March was Kidney Disease Month

UnknownMeet Ms. Kidney

It doesn’t matter that it’s almost over, what matters is that you know something about kidney diseasebecause poorly controlled diabetes is a major contributor. 

Chronic kidney disease is a diabetes complication that usually takes 10 or more years to develop, and if your blood sugar and blood pressure are not well managed, you’re at risk.

The kidneys sit just under the rib cage in the middle of your back. Their jobis to filter waste and water from the blood, regulate blood pressure and maintain the proper balance of salt and minerals in the blood. When your kidneys are impaired wastes build up in the bloodstream making you feel sick and lead to high blood pressure, weak bones and nerve damage. 

Early kidney disease has no signs or symptoms so you should get a blood test every year that  indicates how well your kidneys are working. You should also have your urine tested to check for albumin, a protein that leaks into the kidneys when there is damage.

Symptoms you may begin to feel as kidney disease progresses, is more frequent urination,  particularly in the middle of the night, your urine may be foamy or bubbly, it may contain blood or you may feel pressure while urinating. Your may have swelling in your legs, feet, face or hands, feel fatigued, have a rash or severe itching, nauseaus or vomit, feel short of breath or more.

While you’re calling your doctor to make an appointment for your tests, you can take the National Kidney Foundation’s Kidney Quiz! right now to see if you’re at risk. 

Kidney disease is usually treated with an ACE inhibitor or ARB to slow damage. You may also need to cut down on eating protein. Of course, kidney dialysis is used when the disease is severe. Check here for more information.

Just looking into this, I realize the more you can do to avoid kidney disease, the more you should. Now I can’t wait to see what April is national month for…

Hope Warshaw wants to help providers better understand what it’s like to live with diabetes

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Hope Warshaw, certified diabetes educator, registered dietitian and board member of the American Association of Diabetes Educators (AADE), has been dedicated to diabetes care for over 30 years and written numerous books

Hope and I had worked on some written material two years ago, but I first met Hope at last year’s AADE annual meeting where we broke bread over breakfast. I love her spunk and commitment to helping patients and providers work better together to improve care.

Hope put forth the idea of interviewing me for a post on her blog exploring this topic. I asked Hope if I could share, and she readily agreed. Here’s the article: 

Dialoging about Diabetes: PWDs Offer Ways to Improve Communication and Care – #1 Riva Greenberg

As a diabetes educator/healthcare provider (DHCP) I’m observing that the rapidly growing world of online diabetes social networks is helping people with diabetes (PWD) find and give support and feel supported. People are connecting, building relationships and feeling more positive about their diabetes. I’m delighted to see this trend!

As a DHCP I’ve long realized I can’t walk a mile in a PWD shoes. I can’t know what it is like day in, day out to deal with this challenging and relentless disease. But, what I do know is that we can learn from each other to help shift the dialog between providers and PWD to be more positive and supportive.

In my Dialoging about Diabetes blogs I’ll interview diabetes activists and social networkers. I ask them to offer us DHCPs ways to alter what we do and say to better support your diabetes care efforts and make living your real life…just a bit easier.

Two more goals: Help more PWD get connected and encourage more DHCPs to open the doors of social networking to PWD.

This first Dialoging about Diabetes interview is with Riva Greenberg. Greenberg describes herself as: a person with type 1 diabetes for 39 years, a patient advocate, diabetes book author,blogger for Huffington Post health coach and speaker. To learn more about Riva Greenberg check out her website.

HW Q: If you could give DHCPs tips to improve our understanding of the challenges PWD face in managing diabetes while living their real life, what would you tell them?
RG A: My basic tip is for HCPs to ask their patients more questions. Then listen with focused attention. It is by hearing what is going on for this person that you will understand the challenges managing diabetes presents as a whole, and specifically. People, when given an opportunity to share, are a treasure trove of information about what and where they need help as well as what they’re capable of and willing to do.
Greenberg offers DCHPs these thoughts:

  1. Start off looking for successes: “What has gone well for you since we last met?” Offer congratulations for any positive self-care action.
  2. Next, ask: “What have you found difficult?,” “What would you like to do better?” The answers will reveal the person’s challenges as well as opportunities for improvement.
  3. To assess a person’s support network, ask: “Who are the people who help and support you with your diabetes?,” “How do they help you?,” “How else would you like to be helped?”
  4. Ask questions that explore the person’s life beyond diabetes: family life, job, school, finances. A person’s actions are all rooted in their life systems. Try to understand a person’s challenges within the whole context of his/her life.

And Greenberg reminds us: Don’t forget the follow up questions to obtain a deeper understanding. Probing questions will begin to reveal how a person manages their diabetes amid managing his/her life. A goal is to make this as seamless and integrated as possible.

HW Q: How do the day to day challenges of managing diabetes impact one’s ability to manage diabetes?
 Given how busy we all are these days, life just gets in the way sometimes of doing great managing diabetes. Just last week I was having my bathroom renovated, was fighting a bad cold and had to vacate overnight since I had no toilet! Rushing out the door to my friend’s house I discovered when I got there that I forgot my insulin! This happens to me once every few years. If, however, you’re going through a particularly stressful time, like a divorce or a job loss, you can be sure it will be tougher to complete your diabetes to dos and the stress will interfere with your management and your blood sugar control. Since life will always throw challenges our way, the best way to stay healthy is to know how to manage diabetes and have ways to get through the tough times. It might be doing yoga, exercise, spending more time doing a hobby you love or with friends or family or a writing exercise about what you’re grateful for or using positive self-talk.

HW Q: How can DHCPs be more empathetic, understanding?
RG A: 
This is a great question and very much at the heart of the DHCP:PWD relationship. Many HCPs operate from a traditional “expert-model:” I’m the expert and I’ll tell you what to do. But unless the patient identifies why a change or action is meaningful for them to do, they won’t have much motivation and the change won’t last very long. DHCPs should aim to explore who their patients are, what’s important to them and what they’re willing and able to do. It should be a collaborative effort then to determine actions and goals. If the DHCP takes this approach, empathetic understanding will increase automatically.

HW Q: What messages do you have for PWDs about more actively communicating what they need from their DHCPs? 
RG A: Become more knowledgeable about diabetes: read a book, magazine, and web sites. Bring any questions your have on a piece of paper to your DHCP and write down the answer. Ask about any concerns you have, this may be about yourself or your family, they’re also affected. When your DHCP tells you something ask for clarification if you don’t fully understand. Don’t leave confused or not knowing what to do or why.

HW Q: How do you feel that social networking/being connected online can help people feel supported, possibly improve their care?  
RG A: Only someone with diabetes can know what it’s like to live with from the inside-out. Social networking has given people an incredible resource to share our knowledge, our woes and our successes and they provide support. When living with a chronic illness, support is like medicine.

HW Q: How do you encourage DHCPs to see social networking as an advantage to their efforts and an avenue for PWD to get increased support? 
RG A: Web sites can’t replace the face-to-face interaction with a trained provider. The more knowledgeable people become using social media, the better they may be able to deal with/manage their diabetes which can make a DHCPs job easier. Also, since providers are so short of time, a patient may actually become an expert on something their DHCP may not be and the information flow can go from patient to provider. I talk about this in one of my Huffington Posts, “Are Doctors Losing Their Relevance Due to Social Media Health Sites?”.

Greenberg’s parting comment: Since diabetes will require we have a relationship with our health care providers on a regular basis for the rest of our lives, striving to have one that’s collaborative and rewarding is to everyone’s benefit. If we can work better with our providers it’s one less stress and one more tool in our toolbox.

Thanks for sharing Riva!

How do you want to be remembered?

In my youth…


but you wondered, didn’t you?


I watched Piers Morgan last night on CNN covering the death of Elizabeth Taylor. Yes, she was gorgeous. Yes, she was an icon. Yes, she had 8 husbands, was bold and bawdy and may well be our last “movie star.”

What I also noticed, beside the talkingcelebrity tributes, was at each commercial break they showed tweets from Elizabeth’s celebrity friends memorializing her. 

Elton John, James Earl Jones, Liza Minelli, Angela Lansbury, Dick Cavett, Larry King, Kirstie Alley, Michael Caine, Steve Martin. They were all tweeting what you might call tiny little obituaries. Really, what you’d want your friends to say about you when you die. Like, “She taught me a lot about suffering and joy.” “She had a wicked sense of humor I loved.” “She was passionate about everything and did so much good for the world.”

It’s long been a life-coach exercise to have people write their own obituary to think what they’d like to be remembered for, and then create that life. Somehow seeing it as 140 or less word tweets makes it seem so much more doable. 

So I’m thinking maybe we should all write a few tweets about ourselves that we’d like people to use after we’re gone – and then go about creating that life now. 

When I die I’d like people to tweet (of course I realize by then tweeting will have been replaced by something else, but I’ll use it for now):

“She made me think about my life and helped me make it better. And god she was funny!!!.”

Your turn. 

Today is Diabetes Alert day: Learn your risk for having type 2 diabetes

Today marks the American Diabetes Association’s annual effort to get everyone to test whether they’re at risk for diabetes. 

You know the numbers, or maybe you don’t. They’ve escalated tremendously in just a year! 

26 million people have diabetes, among them 23 million have type 2. 25-35% of those people don’t know they have diabetes. And almost a whopping 79 million people havepre-diabetes!  

Since doctors don’t prescribe medication or much in the way of lifestyle change for pre-diabetes, if you have it chances are high within 5 to 10 years you’ll have type 2 diabetes. So knowing if you have pre-diabetes is just as important as knowing if you have diabetes. 

Risk factors for pre-diabetes/type 2 diabetes:  

People in your family have type 2 diabetes

You’re over 45 years old

You belong to a high-risk ethnic group: African American, Native American, Latino, Pacific Islanders

You’re overweight and don’t move much

You have high blood pressure

You had diabetes while pregnant or delivered a baby weighing more than 9 pounds

Now take the diabetes risk testThe Test asks you simple questions about your weight, age, family history, like above, and other potential risks for type 2 diabetes and prediabetes. You’ll learn whether you are at low, moderate or high risk for type 2 diabetes.

Diabetes Alert Day lasts a month: It runs through April 22 during which time the ADA will be rallying one million people to take the Test. Be among them.

Seriously, you could be walking around with diabetes and not know it like millions of people. 

If that’s true for you, by time you’re officially diagnosed, years from now, you may be among the 25% who have complications upon diagnosis because they had diabetes for years and didn’t know it so didn’t take care of it. 

Trust me, if you can avoid that, do. Take the test, it’s a very small price to pay for a very large gift – knowing whether or not you have diabetes now.

Diabetes transforms Katie Decker

Katie Decker shares her wisdom 


Transforming management through recreation


 I just listened to a great podcast on “Transforming Diabetes” where type 1 patient and health counselor Katie Decker has some great stuff to say. 

Mature beyond her years, Katie’s been living with diabetes and celiac disease for 7 years. She’s made several changes in her life since her diagnosis: she went back to school for health counseling, while still working as an architect, she moved from Los Angeles to Portland, she has grown closer to her family, and diabetes has changed her, her values and how she lives. 

Katie is calm, clear, centered and shares her thoughts about living with diabetes from a productive, constructive, energizing place; a place where we also have a responsibility to strive for our best, maintain balance and ask for support.  

Katie also made me aware of an intriguing organization,InsulinDependence (ID), that is attempting to revolutionize diabetes management by building self-confidence and adaptive management strategies in young people through adventure travel and recreation. The organization also offers leadership training, community and more. ID has an interesting history, an outgrowth of  an experiential diabetes education expedition Peter Nerothin took type 1 youths on in the mountains of Peru in 2005.  

I also like Katie’s idea that we all live on what she calls “primary” and “secondary foods.” Primary foods are those that nourish our spirit like: friends, family, mindfulness, work and hobbies we love. For Katie it’s her love of art. Secondary foods are those we put on our plate. What’s key is when our primary foods aren’t nourishing us we tend to make poor choices in our secondary foods. No doubt in my book.

Tune in to Katie’s interview. So much good information from this young old soul.

DiabetesMine “Design Challenge” open for submissions

My friend, design- and politico-advocate, Amy Tenderich, over atDiabetesMine is once again inviting all your great ideas for new and improved designs for diabetes tools and technologies. It’s the third annual DiabetesMine Design Challenge. 

Do you have an idea for an innovative new diabetes device or web application? The DiabetesMine™ Design Challenge is your chance to win big, and potentially help transform life with diabetes for millions of people.

Whether you’re a patient, parent, caregiver, student, entrepreneur, developer, engineer, etc.:  if you’ve got a great idea for a new tool to improve live with diabetes, send your submission!”

This year there will be three Grand Prizes of $7,000 plus a consultation with IDEO, a complimentary pass to this fall’s Health 2.0 conference, and expert help as appropriate. 

The contest is open for submissions until Friday, April 29. Check it out. Allison Blass tells me there’s a brand new video for this year’s contest. 

Nice to see also that my fellow blogger, Bernard Farrell, will be one of the many impressive judges. Bernard has been a passionate commentator on all things regarding diabetes technologies. 


Transforming diabetes from pain into purpose

Internist Jeff Horacek


Wellness coach Heather Clute


I’ve had a hellish cold and cough these past few weeks and so little energy to post. So I thought this is a good opportunity to make you aware of something sitting quietly on my ‘Press page.’

I was invited back to the radio show,Transforming Diabetes to talk about some simple tools to help you flourish with diabetes. In other words, help you improve your management and create a life with diabetes that’s healthy, happy, productive and meaningful. 

Hosts M.D. Jeff Horacek and wellness counselor, Heather Clute, honored me as their first repeat guest – probably because we got so gabby on the first show there was still much to talk about. That included steps to living from a more flourishing place.

Dr. Horacek is an animal of a different stripe. He’s one of the most open, caring, active listening physicians I’ve had the pleasure to talk with. His deep concern for learning from, and helping, patients puts him in a class of his own.

Heather, who has had type 1 diabetes almost 15 years, and has an old soul to boot with a specialty in mindfulness, authentically understands the every day ups and downs of living with diabetes.

Check out the blog post and listen to the podcast. It’s a great way to rev up your energy and shift your outlook for the better in just 30 minutes. Then tool around the site and have a listen to any number of podcasts that may interest you. I’m in some very good company.