The Diabetes Christmas Challenge!!!!

I may be a bit late with this post as we are only two weeks away from the season’s climax. Most people love the Party Season but for people with diabetes this can be the most difficult time of the year to stay on top of it. The Christmas season presents many temptations with big neon Christmas lights, trying to manage party after party, then, when Christmas day arrives you find you’re sitting around a lot in the presence of bad food choices.

How do you deal with having all this time on yours hands while you’re off work?

I remember the years when I was single and went home to my parents for Christmas for two weeks. There was lots of sitting around, eating and watching tv. I think that if I had that experience now I would have a difficult time getting back to normal in January.

These days, I’m lucky that my job is a stay-at-home Mom because my daily routine doesn’t change much over the holidays. On the years we have an Irish Christmas we spend only a couple of days away from home visiting family and I’m not a big fan of Christmas pudding and usually don’t have enough room for it after dinner. I tend to get my diabetes back on track when we leave the family.

On the years that we have a good old US Christmas the good stuff disappears very quickly when there are 21 people in the house, so if it’s there I have it, if it’s not it’s no big deal. Plus, we tend to organise lots of activities to keep the children entertained and the adults sane. You can’t keep 9 children cooped up in a house and expect them to be relatively quiet!

The fact that I don’t have that dread of all the Christmas parties means that I probably have a more positive attitude towards it. I LOVE the build up towards it more than the actual day itself. I love buying presents, I do miss having parties to go to but not that much, I love the lights and decorations, I love sending Christmas cards … and getting them.

My tip to you would be to remember that it’s only really one week, keep your head and insulin is your friend. Happy Holidays and wishing you a healthy and fit new year.

One of those happy/sad moments

The Story of Jim's Christmas Lights.
In September 2010, I was contacted by a gentleman named Jim O'Driscoll who lived in my town. You see every year he would decorate his house and garden with Christmas lights, snowmen & reindeer, extreme style and use his love of this to give something back to the community by asking people who came to see them for a small donation for charity.

Jim had done this for 10 years and raised thousands for many good causes including; Crumblin’s Children’s Hospital, Cahercalla Hospice and the Clare Sunset Foundation, among others.
As a representative of the local Diabetes Ireland branch I jump at the chance of being the benefactors of this. Jim was so enthusiastic about raising money for diabetes especially when he heard that there was a local branch and because he had Type 2 diabetes for about 20 years.

Sadly, Jim became seriously ill in November and passed away from the complications of his diabetes in February 2011, at the age of 58 before this could become a reality. Because of this, Jim’s wife, Ann want to see his wish through and is dedicating the lights to his memory this year.
Jim's Christmas Lights will officially be switched on at 5:30pm on the 8th of December at No. 75 Elm Park, (behind Ennis Swimming Pool) Gort Road, Ennis, Co. Clare.

On Saturday, the 10th of December, between 4pm and 7pm, there will be a special guest appearance from Santa Claus. “Everyone’s invited and we’ll be having mince pies, mulled wine, hot food and some treats for the children” says Ann O’Driscoll.

The lights can be seen at No. 75 Elm Park, Gort Road, Ennis (behind Ennis Swimming Pool) every evening from the 8th of December to the 6th of January between 4 – 11pm.
The Clare branch of Diabetes Ireland hopes that lots of families from Ennis and the surrounding areas in Co. Clare will come out to see and enjoy Jim’s Christmas Lights and to support his wish to raise money for diabetes awareness and education. People can also make a donation in Jim’s memory to Diabetes Ireland by calling 1850 909 909 or by logging onto www.diabetes.ie and clicking the “Quick Donate” icon.

Proceeds from Jim's Lights a few years ago to The Children's Medical Research Foundation. From left: Gerry Cully, Jim O' Driscoll, Fr. Martin Blake and Anne O' Driscoll. Photograph by Yvonne Vaughan, The Clare People.

Type 2 Diabetes - where to get help.

When someone tells you “you have type 2 diabetes”, the reaction is usually one of shock. You may have gone to the doctor with what you thought a bothersome minor ailment, not expecting in the least to be told you have a serious chronic illness. You might be sitting in the doctor’s office and while s/he is trying to explain diabetes to you your mind is racing with the “how” and the “why”.

Those first days, weeks & months are really difficult. You are trying to accept the hand that you have been dealt, wrestle with the guilt that maybe you could have prevented your type 2 diabetes, and you are trying to bring it under control with new gadgets, medication and overhauling your eating habits.

Diabetes is not a simple illness to explain; it’s difficult for the patient (you & me) to understand and therefore, it’s not easy to be in control of it. The type 2 diabetes patient needs more than just treatment to manage their diabetes; they need support, education, motivation and understanding.

Diabetes is a lot to deal with! But you don’t have to do it alone.

Diabetes management has come a long way in the last 10 years in Ireland. There are now type 2 diabetes classes all over the country. The community dietetic services have extended to try and meet the demand of patients.

Courses available for people with type 2 diabetes living in the Midwest. If you would like information on what diabetes education courses are available in your area contact your local health office www.hse.ie or contact Diabetes Ireland on 1850 909 909 or email: info@diabetes.ie

DESMOND
(Diabetes Education& Self-Management for On-going & Newly Diagnosed) 
This course is provided by the HSE and is available to patients in Limerick, Clare and North Tipperary.

Limerick contact; Anne Geary/Sinead Glover 061/483448
Clare contact: Mary McMahon 065/6865839
North Tipperary contact:  Annette Ridley 067 - 42378

CODE
(Community Orientated Diabetes Education)
This course is provided by the HSE and by Diabetes Ireland.

Limerick Local CODE:  061/482340
St John’s Hospital CODE: 061/462271
Diabetes Ireland CODE: Elaine Newell 071/9146001
Community Dietitians can be accessed through your GP

National Diabetes Health & Awareness Exhibit

I decided to post a little earlier this week given the day that's in it. And what a day it has been! The internet has been "hopping" and so far diabetes has been all over my local radio station and two national ones not to mention one national TV news programme.

Every year in Ireland I would watch for, even a brief mention, in any sort of media, of diabetes on World Diabetes Day but it never happened. Hip, hip, hooray, for "Let's talk Diabetes".

Anyway, my post this week is a review of the National Diabetes Health and Awareness Exhibit.

~~~~~~~~

On Sunday, 13^th November (the day before World Diabetes Day), Diabetes Ireland organised a National Diabetes & Health Awareness Exhibit in the Rochestown Park Hotel in Cork.

I walked into a large conference room filled with stands; everyone from the world of diabetes was there. There were lots of fancy glucose meters on offer, dietitians, diabetes nurses, podiatrists, etc. willing to give you their time. There was so much information on diabetes that it was easy to become overwhelmed.

There was also lots of health checks free to the public; I had my cholesterol  and blood pressure checked recently but I did have my BMI measured at the exhibition, which was just a tad over the recommended 25 but the lads were so nice about it. Thankfully, I had suspected that I was over and it wasn’t a shock to me.

Diabetes Ireland also held their Annual General Meeting, which is usually eye-opener for me as I realise just how much is going on behind the scenes to make things better for me and for all people with diabetes and their families.

Not to mention that they do it all on a teeny-tiny budget and with just a small number of dedicated staff. I jotted down a couple of things that I thought were astounding.

During the period of 1^st November 2010 to the 31^st October 2011;

·         The diabetes helpline received 7,000 calls, with 88% of that number calling for general information on diabetes.

·         A Schools Resources pack was produced and sent to all primary and secondary schools in Ireland to ensure that both teachers and parents know what is expected of them in relation to having a child with diabetes in school.

·         The National Teen Activity day was attended by 87 adolescents (in my opinion this number was too low).

·         There are 12 groups of parents who meet regularly around the country.

·         Thanks to Diabetes Action’s campaign the HSE committed to providing 22 podiatrists dedicated to performing annual foot screening for people with diabetes.

·         Again thanks to Diabetes Action the HSE committed to ring-fencing €4 million to the setting up of a free retinopathy screening service for people with diabetes.

·         A research study was launched on what factors influence self-care and quality of life in the 23-30 year old age group. Apparently, this age group has an extremely difficult time dealing with diabetes and a study of why has never been done before.

 Diabetes Ireland’s objectives for 2012 are:

·         To continue to maintain all the services they currently have; the helpline, the members’ magazine, raising awareness, education and health promotion, etc.

·         To ensure that the podiatry service is delivered.

·         To ensure that the retinopathy service is on track for a national roll-out by the end of 2012.

·         To ensure that the HSE make progress on delivering a better service to children and adolescents with diabetes.

·         To continue to raise awareness about type 2 diabetes and put more emphasis on prevention.

·         And to highlight how care for people with diabetes needs to be integrated.

The Budget:

Diabetes Ireland receives 34% of its funding from the HSE for providing services that should be provided by the HSE (Type 2 diabetes education). They are hugely reliant on funding that comes from the general public. Their income for 2010 was just over €1.3 million which in my opinion is peanuts!

Diabetes Ireland is the only organisation Ireland has for people with diabetes and is dedicated to making the health service serve us better. People with diabetes need this organisation as a source of support and resources as well as to keep fighting for us and Diabetes Ireland needs more of us, the people with diabetes, to support it.

It’s a two-way street and we all win.

“The Slumps” Do you every have them?

My positivity about my diabetes is in a bit of a slump at the moment. Let me fill you in.

During the summer I went overseas for a month with my family. Normally, I let the holidays slide but this was 4 weeks so I tried my best to stay on top of my diabetes. However, it was impossible to maintain a routine and the food just kept changing from week to week. So about half way through I threw my hands up in the air and comforted myself with the knowledge that once I got home everything would go back to normal.

We came home but the children were still off from school and I decided to enjoy two more weeks of “lie-in’s” rather than set the alarm and get my daily walk in before the day started. Again I comforted myself with “when school starts things will go back to normal.

Well, its two months since the children went back to school, my old routine is re-established, daily walk included and I still feel like I’m drowning.

It seems so much more difficult to achieve the consistency I had four months ago; maybe since I’m getting older I’m feeling more tired and weary of diabetes. I wish diabetes had small periods where it was easier to manage, where very little effort was required to have all my blood glucose readings to be reasonably within target and not have any huge swings.

I pride myself on trying my best with my diabetes management but when my HbA1c goes upwards from 7.0% to 7.4% (54mmol/mol), I can’t hide my disappointment.

Thank goodness for my doctor, who is very supportive.  I had my visit with her yesterday. She always perks me up a bit, she tells me not to be so hard on myself and that we will get there with the numbers.

I know what I need to do to get back on track but I don’t seem to have the energy to break the circle.

But I will get back on track; the alternative is not an option. I have too many people in my life that I want to stick around for!  Today, I will draw up all the negativity and the weariness and expel it.

Tomorrow, positivity and the energy to crunch the numbers will prevail. :-)

A Step in the right direction

Ever since I had my second child and had to spend seven days in a maternity hospital I have had a huge fear of ever being admitted to hospital again. That might sound a bit extreme but it’s the truth. I did not have any confidence that any of the staff in the hospital had the ability to care for me should I become incapacitated.

When I was invited to speak at a nurse’s diabetes training day I thought that I might charge in there seeing them as the enemy. Thankfully, my husband, who is very, very, very smart said that I should see it as a chance to let these very important people in the health service know how important it is to me that they are knowledgeable in diabetes and to commend the health service for providing the nursing profession with this opportunity.

Basically, this one day was part of an intensive diabetes training course for people working in the nursing and midwifery profession. And I was invited to give a patient’s perspective.

I talked about all the things I did on a daily basis to management my diabetes, such as the blood glucose testing, carb counting, record keeping, etc., and all the things I felt were important extras, like a good support system in the background and knowledge.

Afterwards, I had loads of really interesting questions. They seemed really interested in learning from me and in my 18 years of experience.

When I walked into the room my objective was to try and explain how diabetes was so complicated to manage and that it wasn’t just as simple as following instructions from a medical professional; I hope I achieved that.

And in return, I received hope that the next time I have a stay in hospital, (because let’s face it, there is no way that I will live out the rest of my days without ever being admitted into a hospital), that I have a bit more confidence in the staff to looke after me.

World Diabetes Day in Ireland

November 14^th is World Diabetes Day. All around the world the diabetes community will mark the occasion in some way or another as we remember those who have passed from this life because of diabetes and  those who are struggling to stay ahead of their complications. We will also be thankful for every day that those who are living well with diabetes continue to do so.

It’s the one day I know I’m not alone in the world of diabetes.

This year the diabetes community in Ireland seems to be mobilising and making sure that the occasion doesn’t go unnoticed.

In doing so, I’m happy to spread the word that the following buildings will be going blue for World Diabetes Day; PricewaterhouseCoopers, Dublin, The Convention Centre, Dublin, The Round Room and Fire Restaurant Business & Events Centre@ The Mansion House, Dublin

On the Sunday the 13^th of November, Diabetes Ireland will hold a “Diabetes Health and Awareness Expo” in the Rochestown Park Hotel in Cork. Diabetes Ireland is also looking for people to come forward and “Go Blue” for World Diabetes Day.

It’s my hope that this year World Diabetes Day make the 6 o’clock news in Ireland, so that everyone living in Ireland hears about it.

The cost of Diabetes in Ireland

People with diabetes are very fortunate when it comes to the cost of living with diabetes in Ireland.

Under the Long Term Illness Scheme, diabetes medications and supplies, such as test strips, needles, insulin, etc., are free to all people with diabetes. This scheme was set up in 1971, specifically to help people with diabetes manage the astronomical cost of medicine and subsequently covers another 14 illnesses.

The cost of a box of 50 test strips for my One Touch Ultra Glucose meter is $61 (€46). I use approximately 7 strips per day which means that it I were to buy a one month supply it would cost me €188 (ouch!!!). That’s just for the test strips for my glucose meter! I’m not going to give anyone a heart attack by telling you what my insulin, needles and the glucagon kit would cost! Believe me you don’t want to know!

I’m just thankful that this fortune doesn’t come directly out of my pocket because I could not afford it. I know that my taxes goes towards this cost but I don’t think I pay enough taxes to cover all the free things that most of us get but that’s not an offer to pay more!!!

We are not the only country who provides people with diabetes this benefit. I came across a discussion thread on  about how many glucose meter test strips GP’s in the UK allow their patients.

The National Health Service (NHS) in the UK, does provide test strips for free to people with diabetes but because of cost cutting measures some GP’s are placing restrictions on how many test strips a person with diabetes can get, regardless of using insulin or not. Some GP’s feel that 4 test strips per day is sufficient but if you are a person with type 1 diabetes (like me) on an insulin pump the pump manufacturers insist you test 6-8 times a day. Plus, if you are an active person or you drive a lot this is just not safe or practical.

I would hate for someone to tell me that I’m not allowed to test my blood sugar levels as many times as I feel necessary. After all, I’m not doing it for fun – it’s not fun at all, believe me!!

I use the information from my blood sugar readings to correct high & low blood glucose levels, to calculate my insulin to carbohydrate ratio for meals and food types. I thing that my having a decent HbA1c is because I can test as many times as I do.

I really am very fortunate to have this scheme and I will never forget it.

Beta Cell Syndrome a.k.a. Type 1 Diabetes

Back in May 2011 I blogged about encouraging the media to be Type Specific when it comes to diabetes and over the course of the Diabetes Action’s paediatric diabetes campaign I thought there was some progress in this area.

I have to say that both Diabetes Action and the Diabetes Federation have been really considerate and careful to be type specific since that campaign’s launch. Well done to them.

However with the launch of safe food’s “Stop the Spread” campaign this progress has taken a huge fall backwards.  This campaign has really maximised its exposure, its broadcast on local and national radio as well as national television.

The ad states, “It is well known that carrying excess weight around the tummy is linked to an increased risk of chronic diseases such diabetes and heart disease and more recently cancer. By measuring our waist, we can each get an early warning about our weight and begin to take steps to address it”, Dr. Cliodhna Foley-Nolan, Director, Human Health & Nutrition, safefood.

The campaign’s message is everywhere and because they overlooked one minor detail stating “diabetes” instead of “Type 2 Diabetes” we are back to square one to educate the general public about the differences between the types of diabetes.

I’m just wondering if it would be more beneficial to rename Type 1 Diabetes altogether – we would avoid this confusion and it’s been done before when the name was changed from Juvenile Diabetes.

We could call it “Beta Cell Syndrome” or something similar that does not have any affiliation to sugar or obesity.

Slave to my insulin!

I needed to clean my house, so, I jumped right in to the hovering. Low (pun intended) and behold about 15 minutes into the project I’m sweating and I’ve got the shakes. I’m annoyed because I have to get the job done before the school collection run and now I have to take time out to treat a hypo.

I have never let my diabetes stop me from doing anything; I’ve travelled, worked, got married, had children. I did not climb any mountains but I didn’t want to. But when it comes to the blasted house cleaning, diabetes gets in the way every time!

In the end I would try to synchronise the vigorous house cleaning with blood glucose testing time, which would also coincide with two hours after a meal and thus lessen the risk of a hypo. But, that just resulted in needing to sit down and have a snack before I started.

Now I don’t know about others but if my mind is geared up for a bit of cleaning I would just as soon get into it than to sit around thinking about it (cos then I run the risk of putting it off altogether).

I felt I would never have the upper hand in blood glucose control.

However, that all changed when I got an insulin pump. An insulin pump is kind of like the intravenous drip you see hospital patients with. The pump is programmed to deliver insulin at different speeds throughout the day (known as a basal programme) and the speed can be as little as .025 of a unit per hour.  And if you need to have more insulin you can dial up the required dose and make the pump give you that insulin all at once, for example like with a shot to cover the carbohydrate in a meal.

 I feel I have more of the control. I know I will never be able to predict what stress and hormones do to my blood sugars but the problem of how the insulin is behaving in my body has been simplified.

So now when it’s time for a bit of cleaning I have the option to either suspend my pump (stop insulin delivery temporarily) or reduce my basal rate by a percentage. No need for snacks unless I’m in the mood for one.

Sometimes, I still feel like I’m a slave to my insulin especially when I get the estimates wrong but it’s not as often and not as frustrating because I use that information to make the next estimate more accurate J

Preventing Diabetic Kidney Disease

Disclaimer: This following information is not provided to you by a medical profession but by a non-medical third party and does not in any well replace any advice given to you by such professionals.

In October 2010, I attended a presentation given by Dr. Ray O’Connor on Diabetic Kidney Disease. I’m getting to the stage in my life where I don’t want to rely on luck alone to stave off the complications of diabetes and even though I trust my endo; I want to know more about the medical side of things myself. I am passing along the information that he provided.

Dr. O’Connor is a full time general practitioner (GP) who has a special interest in diabetes and he is also, among other things, the chairperson of a task force in the mid-west of Ireland to co-ordinate diabetes care in the region.

He introduced his topic by stating that most people who have kidney disease do not have any symptoms and feel well. In the image to the right, the part of the iceberg we see above water represents the number of people who know they have kidney disease and the part of the iceberg represents the people who do not know they have kidney disease.

What is Diabetic Kidney Disease?

Diabetic kidney disease affects 20-30% of people with diabetes (Type 1 & Type 2).

When the kidneys are working well, tiny filters in your kidneys, the glomeruli, keep blood proteins inside your body. You need these proteins to stay healthy. High blood glucose and high blood pressure damage the kidneys' filters. When the kidneys are damaged, proteins leak out of the kidneys into the urine. Damaged kidneys do not do a good job of filtering out wastes and extra fluid. Waste and fluid build-up in your blood instead of leaving the body in urine. With more damage, the kidneys leak more and more protein. More and more wastes build up in the blood. This damage gets worse until the kidneys fail.

What’s that Microalbuminuria all about?

The first sign of Kidney disease will appear when the blood vessels start to leak Microalbuminuria (little bits of protein) in the urine. A normal level of Microalbuminuria is less than 2.5. The test to detect if any microalbuminuria is present is called a Albumin:Creatinine Ratio (ACR) and is done through a urine sample and should be done once a year in all people who have diabetes.

How does your doctor screen for Diabetic Kidney Disease?

Your doctor should take a urine sample once a year to have it tested for the Albumin:Creatinine Ratio. A result of less than 2.5 is normal. A result of between 2.5 and 25 is stage 1 kidney disease and a result greater than 25 is stage 2.

How should we prevention Kidney Disease?

Keeping our blood vessels healthy will help keep your kidneys healthy. We do this by;

• Keeping our Blood Pressure under control, using ACE (angiotensin converting enzyme) inhibitors or ARBs (angiotensin receptor blocker), if necessary. Simply reducing our Blood Pressure with other medicines is effective also,

·         Good glucose control,

·         Restriction of dietary protein may be helpful,

·         Stop smoking will relieve the pressure on our blood vessels,

·         Cholesterol control,

·         Lifestyle modifications are helpful too. 

¾     Weight loss

¾     Exercise

¾     Reduction of protein

¾     Reduction of salt

¾     Reduction of alcohol

Conclusion

Dr. O’Connor summed up his presentation with these few points below that were easy to remember.

·         Get your urine tested for the Albumin : Creatinine Ratio (A:C Ration) at least once a year and Blood Pressure checked regularly

·         Keep your sugars controlled

·         Take your medication

·         Don’t smoke

·         Work on your lifestyle

I think it's safe to say that I have not done his presentation justice; you kinda had to be there to absorb the full impact and everyone who did attend walked out with more knowledge and more motivation to take control of their diabetes.

What should I eat now I have diabetes?

I was at a diabetes information evening last week and we listened to an extremely eloquent and knowledgeable dietitian give a presentation on the most commonly asked questions from people with diabetes.

I started to think about how much focus there is on food when you have diabetes and why this question is always asked, in multiple forms, so many times.

It’s one of the first questions a person asks themselves, irrelevant to what type of diabetes they have, when they get home from the hospital or doctor’s office after being told they have diabetes is “What should I be eating now?”

The answer to this question is different for everyone because each one of us lives very different lives. Some of us work outside the home, some of us don’t, some of us have children and some of us don’t.

So when you ask a dietitian “what should I eat?” The answer will be very general, long and contain a huge amount of information. (S)he loses our attention on sentence three because  it’s not the quick fix/easy answer we were hoping for.

My point is that I don’t think asking this question benefits anyone with diabetes. I think we should be asking “what am I eating every day and how do I modify it?’ Thus, taking control of the situation ourselves and not looking to others for answers. AND not believing that we are going to lose all of our treats.

To find out what we eat every day, we need to keep a food and blood sugar diary for, at least, two weeks. We should do this because when you sit down at the end of the day and list try to remember what we ate we inevitably forget a number of things.

And we shouldn’t just record what we eat but how much of it! This is hugely important because we could be eating all the right things but if you eat more food (healthy or unhealthy) than your body uses up in the form of energy, you will gain weight or be overweight.

Once we have our two week diary, then we can take it to a dietitian and go through it together. (S)he will help us figure out where we fall down on our healthy eating plan and decide what small changes we can make that will benefit us most and smooth out the troughs and peeks in our blood sugars.

Summer Break – Help!

My children are finished school for the summer which means I don’t have as much time to myself as normal. I won’t be posting regularly over the next 6-8 weeks. But I will be back in September fully charged.

I want to thank you all for following the “Diabetes People” blog via FaceBook & Twitter. I know that there are so many Diabetes Blogs out there to keep people entertained and I wanted to thank all of you who value this one too.

I hope you all have a good summer and stay healthy.

Travel Tips from the Clare Type 1 Diabetes Group

In May, the Type 1 Diabetes Group in Clare discussed helpful tips when you are travelling. The following is a combination of tips from the Diabetes Australia and from the American Diabetes Association.


1. Carry a letter from your doctor stating your full name, address and date of birth, that you have diabetes and then listing the medications, insulin delivery devices (syringes, insulin pens or pumps) which you use and blood glucose testing equipment you use, and stating that you must be allowed to carry these with you at all times. Tip added by group; Make several copies of this letter and stash them everywhere.

2. Customs or Security Gates. If questioned about syringes or other diabetes equipment which you are carrying, stay calm, simply state that you have diabetes and explain what the devices are. Show the person the letter from your doctor. The Federal Aviation Authority trains all security staff in what people with diabetes must be allowed to carry. There is no need to ‘declare’ your supplies on domestic or international flights as they are entirely permitted.

3. Take a spare prescription. Always take prescriptions for all medications which you need, and which you are carrying with you. This will both assist you to get more supplies if needed, and reassure security officers that the medications are your own.

4. Bring plenty, if not double, the amount of diabetes supplies that you will need. Sometimes extreme climates can damage test strips and insulin, or if you get delayed at your destination on your way home (remember the ash cloud). It’s always wise to have some spares.

5. When flying carry all your diabetes supplies in your hand luggage. It can be difficult, though not impossible, to obtain all your diabetes supplies away from home if they are lost. Best to keep them close to hand so you don’t have to waste precious time traipsing around an unknown city.

6. Replacing lost supplies. If you do find yourself in this predicament, start with a major hospital’s emergency room which should be able to supply enough to get you through. Alternatively, phone the diabetes organisation where you are and ask someone to explain how you obtain diabetes supplies in their state/country. If heading overseas, you can find out contact details for the local organisation in advance by visiting the International Diabetes Federation’s website: www.idf.org

7. Wear ID. Make sure you have some form of identification which says that you have diabetes such as a Medicalert bracelet, on you, especially if traveling alone.

8. No need to request ‘diabetic’ meals on planes.

9. Always pack hypo supplies & Carb snacks - especially on long flights. Also, don’t be afraid to ask the flight attendant for a lemonade or extra food if you need it to treat a hypo.

10. Get Travel Insurance! It may seem like just another wad of euros which your travel agent is trying to extract from you but if only for your and your family’s peace of mind it could be the best investment you ever make. Make sure your insurance policy covers your diabetes. Some policies may exclude cover for long term medical conditions.

11. If you are travelling across time zones talk to your diabetes team about how to administer your insulin on the days that you travel and what to do once you arrive.

12. Don’t forget extra batteries for your meter.

“Special considerations for amusement parks from the JDRF website.

If you are taking a child with type 1 diabetes to a major amusement park like Disney World/Land, the first thing you should do when you arrive is go to the guest relations office. Explain to the staff that your child has type 1 diabetes and must eat, check blood sugars, and/or take shots at specific times. Some of them will give you a pass that will get your family in the handicapped line for most rides, which will drastically cut the amount of time you will have to wait in lines. Bring a backpack with snacks, juices, water, and all your type 1 diabetes supplies. You may also want to pack meters and insulin pumps in waterproof bags so they don't get wet on water rides. If your child is relatively young, you can also rent a stroller for the day and stash supplies in there.
Many parents also suggest making reservations for sit-down meals at amusement park restaurants before leaving for your trip.”

A little bit of planning goes a long way towards a stress free and well earned holiday.

Health of the Nation - Diabetes

On Wednesday, 29th June the Irish television station RTE broadcast "Health of the Nation" featuring diabetes. If you missed it you can catch it again on the RTE player.

RTE's Health of the Nation - Diabetes episode

 

“Do you know a child or young person with Diabetes?”

If you do Diabetes Action needs your help. Please read on to find out why and how.

Most children and adolescents with diabetes have Type 1 Diabetes. This is an autoimmune disease, which means that for no apparent reason a child’s immune system decided to turn on it and destroy a crucial part of the body. In the case of Type 1 diabetes the immune system attacked the cells that make insulin. Insulin is needed to convert the food we eat into the energy we need to exist. The food, in particular the carbohydrate, we eat is converted into glucose and if the glucose isn’t converted into energy it poisons the body and eventually causes all sorts of organ failure and if untreated death.

Children and young people with Type 1 Diabetes must take insulin in the form of multiple daily injections and must test their blood glucose at least 4 times a day. They must attend outpatient clinics 4 – 5 times a year to monitor their diabetes. These children do attend their hospital appointments regionally however due to lack of resources to offer new treatments that control blood sugar and insulin levels about 50% are referred to the Paediatric Diabetes centres in Dublin, where services are inundated with referrals from children and adolescents with diabetes from the rest of Ireland.

To tackle this Diabetes Action is seeking the reorganisation of existing paediatric diabetes services so that up to date specialist care can be provided equally. The cost of this reorganisation is €750,000 but international studies have shown that improved control of diabetes in children and adolescents can lessen the development of costly complication in adulthood by as much at 76%.

“At present 50% of children and adolescents with diabetes develop some form of long term diabetes complication by the time they are adults. We can dramatically improve health outcomes and quality of life with a very modest investment and a reorganisation of services” says Prof. Hillary Hoey, leading paediatric endocrinologist.

Diabetes Action is asking all people with diabetes to log onto their website http://www.diabetesaction.ie/ and support this campaign for better services for children and young people with diabetes by sending an email to their local TD’s and senators to make representations to the HSE and to the Minister for Health seeking a reorganisation of services.

Diabetes Action asks that if you want to support this campaign but do not have access to the internet that you ask a family member or friend for help or visit the local library.

As of 17th June 2011, 1,200 people have used the advocacy web-site http://www.diabetesaction.ie/ to send over e-mail representations to TDs and Senators in the Oireachtas.

Children and adolescents with diabetes deserve services which will support them to lead a normal and productive life and without future ill health.

 
 
 
 
 
 
Log onto www.diabetesaction.ie now!!!

Type 1 vs Type 2

There is so much confusion out there in the non-diabetes community about diabetes and we (the people with diabetes) are often subjected to comments such as; “Diabetes; doesn’t that mean you can’t have any sugar?” or “Type 1 – which one is that?”

These comments don’t bother me all that much when it’s face to face because I can take the time to explain what Type 1 Diabetes is. But when comments like that come from people who in my opinion should know better, then, I lose it and have to be quarantined before I can be with people again.

For instance, I sent an email to a public representative highlighting a campaign to get better health services for Type 1 diabetes. In my email any time I used the word “diabetes” it was accompanied by Type 1. However, the reply talked only about Type 2 diabetes and what a “scourge” it was, requiring me to send another email to said TD.

In the same week, I had to fill out one of those forms for mortgage protection insurance. You know the out-dated form that asks ridiculous questions such as “How often do you test your blood or urine for sugar?” What? “Is sugar present, often, occasionally or never?” Double what!!! Sugar is always present in blood. Who in-the-name-of-God tests their urine for sugar anymore? I mean it is useless information in today’s world. Yes, before 1985 when there were no Blood Glucose monitors we tested urine for sugar!

Please give sample readings for the last three months (with a small box for the answer). All of my readings would take about three pages for the last three months.

COME ON!!!!!!!!!!!!!!!!!!!!!!!!! One step forward and two steps back.

Is it any wonder that I feel like we are losing the fight to educate people about diabetes and make people more aware of it; never mind that there are two types and what those types are? How will we get people to support us in our quest for better health care services if they don’t even know what diabetes is? Things need to change – I just don’t know what to do to change them!

The more you know about diabetes; the better equipped you are to manage it?

The more we know about diabetes; the better equipped we are to manage it well. New treatments are being introduced all of the time on how to improve our diabetes control.

Diabetes is a disease for life and it changes as we go through our different life cycles. Therefore, Type 1 Diabetes is lifelong learning – we should always be on the lookout for more information.

Those of us who have been around the Diabetes life for more than 10 years will remember switching from the twice daily injections to the multiple daily injections (MDI) and how the way we managed diabetes  changed (and our way of thinking about it) but some of us fell through the cracks and weren’t informed that with MDI we could be more flexible with the timing of our meals and snacks or that if our blood sugars were high we could take and extra shot. So staying on top of the newest information should be a priority for people with type 1 Diabetes, we don’t have to follow it but at least know about it.

So Type 1 Diabetes Education in Ireland; what’s out there?

Initially, our Type 1 Diabetes education starts with the Diabetes Nurse Specialist, and we usually see her/him at our clinic appointments or when we have been admitted to hospital at diagnosis. Most of our information about managing Type 1 Diabetes in the real world comes from this person. We might also receive some Type 1 Diabetes education from a specialist dietician and maybe we have taken home some brochures and booklets to read in our own time. These booklets are usually very general and don’t provide enough information once you have absorbed the basics.

Presently, there is one structured education programme for Adults with Type 1 Diabetes called DAFNE (Dose Adjustment for Normal Eating). “DAFNE is a way of managing Type 1 diabetes and provides people with the skills necessary to estimate the carbohydrate in each meal and to inject the right dose of insulin.”

There are 6 centres in the republic of Ireland who provide DAFNE and you have to be a patient in the Diabetes out-patient clinic of that centre to access DAFNE.

So, where do the rest of us go to get that important knowledge about Type 1 Diabetes from?

Well most of the people I meet go to the internet and spend a lot of time going through different websites. Some look for books on Type 1 diabetes, of which there are many. Some look to people who are in the same boat and want to have person to person contact – this is available if you live in an area that has a support group available (Ennis, Co. Clare would be one of those places, so to would Cork City, and Dublin and more). Most of these groups are organised by volunteers and the Diabetes Federation of Ireland would have contact details for these.

Maybe others listen to advice from people who do not have diabetes or maybe find magazines with good information?

Where do you go to stay informed? Or do you think that it’s not that important to try and find other sources of information for Type 1 Diabetes?

I would love to have you post comments about this and hear other people’s opinions.

****************

Log on to www.diabetesaction.ie today!

When things get out of control how do you get it back?

There are loooaaads of articles online with tips for better blood glucose control or how to “take control of your diabetes”.
However, this one I came across on http://www.diabeteshealth.com/read/2011/05/20/7159/eight-tips-for-super-blood-sugar-control/ was very well written and should be easy to adapt into your own life. The purple text marks some of the original text that I have edited to make it more relevant for Irish people and the text that is highlighted are pieces that I feel are important to consider when you are trying to regain control of your diabetes but that is also a matter of personal opinion.

Eight Tips for Super Blood Sugar Control

By Clay Wirestone (with some editing by Gráinne Flynn)
May 20, 2011

You're heard the doctors. You've read the articles. You know all about tight control.

Ever since the results from the Diabetes Control and Complications Trial were published in 1993, everyone has known that reducing A1C levels staves off complications and keeps us healthy longer. We know this. And we've listened.

But many type 1s--and even type 2s who aggressively manage their illness--suspect that they could do better. And just a bit of searching around the web or browsing in your local bookstore will prove you right.

For me, it was the work of Dr. Richard Bernstein. "Diabetics are entitled to the same, normal blood sugars that nondiabetics enjoy," Bernstein wrote in the preface to his book Dr. Bernstein's Diabetes Solution. He's stated that viewpoint repeatedly in interviews and articles.

And who could argue with it? Some disagree with Bernstein's advice on how to get that level of control--an extremely low-carb diet figures into his plan--but his basic notion tantalizes. Are normal blood sugars possible? Can people with diabetes transform good blood sugar control into great blood sugar control?

I think we can. (Is feidir linn!!) And what's more, it's not that complicated. However, it does require that you, the person with diabetes, make a commitment to yourself to take action. Here are eight suggestions.

Have a goal.

The American Diabetes Association says that people with diabetes should aim for an A1C--a three-month average blood glucose level--below 7%. (From the 1st July 2011, the HbA1c will be measured in units called mmol/mol (pronounced “millimoles per mole”), rather than as a %. The HbA1c target of 7% will equate to 53 mmol/mol.) The American Association of Clinical Endocrinologists advises an A1C of 6.5% (45 mmol) or under. Most doctors would be pleased with either number.

But what's your goal? If your A1C is 8% or 9%, hitting 7% is a worthwhile aim. However, if you've managed to achieve an A1C near 7%, perhaps you could try for a lower number. Talk to your doctor and diabetes educator and see if they think you can safely aim for even tighter control.

Whatever you're aiming for, having that target number in mind will help. That's where you want to go. That's what you want to do. And that goal will help motivate you in the days and weeks ahead.


A note of warning: Don't aim for the impossible right away. If your A1C is quite high, don't immediately try for the lowest possible number. Talk to your doctor and set a reasonable goal. Then meet it. Then set another goal.

Check your blood sugar. A lot.

No piece of advice could be more obvious, but it's easily overlooked in the hustle and bustle of daily life. If you don't know what your blood sugar is, you can't hope to keep it at a nondiabetic level.

According to the National Institutes of Health, which funded the Diabetes Control and Complications Trial, it was once standard practice to check blood sugar a single time each day. That landmark study raised the standard to four.

But four checks a day, while better than one, can miss a lot. If you want tighter control, try six or eight checks a day. That's right: Take your blood sugar every two or three hours when you're awake, and definitely check overnight. You might be surprised to learn where your numbers go.

This can be a costly prospect for some people. You can only do what you can afford. But almost everyone can try the extra checks for a few days or a couple of weeks, and that information alone will be helpful. You'll learn how your body reacts to different kinds of food. You'll find out how long it takes your body to absorb insulin.

This is your baseline information. This is the stuff you have to know. The best technology and the most extensive education don't make the slightest bit of difference if you don't know what your blood sugars are most times of the day.

You also might want to consider a continuous glucose monitor. This device gives you a constantly updated blood glucose trend line and can alert you if your numbers rise too high or fall too low.

Carry glucose tablets. Everywhere.

Lows are a real challenge when trying to maintain near-normal blood sugars for any considerable length of time. Think about it this way: A problematic low of 2.5 is just 2.7mmols away from a great blood sugar of 5mmols. But it's 10mmols away from the high blood sugar of 13mmols. If you hate the way low blood sugars make your feel, it might seem more comfortable to stay in the high range. But that high range increases your risk of serious diabetic complications.

Glucose tablets can help solve this vexing problem. Have a low blood sugar? Pop three of four of them, wait a couple of minutes, and be on your way. Have them available at all times, in all the places that you might need them--at home, in the car, and at work.

The government's Centers for Disease Control and Prevention puts it simply: "Always carry some type of carbohydrate sugar food or drink with you." The CDC also advises wearing a medical alert bracelet and carrying a card in your wallet saying that you have diabetes.

For years, I didn't believe in glucose tablets. Why not use candy, I wondered. Or juice? They were both so much tastier than the tablets. But that's the problem. Who eats just three pieces of candy? Who drinks just a few ounces of OJ? It's too easy to over-correct and send your blood sugar sky high.

Stick with glucose tablets. They're tasty enough to be palatable, but bland enough that you won't be tempted to sneak one when your stomach rumbles.

Get coaching. Now.

Find a diabetes educator (diabetes nurse specialist or dietician) or nutritionist. Go to his or her office and learn.

Perhaps you've had diabetes for a long time and think you know everything you need to know. Perhaps you don't want someone in his 20s or 30s telling you how to manage your disease. Perhaps you think you get along just fine on your own.


If you think any of these things, you really do need to see the educator. Because it's easy for veteran patients to lie to themselves--to say that certain high blood sugars "don't count" or that they're not responsible when bad things happen.

An educator sees right through that. He or she won't discipline you, exactly, but you will need to talk openly and honestly about your disease and how it's going. And your educator will then arm you with knowledge and advice.

Boston's Joslin Diabetes Center actually recommends that people with diabetes go through the education process every year or two, making sure they keep up to date with the latest research and their own goals.

You will leave motivated and ready to look at your disease in a different way. And for those looking to take control to the next level, this motivation is invaluable.

For people more recently diagnosed, educators serve a different role. They can help you understand how the disease works and smooth out your ups and downs. Getting good advice at the start can keep you from making mistakes later.

If you have access to courses like DAFNE or BERGER which are provided by some diabetes clinics then avail of them.

Consider a medical device.

I've already touched on continuous glucose monitors. But it's also important to talk about insulin pumps. Both of these devices can remake your routine for the better. A consistent flow of fast-acting insulin from a pump can more accurately reflect the way a pancreas works. And the constant monitoring available from a CGM gives you nearly real-time feedback.

Neither device works miracles on its own. Nothing about the devices changes the basic nature of diabetes or the challenges of controlling the disease. People on insulin pumps can have poor control. So can people with CGMs.

But the education provided with the devices can be invaluable. And the mere act of closely looking after the disease pays off. It's important to commit to the treatment, learn all you can about it, and give it a chance.

Diabetes educators and medical device companies can be great sources of information if you're considering taking this step. Don't hesitate to ask them for advice and information.

In Ireland, both of these devices can be difficult to get but not impossible. If you are interested in giving the insulin pump or the CGM a try, find someone in your area who already has them for tips on how you get one too. There are 4-5 Type 1 supports groups established in Ireland, where you can find out more about pumps and CGM’s.

Don't just count carbs. Limit them.

Not all experts will agree with this point, but it's one that has worked for me.

The standard for diabetic treatment these days is counting carbohydrates in food. That is, your insulin shot should cover the amount of sugar in your food (most starches, like those in bread, break down into sugar). What that means is that you can eat most meats, cheeses, and green vegetables without affecting your blood sugar that much.

If you want more consistent blood sugars, it only makes sense that you would not only know how many carbs you ate so you could give yourself insulin to cover them, but that you would also limit those carbs. If you ate fewer of them, you'd need less insulin, and your blood sugar wouldn't seesaw so much.

I won't say how drastically you should limit those carbs. Different people react to these plans differently, and not everyone can handle restricting such a core part of the diet. It's up to you and your doctor or nutritionist.

What I would urge is that you do some reading. Not just the books by folks like Dr. Bernstein or science journalist Gary Taubes (both of whom advocate very low-carb diets), but also books and websites from those touting more moderate approaches (like the South Beach or Mediterranean diets). Or books on the Glycemic Index.

You already plan your meals to one extent or another. It only makes sense that you pick an approach that feels right to you.

Take responsibility.

I don't want to write this, and you don't want to hear it. But it's the most important point I can make, and it's the one that any person with diabetes must take to heart.

This is your job. This is your life.

Minnesota's Mayo Clinic puts this item on top of its list of "10 ways to prevent diabetes complications." You have to take responsibility, the clinic says, and you have to make the long-term commitment that such responsibility requires.

Ultimately, you can blame no one else for your health or your decisions. Diabetes is a disease that depends on the choices that we make, day in and day out. The decisions often seem small and unimportant. But over time, they accumulate and mark the progress of the disease.

Do we stay healthy, monitoring our blood sugars and food intake, consulting with our healthcare professionals? Or do we let these healthy behaviors slide, with the understanding that we'll always have time to fix it later?

We don't have time. We have to address our health now.

That doesn't mean we panic, and it doesn't mean that we can't ever have a chocolate bar again. But it does mean that we must take real responsibility for ourselves.

Ultimately, if you take responsibility for your disease, the other seven tips here should follow naturally. They're all about taking a commonsense approach to a challenging situation and improving it bit by bit and day by day.

You won't be perfect. But you don't have to be. You just have to be better than you were yesterday.

*These tips are not intended to replace your healthcare's professional advice. Ask them for their opinion, prior to making any changes to your current therapy.