Living with Diabetes Archives - Page 4 of 52 - Diabetes Counselling Online

Case Study 1: George Mellows (1)

January 21, 2015 by Imagine_David Leave a Comment

Some things you can Control. Diabetes you can manage.

"Enjoying a good quality of life is my goal" George — “Enjoying a good quality of life is my goal”

George Mellows is aged 55. He lives with his wife and his two teenage children, aged 15 and 19.

George works Monday to Friday 8.30 am until 4.30 pm . He works at a desk in a sedentary role, getting minimal activity in his working day. George has not played any sport for some time, but he does enjoy playing lawn bowls.

4 weeks ago George was:

feeling excessively thirsty
was peeing more than normal
was feeling tired and lethargic
and was always feeling hungry

So, George went to visit his doctor. He described the symptoms, and his doctor sent him for a glucose tolerance test to test for diabetes. The results of this test confirmed a diagnosis of type 2 diabetes .

George was a little shocked as he has nobody in the family with diabetes, only a history of heart disease.

Until this diagnosis of type 2 diabetes George had no identified health problems.

Since his doctor discovered diabetes George has had some further blood work and had been found to have high cholesterol.

Measuring the Blood Glucose Level

George decided to start measuring his blood glucose levels as he was still feeling some symptoms, despite the doctor commencing George on Metformin 500mg in the evening with dinner. Table 1 below shows George’s blood glucose level test results.

George has yet to see a diabetes educator, dietitian, exercise physiologist or podiatrist.

Since starting the blood glucose level measurement George identifies, that despite commencing on Metformin, his blood glucose levels are above target.

Below is a table from the RACGP (Royal Australian College of General Practitioners) identifying the target blood glucose levels in type 2 diabetes. *Note: target blood glucose levels need to be individualised.

Targets for self-monitored glycaemic control in type 2 diabetes *

FBG (mmol/L)	Pre-prandial blood glucose (mmol/L)	Postprandial blood glucose (mmol/L)	Comment
6.0–8.0	6.0–8.0	6.0–10.0	NHMRC values

Based on his blood glucose levels after meal, George is concerned. He thought that taking his Metformin would be all that he needed to do. Now, he feels like he has failed.

George joined several groups of people living with diabetes on Facebook ( https://www.facebook.com/diabetes.counselling ) to see if he could glean some further understanding of diabetes self management.

“Self-management means having a daily management plan, setting goals, solving problems and taking responsibility. But it certainly does not mean you are on your own. Mutual trust and respect between yourself and your doctor and other members of the health care team, as well as regular communication with them, are vital to effective self-management.

Previously, traditional care was based on doctors and health professionals being seen as the experts responsible for the diagnosis and management of care. It was accepted that people’s lives should be fitted around their diabetes with goals set by the health professionals.

But this approach is not effective. Diabetes requires daily management. Doctors are not available every day, leaving responsibility for day-to-day care on the patient and the family.

In addition, good results are difficult to achieve if the person involved is not an active participant or does not understand the reasons behind management decisions.

Patient Empowerment takes a new approach. It moves the focus from the doctor to the patient. It involves fitting diabetes into your lifestyle with you making the choices and taking charge of your management and the consequences.” Diabetes Australia

Georges Plan:

Research diabetes and prepare questions for doctor, diabetes educator, dietitian.
Meet with diabetes educator:
“Diabetes educators are healthcare professionals who focus on helping people with and at risk for diabetes and related conditions achieve behavior change goals which, in turn, lead to better clinical outcomes and improved health status. Diabetes educators apply in-depth knowledge and skills in the biological and social sciences, communication, counseling, and education to provide self-management education/self- management training.” American Diabetes Association

“Diabetes educators specialise in the provision of diabetes self-management education for people with diabetes.

They provide support for people with diabetes, including gestational diabetes, integrating clinical care, self-management education, skills training and disease specific information to motivate patients to:
- Understand diabetes and make informed lifestyle and treatment choices
- Incorporate physical activity into daily life
- Use their medicines effectively and safely
- Monitor and interpret their blood glucose patterns” Allied Health Professions Australia
Meet with dietitian: appointment booked
Meet with doctor: appointment booked

George plans to ask about different treatment options.

Here are some questions George has prepared for his team:

Is this the best medication for me?

If I get any side effects what do I do? If this medication does not work, what’s next?

Do you mean ….. ? Is there anything I should not be doing?

How soon should treatment start ?

Can the treatment start next month when I am back from holidays?

Can I stop the treatment when I can’t afford it?

How much will the treatment cost?

What can I do to prevent further problems?

What can I do to keep my condition from getting worse?

How will making a change to my habits help me?

Are there support groups or community services that might help me?

Which other HCP’s will be able to help me manage this health issue?

Hand in hand with your health care professionals you van achieve a good quality of life with diabetes — Hand in hand with your health care professionals you can achieve a good quality of life when living with diabetes

Over to You

What advice would you give to George?

What was your experiences of being diagnosed with type 2 diabetes ?

How did you access your diabetes educator, dietitian, counsellor etc?

**** Added January 26: Part 2 HERE *****

Next time we visit George, we shall see how he is progressing with his diabetes self care plan http://www.diabetescounselling.com.au/choices-in-diabetes-management/

In the meantime, healthy days to you.

Kind Regards,

David, Diabetes Educator @ Diabetes Counselling Online

Please Share!

Guest post from Georgia: Fresh as a daisy!

January 19, 2015 by Helen-Edwards Leave a Comment

Sharing a guest blog from Georgia today

Helen

I have got motivated this week, it is 2015 – a fresh start, my fresh start. After a long (needed) break it was go time, 2015 hit me with full force of determination; I was going to make this year mine.
I started with the compulsory booking of appointments, at first hair & nails, then the medical side of things: Endocrinologist (a new one, for a new start); Podiatrist (my annual care plan appointment); Eye test (my biannually care plan appointment); blood test for my 3 monthly Hba1c and an appointment with my GP to get my referral for my new Endo.

I have a feeling, after a messy 2014 this year is going to deliver the goods, a year to achieve and work towards my goals and get my Fashion Blog well and truly off the ground and get everything (diabetes wise) in the best shape possible.

Not that it is in a bad place at the moment, I feel great but there’s always room for improvement, like my quote of the week “Always be a work in progress”, you can never stop bettering yourself.

A new Endo means a chance to have someone understand me more and to hear my side of things before looking at levels, a new set of eyes to provide me with help and support. It took a while for me to agree to find a new Endo, I was adamant that I could handle everything myself (I’m still confident I could), but it doesn’t hurt and who knows my stubborn self may learn a thing or two. I am going in to this with no qualms what so ever. After my last experience I hold no expectations to my new doctor, but hope that this time round it doesn’t end in guilty tears.

On another note, I am all about challenges – I get stressed when I have so much to do, but I never feel satisfied until my diary is full of commitments. I like being busy and I love challenging myself and investing myself in new tasks.

This year I am focusing on:
1. Getting fitter than ever
2. Having more adventures
3. Possibly undertaking an external course
4. Doing a first Aid Course
5. Expanding my/our Fashion Blog.

I advise you all to make this year your year! I turn 22 this year and I read this great article saying how your 20’s are your selfish years and your 30’s are your years to plan for the rest of your life, me being me I want to make my 20’s both of those things.

But most importantly, I am focusing on me, investing my time on those who I truly care about and who truly care about me. High school was years ago and I am feeling myself grow up and change from the person I was 3 years ago – I am still the same child who dances to One Direction around my room, and my values haven’t changed, but I have and so has my attitude – all for the better of course.

2015 baby!

Au Revoir
Georgia.

Please Share!

How to stand up to the fear of diabetes

January 16, 2015 by Helen-Edwards 2 Comments

http://www.dreamstime.com/royalty-free-stock-photo-fear-concept-choice-acronym-bravery-life-image44534735

I was thinking the other day that if someone could just come up with a way to check blood glucose that does not require turning your fingers into blackened stubs, where multiple areas bleed when you squeeze for one blood test, and they could eliminate hypos, I would be ok with having diabetes.

There are many parts of it I dislike, but these are two of my most hated. In fact the hypos thing is probably the biggest fear for me. And that is the bottom line toughest part of life with diabetes when we break it all down isn’t it, the fear.

It is not that you have to eat healthy, be active, get your rest, plenty of sunshine, check your feet, visit more doctors than usual and reduce your stress. These are all good for you. It is not that you have to take medications or have multiple daily injections or lived attached to a machine, even though that is annoying and sometimes frustrating. It is not even the fact you have a chronic disease that can’t be cured. It is the cold hard fear.

It’s waking up in the morning with a high blood glucose level and having to decide whether to eat breakfast or wait, worrying about whether you are going to end up higher and feel like crap, or dive into a hypo from your correction dose of insulin, and feel like crap….It is sitting up late at night when everyone else is in bed, waiting to see if your levels are going to settle as they have been too high or too low. It’s managing the swings and ups and downs, often alone and not knowing when it will stop.

It is going out on a run, to the gym, dancing, drinking, on holidays, hiking, skiing, having sex, even a walk around the block – and not knowing if you might end up low or high. It is the fear of the unknown. And the fear of the known. The fear that gets drilled into you when you get diagnosed and reminded to you every time you look at a national diabetes week, or world diabetes day poster. It’s sleeping, waking, eating, fasting, sitting, standing, lying, existing – with FEAR.

It’s exhaustion. Which makes fear worse.

It’s all those things that can go wrong, break, stop working, fall off or be chopped off. It is blindness and dialysis and horrible feet. It’s not having babies, or having babies and then trying not to breathe the entire time you are pregnant in case it messes up your blood sugar and harms your precious baby.

It’s working hard in your career and your life dreams and not knowing if your diabetes will cause a problem you don’t want your colleagues to find out about. It’s failing exams because your levels were so high you couldn’t think straight. The stress of losing your license when your job is driving trucks. Losing your ability to make love. Losing your partner. Losing your grip.

Yes indeed, diabetes is a whole lot about fear and a whole lot less about the mechanics of it all, a whole lot less about the actual act of caring for your diabetes. People will tell you that you are “non compliant”, not managing well, not getting it. That is bullshit. You are probably scared. You are probably confused. You are probably exhausted.

Fear creeps up on you, takes hold of you, hangs around in dark corners, jumps out at you from under the bed.

Fear is a bitch.

And if someone could only take away that fear for me, I would be pretty ok with having diabetes, it is not the worst thing to have. The truth is, nobody is going to do that for you but YOU. If you are like me, and fear has a grip on your life with diabetes at times, the only way we can stand up to that fear is together, and alone.

We must take time to notice these fears, to pull them out from under the covers. We must take time to shine a light on them, share them – please don’t suffer fear in silence. Learn how to be more mindful, how to manage fears, how to be more centered, more peaceful. You don’t need to learn how to be more brave – people with diabetes are some of the bravest people I have ever had the pleasure of knowing – and trust me over 15 years working in diabetes I have known many thousands.

By sharing these fears we reduce them. We feel safer, as there is safety in numbers. Fear will always be part of life with diabetes. It is scary. But we can reduce how much it impacts on our daily lives by setting up networks of support, help when we need it, talking about it and facing it head on. And in those moments when you are scared shitless, just remember we are all here holding your hand. We have your back and you CAN do it.

What do you fear most about life with diabetes – please share and get these things out into the spotlight

Helen

Helen Edwards has lived with type 1 diabetes since 1979. She is Mum to 3 sons, the founder of Diabetes Counselling Online, a diabetes educator, social worker and PhD Candidate studying diabetes distress in pregnancy for women with type 1 diabetes. She is also a successful Interiors Blogger and Stylist at www.recycledinteriors.org and runs creative workshops, an online store and studio in Adelaide – just for a life outside of diabetes.

Please Share!

Diabetic Nerve Damage: Neuropathy

January 11, 2015 by Imagine_David Leave a Comment

Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. High blood glucose can injure nerve fibers throughout your body, but diabetic neuropathy most often damages nerves in your legs and feet.

Depending on the affected nerves, symptoms of diabetic neuropathy can range from pain and numbness in your extremities to problems with your digestive system, urinary tract, blood vessels and heart. For some people, these symptoms are mild; for others, diabetic neuropathy can be painful, disabling and even fatal.

Diabetic neuropathy is a common serious complication of diabetes. Yet you can often prevent diabetic neuropathy or slow its progress with tight blood glucose management, and a healthy lifestyle.

Clinical context

Pain and paraesthesia are common peripheral neuropathic symptoms, and if the autonomic nervous system is involved, gastrointestinal, bladder and sexual problems arise.

Diabetic neuropathic complications increase the burden of self-care and overall management.

The clinical focus is on prevention via good glycaemic control, and early recognition facilitated by good history and routine sensory testing.

New modalities are arriving to assist in the management of diabetic neuropathies.

Before any treatment is instigated, exclusion of non-diabetic causes of neuropathy is suggested. This includes assessment for vitamin B12 deficiency, hypothyroidism, renal disease and review of neurotoxic drugs including excessive alcohol consumption.

Autonomic neuropathy

Autonomic neuropathy may result in:

orthostatic hypotension (also called postural hypotension, is a form of low blood pressure that can cause dizziness. It happens when the blood vessels do not constrict (tighten) as you stand up, which makes you feel dizzy) with >20 mmHg drop
impaired and unpredictable gastric emptying (gastroparesis), which can cause a person’s blood glucose levels to be erratic and difficult to control. Pro-kinetic agents such as metoclopramide, domperidone or erythromycin may improve symptoms
diarrhoea
delayed/incomplete bladder emptying
erectile dysfunction and retrograde ejaculation in males
reduced vaginal lubrication with arousal in women
loss of cardiac pain, ‘silent’ ischaemia or infarction
sudden, unexpected cardiorespiratory arrest especially under anaesthetic or treatment with respiratory depressant medications
difficulty recognising hypoglycaemia
unexplained ankle oedema.

Cardiovascular autonomic neuropathy should be suspected by resting tachycardia (>100 bpm) or orthostatic reduction in BP (a fall in SBP >20 mmHg on standing without an appropriate heart rate response). This applies to people not currently on antihypertensive agents that may cause variations in BP responsiveness such as beta blockers. It is associated with increased cardiac event rates.

Diagnosis

The diagnosis of diabetic neuropathy may include:

taking a medical history for symptoms typical of neuropathy
checking your feet and legs for responses to stimuli such as temperature, light touch, pain, movement and vibration
checking the reflexes at your ankles and knees
tests to exclude other possible causes of neuropathy (such as low vitamin B₁or thiamine levels).

Treatment

Damaged nerves cannot be repaired. However, the risk of further complications in the feet can be reduced by:

vigilance – regular inspection of the feet for early signs of trouble or potential problem areas (such as breaks in skin, signs of infection or deformity
getting help at the first sign of trouble – early treatment of foot ulcers gives the best chance that they will heal
good foot and nail hygiene
choosing appropriate socks and shoes properly fitted to the shape of your foot
avoiding activities that may injure the feet. Check shoes for stones, sticks and other foreign objects that might hurt your feet every time before putting your shoes on.

A referral to a podiatrist may be appropriate for assessment and ongoing preventive management of foot complications.

Treatment for painful neuropathy

Appropriate pain management can significantly improve the lives of people with diabetes and painful neuropathy. A number of different medications are available, which produce comparable effects.

Most people would begin with one of either:

serotonin-norepinephrine reuptake inhibitors (such as venlafaxine, duloxetine)
tricyclics antidepressants (such as amityptiline)
anti-epileptics (such as gabapentin, pregabalin).

If one type fails to provide the response required, it is usual to switch to or add another. If all three agents alone or in combination fail, then opioid analgesics and tramadol may be used as second-line treatments.

Prevention of diabetic neuropathy

Be guided by your doctor, but general suggestions to reduce the risk of diabetic neuropathy include:

Maintain blood glucose levels within the target ranges.
Exercise regularly.
Maintain a healthy weight for your height.
Stop smoking.
Reduce your blood pressure and lipid (fat) levels through diet and lifestyle changes, and medication where appropriate
Consult your doctor promptly if you have symptoms including pain, numbness or tingling in your hands or feet.
Have your feet checked at least yearly by your doctor, podiatrist or diabetes educator, or more often if you have signs of problems with your feet or other complications of your diabetes.

Although, potential health complications due to diabetes may happen; don not live in fear, by watching the amount and types of food you eat, exercising, and taking any necessary medications, you may be able to prevent short and long-term diabetes complications.

Keeping blood glucose close to normal can help prevent the long-term complications of diabetes.
Manage high blood pressure.
Monitor your blood sugar level and A1c.
Have regular reviews with your diabetes care team.

Talk to your health care professional team: ask questions and get answers that you understand….. prevention is better than a decreased quality of life.

Please Share!

Hypoglycaemia at School

January 7, 2015 by Imagine_David Leave a Comment

Children of all ages require a safe and effective plan for those times when not under their parents supervision

‘Hypo’ or a low blood glucose level is one of the fears for all people living with diabetes.

A low blood glucose level will often occur unexpectedly, sometimes without an obvious cause.

For the child with diabetes, a low blood glucose level may lead to loss of concentration and behaviour change – possibly disruptive behaviours.

Talk to your child’s school about diabetes to help your child attain an education without discrimination

Education and Care Services National Act and Regulations: Australia

“In January 2012 new national legislation (Education and Care Services National Act and Regulations) requires a type 1 diabetes policy for all services providing or intending to provide education and care on a regular basis to children under the age of 13 years. This includes outside school hours programs. More information on the medical conditions section of this legislation can be found on the Australian Children’s Education and Care Authority website http://www.acecqa.gov.au/national-regulations” from HERE (Diabetes Australia Victoria)

As a parent of a child living with diabetes it is in your best interest to communicate with the headmaster of your childs school before or at enrolment

Duty of Care

Schools have a legal responsibility to provide:

a safe environment
adequate supervision

When the school knows that certain students have diabetes, staff (including relief staff) need to know enough about diabetes to ensure the safety of those students (especially in regard to hypoglycaemia and safety in sport). Parents/guardians have a responsibility to advise the school of their child’s medical condition and the particular requirements for the management of their child’s diabetes. For children with special requirements, a written individual management plan incorporating medical recommendations should be developed with the school in collaboration with the parents/guardians and doctor. This should be attached to the student’s records. from Diabetes Australia

Hypoglycaemia Symptoms

A very good multimedia presentation from the Royal Childrens Hospital, Melbourne, can be found HERE

Managing Hypo

Managing hypoglycaemia

Hypoglycaemia (“Hypo”) means a low level of glucose in the blood. This is a blood glucose value of less than 4.0 mmol/L.

Hypoglycaemia can be caused by:

Too much insulin
Vigorous exercise without extra carbohydrate
Missing or delayed meals
Not eating all serves of carbohydrate
Alcohol intake

If you would like to share, or debrief, about your experiences please visit our Forum or Facebook

Research

“The management of type 1 diabetes in Australian Primary Schools” by Diabetes Nurse Practitioner, Associate Lecturer UWS Anne Marks HERE

Children using insulin pump therapy were more likely (97%) to receive insulin at school than children using injections (55%)
Children in the study who were able to self-administer insulin were more likely to receive insulin (93%) at school than children who were unable to self-administer insulin (65%)

Parent Concerns:

62% reported that they had current concerns about diabetes management at school

Difficulty participating in school activities

Inclusion at meal times

Lack of independence

Missing school, classroom activities or time with peers

Safety

Lack of staff to assist with care

Impact on parental employment

Increased workload of teachers who are willing to assist with care