A new study has found that people with lower incomes are more likely to die of diabetes complications compared to people with higher incomes. And this is in Canada, where we have "free" health care.
Part of the problem, I think, is that different provinces choose what drugs and supplies to cover on their prescription drug plans. Some provinces don't even cover insulin; others don't cover test strips. Some don't cover syringes and needles. When I was forced to go on welfare, I had one social worker tell me that "We're afraid you'll sell them to drug addicts, so we won't pay for your needles. You'll have to pay for them out of your own pocket." (I later found out that this was not the case, but at the time I figured that someone who worked for the government knew what she was talking about.) Diabetic people can drop off used needles at the needle exchange, but cannot pick up clean needles the way drug addicts can.
I thought that living in B.C. sucked, but I have to admit that Pharmacare does cover almost all diabetes supplies. They don't cover insulin pumps, and they don't cover Levemir insulin, but they do cover Lantus. They don't cover 100 percent of the cost of NovoRapid or Humalog, unfortunately, and I had a big problem when I was on disability and trying, out of my very limited income, to cover the portion of NovoRapid that the government doesn't pay for.
I think that another part of the problem is stigma. Diabetes has a very big stigma in our society. People with diabetes are considered to be fat and lazy. "Just lose weight, and your diabetes will go away." People don't want to admit to having diabetes, so they don't. They don't test their blood sugar, they don't take their medication, and they don't follow a proper diet. They probably don't talk to or listen to their doctors, either. Some people who are diagnosed later in life are just set in their ways and don't want to change.
I think this stigma is also part of the reason that governments don't want to pay for diabetes supplies. Who needs expensive insulin, test strips, oral medications or needles when all you have to do is exercise more, eat a healthier diet, and lose weight to get rid of your disease? Anytime I've heard provincial politicians talk about diabetes, they've all mentioned obesity, inactivity and unhealthy lifestyles. They refuse to acknowledge that not everyone who has diabetes, whether it's type 1 or type 2, has it because of weight or lifestyle. It's easier to blame everything on the diabetic person themselves.
It has also been noted that poor people usually live "unhealthy" lifestyles. When you're getting most or all of your food from a food bank, you aren't getting fresh fruits and vegetables. They're perishable. The food bank stocks non-perishable food. You're likely to be getting cereals, pasta, rice, Kraft Dinner and canned soups with a lot of chemical preservatives in them. The vegetables you get are probably canned and probably also contain lots of preservatives. So people who use food banks are getting a lot of starchy, high-carbohydrate food. But as the old saying goes, beggars can't be choosers.
People on income assistance in British Columbia can get an extra $15 a month for special dietary requirements if they have diabetes. This is just a drop in the proverbial bucket. It's not going to get you much, if any, extra food, especially if all of your money is going to keep the rent paid and the hydro turned on. Also, you have to re-establish your eligibility for this extra money every few months, in case you "get better" and your diabetes suddenly goes away. I told the case worker at the disability office that my diabetes is not going to suddenly go away after 35 years; she said, "But it could improve." Not that much, lady.
So what can be done about this problem? Well, the first thing, I think, is for governments to get their collective heads out of their collective asses and make sure that all people with diabetes have access to the prescription drugs and supplies that they need. All essential diabetes supplies need to be covered by provincial prescription drug plans.
Governments also need to stop blaming people for causing their own diabetes. The media could play a part in this too, by not conjoining "diabetes" and "obesity" (or even worse, using the word "diabesity") in every newspaper and magazine article and television news broadcast.
When a person is diagnosed with diabetes, he or she needs to be educated about how serious diabetes can be and why it is essential that it not be ignored. I don't advocate scare tactics, but people need to be aware of what the consequences of improper diabetes care can be. However, doctors need to stop making it sound like insulin is some sort of punishment for "bad" diabetics; I've heard from many people with Type 2 who think that having to go on insulin is some sort of failure, and they resist taking it.
I think that gyms and recreation centres should be more accessible to people with low incomes. It can be very difficult for people to exercise outdoors in winter in many parts of this country, unless they have the financial means to do things such as skiing. Being able to go to a rec centre and use a swimming pool or a skating rink or an exercise room would be beneficial not only for people with diabetes, but for lots of other low-income people as well. Regular exercise can help prevent Type 2 diabetes, and it has many other physical and mental health benefits as well.
To sum up, it is not surprising that people with low incomes are more likely to fall prey to diabetes complications. People need to rethink their views of diabetes to help combat this inequality.
Tuesday, December 22, 2009
Tuesday, November 24, 2009
Getting the munchies
When I'm at work, I tend to get the munchies. I don't know why the urge to snack comes over me more often at work than it does at home, but when I'm at work I really, really want to snack the day away.
Unfortunately, my snacking choices tend to be really high-calorie, high-carbohydrate foods such as muffins, chocolate bars or potato chips. None of those is a very good choice when I'm spending my day sitting in front of a computer, moving only to go the washroom or to grab a cup of coffee from the kitchen.
Last weekend when I was shopping I decided to look for better snack options. I found some mini rice cakes that came in flavours like chocolate, caramel, cinnamon and peanut butter. The cakes are packed into little pouches, and each pouch has about 15 grams of carbohydrate. "Oh, those look good," I thought, "and they're not super-high in carbohydrates."
So what happened? I bought a box, I took the box to work with me, and I ended up downing three pouches of rice cakes in about ten minutes, requiring an insulin bolus. It's one thing to eat a snack that has 15 grams of carbs; it's another to eat a snack that has 45 grams of carbs.
I'm not exactly a low-carber, but I try to be sensible about what I eat. And eating three bags of rice cakes is probably not terribly sensible of me.
Unfortunately, my snacking choices tend to be really high-calorie, high-carbohydrate foods such as muffins, chocolate bars or potato chips. None of those is a very good choice when I'm spending my day sitting in front of a computer, moving only to go the washroom or to grab a cup of coffee from the kitchen.
Last weekend when I was shopping I decided to look for better snack options. I found some mini rice cakes that came in flavours like chocolate, caramel, cinnamon and peanut butter. The cakes are packed into little pouches, and each pouch has about 15 grams of carbohydrate. "Oh, those look good," I thought, "and they're not super-high in carbohydrates."
So what happened? I bought a box, I took the box to work with me, and I ended up downing three pouches of rice cakes in about ten minutes, requiring an insulin bolus. It's one thing to eat a snack that has 15 grams of carbs; it's another to eat a snack that has 45 grams of carbs.
I'm not exactly a low-carber, but I try to be sensible about what I eat. And eating three bags of rice cakes is probably not terribly sensible of me.
Monday, November 9, 2009
The problem of cheating
A couple of days after Halloween I saw a post on a diabetes forum that asked: "Did you cheat this weekend?" "Cheating" in that context referred to eating Halloween candy.
I objected to the wording, and it was revised to "Did you give in to temptation?" A better choice of words, perhaps, but it got me thinking about the concept of "cheating."
I've often heard both diabetic and non-diabetic people refer to "cheating on my diet." This means eating something that is apparently forbidden; you can't have food that you might actually LIKE to eat. That would be cheating. You're supposed to give up sweets. No chocolate. No candy. No ice cream. No cake, cookies or pie. No juice or regular (non-diet) pop. Some people give up bread, pasta and potatoes.
Now, I'm not going to deny that all of those foods are pretty darn high in carbohydrates and/or sugar or that they can be pretty tough on diabetes control.
My problem is in making any food seem "forbidden" so that if you eat it, you are "cheating." Cheating makes you feel guilty. Cheating is a bad thing. It's something you do in secret. You don't talk about it.
Other people make you feel bad about it, too. My ex-girlfriend used to go online and post to various discussion forums about how I was a bad diabetic because I dared to eat an ice cream cone. Other people point and laugh at the person who orders a burger and fries and a Diet Coke "as if the Diet Coke is going to cancel out all the calories in the burger and fries" without knowing that maybe the person who ordered that food is not counting calories, but carbohydrates.
I don't think there is anything wrong with eating that Halloween-size chocolate bar, or having a piece of cake at your friend's birthday party, or a piece of pumpkin pie at Thanksgiving dinner, or an ice cream cone on a hot day, as long as you know how to calculate enough insulin or exercise to cover for it. I remember one summer afternoon when I had an ice cream cone at the recently opened Ben & Jerry's stand at the mall; I fully intended to give myself some insulin to cover for it, but I was waiting for the effects of the fat in the ice cream to wear off first, because the fat delays the carbohydrates making your blood sugar rise. Well, I did so much walking that afternoon that my blood sugar never did rise, so I didn't need to take that extra insulin after all.
Calling something "cheating" gives it a stigma. It makes us ashamed of eating that chocolate, pie, ice cream, whatever. It makes us hide what we're doing instead of asking for help: how do I calculate the carbs in this piece of birthday cake? How long after eating this ice cream should I take this insulin bolus? I think maybe I'm eating too much pie, cake, ice cream, chocolate -- what should I do?
As I've said before in this blog, I don't advocate eating piles of cake, cookies, candy, chocolate, etc. I believe in moderation. What I don't believe in is self-denial. Denial and deprivation can lead to binging. I found this blog that talks about the "deprivation binge." Quote: "when certain foods are restricted because they are ‘bad’ or ‘forbidden’, tension builds up and a breaking point is eventually reached with a binge."
I think that is one of the biggest reasons to get rid of that "cheating" stigma. Binge eating is bad for everyone, but it can be especially bad for a person who has diabetes.
I objected to the wording, and it was revised to "Did you give in to temptation?" A better choice of words, perhaps, but it got me thinking about the concept of "cheating."
I've often heard both diabetic and non-diabetic people refer to "cheating on my diet." This means eating something that is apparently forbidden; you can't have food that you might actually LIKE to eat. That would be cheating. You're supposed to give up sweets. No chocolate. No candy. No ice cream. No cake, cookies or pie. No juice or regular (non-diet) pop. Some people give up bread, pasta and potatoes.
Now, I'm not going to deny that all of those foods are pretty darn high in carbohydrates and/or sugar or that they can be pretty tough on diabetes control.
My problem is in making any food seem "forbidden" so that if you eat it, you are "cheating." Cheating makes you feel guilty. Cheating is a bad thing. It's something you do in secret. You don't talk about it.
Other people make you feel bad about it, too. My ex-girlfriend used to go online and post to various discussion forums about how I was a bad diabetic because I dared to eat an ice cream cone. Other people point and laugh at the person who orders a burger and fries and a Diet Coke "as if the Diet Coke is going to cancel out all the calories in the burger and fries" without knowing that maybe the person who ordered that food is not counting calories, but carbohydrates.
I don't think there is anything wrong with eating that Halloween-size chocolate bar, or having a piece of cake at your friend's birthday party, or a piece of pumpkin pie at Thanksgiving dinner, or an ice cream cone on a hot day, as long as you know how to calculate enough insulin or exercise to cover for it. I remember one summer afternoon when I had an ice cream cone at the recently opened Ben & Jerry's stand at the mall; I fully intended to give myself some insulin to cover for it, but I was waiting for the effects of the fat in the ice cream to wear off first, because the fat delays the carbohydrates making your blood sugar rise. Well, I did so much walking that afternoon that my blood sugar never did rise, so I didn't need to take that extra insulin after all.
Calling something "cheating" gives it a stigma. It makes us ashamed of eating that chocolate, pie, ice cream, whatever. It makes us hide what we're doing instead of asking for help: how do I calculate the carbs in this piece of birthday cake? How long after eating this ice cream should I take this insulin bolus? I think maybe I'm eating too much pie, cake, ice cream, chocolate -- what should I do?
As I've said before in this blog, I don't advocate eating piles of cake, cookies, candy, chocolate, etc. I believe in moderation. What I don't believe in is self-denial. Denial and deprivation can lead to binging. I found this blog that talks about the "deprivation binge." Quote: "when certain foods are restricted because they are ‘bad’ or ‘forbidden’, tension builds up and a breaking point is eventually reached with a binge."
I think that is one of the biggest reasons to get rid of that "cheating" stigma. Binge eating is bad for everyone, but it can be especially bad for a person who has diabetes.
Saturday, October 31, 2009
Trick-or-Treat with diabetes
Today is Halloween, and many little ghosts and goblins will be out collecting treats from their neighbours. Most of those treats will be candy. Sure, some people give out toothbrushes or raisins or apples, but the vast majority of little Junior's haul will be full of sugar.
What does that mean if Junior has diabetes?
These days most diabetics and parents of diabetics know about carb-counting and carbohydrate-to-insulin ratios. They can calculate how much candy is "safe" to eat and how much insulin to take to compensate for it. This was not the case when I was a young diabetic. Remember, this was the 1970s.
When I was a kid, sugar and candy were big no-nos for diabetics. Diabetic-friendly candy was not nearly as popular as it is today, and even if it had been, none of the people whose houses I went to would have known about my diabetes. We were still on what was called the "food exchange" system (where a slice of bread equalled "one bread exchange") and candy and chocolate didn't fit into that system.
However, I still dressed up in costume, and I still went Trick-or-Treating. I collected my fair share of candy. But I couldn't eat it. My mother would go through my goodie bag and take out the raisins and apples that I could eat, but the rest was stored away in a cupboard.
I did have an older brother and sister. And while I was young enough to go Trick-or-Treating, they -- older than I by seven years and five years -- were not, once I hit about eight years old. This did not, of course, stop them wanting candy.
My parents and I hit on an idea. It was still my candy, even if I couldn't eat it. So I sold it. My brother and sister would give me a quarter for each fun-size chocolate bar or other goodie they wanted, and I used the money to buy myself some sugar-free candy, or even a non-food treat such as a comic book.
Not only did this solve the problem of how to accomodate my diabetes, but it probably also made my dentist happy!
What does that mean if Junior has diabetes?
These days most diabetics and parents of diabetics know about carb-counting and carbohydrate-to-insulin ratios. They can calculate how much candy is "safe" to eat and how much insulin to take to compensate for it. This was not the case when I was a young diabetic. Remember, this was the 1970s.
When I was a kid, sugar and candy were big no-nos for diabetics. Diabetic-friendly candy was not nearly as popular as it is today, and even if it had been, none of the people whose houses I went to would have known about my diabetes. We were still on what was called the "food exchange" system (where a slice of bread equalled "one bread exchange") and candy and chocolate didn't fit into that system.
However, I still dressed up in costume, and I still went Trick-or-Treating. I collected my fair share of candy. But I couldn't eat it. My mother would go through my goodie bag and take out the raisins and apples that I could eat, but the rest was stored away in a cupboard.
I did have an older brother and sister. And while I was young enough to go Trick-or-Treating, they -- older than I by seven years and five years -- were not, once I hit about eight years old. This did not, of course, stop them wanting candy.
My parents and I hit on an idea. It was still my candy, even if I couldn't eat it. So I sold it. My brother and sister would give me a quarter for each fun-size chocolate bar or other goodie they wanted, and I used the money to buy myself some sugar-free candy, or even a non-food treat such as a comic book.
Not only did this solve the problem of how to accomodate my diabetes, but it probably also made my dentist happy!
Tuesday, June 16, 2009
Canadian health care, part 2
In yesterday's post I said I was going to write about what the Canadian -- or, more specifically, British Columbian -- health care system was like for me as a diabetic person, but it turned out more to be a factual account of how the system works rather than a personal account. So today I'm going to write a more personal account.
When I'm sick, I go to the doctor. I don't have to ask my HMO if my particular doctor is "approved" by them. I don't have to ask if a particular doctor accepts the kind of insurance I have, because everyone in the province has the same insurance. I either call up my doctor's office and ask to make an appointment, or I go to the nearest walk-in clinic. I tend to use walk-in clinics a lot, actually, because I hate making telephone calls. Regardless, I go to the doctor when I'm sick. I don't sit around worrying about whether I can afford to go to the doctor; I just go. I don't have to pay anything. There is no deductible. There is no co-pay. No bill will show up in the mail.
Three times a year, I go to see my endocrinologist. I get a referral from my GP to go see my endocrinologist; specialists appointments are by referral. You can't just walk in to see a specialist. Specialists don't get paid if there is no referral. But I don't have to pay anything, not even for a specialist. I don't have to ask anyone's approval; I don't have to submit any kind of request to an insurance provider asking if they will "approve" my seeing this doctor. And no, the government doesn't "decide for me" if I can go see the endocrinologist.
My endocrinologist wants particular tests run. They include a hemoglobin A1C and a urinalysis. About a week before my appointment with the endocrinologist, I go to the lab, I give them my medical card, and they run the tests. My endocrinologist will have sent them a request for the tests. Again, I don't pay anything. I don't have to search to find out whether the lab closest to where I live accepts my particular brand of insurance, because as I said, everyone has the same insurance.
It's kind of like everyone in the province has the same HMO, except that for us, the HMO is the government. That's why it's called a "single payer" health system; everyone's health costs are paid for by the same provider, but for us, that provider is the government rather than a private medical insurance company.
Say I was in an accident, or my diabetes care got screwed up somehow and I ended up in DKA (diabetic ketoacidosis), and I had to go to the hospital. No one is going to make me fill out a whole bunch of forms if it's an emergency. No one is going to ask me how I'll be paying for my care. Eventually someone might ask for my MSP (medical services plan) card so that the hospital can bill the government for my care, but that won't be the priority.
Last year I went off disability benefits while I was going to school, and because I'd had a large windfall of money from an income tax refund, I lost my "medical only" income assistance (see yesterday's blog entry for an explanation of medical-only income assistance) and had to pay my own medical premiums. This wasn't a hardship, because I did have enough money. I was just unused to having to pay premiums, having been on either disability benefits or "medical only" assistance for the last ten years. I hadn't had to pay premiums in those ten years. So I forgot about it for awhile, and then I got a letter in the mail reminding me that I hadn't yet paid my premiums.
I had an endocrinologist appointment coming up, and I knew that my payment wouldn't be processed in time for that appointment, so I phoned up the medical services plan call centre and asked if I would still be able to go to that appointment and whether I'd have to pay for the lab tests I'd just had. "Oh, no, that's not a problem," I was assured. "Even if you don't pay your premiums, you still get health care. It's a necessity! We're not going to make you go without."
When I'm sick, I go to the doctor. I don't have to ask my HMO if my particular doctor is "approved" by them. I don't have to ask if a particular doctor accepts the kind of insurance I have, because everyone in the province has the same insurance. I either call up my doctor's office and ask to make an appointment, or I go to the nearest walk-in clinic. I tend to use walk-in clinics a lot, actually, because I hate making telephone calls. Regardless, I go to the doctor when I'm sick. I don't sit around worrying about whether I can afford to go to the doctor; I just go. I don't have to pay anything. There is no deductible. There is no co-pay. No bill will show up in the mail.
Three times a year, I go to see my endocrinologist. I get a referral from my GP to go see my endocrinologist; specialists appointments are by referral. You can't just walk in to see a specialist. Specialists don't get paid if there is no referral. But I don't have to pay anything, not even for a specialist. I don't have to ask anyone's approval; I don't have to submit any kind of request to an insurance provider asking if they will "approve" my seeing this doctor. And no, the government doesn't "decide for me" if I can go see the endocrinologist.
My endocrinologist wants particular tests run. They include a hemoglobin A1C and a urinalysis. About a week before my appointment with the endocrinologist, I go to the lab, I give them my medical card, and they run the tests. My endocrinologist will have sent them a request for the tests. Again, I don't pay anything. I don't have to search to find out whether the lab closest to where I live accepts my particular brand of insurance, because as I said, everyone has the same insurance.
It's kind of like everyone in the province has the same HMO, except that for us, the HMO is the government. That's why it's called a "single payer" health system; everyone's health costs are paid for by the same provider, but for us, that provider is the government rather than a private medical insurance company.
Say I was in an accident, or my diabetes care got screwed up somehow and I ended up in DKA (diabetic ketoacidosis), and I had to go to the hospital. No one is going to make me fill out a whole bunch of forms if it's an emergency. No one is going to ask me how I'll be paying for my care. Eventually someone might ask for my MSP (medical services plan) card so that the hospital can bill the government for my care, but that won't be the priority.
Last year I went off disability benefits while I was going to school, and because I'd had a large windfall of money from an income tax refund, I lost my "medical only" income assistance (see yesterday's blog entry for an explanation of medical-only income assistance) and had to pay my own medical premiums. This wasn't a hardship, because I did have enough money. I was just unused to having to pay premiums, having been on either disability benefits or "medical only" assistance for the last ten years. I hadn't had to pay premiums in those ten years. So I forgot about it for awhile, and then I got a letter in the mail reminding me that I hadn't yet paid my premiums.
I had an endocrinologist appointment coming up, and I knew that my payment wouldn't be processed in time for that appointment, so I phoned up the medical services plan call centre and asked if I would still be able to go to that appointment and whether I'd have to pay for the lab tests I'd just had. "Oh, no, that's not a problem," I was assured. "Even if you don't pay your premiums, you still get health care. It's a necessity! We're not going to make you go without."
Monday, June 15, 2009
The Canadian health care system
There's been a lot of talk about the U.S. possibly implementing a "Canadian-style" health care system, and also a lot of misinformation about what a "Canadian-style" health care system actually is. So I thought I'd write a little about what it's like for me, as a Canadian with diabetes (as well as a few other chronic health conditions), under this system.
First of all, to be perfectly accurate, there is no "Canadian health care system." There are multiple systems -- one for each province and territory. I live in British Columbia, so I can really only talk about what the system is like here, though there are more similarities than there are differences between the different provincial system.
British Columbia is one of only a few provinces that charge health care premiums. These premiums are based on your yearly income. People with an income of less than $20,000 pay no premiums. The maximum premium, for people with an income of $28,000 a year or more, is $54 a month. Between those two amounts are various income levels with various levels of subsidy.
These premiums cover almost everything: doctor visits, hospitalization, lab tests, X-rays, etc. They do not cover prescription drugs. They do not cover psychotherapy. People with the highest premiums, the ones with an income over $28,000, do not get certain services covered, including physiotherapy, chiropractors or massage therapy. People who have lower premiums have these services covered, but do have to pay small "user fee" of about $10 to $15 per visit. People with higher incomes usually have these services paid for by their employers through various benefits packages.
Many of my American friends are surprised to find out that Canadian employers offer medical benefits, since the government does cover most of our health services. Benefits packages usually cover things that the government doesn't cover, like the aforementioned physio, chiropractors, and massage therapy, and prescription drugs. Some cover psychotherapy or offer "employee assistance" packages. Some pay the medical premiums for their employees.
For those who do not have employers who pay for their prescription drugs, we have what is called Pharmacare. Pharmacare is another sliding-scale plan that is based on a person's income. People whose income is less than $15,000 pay no deductible, but must pay 30 percent of their drug costs until they reach a maximum of 2 percent of their annual income spent on prescription drug costs. People whose net income is between $15,000 and $20,000 pay a deductible equivalent to 2 percent of their annual income, and then the government pays 70 percent of drug costs, until the person has spent 3 percent of their annual income on prescription drugs, at which time the government pays 100 percent of the drug costs. And people whose annual income is over $30,000 pay a deductible equivalent to 3 percent of their income, and then the second deductible is equivalent to 4 percent of annual income.
People who are on welfare or disability benefits have all their prescription drug costs covered by the government, and they don't have to pay medical premiums.
Because I am currently on disability, all of my diabetes supplies (and my other prescriptions) are covered by the government. If I go back to work, they will still be covered by the government under a program called "medical-only income assistance." This is a program that pays the costs of medication for people who have left disability assistance to go to work, but who would have trouble paying for their prescription drug costs if those costs were no longer covered by the government. The government sees this as a way to encourage people with disabilities to go to work and get off disability assistance.
What do I think of the British Columbia health care system? (As I said, there is no universal "Canadian" system.) I think it's not perfect, but I prefer it to the lack of a system in the United States. It has its flaws, certainly; the government has a tendency, in my opinion, to see health care as nothing but a big expense, and they tend to stigmatize certain diseases -- especially diabetes -- as being a "drain" on the health care system.
But I know too many Americans who have no health insurance. I know too many who are terrified of losing their jobs because if they do, they lose their health insurance. I have met people who say things like, "I think I'm having a miscarriage, but I can't go to the hospital because I have no money," or "I have diabetes, and I can't afford to pay for my insulin/syringes/test strips/etc."
There must be a better way.
First of all, to be perfectly accurate, there is no "Canadian health care system." There are multiple systems -- one for each province and territory. I live in British Columbia, so I can really only talk about what the system is like here, though there are more similarities than there are differences between the different provincial system.
British Columbia is one of only a few provinces that charge health care premiums. These premiums are based on your yearly income. People with an income of less than $20,000 pay no premiums. The maximum premium, for people with an income of $28,000 a year or more, is $54 a month. Between those two amounts are various income levels with various levels of subsidy.
These premiums cover almost everything: doctor visits, hospitalization, lab tests, X-rays, etc. They do not cover prescription drugs. They do not cover psychotherapy. People with the highest premiums, the ones with an income over $28,000, do not get certain services covered, including physiotherapy, chiropractors or massage therapy. People who have lower premiums have these services covered, but do have to pay small "user fee" of about $10 to $15 per visit. People with higher incomes usually have these services paid for by their employers through various benefits packages.
Many of my American friends are surprised to find out that Canadian employers offer medical benefits, since the government does cover most of our health services. Benefits packages usually cover things that the government doesn't cover, like the aforementioned physio, chiropractors, and massage therapy, and prescription drugs. Some cover psychotherapy or offer "employee assistance" packages. Some pay the medical premiums for their employees.
For those who do not have employers who pay for their prescription drugs, we have what is called Pharmacare. Pharmacare is another sliding-scale plan that is based on a person's income. People whose income is less than $15,000 pay no deductible, but must pay 30 percent of their drug costs until they reach a maximum of 2 percent of their annual income spent on prescription drug costs. People whose net income is between $15,000 and $20,000 pay a deductible equivalent to 2 percent of their annual income, and then the government pays 70 percent of drug costs, until the person has spent 3 percent of their annual income on prescription drugs, at which time the government pays 100 percent of the drug costs. And people whose annual income is over $30,000 pay a deductible equivalent to 3 percent of their income, and then the second deductible is equivalent to 4 percent of annual income.
People who are on welfare or disability benefits have all their prescription drug costs covered by the government, and they don't have to pay medical premiums.
Because I am currently on disability, all of my diabetes supplies (and my other prescriptions) are covered by the government. If I go back to work, they will still be covered by the government under a program called "medical-only income assistance." This is a program that pays the costs of medication for people who have left disability assistance to go to work, but who would have trouble paying for their prescription drug costs if those costs were no longer covered by the government. The government sees this as a way to encourage people with disabilities to go to work and get off disability assistance.
What do I think of the British Columbia health care system? (As I said, there is no universal "Canadian" system.) I think it's not perfect, but I prefer it to the lack of a system in the United States. It has its flaws, certainly; the government has a tendency, in my opinion, to see health care as nothing but a big expense, and they tend to stigmatize certain diseases -- especially diabetes -- as being a "drain" on the health care system.
But I know too many Americans who have no health insurance. I know too many who are terrified of losing their jobs because if they do, they lose their health insurance. I have met people who say things like, "I think I'm having a miscarriage, but I can't go to the hospital because I have no money," or "I have diabetes, and I can't afford to pay for my insulin/syringes/test strips/etc."
There must be a better way.
Tuesday, June 2, 2009
Diabetes and hot weather
While it's not technically summer yet, my city has been experiencing some record-high temperatures over the last few days, and these temperatures are expected to last till the end of the week. When hot weather comes, there are some precautions I have to take when dealing with my diabetes.
One concern is dehydration. Dehydration is a concern for everyone, of course, but people who have diabetes have to be even more concerned. High blood sugar can cause dehydration, and some diabetes complications, such as certain forms of neuropathy, can impair the body's ability to sense dehydration symptoms. So I have to make sure I drink plenty of fluids on hot days.
I've discovered that the symptoms of low blood sugar seem to be pretty similar to the symptoms of heat exhaustion -- sleepiness, lightheadedness, confusion, etc. This causes me to check my blood sugar a lot more often when the weather is hot. Unfortunately, this means I use a lot more test strips than usual! Unfortunately, heat exhaustion is harder to treat than low blood sugar is. I'd rather have low blood sugar.
Heat also seems to lower blood sugar fairly quickly. I've noticed that I have to lower my insulin dosage on days when the temperature is abnormally high. There have been hot days when it seems like no matter what I eat, my blood sugar refuses to go above 4 mmol/l. While it's kind of nice to be able to eat anything I want, it's rather frustrating to have to be constantly treating myself for low blood sugar. I'm also sure it's not good for my weight to spend the day eating anything I want.
Then again, on hot days my appetite is diminished, so then I don't want to eat a lot. This means lowering my insulin dosage even more! Unless, of course, I decide to get a double-chocolate-chip frappucino from Starbucks. It's a lovely, chocolatey, cool drink, and Starbucks has lovely air conditioning, but it's going to wreak havoc on my blood sugar if I'm not careful and don't bolus appropriately for it.
And I'm probably not going to feel like exercising off the carbohydrates in that frappucino if the weather is hot. Exercise plus hot weather can equal dehydration and heat exhaustion, which brings us back to where I started this post.
So I will enjoy this hot weather while it lasts, but I'll also have to keep an eye on my diabetes while I do so.
One concern is dehydration. Dehydration is a concern for everyone, of course, but people who have diabetes have to be even more concerned. High blood sugar can cause dehydration, and some diabetes complications, such as certain forms of neuropathy, can impair the body's ability to sense dehydration symptoms. So I have to make sure I drink plenty of fluids on hot days.
I've discovered that the symptoms of low blood sugar seem to be pretty similar to the symptoms of heat exhaustion -- sleepiness, lightheadedness, confusion, etc. This causes me to check my blood sugar a lot more often when the weather is hot. Unfortunately, this means I use a lot more test strips than usual! Unfortunately, heat exhaustion is harder to treat than low blood sugar is. I'd rather have low blood sugar.
Heat also seems to lower blood sugar fairly quickly. I've noticed that I have to lower my insulin dosage on days when the temperature is abnormally high. There have been hot days when it seems like no matter what I eat, my blood sugar refuses to go above 4 mmol/l. While it's kind of nice to be able to eat anything I want, it's rather frustrating to have to be constantly treating myself for low blood sugar. I'm also sure it's not good for my weight to spend the day eating anything I want.
Then again, on hot days my appetite is diminished, so then I don't want to eat a lot. This means lowering my insulin dosage even more! Unless, of course, I decide to get a double-chocolate-chip frappucino from Starbucks. It's a lovely, chocolatey, cool drink, and Starbucks has lovely air conditioning, but it's going to wreak havoc on my blood sugar if I'm not careful and don't bolus appropriately for it.
And I'm probably not going to feel like exercising off the carbohydrates in that frappucino if the weather is hot. Exercise plus hot weather can equal dehydration and heat exhaustion, which brings us back to where I started this post.
So I will enjoy this hot weather while it lasts, but I'll also have to keep an eye on my diabetes while I do so.
Wednesday, May 20, 2009
Feline diabetes
A few days ago, my cat Poupée was diagnosed with feline diabetes. To me, this was a relief. Her symptoms could have been caused by kidney failure, and I'd already lost a cat to kidney failure two years ago. Having another cat with kidney failure would be devastating.
She had the usual signs: drinking a lot (three bowls of water a day), peeing a lot, being sleepy all the time. So the vet told me to start giving her injections of Lantus. I was surprised, but relieved, that I didn't have to give her a particular cat-specific type of insulin. I don't have a job right now, and the government program that pays for part of the cost of my prescription drugs wouldn't pay for medication for a cat.
I can give Poupée my own Lantus. I can even use my own insulin pen. I'm actually much more comfortable with pens these days than I am with syringes. I tried using a syringe on Poupée, and she squirmed away from me. So the next day I used my pen, and she seemed to be more comfortable with that. So as long as she's taking an even number of units of Lantus, I can use my pen. (The pen only goes in increments of two.)
Diabetic kitties should have their blood sugar tested, but so far I have failed at this. You're supposed to use your lancing device (the one you would use to poke your fingers as a human diabetic) to poke the kitty's ear. Well, I've tried, and Poupée has been amazingly tolerant of my efforts to get blood from her ear, but so far I haven't succeeded. I'd really like to know what her blood sugar is like and how her insulin is affecting her. At least she's not drinking nearly as much water as she was before she went on insulin.
Poupée also has to go on a low-carb diet, which means all the cats in my household have to go on a low-carb diet. She's eating Purina diet cat food. The vet calls it the "catkins" diet.
I think for many people it's a big deal when their cat is diagnosed with diabetes. Maybe because I've had diabetes for almost my entire life, it's not such a big deal for me. Granted, it cost me a lot of money to get her diagnosis in the first place, but at least I can share my own diabetes supplies with Poupée so they won't cost me any extra. Sure, I would prefer it if my kitty didn't have diabetes, just like I'd prefer not to have diabetes myself. But at least it can be treated, for both of us.
She had the usual signs: drinking a lot (three bowls of water a day), peeing a lot, being sleepy all the time. So the vet told me to start giving her injections of Lantus. I was surprised, but relieved, that I didn't have to give her a particular cat-specific type of insulin. I don't have a job right now, and the government program that pays for part of the cost of my prescription drugs wouldn't pay for medication for a cat.
I can give Poupée my own Lantus. I can even use my own insulin pen. I'm actually much more comfortable with pens these days than I am with syringes. I tried using a syringe on Poupée, and she squirmed away from me. So the next day I used my pen, and she seemed to be more comfortable with that. So as long as she's taking an even number of units of Lantus, I can use my pen. (The pen only goes in increments of two.)
Diabetic kitties should have their blood sugar tested, but so far I have failed at this. You're supposed to use your lancing device (the one you would use to poke your fingers as a human diabetic) to poke the kitty's ear. Well, I've tried, and Poupée has been amazingly tolerant of my efforts to get blood from her ear, but so far I haven't succeeded. I'd really like to know what her blood sugar is like and how her insulin is affecting her. At least she's not drinking nearly as much water as she was before she went on insulin.
Poupée also has to go on a low-carb diet, which means all the cats in my household have to go on a low-carb diet. She's eating Purina diet cat food. The vet calls it the "catkins" diet.
I think for many people it's a big deal when their cat is diagnosed with diabetes. Maybe because I've had diabetes for almost my entire life, it's not such a big deal for me. Granted, it cost me a lot of money to get her diagnosis in the first place, but at least I can share my own diabetes supplies with Poupée so they won't cost me any extra. Sure, I would prefer it if my kitty didn't have diabetes, just like I'd prefer not to have diabetes myself. But at least it can be treated, for both of us.
Monday, May 11, 2009
Explaining diabetes to non-diabetics
Something I often wonder about is how to explain what it's like to have diabetes to someone who doesn't have it. There are people who freak out at the mere mention of the fact that I have to "take needles" four times a day and say that they would die if they had to do that. Then there are people who ask me why diabetes is "such a big deal."
How do I explain what hypoglycemia feels like? I could say that it's unpleasantly like being drunk, but I remember Arthur Dent in the Hitchhiker's Guide to the Galaxy asking, "What's unpleasant about being drunk?" (Ford Prefect's reply is, "Ask a glass of water.")
How do I explain what hyperglycemia feels like? "You're thirsty all the time. You keep having to pee. You're tired and grouchy." All of these are true, but they barely begin to cover it.
Then, of course, there are the misconceptions. "You can't eat sugar." Wrong. Sugar is not the big bad that people make it out to be. Carbohydrates are the real culprit. And they don't have to be eliminated entirely, just taken in moderation. But I still have people trying to hide the candy dish when I'm around or telling me, "You can't eat that!"
Of course, people laugh at me when I order a burger, fries and a Diet Coke. "Oh right, like the Diet Coke is going to cancel out the calories from the burger and fries!" Actually, I'm not concerned about calories. I'm concerned about carbohydrates. I'm drinking a Diet Coke because I don't want to add a couple of dozen more grams of carbohydrate to my meal. If I explain that I have diabetes, then I'll have the same people saying, "But a diabetic shouldn't be eating that!" Argh!
How do I explain what hypoglycemia feels like? I could say that it's unpleasantly like being drunk, but I remember Arthur Dent in the Hitchhiker's Guide to the Galaxy asking, "What's unpleasant about being drunk?" (Ford Prefect's reply is, "Ask a glass of water.")
How do I explain what hyperglycemia feels like? "You're thirsty all the time. You keep having to pee. You're tired and grouchy." All of these are true, but they barely begin to cover it.
Then, of course, there are the misconceptions. "You can't eat sugar." Wrong. Sugar is not the big bad that people make it out to be. Carbohydrates are the real culprit. And they don't have to be eliminated entirely, just taken in moderation. But I still have people trying to hide the candy dish when I'm around or telling me, "You can't eat that!"
Of course, people laugh at me when I order a burger, fries and a Diet Coke. "Oh right, like the Diet Coke is going to cancel out the calories from the burger and fries!" Actually, I'm not concerned about calories. I'm concerned about carbohydrates. I'm drinking a Diet Coke because I don't want to add a couple of dozen more grams of carbohydrate to my meal. If I explain that I have diabetes, then I'll have the same people saying, "But a diabetic shouldn't be eating that!" Argh!
Sunday, May 10, 2009
Diabetes on TV
I must admit, most portrayals of diabetes on TV bug the hell out of me. About 99 percent of shows that deal with diabetes have a simple plot of "separate the diabetic from his/her insulin and watch him/her go into a coma instantly!" I watched an episode of "Adam-12" in which a young boy ran away from the hospital a few hours after being diagnosed with juvenile diabetes.
The doctors pronounced gravely, "If we don't find him within four hours, he will go into a coma!" I'm thinking: go into a coma from what? If he's due for an insulin shot in four hours and doesn't get it, then he'll develop high blood sugar and it will be nasty and unpleasant, but he won't go into a coma as soon as he hits the four-hour mark. If four hours is the time his insulin peaks and he hasn't had anything to eat, then he might get low blood sugar and might pass out not long after he hits that four-hour mark, but he probably wouldn't go into a coma.
There was an episode of "Touched by an Angel" that dealt with a teenage girl being diagnosed with diabetes. In this episode, the girl's mother would go into her bedroom in the middle of the night, check her blood sugar (while the girl was still sleeping!) and give her an insulin injection. Every night. I'm going: "Huh?" The girl is about 18 years old, so I'm sure she is perfectly capable of testing her own blood sugar, and I can't see any purpose for giving her an injection in the middle of the night, every night. If it happens that her blood sugar is exceptionally high one night, then I can see taking an injection (which she should be capable of doing on her own) on that occasion, but not every single night. It is simply not practical and not realistic.
The climax of the episode has the girl having a fight with her boyfriend in the school gym, because he doesn't want her anymore due to her diabetes. She is trying to demonstrate to him that diabetes is not such a big deal. To prove this, she injects herself with what I can only guess is a massive amount of insulin, since it took effect so quickly, and promptly collapses from an insulin overdose. What that was supposed to prove to her boyfriend, I'm not exactly sure. Maybe it was supposed to make him feel sorry for her.
One show from the '70s that I enjoy watching on DVD is "Emergency!" They don't spend a lot of time dealing with diabetes, but for the most part they portray diabetes cases fairly realistically. The paramedics are called to deal with a man who is acting strangely; everyone thinks he's on drugs, but it turns out he's a diabetic whose blood sugar is dangerously low. A mother calls the paramedics because her son, who has been unwell for a while, won't wake up from his nap. It turns out the son has gone into diabetic ketoacidosis. The firefighters rescue a child and a teenager from a house fire, and can't figure out why the teenager is unconscious while her younger sister is fine. They haven't inhaled too much smoke from the fire, so what is wrong? The younger one tells the firefighters that her sister "hasn't been taking her medication like she's supposed to." Turns out the older sister has diabetes and hasn't been taking her insulin!
Even one of my favourite TV shows, "Boston Legal", didn't handle diabetes very well. One of the characters filed a class-action suit against the manufacturer of a popular snack cake that was sweetened with high-fructose corn syrup. Why? Because eating the snack cake apparently caused people to get Type 2 diabetes. Another lawyer character represented a client with Type 2 diabetes who was suing after being dropped from the clinical trial of a new diabetes drug. The lawyer treated the diabetic client as if she had a terminal disease and was going to drop dead any moment -- because, apparently, she was going to die if she didn't get this experimental diabetes drug.
I wish that when TV shows dealt with diabetes, they would take the time to research it and find out what it's all about. I wish they would stop over-dramatizing it. A diabetic is not going to go into a coma if their insulin injection is delayed for a few minutes, nor is he/she going to drop dead. He/she is also not going to drop dead if he/she eats sugar. You don't need to treat a diabetic person as if he/she has a terminal illness. But I guess that's just not dramatic enough for TV.
The doctors pronounced gravely, "If we don't find him within four hours, he will go into a coma!" I'm thinking: go into a coma from what? If he's due for an insulin shot in four hours and doesn't get it, then he'll develop high blood sugar and it will be nasty and unpleasant, but he won't go into a coma as soon as he hits the four-hour mark. If four hours is the time his insulin peaks and he hasn't had anything to eat, then he might get low blood sugar and might pass out not long after he hits that four-hour mark, but he probably wouldn't go into a coma.
There was an episode of "Touched by an Angel" that dealt with a teenage girl being diagnosed with diabetes. In this episode, the girl's mother would go into her bedroom in the middle of the night, check her blood sugar (while the girl was still sleeping!) and give her an insulin injection. Every night. I'm going: "Huh?" The girl is about 18 years old, so I'm sure she is perfectly capable of testing her own blood sugar, and I can't see any purpose for giving her an injection in the middle of the night, every night. If it happens that her blood sugar is exceptionally high one night, then I can see taking an injection (which she should be capable of doing on her own) on that occasion, but not every single night. It is simply not practical and not realistic.
The climax of the episode has the girl having a fight with her boyfriend in the school gym, because he doesn't want her anymore due to her diabetes. She is trying to demonstrate to him that diabetes is not such a big deal. To prove this, she injects herself with what I can only guess is a massive amount of insulin, since it took effect so quickly, and promptly collapses from an insulin overdose. What that was supposed to prove to her boyfriend, I'm not exactly sure. Maybe it was supposed to make him feel sorry for her.
One show from the '70s that I enjoy watching on DVD is "Emergency!" They don't spend a lot of time dealing with diabetes, but for the most part they portray diabetes cases fairly realistically. The paramedics are called to deal with a man who is acting strangely; everyone thinks he's on drugs, but it turns out he's a diabetic whose blood sugar is dangerously low. A mother calls the paramedics because her son, who has been unwell for a while, won't wake up from his nap. It turns out the son has gone into diabetic ketoacidosis. The firefighters rescue a child and a teenager from a house fire, and can't figure out why the teenager is unconscious while her younger sister is fine. They haven't inhaled too much smoke from the fire, so what is wrong? The younger one tells the firefighters that her sister "hasn't been taking her medication like she's supposed to." Turns out the older sister has diabetes and hasn't been taking her insulin!
Even one of my favourite TV shows, "Boston Legal", didn't handle diabetes very well. One of the characters filed a class-action suit against the manufacturer of a popular snack cake that was sweetened with high-fructose corn syrup. Why? Because eating the snack cake apparently caused people to get Type 2 diabetes. Another lawyer character represented a client with Type 2 diabetes who was suing after being dropped from the clinical trial of a new diabetes drug. The lawyer treated the diabetic client as if she had a terminal disease and was going to drop dead any moment -- because, apparently, she was going to die if she didn't get this experimental diabetes drug.
I wish that when TV shows dealt with diabetes, they would take the time to research it and find out what it's all about. I wish they would stop over-dramatizing it. A diabetic is not going to go into a coma if their insulin injection is delayed for a few minutes, nor is he/she going to drop dead. He/she is also not going to drop dead if he/she eats sugar. You don't need to treat a diabetic person as if he/she has a terminal illness. But I guess that's just not dramatic enough for TV.
Wednesday, May 6, 2009
You say it's your birthday....
My birthday is coming up on Friday. I'll be 41 years old. I count my number of years as a diabetic by how old I am, and I am pretty sure I was five years old when I was diagnosed, so this will make 36 years of having diabetes. (My older brother insists I was four years old, however, so it may actually be 37 years.)
My birthday and Christmas are the two times of year when I throw caution to the wind and eat anything and everything I want. Now, if you read my "why I don't low-carb" post, I said that I pretty much eat that way anyway. But actually, I try not overdo it most of the time. Except on my birthday and Christmas. And actually, I don't even do it that much at Christmas, because I generally don't enjoy parties, and if I don't go to Christmas parties, then there's no temptation.
I once went to a chocolate buffet for my birthday. It had been a very tough time for me that particular birthday; my beloved cat had just passed away suddenly and unexpectedly, and then a couple of days later I got yelled at by my landlord for having a messy apartment. So I figured I deserved a treat.
To my surprise, there was actually sugar free chocolate at the chocolate buffet! This helped me feel less guilty. Granted, I did wake up the next morning with a blood sugar somewhere around 17 (that would be around 300 for the Americans.)
I'd like to go to the chocolate buffet again this year, but I think I'll try to opt for a lower-fat supper (I had fish and chips for supper the night of the chocolate buffet, and the fat content prevented the chocolate from raising my blood sugar right away) and I might have to get up a few times during the night to check my blood sugar in order to prevent it from going up as high as it did the first time I went. And maybe I'll have more of the sugar-free chocolate this time.
I'm not recommending that any diabetic go to a chocolate buffet or go overboard on their birthday. Going overboard is definitely not healthy. But I think we all deserve a treat now and then, and what better time for a treat than your birthday?
My birthday and Christmas are the two times of year when I throw caution to the wind and eat anything and everything I want. Now, if you read my "why I don't low-carb" post, I said that I pretty much eat that way anyway. But actually, I try not overdo it most of the time. Except on my birthday and Christmas. And actually, I don't even do it that much at Christmas, because I generally don't enjoy parties, and if I don't go to Christmas parties, then there's no temptation.
I once went to a chocolate buffet for my birthday. It had been a very tough time for me that particular birthday; my beloved cat had just passed away suddenly and unexpectedly, and then a couple of days later I got yelled at by my landlord for having a messy apartment. So I figured I deserved a treat.
To my surprise, there was actually sugar free chocolate at the chocolate buffet! This helped me feel less guilty. Granted, I did wake up the next morning with a blood sugar somewhere around 17 (that would be around 300 for the Americans.)
I'd like to go to the chocolate buffet again this year, but I think I'll try to opt for a lower-fat supper (I had fish and chips for supper the night of the chocolate buffet, and the fat content prevented the chocolate from raising my blood sugar right away) and I might have to get up a few times during the night to check my blood sugar in order to prevent it from going up as high as it did the first time I went. And maybe I'll have more of the sugar-free chocolate this time.
I'm not recommending that any diabetic go to a chocolate buffet or go overboard on their birthday. Going overboard is definitely not healthy. But I think we all deserve a treat now and then, and what better time for a treat than your birthday?
Friday, April 24, 2009
Those darn needles
Because I have diabetes and do not have an insulin pump, I have to take injections. I take them before every meal, and also once at night before I go to bed. I've been doing this since I was a young child (well, except that my mother did them for me when I was very young) and to me, it's just not a big deal.
I generally don't go around flaunting my needles. I don't wave my hands in the air and say, "Look at me, I have a needle!" or "Watch me do my shot!" I don't hide it, either. I don't feel the need to go sneaking off to the bathroom to do my shot away from other people, unless of course I need to actually remove an item of clothing in order to do the shot. All of my friends know I have diabetes, and none of them have a problem with my needles.
The rare times I'm with new people, I'll try to remember to say something like, "Excuse me, does anyone here have a problem with needles? I have to do an insulin injection and I don't want to bother anyone." The last time this happened, I was at a political fundraising barbecue, and it turned out that of the people I was with, almost all of them were either nurses or other health care workers, and the one who wasn't had just come from a round of cancer treatment that she said had subjected her to plenty of needles.
Generally, when I'm out in public, I'll discreetly take my insulin pen from my purse, dial up my dose and then raise my shirt a tiny bit and stick the needle into my abdomen. Sometimes I'll roll up a sleeve and do an injection in my arm. I've had people ask me, "But what if someone else in the restaurant is afraid of needles and they see you doing your shot?" I figure that most people are going to be paying attention to their own meals and their own companions, not watching to see what the blonde woman at the next table is doing.
Shots are somethig that I need to do for my own health, something I do to literally stay alive. What if I had a fear of dogs? Should I demand that no one can bring a service dog into a restaurant where I'm eating? No, because people who have service dogs have them because they need them.
One day a couple of years ago I was eating supper in a Chinese restaurant. As I usually do, I pulled out my insulin pen and did my injection. Then I got up to go get my meal from the buffet. Someone approached me and said, "Excuse me, I just wanted to thank you." "Thank me for what?" I asked. "Thank you for being brave enough to do your insulin shot in public." "Er, you're welcome, but I don't see what's so brave about it."
Turns out this fellow had once had someone yell at him in the middle of a crowded restaurant because he had done an insulin shot in public. After that he had felt ashamed of doing his injections in public and would go do them in the bathroom. He said that seeing me do my shot made him feel better about doing his, and maybe he'd go back to doing them in public after all.
I generally don't go around flaunting my needles. I don't wave my hands in the air and say, "Look at me, I have a needle!" or "Watch me do my shot!" I don't hide it, either. I don't feel the need to go sneaking off to the bathroom to do my shot away from other people, unless of course I need to actually remove an item of clothing in order to do the shot. All of my friends know I have diabetes, and none of them have a problem with my needles.
The rare times I'm with new people, I'll try to remember to say something like, "Excuse me, does anyone here have a problem with needles? I have to do an insulin injection and I don't want to bother anyone." The last time this happened, I was at a political fundraising barbecue, and it turned out that of the people I was with, almost all of them were either nurses or other health care workers, and the one who wasn't had just come from a round of cancer treatment that she said had subjected her to plenty of needles.
Generally, when I'm out in public, I'll discreetly take my insulin pen from my purse, dial up my dose and then raise my shirt a tiny bit and stick the needle into my abdomen. Sometimes I'll roll up a sleeve and do an injection in my arm. I've had people ask me, "But what if someone else in the restaurant is afraid of needles and they see you doing your shot?" I figure that most people are going to be paying attention to their own meals and their own companions, not watching to see what the blonde woman at the next table is doing.
Shots are somethig that I need to do for my own health, something I do to literally stay alive. What if I had a fear of dogs? Should I demand that no one can bring a service dog into a restaurant where I'm eating? No, because people who have service dogs have them because they need them.
One day a couple of years ago I was eating supper in a Chinese restaurant. As I usually do, I pulled out my insulin pen and did my injection. Then I got up to go get my meal from the buffet. Someone approached me and said, "Excuse me, I just wanted to thank you." "Thank me for what?" I asked. "Thank you for being brave enough to do your insulin shot in public." "Er, you're welcome, but I don't see what's so brave about it."
Turns out this fellow had once had someone yell at him in the middle of a crowded restaurant because he had done an insulin shot in public. After that he had felt ashamed of doing his injections in public and would go do them in the bathroom. He said that seeing me do my shot made him feel better about doing his, and maybe he'd go back to doing them in public after all.
Tuesday, April 21, 2009
Diabetes is complicating
Most diabetic people know what diabetes complications are: neuropathy, nephropathy, retinopathy, etc. All those -opathies.
I would like to talk about a slightly different kind of diabetes "complication" -- the way diabetes "complicates" my life.
A few days ago my wonderful partner invited me to take an overnight trip to Vancouver with him, all expenses paid. Lovely! However, here is where the complications set in.
What do I take with me? Insulin pens, of course. Insulin. Extra insulin. Blood glucose meter. Test strips. Extra test strips. Pen needles. Yes, extra ones of those too. Glucose tablets in case of low blood sugar while on the road. A handful of granola bars and a couple of tins of so-called meal-replacement shakes (those things do not replace a meal, believe me) in case a meal gets delayed or I just get hungry in the middle of the night at the hotel. All the diabetes supplies I can carry, just for being away from home for less than 48 hours.
You never know what might happen. BC Ferries might go on a wildcat strike and shut down. Or the ferry might simply break down (they do that often enough.) We might miss our bus out to the ferry and have to spend an extra night in Vancouver. Better to have too many supplies than not enough.
That's just for an overnight trip. Imagine what I would have to do to go away for something like an entire week or more! Sadly, neither my partner nor I have the money for that right now. Who knows, maybe that's a good thing.
But really, there are "complications" that come with everyday life, not just with overnight trips, as I'm sure my fellow diabetic people know. I've written before about what happens when I forget my insulin pen. Everywhere I go, I try to remember everything I need to carry with me: insulin pen, blood test machine and test strips, glucose tablets. Maybe a snack if I'm not going to be somewhere that I can easily buy something.
I might not need to carry the amount of stuff that I would carry on an overnight (or longer) trip, but I need to carry pretty much the same things, just in smaller amounts. And I still might need extras of some of my supplies. I don't want to be drawing up an injection at dinner in the middle of a restaurant only to discover there's not enough insulin left in the pen, or taking out my blood glucose meter at work only to discover I'm out of test strips.
Then of course there are the meal planning complications. Things are somewhat easier than they were, say, ten years ago, with both faster-acting and longer-acting insulins. But having diabetes means that I do have to keep a somewhat regular schedule, and delaying or missing a meal or an injection can have some serious complications. Delaying a meal can mean low blood sugar because of lack of food, or high blood sugar because the mealtime insulin injection has been delayed.
Maybe you're spending the day/night/weekend with someone who has a completely different meal schedule from yours. They might skip breakfast, for example, and eat a bigger lunch to make up for it, but you can't skip breakfast. Or they might decide that they're not going to eat after a certain hour of the day in an effort to lose weight, and expect you to go along with that schedule when you can't.
Maybe your employer has scheduled a 7:00 a.m. meeting, which means that you might have to get out of bed and eat breakfast as early as 5:00 a.m. in order to get to work on time (depending on your commute), assuming that it's not a breakfast meeting. But lunch isn't until noon, and you have too much work to do to take a coffee break. Your breakfast time insulin isn't going to last until noon, and you're starving by 10:00 a.m. What are you going to do? This is where one of those granola bars I mentioned earlier, stored in a drawer in your desk, might come in handy.
Yes, diabetes has its complications, and it is complicated. But we do learn our own tricks to manage our way through those complications. Don't you wish we didn't have to?
I would like to talk about a slightly different kind of diabetes "complication" -- the way diabetes "complicates" my life.
A few days ago my wonderful partner invited me to take an overnight trip to Vancouver with him, all expenses paid. Lovely! However, here is where the complications set in.
What do I take with me? Insulin pens, of course. Insulin. Extra insulin. Blood glucose meter. Test strips. Extra test strips. Pen needles. Yes, extra ones of those too. Glucose tablets in case of low blood sugar while on the road. A handful of granola bars and a couple of tins of so-called meal-replacement shakes (those things do not replace a meal, believe me) in case a meal gets delayed or I just get hungry in the middle of the night at the hotel. All the diabetes supplies I can carry, just for being away from home for less than 48 hours.
You never know what might happen. BC Ferries might go on a wildcat strike and shut down. Or the ferry might simply break down (they do that often enough.) We might miss our bus out to the ferry and have to spend an extra night in Vancouver. Better to have too many supplies than not enough.
That's just for an overnight trip. Imagine what I would have to do to go away for something like an entire week or more! Sadly, neither my partner nor I have the money for that right now. Who knows, maybe that's a good thing.
But really, there are "complications" that come with everyday life, not just with overnight trips, as I'm sure my fellow diabetic people know. I've written before about what happens when I forget my insulin pen. Everywhere I go, I try to remember everything I need to carry with me: insulin pen, blood test machine and test strips, glucose tablets. Maybe a snack if I'm not going to be somewhere that I can easily buy something.
I might not need to carry the amount of stuff that I would carry on an overnight (or longer) trip, but I need to carry pretty much the same things, just in smaller amounts. And I still might need extras of some of my supplies. I don't want to be drawing up an injection at dinner in the middle of a restaurant only to discover there's not enough insulin left in the pen, or taking out my blood glucose meter at work only to discover I'm out of test strips.
Then of course there are the meal planning complications. Things are somewhat easier than they were, say, ten years ago, with both faster-acting and longer-acting insulins. But having diabetes means that I do have to keep a somewhat regular schedule, and delaying or missing a meal or an injection can have some serious complications. Delaying a meal can mean low blood sugar because of lack of food, or high blood sugar because the mealtime insulin injection has been delayed.
Maybe you're spending the day/night/weekend with someone who has a completely different meal schedule from yours. They might skip breakfast, for example, and eat a bigger lunch to make up for it, but you can't skip breakfast. Or they might decide that they're not going to eat after a certain hour of the day in an effort to lose weight, and expect you to go along with that schedule when you can't.
Maybe your employer has scheduled a 7:00 a.m. meeting, which means that you might have to get out of bed and eat breakfast as early as 5:00 a.m. in order to get to work on time (depending on your commute), assuming that it's not a breakfast meeting. But lunch isn't until noon, and you have too much work to do to take a coffee break. Your breakfast time insulin isn't going to last until noon, and you're starving by 10:00 a.m. What are you going to do? This is where one of those granola bars I mentioned earlier, stored in a drawer in your desk, might come in handy.
Yes, diabetes has its complications, and it is complicated. But we do learn our own tricks to manage our way through those complications. Don't you wish we didn't have to?
Friday, April 17, 2009
Why I don't low-carb
On the many and varied diabetes forums I belong to, I see a lot of posts about what is called "low-carbing." From what I understand, that means depriving yourself of foods such as bread, rice, potatoes, pasta, pizza, tacos, fruit, most vegetables, any kind of fruit juice, and just about everything else that has any amount of sugar in it.
When I tell people that I don't do the low-carb diet, they look at me like I'm nuts before solemnly declaring that I'm going to either die or at least suffer horrible diabetes complications, even when I tell them that my hemoglobin A1C has been at or below 6.0 for at least the last ten years.
Now, don't get me wrong; I don't stuff myself with cake, pie, cookies, ice cream, etc. I try for moderation. But I refuse to deprive myself of anything. When I was a kid, diabetes seemed to be all about deprivation. You can't have this because you're a diabetic. You can't have that because you're a diabetic. Watching other people eat chocolate-chip cookies or birthday cake was torture because I couldn't have any. And I truly believed I would never be able to have any.
When I left home, I tried to be a "good" diabetic, but since I was no longer under my mother's watchful eye, I went a bit nuts. I ate anything and everything that I wanted without bothering to test my blood sugar or adjust my insulin. And my blood sugars went all over the place.
Fortunately, with the help of a sympathetic doctor and the local diabetes education clinic, I eventually got back on track. But I realized that my rebellious behaviour was a direct result of being deprived for so long.
With some help from the dietitian at the diabetes education centre, I learned how to adjust my insulin to compensate for the carbohydrates that I ate. I realized that I don't have to deprive myself. If I choose not to eat something that contains a lot of carbohydrates, it's not because I "can't." It's because I don't want to. And if other people choose to eat a low-carbohydrate diet because that is what they want, that's fine with me. I'm not going to lecture them the way I have been lectured.
People say, "But if I eat an apple, it spikes my blood sugar." Isn't that what insulin is for? If I want to eat something, I take insulin. I thought that was the whole idea of insulin.
Now, some people are trying to lose weight, and foods that are high in carbohydrates and calories might have to be avoided for that reason. But for people who aren't trying to lose weight, who don't have insulin resistance, I don't see carbohydrates are considered to be so evil. Carbohydrates are what give you energy. When your blood sugar is low, you need carbohydrates to bring it back up. (Though I once encountered a diabetic who asked, "Since I'm on a low-carb diet and can't eat sugar, can I use Splenda to treat hypoglycemia?")
I guess in the end it comes down to: whatever works for you, fine. Just don't push it on me. That's what bugs me most. One of my co-workers went on the Atkins diet and tried to push it on me every time she spoke to me. And since we caught the bus at the same bus stop, that meant that I saw her every day, and every day for close to a year, she tried to convince me that I should go on Atkins "because you're a diabetic."
When I tell people that I don't do the low-carb diet, they look at me like I'm nuts before solemnly declaring that I'm going to either die or at least suffer horrible diabetes complications, even when I tell them that my hemoglobin A1C has been at or below 6.0 for at least the last ten years.
Now, don't get me wrong; I don't stuff myself with cake, pie, cookies, ice cream, etc. I try for moderation. But I refuse to deprive myself of anything. When I was a kid, diabetes seemed to be all about deprivation. You can't have this because you're a diabetic. You can't have that because you're a diabetic. Watching other people eat chocolate-chip cookies or birthday cake was torture because I couldn't have any. And I truly believed I would never be able to have any.
When I left home, I tried to be a "good" diabetic, but since I was no longer under my mother's watchful eye, I went a bit nuts. I ate anything and everything that I wanted without bothering to test my blood sugar or adjust my insulin. And my blood sugars went all over the place.
Fortunately, with the help of a sympathetic doctor and the local diabetes education clinic, I eventually got back on track. But I realized that my rebellious behaviour was a direct result of being deprived for so long.
With some help from the dietitian at the diabetes education centre, I learned how to adjust my insulin to compensate for the carbohydrates that I ate. I realized that I don't have to deprive myself. If I choose not to eat something that contains a lot of carbohydrates, it's not because I "can't." It's because I don't want to. And if other people choose to eat a low-carbohydrate diet because that is what they want, that's fine with me. I'm not going to lecture them the way I have been lectured.
People say, "But if I eat an apple, it spikes my blood sugar." Isn't that what insulin is for? If I want to eat something, I take insulin. I thought that was the whole idea of insulin.
Now, some people are trying to lose weight, and foods that are high in carbohydrates and calories might have to be avoided for that reason. But for people who aren't trying to lose weight, who don't have insulin resistance, I don't see carbohydrates are considered to be so evil. Carbohydrates are what give you energy. When your blood sugar is low, you need carbohydrates to bring it back up. (Though I once encountered a diabetic who asked, "Since I'm on a low-carb diet and can't eat sugar, can I use Splenda to treat hypoglycemia?")
I guess in the end it comes down to: whatever works for you, fine. Just don't push it on me. That's what bugs me most. One of my co-workers went on the Atkins diet and tried to push it on me every time she spoke to me. And since we caught the bus at the same bus stop, that meant that I saw her every day, and every day for close to a year, she tried to convince me that I should go on Atkins "because you're a diabetic."
Monday, April 13, 2009
Diabetes and Cats
I live with three cats -- Calli, Poupée and Chaya. You might wonder what cats have to do with diabetes. Well, I'll tell you. My cats are the closest thing I have to a continuous glucose monitor with a hypoglycemia alarm.
A few years ago my diabetes was not under such good control. I had a wonderful hemoglobin A1C, but I was having low blood sugars in my sleep, sometimes to the extent of falling out of bed and having seizures. My boyfriend recalls that one time when I had hypoglycemia I apparently asked him if I should eat Calli for lunch.
One early morning several years ago I woke up because my cat Puff (who has since passed away) kept jumping on me. She would literally jump on me, then jump off the bed, then jump up on me again. She kept doing that until I woke up and became aware that I had low blood sugar. At first I thought this was a coincidence, until she did the exact same thing the next time I had low blood sugar while I was sleeping.
Other times, Calli has woken me up when I have had low blood sugar. (We wonder if this is to stop me threatening to eat her.) She stands on my chest and starts to tap my face with her paw. If I don't respond to this treatment, she will bite my nose. Chomp! This is enough to penetrate even the worst hypoglycemic fog. Believe me, having your nose bitten hurts!
After Puff passed away two years ago, I adopted a kitten, Chaya. I no longer need a feline alarm to wake me when I have low blood sugar while I'm sleeping; since I switched from Regular insulin to NovoRapid, I have started waking up when I have hypoglycemia. But sometimes when I'm concentrating on something, I don't notice the symptoms right away.
Sometimes when I'm using the computer I get very involved in what I'm doing. If I get low blood sugar while doing this, Chaya will start putting her paws up on my lap and going, "Meow! Meow!" I'll reach down to pet her, and she'll keep going, "Meow, meow!" Sometimes she does this when I have low blood sugar; sometimes she does it just because she wants attention. I have not figured out whether it's just a coincidence that she starts behaving this way when I have low blood sugar, but it's enough to make me stop what I'm doing and test my blood sugar -- just in case!
A few years ago my diabetes was not under such good control. I had a wonderful hemoglobin A1C, but I was having low blood sugars in my sleep, sometimes to the extent of falling out of bed and having seizures. My boyfriend recalls that one time when I had hypoglycemia I apparently asked him if I should eat Calli for lunch.
One early morning several years ago I woke up because my cat Puff (who has since passed away) kept jumping on me. She would literally jump on me, then jump off the bed, then jump up on me again. She kept doing that until I woke up and became aware that I had low blood sugar. At first I thought this was a coincidence, until she did the exact same thing the next time I had low blood sugar while I was sleeping.
Other times, Calli has woken me up when I have had low blood sugar. (We wonder if this is to stop me threatening to eat her.) She stands on my chest and starts to tap my face with her paw. If I don't respond to this treatment, she will bite my nose. Chomp! This is enough to penetrate even the worst hypoglycemic fog. Believe me, having your nose bitten hurts!
After Puff passed away two years ago, I adopted a kitten, Chaya. I no longer need a feline alarm to wake me when I have low blood sugar while I'm sleeping; since I switched from Regular insulin to NovoRapid, I have started waking up when I have hypoglycemia. But sometimes when I'm concentrating on something, I don't notice the symptoms right away.
Sometimes when I'm using the computer I get very involved in what I'm doing. If I get low blood sugar while doing this, Chaya will start putting her paws up on my lap and going, "Meow! Meow!" I'll reach down to pet her, and she'll keep going, "Meow, meow!" Sometimes she does this when I have low blood sugar; sometimes she does it just because she wants attention. I have not figured out whether it's just a coincidence that she starts behaving this way when I have low blood sugar, but it's enough to make me stop what I'm doing and test my blood sugar -- just in case!
Sunday, April 12, 2009
Diabetes and Money
It's a sad fact that the more money you have, the better you can manage your diabetes. The more money you have, the more tools are available to you.
For example, while I don't have to pay to go the doctor or spend time in hospital, I would still have to pay to have an insulin pump or a continuous glucose monitoring system. I don't currently have a job, and when I did have a job, my medical benefits were limited to $500 a year. And that was after having that job for six years with no medical benefits. An insulin pump costs around $6,000 to $7,000. There are payment plans, but since I don't have a job at the moment -- and the job I did have was seasonal -- there is no payment plan that fits me.
Currently there are no private or public insurance plans that will pay for a continuous glucose monitoring system (CGMS). The attitude of insurers seems to be that the finger-poke blood testing system works just fine and doesn't need to be replaced. The problem is that while a finger-poke blood test will tell you what your blood sugar is at any given time, it won't give you a trend. It won't tell you if your blood sugar is on the way up or on the way down, which can be very important information.
I am not one to go around saying that pharmaceutical companies are evil. They make products that I need in order to manage my diabetes, and there is no reason why they shouldn't make a profit, because they are businesses first and foremost. They aren't in it for altruistic reasons. I certainly wish their products were less expensive, but I don't expect them to give them away for free.
I think the problem is with the insurance providers, both public and private. They will almost always choose to pay for the cheapest option, regardless of whether the patient will benefit more from the more expensive option. Insurance providers don't generally look at the long term. If there is a product that is more expensive than another, it doesn't matter that that product will save money in the long run by delaying or preventing long-term diabetes health complications. All the insurance provider looks at is the up-front cost.
For example, while I don't have to pay to go the doctor or spend time in hospital, I would still have to pay to have an insulin pump or a continuous glucose monitoring system. I don't currently have a job, and when I did have a job, my medical benefits were limited to $500 a year. And that was after having that job for six years with no medical benefits. An insulin pump costs around $6,000 to $7,000. There are payment plans, but since I don't have a job at the moment -- and the job I did have was seasonal -- there is no payment plan that fits me.
Currently there are no private or public insurance plans that will pay for a continuous glucose monitoring system (CGMS). The attitude of insurers seems to be that the finger-poke blood testing system works just fine and doesn't need to be replaced. The problem is that while a finger-poke blood test will tell you what your blood sugar is at any given time, it won't give you a trend. It won't tell you if your blood sugar is on the way up or on the way down, which can be very important information.
I am not one to go around saying that pharmaceutical companies are evil. They make products that I need in order to manage my diabetes, and there is no reason why they shouldn't make a profit, because they are businesses first and foremost. They aren't in it for altruistic reasons. I certainly wish their products were less expensive, but I don't expect them to give them away for free.
I think the problem is with the insurance providers, both public and private. They will almost always choose to pay for the cheapest option, regardless of whether the patient will benefit more from the more expensive option. Insurance providers don't generally look at the long term. If there is a product that is more expensive than another, it doesn't matter that that product will save money in the long run by delaying or preventing long-term diabetes health complications. All the insurance provider looks at is the up-front cost.
Being a kid with diabetes
When I was diagnosed with diabetes, things were a bit different from how they are today. There were no insulin pumps, no insulin pens (in fact, I believe disposable syringes had only recently become common) and no blood glucose meters. No one ever talked about counting carbohydrates, and all you ever heard about diabetes was "you can't eat sugar." No one ever dreamed of adjusting insulin to fit what you were eating. Instead, you adjusted what you ate to fit your insulin, and you took the exact same insulin dosage every day.
I was the only diabetic kid in my school. I'm pretty sure this made the teachers nervous. I once had to be sent home from school because one of the other kids stole my morning snack, which I needed to compensate for my breakfast-time insulin peaking at around 10:00 in the morning.
What I really hated was classroom parties. It seemed like we had those fairly often -- Christmas, Easter, Halloween, last day of school before summer holiday, other kids's birthdays. These parties always included lots of cake, or cookies, or candy, or all three. And I couldn't eat any of these things. So I was excluded. I would sit in my seat and try not to cry.
I spoke to a young diabetic woman yesterday who told me the story of one such school experience she had. She is 20 years younger than I am, but she went through the same kinds of things I went through. One time her grade one teacher handed out chocolates to all the kids for a "treat," and then gave my diabetic friend the empty chocolate box for her "treat." Can you imagine? "Here, everyone else can have chocolate, and YOU can have the empty box!"
Why couldn't the teacher have provided some sugar-free chocolate, since she knew she had a diabetic student? Or how about not giving kids candy at all, but maybe some stickers or something like that -- much healthier, doesn't single out the diabetic kid, and avoids the risk that another student or students might have food allergies.
I was the only diabetic kid in my school. I'm pretty sure this made the teachers nervous. I once had to be sent home from school because one of the other kids stole my morning snack, which I needed to compensate for my breakfast-time insulin peaking at around 10:00 in the morning.
What I really hated was classroom parties. It seemed like we had those fairly often -- Christmas, Easter, Halloween, last day of school before summer holiday, other kids's birthdays. These parties always included lots of cake, or cookies, or candy, or all three. And I couldn't eat any of these things. So I was excluded. I would sit in my seat and try not to cry.
I spoke to a young diabetic woman yesterday who told me the story of one such school experience she had. She is 20 years younger than I am, but she went through the same kinds of things I went through. One time her grade one teacher handed out chocolates to all the kids for a "treat," and then gave my diabetic friend the empty chocolate box for her "treat." Can you imagine? "Here, everyone else can have chocolate, and YOU can have the empty box!"
Why couldn't the teacher have provided some sugar-free chocolate, since she knew she had a diabetic student? Or how about not giving kids candy at all, but maybe some stickers or something like that -- much healthier, doesn't single out the diabetic kid, and avoids the risk that another student or students might have food allergies.
Thursday, April 9, 2009
The highs and lows of insulin adjustments
Because I keep having low blood sugar early in the morning, I decided to reduce my dose of Lantus last night. My Autopen only adjusts by two units at a time, so I reduced my dose by two units.
At first, everything seemed great. I slept late this morning for the first time since starting Lantus without getting low blood sugar. When I woke up, my blood sugar was 5.9 mmol/l (106 mg/dl). I also managed to avoid the dawn phenomenon. I decided to add a little extra fast-acting insulin at breakfast just to be on the safe side.
Since I ate breakfast later than usual, I figured I'd have a late lunch. About an hour before lunch, I checked my blood sugar, and all was well: 6.4 mmol/l (115 mg/dl.) But when I was ready for lunch, it had gone up to 13.9 mmol/l (250 mg/dl) without my having eaten anything.
I'm going to have to talk to my endocrinologist about this when I see him next month. In the meantime, I think I'll experiment with different foods for breakfast and see if that makes a difference. And maybe I'll play with my Lantus dosage some more.
There are many things that can cause high blood sugar: too much food, not enough insulin, a rebound from a previous low blood sugar, stress, and hormones, just to name a few. I have to figure out what is causing these lunchtime high blood sugars.
At first, everything seemed great. I slept late this morning for the first time since starting Lantus without getting low blood sugar. When I woke up, my blood sugar was 5.9 mmol/l (106 mg/dl). I also managed to avoid the dawn phenomenon. I decided to add a little extra fast-acting insulin at breakfast just to be on the safe side.
Since I ate breakfast later than usual, I figured I'd have a late lunch. About an hour before lunch, I checked my blood sugar, and all was well: 6.4 mmol/l (115 mg/dl.) But when I was ready for lunch, it had gone up to 13.9 mmol/l (250 mg/dl) without my having eaten anything.
I'm going to have to talk to my endocrinologist about this when I see him next month. In the meantime, I think I'll experiment with different foods for breakfast and see if that makes a difference. And maybe I'll play with my Lantus dosage some more.
There are many things that can cause high blood sugar: too much food, not enough insulin, a rebound from a previous low blood sugar, stress, and hormones, just to name a few. I have to figure out what is causing these lunchtime high blood sugars.
Wednesday, April 8, 2009
Diabetes pet peeves
As a diabetic, I have some pet peeves. High blood sugar, low blood sugar, unexplained blood sugar swings -- all of these are familiar to people like me who have diabetes.
One of my biggest diabetes peeves is having to eat when I don't feel like it. This most often happens at night. I'm prone to hypoglycemia in the wee hours of the morning, most often between 5:00 a.m. and 7:00 a.m. So I try not to go to bed at night with a blood sugar below about 10 mmol/l (that's 180 mg/dl for the Americans.)
Last night at bedtime, my blood sugar was 6.2 mmol/l (about 112 mg/dl.) This meant that I had to eat something. But I wasn't hungry! I don't know if this happens to other people; for non-diabetics, I imagine that if you're not hungry, you just don't eat -- right? I don't always have that option.
I compromised and instead of eating, I drank a cup of fairly high-sugar hot chocolate. I hoped the chocolate would raise my blood sugar and the milk I used to make the hot chocolate would help keep my blood sugar steady throughout the night. When I woke up just before 7:00 this morning, my blood sugar was 3.4 mmol/l (about 62 mg.dl), which is just a touch on the low side. This also meant I had to get up half an hour earlier than I would normally, because my normal getting-up time on workdays is 7:30 a.m.
This brings me to another pet peeve. When you have diabetes, you can't sleep in! Doesn't matter if it's a weekend or a holiday; the diabetes doesn't take a day off. For me, I can't sleep late because my blood sugar tends to dip lower the later in the morning it gets if I don't eat breakfast. For other people, they get what's called "dawn phenomenon," which is when the liver releases glycogen (stored-up sugar) in the morning and causes the blood sugar to go up. I understand that insulin pumps might be able to help with this, because they can be pre-programmed to deliver insulin in certain amounts on a certain schedule. Unfortunately, an insulin pump is outside of my financial abilities at the moment.
For any other diabetic people reading this: what are your diabetes pet peeves?
One of my biggest diabetes peeves is having to eat when I don't feel like it. This most often happens at night. I'm prone to hypoglycemia in the wee hours of the morning, most often between 5:00 a.m. and 7:00 a.m. So I try not to go to bed at night with a blood sugar below about 10 mmol/l (that's 180 mg/dl for the Americans.)
Last night at bedtime, my blood sugar was 6.2 mmol/l (about 112 mg/dl.) This meant that I had to eat something. But I wasn't hungry! I don't know if this happens to other people; for non-diabetics, I imagine that if you're not hungry, you just don't eat -- right? I don't always have that option.
I compromised and instead of eating, I drank a cup of fairly high-sugar hot chocolate. I hoped the chocolate would raise my blood sugar and the milk I used to make the hot chocolate would help keep my blood sugar steady throughout the night. When I woke up just before 7:00 this morning, my blood sugar was 3.4 mmol/l (about 62 mg.dl), which is just a touch on the low side. This also meant I had to get up half an hour earlier than I would normally, because my normal getting-up time on workdays is 7:30 a.m.
This brings me to another pet peeve. When you have diabetes, you can't sleep in! Doesn't matter if it's a weekend or a holiday; the diabetes doesn't take a day off. For me, I can't sleep late because my blood sugar tends to dip lower the later in the morning it gets if I don't eat breakfast. For other people, they get what's called "dawn phenomenon," which is when the liver releases glycogen (stored-up sugar) in the morning and causes the blood sugar to go up. I understand that insulin pumps might be able to help with this, because they can be pre-programmed to deliver insulin in certain amounts on a certain schedule. Unfortunately, an insulin pump is outside of my financial abilities at the moment.
For any other diabetic people reading this: what are your diabetes pet peeves?
Tuesday, April 7, 2009
Insulin and ice cream
Today was one of the first nice days we've had all year. We had an impossibly cold March with temperatures regularly dipping below freezing, and we even had snow. Some parts of the city even had snow the first week of April, so the temperature going up to 15 degrees Celsius today made me want to go out and enjoy it.So I went out to Beacon Hill Park for the first time this year.
I met my friend Jen there, and we stopped by the Beacon Drive-In for ice cream. That was when I realized I'd forgotten to bring my insulin pen with me. One would think that with all the years I've had diabetes, it would be a habit -- leave the apartment, bring insulin pen. Sadly, it is not. I had the ice cream anyway, figuring that the fat content of the ice cream would delay my blood sugar rising long enough for me to go home and take my injection.
Of course, the best-laid plans of mice, men and diabetic people go oft awry, and that was the case in this instance. Jen and I hadn't seen each other in awhile, and we had a lot of catching up to do. So we stayed at the drive-in for quite some time. Then we had a walk to the bus stop, and then I had to stop at the supermarket to buy ingredients for a pasta salad I'm making for a potluck we're having at work tomorrow to mark our last day of work till the fall.
By the time I got home my blood sugar was 17.1 mmol/l (that's 307 mg/dl for the Americans). I decided to delay my supper for a while (since I wasn't hungry anyway) and took a bolus injection of insulin. Two hours later, when I sat down to supper, my blood sugar had come down to a nice, normal 5.5 mmol/l (99 mg/dl). For once I actually managed to calculate my insulin bolus correctly and didn't go too low.
The moral of this story is that while I can eat anything I want as long as I take enough insulin to cover the carbohydrate content, I need to actually have my insulin with me in order to do that. Oh, and also: don't rely on the fat content of a food to keep my blood sugar from rising.
I met my friend Jen there, and we stopped by the Beacon Drive-In for ice cream. That was when I realized I'd forgotten to bring my insulin pen with me. One would think that with all the years I've had diabetes, it would be a habit -- leave the apartment, bring insulin pen. Sadly, it is not. I had the ice cream anyway, figuring that the fat content of the ice cream would delay my blood sugar rising long enough for me to go home and take my injection.
Of course, the best-laid plans of mice, men and diabetic people go oft awry, and that was the case in this instance. Jen and I hadn't seen each other in awhile, and we had a lot of catching up to do. So we stayed at the drive-in for quite some time. Then we had a walk to the bus stop, and then I had to stop at the supermarket to buy ingredients for a pasta salad I'm making for a potluck we're having at work tomorrow to mark our last day of work till the fall.
By the time I got home my blood sugar was 17.1 mmol/l (that's 307 mg/dl for the Americans). I decided to delay my supper for a while (since I wasn't hungry anyway) and took a bolus injection of insulin. Two hours later, when I sat down to supper, my blood sugar had come down to a nice, normal 5.5 mmol/l (99 mg/dl). For once I actually managed to calculate my insulin bolus correctly and didn't go too low.
The moral of this story is that while I can eat anything I want as long as I take enough insulin to cover the carbohydrate content, I need to actually have my insulin with me in order to do that. Oh, and also: don't rely on the fat content of a food to keep my blood sugar from rising.
Monday, April 6, 2009
Introduction
Welcome to my diabeteblog. I'm rainbow. I'm 40 years old, and I've had Type 1 diabetes since I was four years old. I did not get diabetes because I was fat, because I was inactive, or because I ate too much sugar.
No one is quite sure why I got diabetes, but the prevailing theory is that it was due to an autoimmune reaction caused by a case of the mumps. My body created antibodies that for some still-unknown reason attacked the beta cells in my pancreas instead of attacking the mumps virus.
I had all the usual symptoms: rapid weight loss, fatigue, extreme thirst, numerous trips to the bathroom to pee. My mother tried to deny there was anything wrong with me. She'd try to forbid me to drink water, leading me to sneak into the bathroom in the middle of the night to drink straight from the tap. My dad tried to talk to her about it; he'd seen public-service announcements on TV from the Canadian Diabetic Association that described my symptoms perfectly, but my mother ignored him. She didn't want there to be something wrong with me, and she was scared.
One day my parents took all of kids to visit a family friend. My brother and sister immediately went out to play with the friend's kids. They were outside running around, while I was lying listlessly on the couch. My parents tried to persuade me to go join the other kids, but I was almost totally unresponsive. This, according to my dad, was the turning point. He was quite certain now that something was seriously wrong with me.
The next day at home I was again lying on the couch and not moving. My dad picked me up, carried me to the car and announced that we were going to the hospital. I guess my mum didn't have any choice but to go along! Once I was there the diagnosis was immediate: juvenile diabetes. The nurses had trouble starting an IV in my arm because my veins were so small. My dad remembers watching them poke my arm several times trying to hit a vein with the IV needle, and me not even whimpering. He says that scared him half to death.
I was in the hospital for a week, and then I went home to discover that everything had changed. Suddenly I had to have shots every day. I couldn't eat candy or chocolate bars. My mother took care of my diet, my shots, and the awful urine tests that had to be done four times a day until I was old enough to do it myself.
That was 36 years ago. Things have changed since then, mainly for the better; there are newer types of insulin, and urine tests are mostly a thing of the past. But there are times when I find myself thinking: "Okay, why haven't they found a cure yet?"
No one is quite sure why I got diabetes, but the prevailing theory is that it was due to an autoimmune reaction caused by a case of the mumps. My body created antibodies that for some still-unknown reason attacked the beta cells in my pancreas instead of attacking the mumps virus.
I had all the usual symptoms: rapid weight loss, fatigue, extreme thirst, numerous trips to the bathroom to pee. My mother tried to deny there was anything wrong with me. She'd try to forbid me to drink water, leading me to sneak into the bathroom in the middle of the night to drink straight from the tap. My dad tried to talk to her about it; he'd seen public-service announcements on TV from the Canadian Diabetic Association that described my symptoms perfectly, but my mother ignored him. She didn't want there to be something wrong with me, and she was scared.
One day my parents took all of kids to visit a family friend. My brother and sister immediately went out to play with the friend's kids. They were outside running around, while I was lying listlessly on the couch. My parents tried to persuade me to go join the other kids, but I was almost totally unresponsive. This, according to my dad, was the turning point. He was quite certain now that something was seriously wrong with me.
The next day at home I was again lying on the couch and not moving. My dad picked me up, carried me to the car and announced that we were going to the hospital. I guess my mum didn't have any choice but to go along! Once I was there the diagnosis was immediate: juvenile diabetes. The nurses had trouble starting an IV in my arm because my veins were so small. My dad remembers watching them poke my arm several times trying to hit a vein with the IV needle, and me not even whimpering. He says that scared him half to death.
I was in the hospital for a week, and then I went home to discover that everything had changed. Suddenly I had to have shots every day. I couldn't eat candy or chocolate bars. My mother took care of my diet, my shots, and the awful urine tests that had to be done four times a day until I was old enough to do it myself.
That was 36 years ago. Things have changed since then, mainly for the better; there are newer types of insulin, and urine tests are mostly a thing of the past. But there are times when I find myself thinking: "Okay, why haven't they found a cure yet?"
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