management Archives - Diabetes Counselling Online

Guest Blog: Foot care, diabetic #neuropathy

March 11, 2015 by helwild Leave a Comment

One of our Closed groups on the Social Media platform of Facebook is called ‘Diabetes Education and Management’. This group is supported by Diabetes Educators and a Midwife, a Dietitian, and a Pharmacist, as well as Mental Health Counsellors.

Recently one of our Diabetes Educators posted a link to a blog about complications and Foot Care in diabetes management, a fairly regular topic of discussion. Footcare form edited July 09

A very heartfelt and powerful response came from a member of the group, Zac. Zac has very strong views on the importance of seeking truth, accurate information, and developing informed knowledge about foot care and diabetic neuropathy in particular. He warns about the high risks associated with poor diabetic control, and not being proactive in our own health care, risks that he believes were not made clear to him before it was too late. Here are Zac’s powerful words:

This topic is very interesting to me, being a Diabetic T2 for a few years now. I visit my Clinic only once a year. They make my appointments, not me. BUT I just wish I had’ve been told about the seriousness of COMPLICATIONS of Diabetes as so far as Peripheral Neuropathy is concerned, as I now have it.

Not once was I referred to a Podiatrist, so I asked to make an appointment, only to be told they are not taking any more patients as they are over loaded. Well, I didn’t bother too much about it at the time, as I didn’t have Peripheral Neuropathy, and thought nothing of it. Until, that is, for another 2 yrs. By then, my feet felt like they were in a bucket of bull ants.

Not realising this was nerve damage, I put up with it, until, on one of my visits to my Clinic the nurse did a small test on my feet. She looked at them and said, “Oh, your feet are fine.” So I asked, “What would be making my feet feel like they are being bitten by bull ants?” She looked at them again, said she didn’t know, and again, said she thought my feet were fine, so home I went, feeling disappointed.

On the next visit, I demanded. I said, “Something is SERIOUSLY WRONG with my feet, please help me.” So the nurse called in some guy, whom I wasn’t introduced to, and he put a name to it, called it ‘Peripheral Neuropathy’. Well, I was just over the moon that someone had finally worked out what was wrong with them!

But then he said, “Go to your chemist buy some Phanalgon Cream. This helps some people.” my reply was, “But I want something that will definitely help my feet!”

He said, “There is no cure for Peripheral Neuropathy.”

So I said, “You’re kidding me, in this day and age there is no cure for it?”

He said, “Yes, no cure.”

So home I went, with Phanalgon Cream in hand, only to have a bad reaction to it. My skin started to peel off from my feet, as it has chilli in it. So I tried again when my feet healed, but used less of the cream. Still I had a reaction to it, so I gave that the flick…..

I’m ANGRY at myself. First of all, for being so flippant about Diabetes; and not educating myself about complications which I never knew existed. And I’m ANGRY at my Clinic for not pointing these matters out to me in the first place. After all, isn’t this why we attend clinics? When the nurse used to test my feet, I was never given an explanation as to why. It’s the same with my eye tests. I was never told that Diabetes can affect your eyes. I just thought it was a normal eye test…Sorry this is long winded but if I can help just ONE person to realise the seriousness of Diabetes Complications then it will have been worth while typing all of this.

I just wish I had been warned. Peripheral Neuropathy is the pits, and I don’t have a normal life now. I am practically house bound because of it…..If you have read this far I Thank You and I Thank you David Mapletoft and Sally Marchini and for everything I have learned through your expertise and knowledge, even though it’s too late. Well, not too late as far as Diet is concerned, but it’s too late for my suffering feet. Thank you Zac

Zac has kindly shared his experience here. Do you have a similar experience? Can you give Zac any suggestions on how to manage his foot discomfort and pain?

Helen Wilde

Senior Counsellor

Helen has been a Counsellor with the service since 2003. She has been the parent of someone living with Type 1 diabetes since 1979, and has lived with type 2 diabetes herself since 2001.

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Guest Blog:Thanks Teacher

February 22, 2015 by helwild 1 Comment

Our guest poet, Maureen Campey, has written another great poem about Parenting a child with diabetes. This time, Maureen has written about her teenage son starting a new year of High School, one of those momentous hurdles that we all face as parents.

Here are Maureen’s wise words.

Sending our kids back to school always brings its own set of worries and frustrations. My T1 14yr old has gone back to a new set of teachers. He seems pretty cool with it all. My ‘coping mechanism’ seems to have become, Writing Poetry! Weird, I know but it helps me get it out of my system. I hope you don’t mind if I share!

Dear Teacher

Hi, hello, it’s me again.
Please don’t roll your eyes!
I’m not a helicopter parent,
I come in peace!

I need to explain
That my child will be carrying an invisible pancreas.
You won’t even know it’s there.
He will carry it with him wherever he goes.
He will do its job and look after it
But sometimes he may grow a little weary.
Your help may be needed as he mustn’t let go of this tiresome load.

Scared? Don’t be!
Imagine how he feels all day, every day
Yet he keeps on going.
Your job is small and help is at hand for you.

My child must calculate many things at the same time.
He must think like a pancreas.
Can you imagine?
As well as trying to learn,
He must anticipate the effect of every action and piece of food
Whilst travelling from class to class, and teacher to teacher.
No mean feat!

I will make sure you are given the knowledge you need.
I ask that you are willing to accept your role.
Let him be and don’t become a helicopter teacher.
He is not perfect.
Do not expect gratitude,
There will be no immediate reward for what you do
But know that he will go on to live a full life
Having learnt from you that this burden can be shared.

You will never know the gift you have given my child
But please know that I will be forever in your debt.

Maureen Campey

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#sick day #plan with #diabetes- the best laid plans

April 11, 2014 by helwild 3 Comments

without the noodles- for T2diabetic! LOL

I didn’t get my blogpost written for the group blog this week. Nor last week. In fact, I haven’t had my head up out of the sheets much since dinnertime on April 1st, when I went out to dinner to celebrate my son in laws’ 50th. With frog cakes..

That’s because I’m sick. I don’t mean with a metabolic disorder (Type 2 diabetes); nor an auto immune disease-my asthma; nor chronic pain; nor reflux; nor blood pressure; nor cholesterol; nor neuralgia; nor neuropathy; nor arthritis. I have a virus. A drag me down, unrelenting, constantly mutating virus. First it was probably the odd sneeze, next the extreme sore throat + a crushing, debilitating headache. Sweating of course, a cough. I slept. For 3 days. Because I take panadol constantly anyway, some symptoms were dealt with. What was I to do about my diabetes? I knew I should eat some carbs, I should try to exercise. On two days I staggered around the block, feeling dizzy & unsafe. On the other days I briefly wandered in my back yard, in my nightie. Eating was of no interest. Nor was checking my blood glucose levels. But I did keep taking all of my oral medications as prescribed, at the usual times. I cancelled all appointments. I stopped reading & working. I couldnt scroll on my mobile, as that was dizzying, so no Facebooking either. I couldn’t care for my grandchildren. I couldn’t visit my poor, demented elderly mother.

I didn't test my bgl.. — I didn’t test my bgl..

On the 8th day, the mutation was sudden. By now my sore throat had eased, the sneezing was still intermittent, & I’d developed what medicos call ‘a productive cough’. I’m a grandma, I know the lingo. But on this day, I actually felt a little better. I did 2 hours of paperwork. Then I stood up. The world swam around me. I felt nauseous, faint. I nearly passed out. I had other symptoms too. The worst was the severe vertigo. I tested my bgl. Steady at 6.2. So it wasn’t low blood glucose. I tested my BP. That was pretty ‘normal’. I rang the Dr’s rooms for advice, the Dr said come here straightaway, or go to Hospital. Now I have never been to an Emergency Department for myself. But I have been many times with Family members. I know you do not want to be in a ‘walk in’ situation in Emergency. I couldn’t drive, I couldn’t even open my eyes for the vertigo, I could barely walk. So my husband drove me. I carried a blue bucket, & a green towel. I was in old ‘trackie dacks’, my hair was a mess. The journey was quick, the Dr terrific. I threw up in my bucket, conveniently, she could test it for blood. She gave me an injection, a prescription, instructions to my husband about blood pressure, & a letter for the Hospital, should certain indications occur. Instructions to “Come back to see me on Thursday”. We set off home. The injection helped very quickly. Although I kept my eyes closed in the car, I was able to walk with eyes open to get to the car, & to have a rational discussion about filling the prescription.

I now had a new regime. 2 hourly Blood pressure checks, to particularly note if the pulse rate climbed & the BP dropped. A new medication, 8 hourly, so unfortunately, to start with, alarms & early morning wakings. My vertigo eased, I slept some more, & suddenly it was Thursday. My husband rang to book me in, of course it had to be a ‘double booking’. My husband said I needed to find something ‘decent’ to wear, as he wasn’t going to take me in as ‘disheveled’ as I’d been on Tuesday. That made me laugh. When the Dr saw me, I was neat, tidy, walking steadily, I was wearing earrings. (Diabeadies by Vivi of course). But when the Dr. examined me, she found another ‘mutation’. Now I have a chest infection, I need an antibiotic. Sigh. My chest does hurt. But apparently it’s not asthma.

Now it’s the next day. The antibiotics are making me nauseous. The metformin is affecting my gut. The stemetil is helping with the vertigo & nausea, but apparently is only ‘masking’ those symptoms, I still have the virus. The family’s long made plans for the School Holidays are ‘on hold’.

Last night my daughter flew from Sydney to Adelaide. Her plane, like most of the traffic to & from the Eastern seaboard yesterday, was delayed by the massive Category 5 cyclone Ita, which is currently approaching North Queensland.

During the delay, she was texting, & suddenly about 40 minutes before boarding, she texted, “I’m low.” A message like that puts my virus into perspective. Managing my type 2 diabetes when I’m sick is not hard, & it’s not life threatening. I might go high, or low. I might have work to do when the virus passes. But when you are insulin dependent, day by day, hour by hour, minute by minute, intensive mathematical calculations have to be worked through, instant decisions made, not always with a fully functioning brain. In either case, systems & plans are crucial in getting through the situation. Knowing that I’d be worried, my daughter texted, “I’m eating lots of glucose, back up to 10 now. Have longer acting carbs on board. Will make sure I’m 14 before boarding”. What a lovely clear, reassuring plan. Mine is to take the medication as prescribed, rest as prescribed, watch for changes as prescribed. Eat when I can, exercise if I can. I have had somewhat of a ‘bonus’. Not eating much other than my obligatory bananas (for the leg & foot cramps, to get the potassium), I have lost around 4kg. So maybe my T2diabetes is cured? Or maybe the chicken soup will cure me. LOL….

Last night I made Chicken soup.

And today, as cyclone Ita bears down upon North Queensland, I am hoping that no lives are lost.

http://www.abc.net.au/news/2014-04-11/cyclone-ita-compared-to-tracy-larry-and-yasi/5383224

Helen Wilde

Helen is a long term Senior Counsellor with Diabetes Counselling Online. She is the parent of someone who has been living with Type 1 diabetes since 1979, & has had Type 2 diabetes herself since 2001.

If you feel you’d like to talk with Helen or another member of our team, please contact us on this link:

http://www.diabetescounselling.com.au/counselling-request/

Or look out for the chatline on the front page of the site, you can chat live when a counsellor is ‘in’, or leave a message for later.

Please feel free to leave a comment after this post!

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#Parenting a child with #diabetes #struggles & #rewards: owning your own #lifetime

March 20, 2014 by helwild 10 Comments

This is a blog I have wanted to write for some time. As the parent of a now grown up child with diabetes, I feel a ‘special’ bond with other parents. Because of this, I am one of the moderators of the Facebook Closed group Parents of kids with diabetes. Almost every day I read & respond to heroic, wonderful, ordinary, or desperate stories of parents, ordinary people, most of them with no prior knowledge or experience of life with diabetes. Some are the parents of newly diagnosed infants. Those of us diagnosed as adults, no matter what type of diabetes, we know the emotional rollercoaster that diagnosis brings. Imagine that diagnosis being pronounced on your baby or your child.

The journey of acceptance of the diagnosis of diabetes is often described as the journey of loss, a journey through the stages of mourning. Some people diagnosed, or some partners of people who are diagnosed, get ‘stuck’ in one of the very earliest of stages, Disbelief & or Denial. They may delay or refuse the suggested treatment or advice for management. They may hide their diagnosis from those around them. That stage is bypassed in a Blink for the parent whose child is diagnosed. From lasting perhaps years, this stage is reduced to a few moments, a few hours, a day, a couple of days. From then on, ‘Disbelief’ & ‘Denial’ do not exist. We leap straight to fear, panic, guilt; into anger, blame, shame. We also leap straight into fierce Warrior protector mode. For most of us, our fear has to be submerged into Action, Compliance, & Learning, all embedded in a fierce protective mode that overrides everything else. Our own sadness, mourning, self blame must be submerged under the need to be the responsible Parent, the one who will manage the journey of our precious child into adulthood with lifelong chronic disease. I imagine the journey is similar to that of any parent whose child is diagnosed with a chronic disease or condition.

One of the differences lies in the management. Daily, a parent must monitor & restrict or ‘manage’ the food intake of their child. When birthday parties or celebratory occasions come up, the decisions about how to manage party food become an obsession. We handle insulin, a powerful hormone with great responsibilities attached, several times a day. We check glucose levels, ketones. We must ensure that we never run out of any supplies. We make & keep appointments with a range of HCP’s. We keep records, or trust our children to. We learn jargon. We FB, we Tweet, we SoMe. We must budget to afford all this, & although thankfully in Australia parents do receive some government assistance with costs whilst their children are under 16, in some countries this is a crushing, unsustainable burden. Our sleep is interrupted, sometimes many times a night, for the duration of the time our child with diabetes lives under our roof; and in the case of our daughters, possibly again when (if) (joyfully; & scarily) pregnancy occurs. We become master mathematicians & pseudo nurses & endocrinologists, calculating complex equations several times a day, carbs, insulin, bgl ratios.

Another difference between being diagnosed yourself & having your child diagnosed is the type & level of Guilt & Self Blame that occurs. For ourselves, it becomes tied up in not talking about our diabetes, in hiding it so that we check our bgl’s or inject our insulin or take our oral medication very privately. We may even not do these things at all if a social occasion comes up. When it’s your child, ‘compliance’ is not an issue. We follow our instructions to the letter, to the minute. We advocate, we speak out, we question, we seek knowledge, advice, support. We talk to teachers, schools, principals, classrooms full of children. For many parents, their Guilt & Self Blame becomes lifelong, but is submerged into supporting a search for a cure. This is absolutely normal. It gives Hope, which is so wonderful. However, for some people supporting a cause such as this can become obsessive, preventing Acceptance, & interfering with normal life, & just getting on with managing the diabetes as best as possible.

It can seem impossible to set aside time for managing to care for ourselves. We can feel as though we are too tired, too busy, too responsible to take some time out just to be ourselves, just to breathe & enjoy our lives. We feel driven to Act, to do. The younger the child, & the more young siblings there are, the more difficult this becomes. Many parents are fortunate in having the practical support of a partner, grandparents, their own siblings. Others have friends in the ‘real’ world as well as in the virtual world. You may have access to good Child Care, where people are already trained or are open to be trained in managing your child’s health condition. It is hard to accept that it is not selfish to use such practical help to simply ‘take a sanity break’. However, doing so can actually be a wise management strategy. By allowing someone else to take care of our child with diabetes for a half a day, a day, a ‘sleepover’, a weekend; we are teaching everyone concerned that if for some reason we are unavailable, they can manage, & manage well. We’re teaching our child that there are safe people & places in the world, & as they get older, that they are clever, brave, strong; and normal. They can be away from us, & we can be away from them. We will come back, & we will all be OK. And we’re teaching ourselves that our lives exist outside our Parenting role, a role which changes over time for everyone, regardless of any health condition of their child.

What activities do you currently do that are solely for yourself? Do you walk, run, climb, meet a friend, visit a library, play a sport, go to the gym, sew, go to the cinema, study, paint, garden, play with animals, swim, do yoga, ski, ride a motorbike or bicycle, box, write a diary or blog? What have you stopped doing that you would like to go back to? What have you always wanted to do or try that you have not yet tried? Do you know how to practice relaxation, controlled breathing, or any stress relief practices?

Always remember, you are a Parent of a child, & you are a Person. These roles do not exclude or preclude each other. Your life is yours, you own it. We have a short time on this earth, & our time is Now.

Remain in Light. Talking Heads

carpe diem

Helen Wilde

Helen is a Senior Counsellor with Diabetes Counselling online, a Teacher, & the Parent of a person living with Type 1 diabetes since 1979. She has lived with Type 2 diabetes herself since 2001.

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Diabetes and healthy weight with a twist

February 17, 2014 by Sally 2 Comments

Hi Peeps with D!

This week I thought it would be good timing to discuss the First of the Five guidelines in the Australian Dietary Guidelines and what having a healthy weight means to us with diabetes.

The twist is that this Monday (today!) marks the start of Australia’s Healthy Weight Week (AHWW) we’ll take a closer look at what the Dietitians Association of Australia has planned for our population to help them achieve a healthy weight, what the Australian Dietary Guidelines say about it and most importantly, why a healthy weight is especially important to work towards when you have diabetes (all types included) as we do.

When you’re at your peak Wellness-wise, chances are you’ll be at the right weight for you too. And of course understanding Food and how it helps you towards wellness, combined with physical activity, makes a big difference. It can be quite a steep learning curve and is one of the reasons that I can find something to write about in my blog each week for us with D as the social media dietitian for Diabetes Counselling Online.

Guideline One reads:

“To achieve and maintain a healthy weight, be physically active and choose amounts of nutritious foods and drinks to meet your energy needs.

• Children and adolescents should eat sufficient nutritious foods to grow and develop normally. They should be physically active every day and their growth should be checked regularly.

• Older people should eat nutritious foods and keep physically active to help maintain muscle strength and a healthy weight.”

There is extremely good evidence to support that First guideline. The Australian Dietary Guidelines document explains this well: “Overweight and obesity are associated with increased risk of type 2 diabetes, cardiovascular disease, hypertension, metabolic syndrome, some cancers, musculoskeletal conditions, respiratory conditions, sleep apnoea, gall bladder disease, hernia, reproductive disorders, urinary incontinence, fatty liver disease, and depression and other mental health disorders. About 70% of people who are obese have at least one established comorbidity, resulting in medical costs that are about 30% greater than those of their healthy weight peers. Compared to having a BMI of 18.5–25 kg/m2, having a BMI of 30–35 kg/m2 reduces life expectancy by 2–4 years, and having a BMI of 40–45 kg/m2 reduces it by 8–10 years. The relative increase in mortality rate attributable to obesity tends to decline with age. Mortality and morbidity are also associated with the amount of weight gained in adult life.”

It goes on to remind us that “Many obesity-related conditions are preventable, and several are at least partially reversible through weight loss achieved by adopting a nutritious dietary pattern and active lifestyle.” which is why this special week has been arranged by the Dietitians Association of Australia.

Australia’s Healthy Weight Week (AHWW)

Fitting in perfectly for our look at Dietary Guideline No. 1, AHWW will be celebrated this week and runs from Monday 17^th to the 23^rd February 2014. You’ll see there are many events being arranged by Dietitians across the country this week designed to help people achieve their own healthy weight. Click here to look out for the ones near you!

The AHWW website also offers lots of tools to help you work towards your healthy weight including an e-newsletter, a guide to eating well including strategies to help keep you on track, information about physical activity, a wonderful cook book with easy to cook healthy recipes, a ‘fad-free’ meal plan and a whole lot more!

Do You Tweet?

If any of you are on Twitter, the DAA is also hosting a Tweetchat this Wednesday between 8pm and 9pm Sydney/Melbourne time on the topic of ‘Inspiring adults to participate in healthy home cooking and to choose the correct portion sizes.’ You can read more about it here, and they’ve also provided a ‘cheat-sheet’ so you can learn the basics before joining in the conversation. I’ll be there as @SallyMDietitian to represent us with Diabetes so it would be awesome if some of you came along as well.

Being a healthy weight is beneficial for our diabetes

The American Diabetes Association (2013) lists a key strategy for all people with diabetes as ‘Portion control should be recommended for weight loss and maintenance.’ The main reason for this strategy is that increased body weight can lead to increased insulin resistance and defects in insulin secretion (AIHW 2008).

The Australian Institute of Health & Welfare tells us that ‘in 2007–08, almost 520,000 people with diabetes (58%) also had cardiovascular disease, based on self-reported data from the National Health Survey (NHS)’. Being overweight dramatically increases your risk of developing a heart condition. I hope you know that we all need to look after our heart health.

Then there’s grade A (the best) evidence that is recommended by the American Diabetes Association (2013) for those with type 2 diabetes under ‘Energy Balance’ that reminds us, “Modest weight loss may provide clinical benefits (improved glycemia, blood pressure, and/or lipids) in some individuals with diabetes, especially those early in the disease process.” This relates to increased insulin resistance for those above their healthy weight range.

Sometimes it can be harder for people with diabetes to lose weight for various reasons including some of the medications prescribed, and the American Diabetes Association Nutrition Therapy Recommendations for the Management of Adults with Diabetes (2013) adds, “A number of factors may be responsible for increasing adiposity in people with diabetes, including a reduction in glycosuria and thus retention of calories otherwise lost as an effect of therapeutic intervention, changes in food intake, or changes in energy expenditure.”

And it should not be forgotten that being underweight can also lead to severe health issues relating to malnutrition, so be careful to let your health care team know if you’re losing weight unintentionally.

Of course eating well by following the Australian Dietary Guidelines and learning from the dietitian written blogs provided each Monday through Diabetes Counselling Online will help to improve our overall health knowledge which should also improve our diabetes management results.

If you have any concerns about your own wellness or weight, it may be useful to register for a personalised e-counselling session with one of our Diabetes Counselling Online dietitians – a free service provided for all Australians with diabetes, with only a small charge for those from other countries. Click here to register or find out more.

Hoping that you benefit from the suggestions made through AHWW over the next week or so, and please let me know if there are any questions or issues that you’d like further clarification on.

Wishing you all good health! Sally

Sally Marchini is the Social Media Dietitian with Diabetes Counselling Online, owner of her private practice (Marchini Nutrition), has had type 1 diabetes for close to 40 years and coeliac disease for many years too.

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