where I was speaking yesterday. Years ago as a teen he was caught in a neighborhood shoot-out. A bullet cost him his leg, and three months of his life as he lay in a coma.
When he awoke, this active boy couldn't participate in the usual pick up game of basketball, but one day he tried skiing and loved it. So with a dream and much determination, he moved away from his family, friends and home to Colorado to train for the Special Olympics.
Today he is part of the Special Olympics training program. He works as a sales rep at Home Depot and gets time to train. I was awed by this young man. Not just because he can stay erect on one leg whipping down a mountain, but because of his relentless positive spirit, optimism and good will.
When not on the slope or in Home Depot's paint department, he's touring -- influencing kids to stay in school and spreading his good cheer and message about what you can accomplish when you put your mind to it.
I really wish I had remembered to tell my diabetes group this story. A man, from just where we were gathered, had turned his life around after tragedy struck. They would have seen how much is possible, how you can come through life on top -- including living with diabetes -- when you put your mind to it. And that goes double for my newbie who's just starting to wrap his hands around diabetes. Right now he can choose to look at his diabetes as a terrible thing or a stimulus for getting healthier, and also help his family members who've all been "suffering" with diabetes for years.
At the end of the TV segment the reporter asked the skiier how he stays so positive. He said, smiling, that when he was a kid his grandmother told him something he'll never forget. She said, "No matter what, you're already a champion because of who you are, and the influence you have on yourself and others." I think we'd all do well to heed his grandma's words.
Know that there is a champion within you and that your champion will carry you as high as you aim to go. Then when you get up there, take a look back, reach out your hand and help pull someone up who's struggling below you.
As you may know, November is Diabetes Month, and today is Diabetes Day. In New York City the day kicks off in front of the United Nations and the Empire State Building will be lit in blue, our now officially established diabetes color. As much as I love that we now have our own month and day, I’m thinking wouldn’t it be nicer if we didn’t need one?
I said this yesterday to Scott King, publisher of DiabetesHealth magazine, which I'll have my first article in in December's issue. I bumped into Scott, totally unexpectedly, at Novo Nordisk's block-long exhibit in Union Square yesterday. Divabetics also had a tent there with stylists and fun-fetching ways to access diabetes information.
Scott's good fortune bumping into his columnist (me) by surprise, led to an impromptu interview, which I expect will surface on DiabetesHealth's web TV sometime soon. We chatted about the state of diabetes, my new opinionated column, my new upcoming book, The ABCs Of Loving Yourself With Diabetes (soon to appear here), and some things off the record.
Here's one bold concept we chatted about. Why aren't we incentivizing staying well? Really and truly. What if we put our energy into keeping people well, rather than letting them get sick. In ancient China village doctors were compensated not to cure the sick but to keep people well. Imagine doctors here getting paid for keeping people well and your health insurance going down if you kept yourself well. In China when people were sick doctors' pay was cut and if patients fell ill the doctor had to treat them for free.
No wonder you see flocks of Chinese people, like graceful birds, contorting in odd configurations in the park. They’re doing Tai Chi or Chi gong -- practices that keep the body’s vital breath and energy robust and circulating.
Can you imagine health care practitioners getting paid to keep people healthy? The first thing I envision is a lot more lively people running around, and smiling. The majority of seniors would be slimmer and wouldn’t automatically get the illnesses we associate with aging; their bodies would never have deteriorated to that point. Hmmm...focusing on wellness rather than unwellness. Now wouldn’t that just screw with our health insurance companies something awful!
Since doctors get paid to treat sick people there's little incentive in keeping people well. We’ve all read about how physicians make more money doing surgeries and so surgeries get scheduled like a Macy’s one day sale – pack ‘em in. How did it happen that our focus became treating the sick rather than keeping people well, anyway?
If you saw Michael Moore’s film Sicko, he’ll tell you one of the first health insurance companies realized they could make big bucks by letting people get ill and then treating them. And President Nixon thought that was kind of a cool idea too.
I'm not saying pharmaceutical companies aren’t necessary or that there aren’t new medications that are saving and prolonging lives. I do think you can earn a profit and do good work at the same time. And I'm certainly not saying that we shouldn’t treat the sick. After all, type 1 diabetes is not preventable. Or is it?
If we began from the premise of keeping people well by exercising, eating properly, keeping our environment clean, minimizing stress to our body and psyche through cultivating different societal values, maybe we wouldn’t even get diabetes. Maybe we wouldn't get the viruses or traumas that scientists now think cause type 1, and maybe the genetic predisposition most people who get type 2 carry, well maybe those genes would lay dormant and not switch on. And, of course healthier eating and exercise could almost wipe out type 2 diabetes. Maybe some of that pharma money apportioned for research and development could be dispersed to creating the infrastructure that would help us prevent disease.
It would just be nice if we started from the premise that we should keep ourselves healthy rather than take drugs and have operations to deal with all the unhealthful food on our grocery shelves rife with life-decimating, farm-bill approved trans fats and high fructose corn syrup, 60-80 hour work weeks with no time to move our body or refresh our minds, and the expectation that we will get ill as we age.
But, alas, until that day, I’ll have to settle for Diabetes Day. So if you’re in New York, go out, get informed and be counted. If you're in Tokyo, go stroll past Tokyo tower, my friend there told me it's lit in blue too. See what's doing in your community this month. It's the best way we have right now to make diabetes visible, learn even more and help others on their diabetes journey.
Cast your vote to reimburse technology & its education
Me? I’d be back like Journeyman to the world I lived in 25 years ago, never knowing what my blood sugar was, hopelessly trying to eat the same stuff every day and blithely thinking 200+ blood sugars was “doing well.” Pffff! How times have changed.
Now let’s change them again -- for all diabetics! As we count down to Diabetes Day, tomorrow, I've been asked among the diabetes blogging community, to have your voice heard to get more health insurance coverage for the very things that keep us going with diabetes: Diabetes Technology -- meters, pumps and continuous glucose monitors -- as well as the education how to use these.
Here’s your chance to add your voice to the rising chorus of "yea-sayers." Just fill out this survey and you'll be helping to turn the tide, http://www.surveymonkey.com/s.aspx?sm=CeG1e2pg7dS0ajPv26na9g_3d_3d. You'll be changing a life.
For more information, see Amy Tenderich’s article on her blog DiabetesMine: http://www.diabetesmine.com/2007/11/stand-up-for--1.html.
It takes only 5 minutes to change the world
Novo's bus touring the world
As part of the festivities for Diabetes Month - November for those of you who don't know - this Tuesday, November 13, Novo Nordisk will have a bus packed with diabetes information, Changing Diabetes® Bus World Tour, on the North side of Union Square, from 11 - 7 PM. Visitors will be welcomed aboard the 59-foot mobile showroom that has been traveling the globe to raise awareness about diabetes prevention and control. The Changing Diabetes® Bus has visited five continents - Europe, Africa, Asia, Australia, and now North America. On the bus are interactive, multimedia exhibits about diabetes and you can help support the UN Resolution on diabetes by signing a petition.
Outside the bus, visitors can get free health screenings and meet some of the crew from Divabetic's 'Makeover Your Diabetes' team including: best-selling author/motivational speaker, Mother Love, style advisor, Catherine Schuller, celebrity makeup artist, Jeff Jones, fitness & food expert, Jessica Issler, celebrity photographer, Winston Kerr, Divabetic founder, Max Szadek, life coach, Dana Hariton, fitness expert, Rochelle Rice, Divabetic spokes person, Seveda Williams and a dazzling array of DIVA volunteers and motivators will be on hand to help you makeover your diabetes. Diabetes isn't fun, but they'll almost make you think it is, while you get educated and in touch with your inner 'diva.'
Don't throw a day in the trash
My mother got a new refrigerator two months ago. It’s part of the renovation she's doing on my parent's new apartment. It’s probably the first time in 20 years she’s bought a major appliance. The refrigerator is made in New Zealand and she really liked it – until it stopped working. To say the store where she purchased it was in no way customer-oriented was problem enough. An even bigger problem, however, was that my mother refused to send the refrigerator back, or make waves, because she didn’t want to be a problem.
Many patients exhibit this same kind of behavior. They think, well... the doctor told me to take these pills… I don’t see any difference in my blood sugar, but the doctor must know best. Would you be surprised to know that most physicians, outside of endocrinologists, get one day of diabetes training in medical school? My type 1 friend's doctor told her to eat a bowl of cereal when she experienced hypoglycemia. Hey, when your blood sugar’s headed below 50 and you’re on your knees, a nice crunchy bowl of toasty oats is not the answer – glucotabs, Coke, honey and pure glucose like Sweet Tarts are! But she learned that from me, not her doctor.
Another friend couldn’t figure out why, when doing everything her doctor told her to, her blood sugars hovered around 200. Well, maybe it’s because he doesn’t think that’s anything to be concerned about. Has he heard the only thing that prevents or reduces the risk of diabetic complications is tight blood sugar control? 200 to me is like unfurling a blanket in the park and laying it with baguettes, potato chips, bagels, cheese cake and tootsie rolls. To be fair, the way health care is set up today, most patients get a scant 10-15 minutes with their doctor. How can you possibly get all the information you need in such time? How can your physician get to know what he or she needs to know to help you? But if they're not asking and you don't tell no one wins. And you definitely lose.
Then, so many patients are more concerned about being nice to their doctor than getting the care and treatment they need. They are afraid to rock the boat or doubt their own feelings in front of a white coat and stethoscope. They think they know nothing in the same room as someone who went to medical school. What I know for sure is that patients give their power away every day -- and this makes it harder for their health care provider to help them. We patients are consumers of health care. Yet, we hardly think about it this way. If your doctor isn’t solving your problems, or even particularly concerned, you need to be.
When my mother’s refrigerator first arrived she had chest pains for three weeks. No, not anxiety. It was coming from opening the refrigerator's tightly pressurized door. She told me pretty quickly, but took another two weeks to tell the store. They sent over a not-too-pleasant repairman who made my mother think it was all in her head. Until he said, “Best thing to do is tape some pennies between the unit and the door, some people say.”
That worked, but then the refrigerator’s temperature began vacillating between 38 to over 55. Everything perishable, hundreds of dollars worth of groceries, found the trash can their new home. I urged my mother to call the shop and return this lemon and write a letter of complaint demanding compensation for the tossed food. “But I don’t want them to think of me as a complainer. This is a small town and I don’t want a bad relationship,” my mother pleaded.
Two weeks later she called the store as it was becoming a weekly practice to toss her yogurt and milk in the garbage. The same repairman came. “Why are you always complaining?” he asked. My mother had tears in her eyes. As he turned to leave, he obviously thought of something, opened the fridge and mumbled, “Hmm…the sensors aren’t telling me this, but it looks like the fridge might be in constant defrost mode.” “So you mean maybe I’m not crazy?” my mother urged with such hope, and, hallelujah, finally anger.
So how’s your refrigerator, metaphorically -- the housing that's keeping your bodily functions working? If you don’t think your diabetes is well controlled -- maybe it’s you or maybe you’re not getting the proper care. Chances are, deep down you know which is true. Certainly the dietician who gave my type 2 overweight, uncontrolled Aunt a daily diet of 300 grams of carbohydrates must be right, right? She's the pro, no? No. Only you are the pro on you.
Six weeks after the refrigerator entered my mother’s house she demanded the store take it back. They told her to call the manufacturer in New Zealand. She did. Two weeks later she called the store to ask if it had arrived. They said they didn’t know, “Call New Zealand!” She did. They said it had arrived in her local store a week earlier. She called the store. They said they didn’t see it. Finally my mother said, “I don’t think it’s my job to track down this refrigerator!” Three days later, for the very first time, the store-owner called my mother and said her new refrigerator would be delivered that week.
It was, it’s fine and the food is where it belongs, and we hope won't see the trash again anytime soon. There’s an oft-quoted expression in Japan. The translation is, “The squeaky wheel gets the grease.” It’s not fun being a squeaky wheel but sometimes that’s what it takes.
If you’re not happy with your care and you feel you don’t have the right team to help you, look further. While it’s not always easy finding a good doctor, one who knows his or her stuff, treats you with respect and will help you manage your diabetes, if you don’t look, you’re sure not to find him or her.
Don’t throw your perishable latter years away when you could be doing so much now to preserve them. You’re the customer, and while the customer may not always be right, when it comes to diabetes-care, I guess I'm just a little prejudiced that they usually are.
Stores medical, family and emergency information
I'm not in the habit of pitching products, except the ones I mysteriously find and love. But Marie found me, and loves the medic alert bands her company makes so much she wanted to share the news.
So I checked them out, ID On Me, and want to pass along the word for those of you who may love them too. According to Marie, they're "lightweight, stylish, great for kids and adults and only $12." Combing their website I see they're also waterproof and store, on paper in their little case, a wealth of information: your medical conditions, emergency contacts and family info -- seems this is a particular advantage. So, there's our little community. If you love something, let me know.