Realistic Goal-Setting and Avoiding Stigma: One Mom’s Perspective

This content originally appeared on Beyond Type 1. Republished with permission.

By Bonnie O’Neil

The title of the article arrests my attention, compelling me to read further. The Numbers of Shame and Blame: How Stigma Affects Patients and Diabetes Management. I shudder as I read the results of a study by the diaTribe Foundation. “Diabetes stigma affects 76% of people living with type 1 diabetes (T1D) and 83% of parents raising a child with T1D.” The statistics are so high.

Stigma. The word itself sounds uncomfortable on my lips. Diabetes stigma means carrying a sense of disgrace or shame because of having T1D, an unpreventable auto-immune disease.

I continue reading. “The majority of respondents who believe T1D is associated with social stigma identified the top three drivers of diabetes stigma — a perception of failure of personal responsibility, a perception of being a burden on society, and a perception of having a character flaw.”

I cringe as I read these findings. Does my son feel like he’s a failure when his blood sugars don’t cooperate and do what he wants them to do? Maybe he does. I know as his parent and caregiver I feel like a failure when his A1c isn’t what I had hoped it would be. Does he feel like he’s a burden on society? On his school? On his family? Oh, I hope not. I can hardly even reread that last driver of stigma on the list. Does he feel like he has a character flaw simply because he has T1D? My heart rises up to my throat.

How can I help my son navigate living with T1D in such a way that he doesn’t fall prey to the shame and failure associated with disease stigma? Rereading the statistics, I pause and ask myself another question. How do I as his parent carry disease stigma? The survey tells me 83 percent of us parents raising a child with T1D are affected by it. Am I a part of that 83 percent? When his physician suggests we make some changes to achieve better outcomes, do my reactions model for my son my own feelings of failure, guilt, or shame?

Whether overtly stated or simply implied, we all have goals in mind for our child’s T1D management. While I never announced my goals as clearly as I would my New Year’s resolutions, my son and I both knew what they were.

  • A1c at 7.0 or below
  • Blood sugars between 80-150
  • Not too many juice boxes in a day

Setting goals is important; it’s what keeps us moving forward as humans. During certain times of the year we’re especially focused on goal setting. Whether it’s January’s hopes for the new year, September’s back-to-school focus, or our birth month marking one more circuit around the sun, we can’t escape the human drive to set goals.

But in our best efforts to keep our child healthy and safe, how can we set reasonable goals that serve more as guard rails than leave us feeling stigmatized if the goals are left unmet?

Set Realistic Goals

It’s easy to slip from the hope and optimism of setting a new goal to feeling shame if those goals aren’t attained. Start small when setting new goals. Remember your child lives with this disease 24/7. Your eagerness to try a new approach to glucose management might feel like the addition of one more heavy weight placed on top of what your child is already carrying. Check in with your child. How does he feel about your goals? There’s a fine line between maintaining glucose control and contributing to diabetes burnout.

Hold Your Goals Loosely

Beware of the trap of stigma when we don’t hit our goals. Commit to living in the no-shame zone. The statistics reveal that 83% of parents raising a child with T1D struggle with stigma, meaning we parents struggle more with shame than even our children with T1D do. The next time you find yourself stressing over an unmet goal you have for your child’s care, recognize that the 83% is you. And it’s me. Let’s break the power of stigma in our own lives so we don’t model it and pass it along to our children. Offer grace to yourself and your child if the goals go out the window for a period of time. You can always get back on track once this season is over, so don’t buy into the failure narrative. Be good to yourself and to your child.

Be Aware of What You Reward

When my son was young, I would often take him to buy a small toy or gift after his appointments with his endocrinologist. It was a few years before I realized that I only bought him a treat when his A1c was at a level that met or surpassed the goal I had in mind. What message was I sending to my son? That I only reward what makes me proud? That my pride in him was linked to his A1c? Even well-intentioned gestures can leave our children feeling shame when they don’t reach our goals. Instead of rewarding only those times when the numbers match our goals, why not celebrate our child’s hard work and the joy of sharing life together after every appointment?

Watch Your Words

Goals like “Let’s do better with blood sugar control next year” imply a judgment that the past year was less than stellar. Your child (or you) may receive this message as a judgment that they (or you) were less than stellar last year. Words like better, good, and bad, which we use all too frequently when talking about blood sugars, are qualitative and can leave our child feeling stigmatized. Blood sugars and A1c’s are just numbers that provide us valuable information from which to make future decisions. Being careful with our language can help protect our child from carrying a sense of stigma.

Remember above all, our goal isn’t really about reaching blood sugar goals. Our goal is to build a healthy lifelong relationship with our child based on respect, encouragement, and love.

Source: diabetesdaily.com

The Importance of Sleep Health for Diabetes

Everyone who lives with diabetes knows that the cornerstones of successful management include insulin therapy, strict monitoring of one’s diet, exercise, and managing stress. But another, lesser-known key element to good diabetes management is sleep health.

According to the Centers for Disease Control and Prevention (CDC), nearly 1 in 3 Americans don’t get enough sleep. The National Sleep Foundation recommends that adults between 18 and 60 sleep at least 7 hours every night. Sleeping less than that is associated with an increased risk of developing chronic conditions such as obesity, type 2 diabetes, hypertension, heart disease, and even stroke.

Sleep health is especially important for people with diabetes. This article will outline the reasons why sleep health is so important and how you can improve your sleep health to improve your diabetes management.

Why Is Sleep Important?

Sleep is important for everyone. Sleep plays an important role not only in physical health but in mental health maintenance as well. During sleep, the body heals and repairs cells damaged during the day (like muscles worked and stretched during exercise), and even restores and clears out both heart and blood vessels, reducing inflammation throughout the body.

Sleep brings much-needed balance back to hormone levels, such as cortisol, serotonin, leptin, ghrelin, melatonin, and adrenaline, working to restore mental and emotional health. Restoration of these key hormones helps the body control stress, combat depression, achieve satiety, and manage hunger levels throughout the day.

Most importantly, sleep helps protect immune function. One study monitored the development of the common cold after giving people nasal drops with the virus to a group of people. The researchers discovered that those who sleep fewer than 7 hours for two weeks were nearly 3 times more likely to develop a cold than those in the study who slept 8 or more hours each night for the duration of the study.

Americans Are Not Getting Enough Sleep

This is all great, except Americans are simply not getting enough sleep. City-dwellers are more likely than those living in rural areas to suffer from sleep deprivation, and the CDC shows that the northeastern and Appalachian mountain parts of the country are the most affected. Nearly 11 percent of Americans are only getting 6 or fewer hours of sleep per night!

There are many reasons why people aren’t getting enough sleep: 24/7 technology, ever-increasing workloads, light and noise pollution in cities, the but most stunning reason, from the National Sleep Foundation, is that Americans simply don’t prioritize sleep.

In a survey, when Americans were asked which of five activities were most important to them, just 10% of people said sleep, the lowest by far out of exercise, nutrition, work, and other hobbies.

As a nation we are not getting enough sleep,” said Dr. Wayne Giles, director of CDC’s Division of Population Health. “Lifestyle changes such as going to bed at the same time each night; rising at the same time each morning; and turning off or removing televisions, computers, mobile devices from the bedroom, can help people get the healthy sleep they need.”

People With Diabetes Need to Prioritize Sleep!

Even though sleep is often disrupted because of diabetes due to CGM alarms, insulin pumps beeping, low and high blood sugars, and the 24/7 nature of the disease, sleep is crucial for good diabetes management.

“Getting inadequate amounts of sleep can negatively impact blood sugar levels short and long term,” says Dr. Gregg Faiman, an endocrinologist at University Hospitals Cleveland Medical Center. “In fact, sleep is as essential to your health as nutrition and exercise,” he says.

Not having enough of it can cause insulin resistance and insatiable hunger due to out of balance hormones, fatigue that makes exercising more difficult, and brain fog that makes carbohydrate counting and the self-control to properly manage food and diet harder.

Sleep affects all other elements of diabetes management: when you don’t have enough sleep, you need more insulin (due to insulin resistance from spiked cortisol levels) to control blood sugars, your body is hungrier when your hormonal leptin levels are off balance, which makes eating and balancing carbohydrates more complex, you’re more tired which makes exercise all the more difficult, and your body is naturally stressed out, wreaking havoc on diabetes management.

Plus, if you nap during the day to try and make up for a bad night’s rest, you may not be tired at bedtime, and one sleepless night can lead to two, which can then turn into a chronic problem, which sets the stage for harder to control blood sugars, higher HbA1c, and possibly even complications later on in life.

how to get enough sleep

Photo credit: iStock

Strategies to Improve Sleep Health

Creating good sleep habits can take time, but the following recommendations can help you improve your sleep, which will positively affect not only your diabetes management but your overall health as well:

  • Exercise daily so you are tired at bedtime
  • Avoid all caffeine after 12 p.m.
  • Go to sleep and wake up at the same time every day
  • Do not nap during the day
  • Use the bathroom right before bed, so you don’t wake up in the middle of the night to go
  • Limit fluids before bed
  • Make sure your blood sugar isn’t too high or low at bedtime
  • Turn your thermostat down at bedtime for more peaceful sleep
  • Take a relaxing bath before bed
  • Eat foods that contain natural melatonin at night: cherries, pomegranate, grapes, walnuts, peanuts, or sunflower seeds work well
  • Do some gentle yoga, meditation, or breathing exercises to calm you down before bed
  • Do not allow screens in the bedroom; opt for journaling or reading in bed instead (except, of course, your continuous glucose monitor and insulin pump)
  • Close all curtains and make your room as dark as possible
  • Keep pets outside of the bedroom, and especially off the bed (except diabetes alert dogs, of course).

Managing sleep can be complex and challenging, but making sure to get at least 7 hours of quality sleep per night will make diabetes management easier and better blood sugars more achievable.

Try out these tactics for several weeks, and see if any make a meaningful difference in the amount of quality sleep you’re getting each night, and if it has any positive effects on blood sugar levels the next day.

While an underrated component of diabetes health, sleep is crucial for better blood sugar management, one night at a time. Do you struggle with getting an adequate amount of quality sleep each night? What tactics have helped you improve your sleep health? Share this post and comment below!

Source: diabetesdaily.com

Diabetes is Ruff: Diving into the World of Diabetes Service Dogs

This content originally appeared on diaTribe. Republished with permission.

By Julia Kenney

When you think of tools to help you manage diabetes, you likely think of therapies and devices – but what about dogs? We spoke with Mark Ruefenacht, who trained the first diabetes service dog in the world, to learn how these special animals can support people with diabetes.

There are many reasons to love dogs. Because they are cute, because they are smart, because they are the furry best friends you didn’t know you needed, and they love you unconditionally. But did you know that some dogs can also save your life and help you manage diabetes? Just one more thing to add to the list.

In diabetes, severe cases of high or low blood sugar (hyperglycemia and hypoglycemia, respectively) are dangerous and can lead to serious long and short-term health complications. Diabetes service dogs are trained to help, specifically when the owner’s blood sugar is too low or too high.

There are two kinds of diabetes service dogs, Medical Response Dogs and Diabetic Alert Dogs. Medical Response Dogs are trained to respond to the symptoms of severe low blood sugar such as fatigue, loss of consciousness, and seizure-like behavior to help notify you and others of hypoglycemic events. Medical Response Dogs can also retrieve “low” supplies such as food, drinks, or an emergency kit. Diabetic Alert Dogs, also referred to as DADs, are trained to smell the compounds that are released from someone’s body when blood sugar is high or low. Because of this, Diabetic Alert Dogs are able to alert their owners of dangerous levels of blood sugar before they become symptomatic. A variety of breeds can be trained to be diabetes service dogs, including golden retrievers, Labrador retrievers, mixed-sporting breeds, and poodles.

Dog

Image source: diaTribe

Nobody knows more about these dogs than Mark Ruefenacht, founder of Dogs4Diabetics (D4D), one of the leading diabetes service dog training organizations in the world. Ruefenacht  has lived with diabetes for over 30 years and got involved with service dogs for the blind due to his family history of diabetes-related eye disease (retinopathy). After an incident of severe hypoglycemia, Ruefenacht started training Armstrong, the world’s first diabetes service dog, to recognize and respond to the scent of hypoglycemia in his sweat and breath. Through training and testing, Ruefenacht found that there might be a scent associated with hypoglycemia that is common among people with diabetes and could be taught to other dogs. Since then, he has helped train hundreds more dogs with D4D. In our interview, Ruefanacht shared his insights on the benefits of Diabetic Alert Dogs and how to know if they are right for you.

How are Diabetic Alert Dogs trained? Who are they trained for?

Diabetic Alert Dogs are typically trained for people with type 1 diabetes or insulin-dependent type 2 diabetes. This is for two reasons. As Ruefenacht describes, people with type 2 diabetes who are not dependent on insulin typically do not have life-threatening low blood sugars. Because of this, Diabetic Alert Dogs are most helpful for people who are insulin-dependent. Furthermore, under the Americans with Disabilities Act, service dogs can only be given to people with a recognized disability, which could cause barriers to getting a service dog, especially for people with type 2 diabetes who are not insulin dependent. There are additional requirements and limitations for public service dogs under the Americans with Disabilities Act, so diabetes service dog organizations also train dogs in various support skills to help people with diabetes at home (and not in public). Dogs4Diabetics refers to these dogs as “Diabetes Buddy Dogs.” If you are wondering whether you could qualify for a service dog, talk to a service dog organization.

As for the training these dogs receive, the programs typically focus on scent discrimination. This means that the dogs are taught to detect smells in the air associated with blood sugar changes and to ignore smells associated with normal, safe bodily functions. Ruefenacht said, “The big myth is that dogs are smelling blood sugar. But the dogs are actually sensing the compounds that come out of the liver when the blood sugar is either dropping rapidly or is low.” Though humans can’t detect these smells, dogs likely can. Scientists are not sure what exactly the dogs identify, but research suggests that it’s ketones (for high blood sugar) and may be a natural chemical called isoprene (for low blood sugar). Ruefenacht uses low and high blood sugar breath samples to train the dogs; after about six months of intensive training, they can distinguish these scents in people.

Can diabetes service dogs reliably alert their owners to changes in glucose levels? It depends on the dog and it’s training – but research shows that diabetes service dogs can often be effective, and that quality of life and diabetes management tends to improve in owners. According to Kim Denton, who works for Dogs4Diabetics and has had type 1 diabetes with hypoglycemia unawareness for over 40 years, having a Diabetic Alert Dog “changed my life for the better by helping me keep my blood glucose in a much tighter range, which means fewer health complications and I feel much better both physically and mentally.”

How can diabetes service dogs help their owners?

Dog

Image source: diaTribe

Denton says that her dog, Troy, “has saved my life so many times by alerting me before my glucose dropped to a life-threatening level, that I can’t keep track anymore. Troy tells me long before my CGM detects a rapid drop or rise in my glucose levels, and he does it without that annoying beeping! If my sugar starts dropping while I am sleeping, Troy jumps on me to wake me up and will continue licking my face if I start to fade off.” In addition to alerting owners to early changes in blood sugar so that they can act to stabilize glucose levels, there are other skills that diabetes service dogs can learn. Here are some examples, though every organization has different training programs:

  • Alert the owner to audio signals from insulin pumps, continuous glucose monitors (CGM), and other devices. This is especially helpful for people with impaired hearing, for children, and for diabetes management while sleeping.
  • Alert people nearby to help the owner in cases of severe blood sugar changes, or retrieve a cell phone.
  • Retrieve medications and other necessary supplies in an emergency.
  • Provide emotional support.

It is important to know that diabetes service dogs are an additive tool to help people manage their diabetes. A service dog should never replace CGM, self-monitoring blood glucose with fingersticks, hypoglycemia prevention methods, or healthy lifestyle efforts; a diabetes service dog can be an additional form of support for people with diabetes.

How do service dogs provide emotional support? Why is this important?

The majority of diabetes service dogs are also trained with emotional support and wellness skills. This means that in addition to helping people manage their blood sugar, these dogs can also help improve their owner’s mental and emotional wellbeing. This is especially important for people with diabetes because of the stress that often comes with long-term management of a chronic condition – learn about diabetes distress and how to reduce it here. People with diabetes are also two to three times more likely to experience symptoms of depression than the general population, according to the CDC.

Ruefenacht is keenly aware of the relationship between diabetes and mental health, and he has worked to address this through his diabetes service dog training programs. Ruefenacht says his clients appreciate the diabetes management component of the service dog training, “but they value the companionship and emotional support more.” Like most other dogs, diabetes service dogs are companions and become part of the owner’s family. Many owners appreciate the stress-relieving experience of walking, playing, or just being with a dog, which can be incredibly helpful for people with diabetes. Denton says “Troy understands not only my need to have normal glucose levels but also my need for comfort and companionship when my diabetes gets me down.” Dogs can also be trained to cater to specific mental health conditions such as depression and anxiety.

Could a diabetes service dog be right for me? 

Dog

Image source: diaTribe

Diabetes service dogs are a great option for some people, but not for everyone. There are several ways that people can get support in managing their diabetes, and it is important to think about what works best for you – for example, Diabetic Alert Dogs are trained to sense blood sugar changes in their owners, but for many, this can be accomplished using a CGM. Diabetes service dogs can be a helpful option for people who frequently experience episodes of hypoglycemia, experience hypoglycemia unawareness, need help regulating their blood sugar at night, or need additional support. According to Taylor Johnson, who has type 1 diabetes and a Diabetic Alert Dog named Claire, “Having a service dog is the best decision I’ve ever made regarding my diabetes management. I love gadgets and tech but they are not foolproof, and Claire is the additional piece of mind I need to sleep at night.” Talk with your healthcare professional to assess your need for a diabetes service dog if it is something that you are considering – and remember, a diabetes service dog will not replace the need for careful glucose monitoring and hypoglycemia prevention efforts.

There are a few more important things to think about:

  • Cost: The process of getting and training diabetes service dogs and their owners can be expensive. There are some organizations that provide training services for free or for a reduced cost for those who qualify. Other organizations offer financial assistance or payment plans for those who qualify. For example, as a 501(c)(3) nonprofit that relies on charitable donations, D4D does not charge its clients for the dogs or other program services which significantly reduces the costs of owning a diabetes service dog.
  • Time: Owners also need to put a significant amount of time into training and maintaining the skills of their diabetes service dog outside of the formal training the dogs receive. This includes participation in some of the initial training of the dog, giving the dog time to acclimate to your specific needs as a person with diabetes, and follow-up training throughout the dog’s lifetime.

Want to learn more about diabetes service dogs?

  • Check out some different diabetes service dog organizations to get a sense of the application process, service dog training programs, and service dog community

Source: diabetesdaily.com

Diabetes Complications: How They Affected My Body

I have a list of excuses as to why my diabetes was never really properly controlled. At 24 years old, I was diagnosed, but I was treated as a type 2. My doctor based it on my age. For 2 years that I was treated as a type 2, my sugars were never coming down, and my doctor kept upping my dosages until I was taking over 20 pills a day. I had tried a couple of different doctors through my insurance, but with no result. Finally, I went to see a highly rated endocrinologist, whom I had to pay out of pocket. At 26, I didn’t exactly have the funds to do so. I was properly diagnosed by this doctor, but unfortunately, couldn’t keep seeing him at such a high cost.

Recently, through type 1 (T1) meetup groups and social media, I see many young women, men too, who’ve been diagnosed in their twenties. There really isn’t any time in someone’s life that’s a great time to be diagnosed, but for me, and I’m assuming many others, your twenties can be difficult for so many reasons. You’re suddenly on your own health insurance. Your parents are no longer in control of it, and I’m sure, like me, you don’t want them to be! In your twenties, you’re invincible! Your life is yours, your decisions are yours, you feel like everything is yours.

Suddenly the doctors are telling you, “You can’t do this, you can’t have that,” and that diabetes will affect other aspects of your life, your health. But I wasn’t told specifically, all the things. For me, it started to feel like the doctors were in some conspiracy to take all (and more) of the money I made. I couldn’t afford diabetes.

Go to the dentist for a cleaning, I’m told I should be going every 3 months. I didn’t have dental insurance, and I always had great teeth. Never had a cavity, why do I need to worry now?

Quickly I became frustrated. Another endo, who had come highly recommended, did accept my insurance, so I vowed to take better care of myself. And then he started selling me bars and shakes, thought I needed to lose weight (I weighed 138 lbs., I’m 5’7” – not exactly overweight). I tried for a while but realized it was a lifestyle I could never keep up with, and he obviously had ulterior motives.

I felt that if the people who were “supposed” to be helping and supporting me didn’t care, why should I? Well now I wish I did, I wish I had understood all of the “little” complications, some of which are discussed, and some that aren’t as much.

I see young women on social media, who have changed their ways (and I applaud them), but I know there are many who suffer from diabulimia. You’re young, you’ve lost all this weight, you suddenly can wear anything you want, it seems like there’s at least one benefit of this illness. And there are those who have fallen into a depression, have lost hope, and just don’t care for themselves properly.

My sugars were always a little high, but I never (knowingly) missed a shot. My A1c typically ran in the 9% range. Definitely not near where it should be, but I see people who’ve run 13-14%, just to remain slim.

Gums and Teeth

First, it started with my gums. While I was still in my twenties,  I sliced them, just on a potato chip. Crazy! Usually, if that happened, it would heal, almost immediately. Not this time. This time, I got an infection. Gum disease isn’t pretty, especially when your mouth is constantly infected. Infections can raise glucose levels, and raised glucose levels can exacerbate infections. Round and round it goes. And this doesn’t happen overnight.

Nothing really ever went wrong until I hit 40. Even though through my thirties, I had surgeries and saw a periodontist every three months; eventually my gums just weren’t strong enough to keep my teeth in place. But at 20-something, who thinks they’re going to lose their teeth? I was someone who was always known for smiling. I have one of the biggest, cheesiest grins. But suddenly, I lost it, five teeth, and a lot of bone to go with it. Dental implants? Well, aside from being expensive, I need sinus lifts just to ensure the implants take hold.

Frozen Shoulder

What almost seemed out of the blue, I suddenly could not move my shoulder. It didn’t happen overnight, so at first, I thought maybe I was just sleeping funny. But then, I couldn’t raise my arm, even a little. Of course, it was my left shoulder, as I’m left hand dominant (Murphy’s law, right?). I hadn’t heard of this, but it was debilitating. When you can’t move your shoulder, raise your arm – showering, getting dressed, every basic thing becomes nearly impossible to do. I went for an MRI, physical therapy…and this went on for months. It finally subsided, but for months, I couldn’t get dressed, or undressed, without help. For someone who has always been active, lifted weights, this was frustrating, depressing, completely debilitating.

Diabetic Gastroparesis

My sugars definitely got a little out of control when I took a second job. I was working constantly, my part-time job was at a catering hall, so getting fed properly, and at proper times, became nearly impossible. Checking my sugar? Well, that was out the window too. That’s on me for taking that job, but when you need money, you do what you have to. Until you can’t. I’d be feeling fine, I’d finally eat, and almost immediately, I was nauseous, vomiting, feeling like I was going to die. At first, I just assumed I had a stomach flu. Nothing can really be done, you just have to let those run their course. But then, it was happening every week, two times, then three, until I was driving home from work, less than a 15-minute commute, and I couldn’t even pull my car over, I was just opening my car door and vomiting right out the door, several times.

I couldn’t get an appointment with the doctor, so I was told I could see a nurse. As soon as she took my vitals, she told me I needed to see the doctor, and she immediately set me up for an EKG. Fortunately, my heart is fine. But I do suffer from diabetic gastroparesis. Now that I’m aware, I can properly handle, and though every now and again I have a bout with it, overall, it’s basically under control.

Diabetic Mastopathy

I’m 43 years old, and I finally went for my first mammogram. Yes, I’ve been putting it off, because I’ve been in fear of finding something else wrong with me. I loved my teeth, I’ve lost them. I loved my hair, lost a lot around the time I was diagnosed, and though it did get better, it never was the same. I’ve dealt. But I’ve always felt that whatever else could happen to me, I would never let anyone cut into my breast(s), so the less I knew… I know, irresponsible, and ignorant.

Well, I finally went, and just to my luck, they found a lump. I had to be scheduled for a biopsy right away. To say this was nerve-wracking (even though I know women go through this every day, I’m sure they’re not calm about it either), was an understatement. (The stress also seemed to elevate my blood sugars like I’ve never known) I went for my biopsy, and metal markers were inserted, should I need surgery. I waited, very impatiently, for my results. Fortunately, my doctor called me immediately following the weekend (I went on a Thursday).

Now funny, you would think the doctor would know my medical history, but he didn’t! Thankfully, first, he did say it was benign. I can’t tell you what relief I felt, but then he followed with, “Are you an insulin-dependent diabetic?” What? What does that have to do with anything? Well, apparently, diabetic mastopathy happens to more of than not type 1s, but even types 2s, who are insulin-dependent, and whose glucose levels run higher.

Fortunately, this is not life-threatening. None of what I’ve gone through has been. But I promise you, I would’ve preferred to not have had to endure any of it. Managing diabetes alone can be difficult. There’s no need to add anxiety, fear, cost, insecurity, to an already consuming illness. What I wouldn’t give to have my teeth, the hours spent clinging to the toilet or garbage can, thinking I might die, or the lost months of movement in my shoulder/arm back. I would’ve preferred to never have dealt with the anxiety of knowing metal clips were being inserted. Granted, anything in life can happen to us, whether or not we’re diabetic. People lose teeth, suffer from gastroparesis, lose mobility, or get biopsies, who aren’t diabetic. But if we can help to not exacerbate or trigger the situation by managing our blood sugar levels properly, why wouldn’t we? No matter how skinny you might feel you need to be, if you have no teeth to show your smile, no mobility in your shoulder, how good can you really feel about yourself? At 43, my will to be healthy, to live healthy, is stronger than it ever was.

Source: diabetesdaily.com

Could Your Stress Actually Be Diabetes Distress?

This content originally appeared on diaTribe. Republished with permission.

By Kamren Khan

We are reminded during National Diabetes Awareness Month of the many daily challenges that are a part of living with diabetes – especially during COVID-19 and the holidays. If you are feeling overwhelmed it could be diabetes distress. Learn how to identify signs of diabetes distress, and what you can do to find support and manage negative emotions

Have you ever felt frustrated, angry, or stressed while managing your diabetes? You’re not alone – many people have a hard time coping with the emotional demands of diabetes management. In fact, the term “diabetes distress” is used to describe the experience of negative emotions that come from the challenges of living with diabetes.

If this resonates with you, you should know that diabetes distress is quite common. In fact, Diabetes UK reports that one in four people with type 1 diabetes and one in five people with type 2 diabetes experience high levels of diabetes distress. Data from the CDC indicates that rates of diabetes distress may be even higher, reporting that one in three people with type 2 diabetes may experience it. Moreover, researchers predict that rates may be further elevated due to the effects of COVID-19, including social isolation, increased general anxiety and depression, and disruption of normal routines. See here for diaTribe’s list of mental health resources during COVID-19.

Dr. Korey Hood presented “Diabetes Distress & Coping in the Time of COVID-19” as part of Stanford’s Project ECHO Diabetes series. He explained that many people worry extensively about future diabetes complications, which can prompt increased levels of distress. Other common stressors for people with diabetes include: concerns about glucose levels, insulin doses, device functionality, the ways diabetes interferes with daily life, feelings of social embarrassment or dependence, or fear of needles.

What are some signs of diabetes distress?

The symptoms of diabetes distress vary widely. Many people feel overwhelmed and frustrated with the day-to-day demands of managing their diabetes. Additionally, diabetes distress can be represented by feelings of isolation, exhaustion, or the lack of motivation to keep up with a diabetes management routine.

The Diabetes Distress Scale (DDS) is a seventeen-question survey used to screen for diabetes distress. It can be completed in just a few minutes and yields instant results. Some diabetes clinicians suggest using the DDS regularly to gauge a person’s emotional and mental well-being. If you think that you might be experiencing diabetes distress – or have never been given the DDS – ask your healthcare professional if you can take it.

How is diabetes distress different from depression?

Depression is also prevalent in diabetes: people with diabetes are two to three times as likely to have depression than people without diabetes. However, there are important distinctions between depression and diabetes distress: depression is considered a mental health disorder, while diabetes distress is seen as an emotional reaction to managing diabetes stressors. Although diabetes distress and depression share some symptoms, they have distinct diagnostic criteria and require different methods of treatment.

According to the DSM-5, people with a minimum of five of the following symptoms for at least two weeks fit the diagnosis of depression:

  • Decreased interest or pleasure in daily activities
  • Significant weight loss or highly volatile appetite
  • Depressed mood lasting most of the day
  • Decreased feelings of self-worth or inappropriate guilt
  • Decreased focus or concentration
  • Repeated suicidal ideation
  • Fatigue or low energy
  • Observable decrease in physical movement

Diabetes distress is more common than clinically diagnosed depression in people with diabetes, though many people with depression may not be diagnosed.

How can diabetes distress affect your diabetes?

The relationship between depression or diabetes distress and diabetes is a vicious circle.  Depression and diabetes distress can make managing diabetes harder, and diabetes management can intensify feelings of depression or diabetes distress. Further, levels of diabetes distress and A1C are related; people experiencing high levels of diabetes distress are more likely to have a higher A1C.

How can you manage diabetes distress?

If you feel that you are experiencing any form of diabetes distress, it is important that you reach out to your diabetes educator or healthcare professional so they can evaluate your symptoms and establish a care plan. Here are some coping strategies you can try:

  • Seek support from friends or family and let them know how you’re feeling
  • Consider talking to a mental health professional
  • Get involved with a diabetes support group
  • Change up your routine
  • Try using new diabetes technology – like a continuous glucose monitor or automated insulin delivery system – that can reduce or simplify some of the day-to-day diabetes tasks. Check your health insurance to see if it will cover a new diabetes device.
  • Set realistic goals and don’t expect to be perfect
  • Get involved in advocacy or service projects – this can be more difficult during the current COVID-19 pandemic; make sure you are staying safe and finding ways to volunteer virtually

What resources are available?

Source: diabetesdaily.com

How to Get Through to Your Teen With Diabetes

If you’re raising a pre-teen or adolescent living with diabetes, you know that sometimes conveying the seriousness of the disease can be a difficult challenge. What oftentimes is easier and convenient now, such as grabbing fast food on the go, or neglecting to adequately count carbohydrates, take insulin or even test for days on end can contribute to serious complications later on in life. It can be extremely difficult to get through to your teen but making sure they know the seriousness of a life with diabetes is paramount. So, how do you communicate with a teenager when diabetes is the last thing they want to deal with? Does “tough love” work on teens?

Feeling Invincible

One’s adolescent years are an incredible time of drastic and fast change. Not only are teenagers growing rapidly physically and emotionally, but they’re also dealing with the drama of school and friends, and the challenges that managing a chronic condition brings. Teenagers and young adults often tend to feel quite invincible, even earning the nickname “young invincibles” for their seeming unwillingness to buy affordable health care plans or take reasonable preventive actions to take care of themselves and their bodies. More often than not, when teenagers neglect their diabetes management, it’s a sign of feeling quite burnt out.

Do Scare Tactics Work?

Can scare tactics help your teenager take their diabetes more seriously? When communication is difficult, it can seem almost impossible to prioritize diabetes management. Sometimes a teenager just doesn’t want to hear it, and in the worst of cases, giving your teenager scare tactics in the form of storytelling worst-case scenarios, playing the game of “what if” with complications, and threatening them can backfire, resulting in dangerous management patterns, disordered eating, or can even cause them to completely shut down all communication.

Lynn, from Pennsylvania, says,

“Scare tactics don’t work with me, and no one I know has used them. The best support I’ve gotten is when my loved ones decided to eat keto. We plan low-carb meals and look for new recipes together. If [my family] was eating tons of carbs, it would make it harder for me to stay low-carb. Otherwise, we don’t really talk much about my diabetes…my family does sometimes ask about my blood sugar after trying a new dish to see if it ‘worked’ for me.”

Cora adds,

“As young people, people with type 1 diabetes take criticism and scare tactics to heart. It’s basically verbal abuse because we don’t hear the practicalities behind what the parent is saying. Young people hear strongly worded comments about efforts to control our diabetes, and we take it personally. Except it comes through as ‘you’re bad’, ‘you’re lazy’, or ‘you’re incompetent’.”

Alienating your teenager with scare tactics is harmful, and you most likely will not get your desired result (more attention paid to their diabetes). There are healthier ways to help a person with diabetes in your life.

Photo credit: Adobe Stock

Honesty Doesn’t Have to Be Scary

It’s important to not scare your teenager with threats of complications, or a dark and scary future that may not come to fruition. Instead, model good behavior and have the whole family adopt practices that encourage a healthy lifestyle.

Meryl says,

“The best thing I have found to do is offer foods that he likes and can eat and not to nag.”

The good news that is well-adjusted teenagers eventually will take over the management of their diabetes, and thanks to technology, will begin to thrive. The power struggle and shirking of responsibility that comes with adolescence will end. In the meantime, here are some strategies to help you and your teenager thrive through this period of transition.

  1. Be there to listen. The power struggle between a teenager with diabetes and their parents comes down to them wanting to feel more independent, and the parents ultimately having to give up some (or all!) control of diabetes management and rigorous expectations. Make sure you’re there to talk with your teen, but more importantly, to listen to their wants and needs. If they want autonomy and space, be there to give it, but also hold them accountable (by showing you their glucometer memory, pump data, or meals and carbohydrate counts), to eventually earn more freedom. This way, you can problem-solve and strategize around emerging issues together. Additionally, here are some things not to say to someone with diabetes. 
  2. Find a great endocrinologist. Find a doctor that your teenager will work well with, and remember that communication is key. Finding the right dietitian, social worker, nurse, and primary care physician is also critical during this vulnerable time in a teenager’s life. Make sure your teenager feels comfortable talking with their doctors, sharing their concerns, and standing up for themselves during visits. This will be crucial for good diabetes management as they take on more of the responsibility of their care moving forward.
  3. Expose them to other teens with diabetes. Sign your teenager up for a diabetes camp, or a local support group for teenagers dealing with diabetes. Make sure they know that they are not alone, and find ample opportunities for them to meet other kids their age who are struggling with the same issues that they are. Usually, once a kid or teenager makes a “dia-bestie” their diabetes management improves, because now the thing that used to single them out suddenly makes them part of the cool crowd, like having the newest Patch Peelz or insulin pump.
  4. Try a tech break. If your teenager is struggling with constant insulin pump and continuous glucose monitor (CGM) changes all the time and is feeling like a cyborg, let them take a technology break. Sometimes a change in routine helps everyone suffering from diabetes burnout, and it can help bring a fresh perspective of and appreciation for the technology when you bring it back.
  5. Seek individual or family counseling. Sometimes a child loses interest in their diabetes management due to depression, which is more common among people with diabetes. Teenagers who have depression may not always exhibit the classic symptoms of depression such as crying, sudden anger, and changes in sleep and eating patterns. Regardless, a teen who stops taking an interest in their diabetes management is sending a clear message and call for help. This is an excellent time to find a great therapist who can help your teenager work through their issues.

Peter from New Jersey adds,

“From my experience, the key is to bring them to these realizations gradually, at a pace they can handle. That pace is very individual, and parents, and sometimes even doctors need to work on understanding that pace. In the meantime, just support them and make sure they don’t make any huge mistakes.”

These strategies can help you and your teenager thrive during this turbulent time in their lives, by prioritizing compassion, openness, and love. Also, be sure to check out recent research from the American Diabetes Association (ADA) about what works when it comes to transitioning to self-management.

What have you found to be the most helpful strategies in helping your teens thrive with diabetes? Please share your thoughts and experiences in the comments below.

Source: diabetesdaily.com

The Mental Impact of COVID-19 on Children with Diabetes

The negative mental impact of a pandemic like COVID-19 is well-known and documented. According to the U.S. Census Bureau, now 1 in 3 Americans is showing signs of clinical depression and anxiety. Coping with this (hopefully) once-in-a-lifetime event is something that a human brain has a hard time assimilating to: extreme and extended social distancing can make one feel anxious and isolated, constant vigilance to adhere to hand washing and mask wearing protocols and the 24/7 news media can increase one’s stress and anxiety levels, financial insecurity from the widespread economic fallout from the pandemic, fear of getting sick, and the unprecedented levels of community spread of the disease are just some of the reasons why people may feel anxious and depressed. Americans have been hard hit: with just 4% of the world’s population, we have 25% of the world’s COVID-19 cases, and researchers, doctors, and scientists alike are fearful of a “twindemic” where flu season and a second wave of COVID-19 cases will coincide over winter, once most outdoor activities become infeasible when the temperature drops across the country.

Children, and especially children with chronic conditions like diabetes that put them at higher risk for more severe reactions to the virus, are especially susceptible to the mental health impacts of the pandemic. A recent study from the American Journal of Pediatrics of over 1,000 U.S. parents in early June showed that 27% said their mental health had worsened since March, and 14% said their children’s behavior problems had gotten worse. Families with younger children reported worse mental outcomes than those with older children. About 10% of all families said their children’s mental and behavioral health worsened.

Vanderbilt University researchers said that disrupted routines are hard on young children, and in the study, 48% of families reported losing their normal childcare. Abnormal school routines can also be hard on children.

“In some communities, school will be remote, and schools should consider working with pediatricians and mental health professionals on how they may address the mental health of children, parents and staff even when school is remote,” the researchers wrote. “To implement these strategies effectively, Congress could consider enhanced funding to schools to address schools’ budgetary challenges related to implementing these recommendations.”

In another study out of China, published in JAMA Pediatrics, researchers in Hubei province,  examined a sample group of 2,330 school-aged children for signs of emotional disturbances. The children had been on lockdown for an average of 33.7 days. Even after one month, 22.6% of children reported depressive symptoms and 18.9% were experiencing anxiety.

These problems are exacerbated in children with diabetes for a few reasons. First, since most children are spared the brunt of the disease, many children without chronic conditions are starting to socialize again, with many schools across the country going back to in-person classes, sometimes with the option for remote learning for students who don’t feel safe. This leaves those affected by chronic disease feeling more isolated than ever before. It’s not just young children that are feeling the negative mental health repercussions of the pandemic. Teenagers and young adults are affected, too.

Ian Fleming, a freshman at CU Boulder, says, “Starting college as a freshman this year has been very difficult. I was looking forward to football games and parties. However, because of the COVID-19 pandemic, I will have to wait for the traditional college experience. I have been overwhelmed and scared because I have type 1 diabetes; I could still have serious complications if I contracted the virus. Being a college student has not helped with this stress as I am in a place where kids are still partying and being irresponsible when we need to unite and protect each other.”

Another college student in Colorado, Faith Riddell-Harding, says, “There are still students (on campus) who are going out and partying, which as someone who is high risk, is somewhat infuriating. I could not justify having a dorm roommate this year, with my compromised immune system, so I worked with the University Disability Center to request a single, until a vaccine is available.”

Second, children and young adults with diabetes are already at heightened risk for depression and anxiety, with rates estimated between 13-17%. Those with diabetes are twice as likely to receive a psychiatric diagnosis by age 18 as kids without the condition. Adding the fear, stress, and anxiety of an uncontrolled pandemic on top of that can mean a recipe for disaster.

Izzy Myszak from Indiana says, “Having type 1 diabetes already brought my mental health down. Coronavirus and T1D has skyrocketed my anxiety.”

Lynda Jimenez, of Arizona, adds, “It’s hard to watch your friends and family not taking this seriously when you have to be extra cautious as someone with a chronic illness. On top of the worry that comes from a pandemic, we have to deal with this dichotomy too.”

Finally, it can be really devastating on one’s mental health with on-going lockdowns and no end in sight to the pandemic. But there is hope. The Centers for Disease Control and Prevention has developed several tools to help you care for your child’s mental health during this time. The COVID-19 Parental Resource Kit offers help for understanding your child’s mental health needs according to their age group. The Essentials for Parenting Toddlers and Preschoolers page helps with common parenting challenges and provides information on building a positive, healthy relationship with your child.

Exercise helps improve mental health

Exercise helps improve mental health. Photo credit: Adobe Stock

Additionally, it’s important to keep children on a regular routine, make sure they’re exercising and getting plenty of fresh air every day, limiting screen time, and that families aim for regular dinners together to ensure that your child is getting both socialization and healthy nutrition. Many families have also created a “social pod” with another family or two to both mitigate COVID-19 risk and maintain mental sanity, while also achieving healthy socialization for their children.

If your child or teenager is exhibiting suicidal ideations or extreme depressive symptoms, call their pediatrician or primary care physician immediately or contact the National Suicide Prevention Hotline: 800-273-8255 to get help immediately.

Maintaining an optimistic outlook and having hope is paramount. Ian adds, “I have been safe and diligent about where I go, who I hang out with, and making sure that I always wash my hands and don’t touch my face, but my hope is that a vaccine comes out soon and we can all have the college experience we were hoping for.”

And sometimes, hope is all we can do.

How has your child with diabetes coped during the pandemic? What strategies have helped you? Share this post and comment below; we love hearing from our readers!

Source: diabetesdaily.com

How to Increase Your Life Expectancy

If 2020 has taught us anything, it’s that health is everything. There are simple steps everyone can take to increase their life expectancy, and to give individuals the best chance at living a long, healthy life. Incorporate these simple habits into your daily and weekly routines to increase your life expectancy and improve your health now and into the future.

1. Keep Your HbA1c Low, TiR High

If you live with diabetes, one of the healthiest life-extending habits you can adopt is keeping your HbA1c low and time in range (TiR) high. Tightly managing blood sugar levels can help prevent devastating complications such as blindness, amputation, heart disease, kidney failure and premature death.

In addition, since the HbA1c test is simply an average of one’s high blood sugars and low blood sugars, it’s important to keep your blood sugar consistent and stable, with your time in your target range as high as you can get it. Studies have linked more stable blood sugars (and not gigantic swings between highs and lows) to longer life for those with diabetes. Most people aim for an HbA1c lower than 7%, but check with your doctor for your ideal target.

2. Wear Sunscreen

Wearing sunscreen daily is crucial for preventing the deadliest form of skin cancer, melanoma. Even on cloudy days, your skin will absorb 80% of the sun’s rays, and with it, harmful UV radiation. The American Academy of Dermatology recommends using a broad-spectrum sunscreen of at least 30 SPF every time you go outside. Ample use is crucial: On average, people only use about 20-25% of the amount of sunscreen needed for sufficient protection, so make sure to lather up!

3. Move Your Body

It’s no surprise that exercise is healthy for people, especially people living with chronic conditions like diabetes. Exercise is crucial for heart health, to manage blood sugars, increase lung capacity, and build and tone muscles to prevent future injury. All of the short term benefits of exercise add up to a longer, healthier life. Aim for 30 minutes of moderate exercise most days of the week, more if able! A study showed that people who exercise vigorously for only 3 hours a week had cells that were 9 years younger than nonexercisers.

Photo credit: Adobe Stock

4. Spend Time Outside

Nearly 50% of adults have low vitamin D levels, due to our sedentary lifestyle and the fact that most Americans live and work inside most hours of the day. Vitamin D (which can be absorbed right into the skin when people go outside) is important for proper immune system functioning, healthy teeth and bones, managing depression, and may even help prevent both type 1 and type 2 diabetes! Getting outside for just 15 minutes a day is usually enough to maintain adequate vitamin D levels for most people.

5. Spend More Time with Family & Friends

Blue Zone countries, places around the world that have notoriously long, healthy life expectancies, place a lot of emphasis on socializing with family and friends. Having a social circle can help people get through hard times, reduce daily stress, boost resilience and immune response, and act as a literal shoulder to cry on. This is especially important for people with diabetes who can oftentimes feel isolated and alone with their condition. Connecting with others in our struggle can help extend life expectancy: studies show that maintaining a social circle can help people live up to 50% longer, and having just 3 close social ties can decrease your risk of an early death by 200%. 

6. Eat Whole Foods, Mostly Plants

Consuming a diet rich in fruits and vegetables will be full of vitamins, minerals, and antioxidants that can extend life. Even if you don’t go completely vegetarian or vegan, eating more whole, unprocessed foods is beneficial for a healthy life, and to prevent diabetes complications. Many studies over the years have correlated a plant-forward diet to a lower risk of premature death, as well as protective factors against cancer, heart disease, depression, and dementia. People who eat mostly plants tend to have lower body weight, healthier blood pressure levels, and have significantly lower mortality risk. Bon Appetit!

7. Meditate to Manage Stress

Stress has been correlated with shorter life expectancies, and learning to manage it through meditation and yoga can improve and lengthen your life. Successfully managing stress through meditation can improve the quantity and quality of your sleep, boost your immune response, and improve your relationships, all of which add up to a healthier, longer life. Check out some free meditation apps to get you going!

Photo credit: Adobe Stock

8. See Your Doctor Regularly

Regularly seeing your doctor for screens and tests can catch diseases early (such as cancer), and can ensure an appropriate and timely treatment plan if something is detected. Mammograms, colonoscopies, and pap smears are some of the routine tests and screens scientifically proven to decrease mortality from the diseases they screen for. It may not be fun, but it’s proven, effective, and worth it!

9. Reduce Your Sugar Intake

Sugar is the new tobacco. Dr. Aseem Malhotra, a cardiologist from England, shares, “…added sugar is completely unnecessary. Contrary to what the food industry wants you to believe, the body doesn’t require any carbohydrate energy from added sugar.”

There is evidence linking sugar not only to obesity and higher incidence rates of type 2 diabetes, but also to liver disease, heart disease and tooth decay (which can lead to dementia). If you cut out added sugar from your diet, you are also more likely to gravitate to unpackaged, whole foods, which are chock full of vitamins, minerals, antioxidants, and life-extending properties.

10. Get More Sleep

One in three Americans don’t get enough sleep. Lack of sleep has been linked with a plethora of negative outcomes on many body systems, including cardiovascular, endocrine, immune, and nervous systems. Side effects of not getting enough Zs include obesity, heart disease, hypertension, anxiety, depression, alcohol abuse, stroke and increased risk of developing cancer that can all shorten one’s life. Sleep is when the body replenishes cells, is crucial to proper brain functioning, regulates one’s metabolism, and repairs damage done to the body during the day. Adequate sleep promotes healing of all body systems, and getting enough of it can extend your life. Aim for 7-9 hours per night.

These small, easy changes can add up to many more healthy years. Try to incorporate a few of these strategies into your routine today to increase your life expectancy!

Source: diabetesdaily.com

The Rise of Childhood Obesity in the United States

September is National Childhood Obesity Month in the United States, according to the Centers for Disease Control and Prevention. Currently, about 1 in 5 American children (19%) is obese, and the numbers are startlingly and steadily rising. Bringing awareness to this health crisis can help educate parents and caregivers about warning signs for childhood obesity, and how to prevent it for their children and loved ones.

Childhood Obesity is a Major Public Health Concern

It’s important to know that childhood obesity is not about vanity or looks. Childhood obesity is a serious public health issue that has serious and devastating consequences for children and families. Children who are obese have a body mass index (BMI) at or above the 95% percentile (a pediatrician can perform this measurement for you). Children experiencing obesity are at higher risk for other chronic health conditions, including asthma, sleep apnea, hypertension, type 2 diabetes, cardiovascular disease, and even many types of cancers. Additionally, children who are obese are more likely to be bullied in school, and can face mental health issues such as depression, anxiety, and suicidal ideation as they age.

Causes of Childhood Obesity

Childhood obesity can have many causes, most of which are behavioral in nature, although metabolism and genetics do play a strong role. Lack of physical activity and unhealthy eating patterns are some of the highest risk factors for developing obesity, as is a lack of sleep, and simply not having access to a safe place to exercise or the ability to buy healthy foods (living in a food desert, for example). Many social determinants of health play a role here. Children of lower socioeconomic status are at higher risk of developing obesity than children of higher socioeconomic status, who may have better access to parks and recreation and healthy foods.

Preventing Childhood Obesity at Home

There is a lot that family and friends can do to help to prevent obesity from affecting a child’s life.

  • Tracking a child’s weight and Body Mass Index (BMI) regularly can keep a child on track; if you see rapid weight gain, you can catch it more quickly and reach out to your doctor for a check-up.
  • Focusing meals on fresh fruits and vegetables, and eating foods in their most natural state prevents eating additional additives, preservatives and chemicals that won’t fill a child up, but are loaded with empty calories.
  • Make sure your child is active every day. Aim for 60 minutes of physical activity. This need not be a formal activity, like a soccer game. Walking the dog, helping to clean the house, and even walking around the shopping mall are all great forms of physical activity that gets a child moving and don’t cost any money.
  • Limit screen time. In 2019, the World Health Organization released new guidelines for the recommended amount of screen time by age, for children.
  • Make sure children are drinking water and not soda. About 40% of the calories consumed by 2-18 year olds comes in the form of these empty calories. Swapping soda out for water will save a ton of calories and will ensure that your child is filling up on wholesome, nutrient-dense calories instead.
  • Make sure your child has a healthy HbA1c. Keeping tight control on blood sugars and HbA1c can prevent overtreating lows and overeating, both of which can contribute to weight gain.
  • Eat healthy meals as a family. Children do what you model, not necessarily what you tell them to do. If you act as a role model with healthy meals, they will naturally follow.
  • Make sure your child is getting adequate sleep. When sleep patterns and circadian rhythms are off, children’s hormone levels become out of range, and they are more likely to overeat and not be physically active. They may also fall behind in school and suffer low self-confidence, resulting in overeating as a coping mechanism. Make sure your child is getting good sleep every night of the week.

Community and Societal Support

Preventing obesity may start at home, but it takes a village to raise a healthy child. Communities should provide safe and healthy playgrounds and parks accessible to all children, and local schools should provide free, clean, and safe drinking water and lunchroom cafeterias should provide balanced, healthy meals. Schools should also encourage physical activity, and provide robust physical education classes and electives for children and teens.

Additionally, your child’s health care provider should be conducting regular physical and mental health checks, to make sure your child is on track to enter adolescence and adulthood in a healthy mindset and at a healthy weight, especially if they are living with diabetes, which can make them more prone to disordered eating.

Together, with cooperation from parents, caregivers, schools, communities and engaged pediatricians and care teams, we can work to prevent childhood obesity and set the stage for healthy children and the future (healthy) adults we hope they will become.

Source: diabetesdaily.com

Top Ten Myths About Peer Programs

I have been living with type 1 diabetes for almost 30 years (this October 19th marks my 30th diaversary) and I’ve worked in the diabetes industry for over 20 years. I’ve primarily focused my career on community education and peer programs and have seen time and time again how beneficial they are. But I’ve also heard, for a variety of reasons, that many are reluctant to take part in a community or join a group. And we think it might be due to some misconceptions or myths about peer programs. Here’s our list of the top ten myths about peer mentorship!

Myth #1: My healthcare team is the most important part of my diabetes management. 

YOU are the most essential part of your diabetes management. You manage your diabetes for 525,600 minutes per year. While your healthcare team is vital, research suggests that a peer community is just as important as an educated healthcare team.

Fisher et al. conducted a systematic review that analyzed data from peer support for diabetes management studies and concluded that,

“across diverse settings, including under-resourced countries and health care systems, PS [peer support] is effective in improving complex health behaviors in disease prevention and management including in diabetes.” 1

If you visit your diabetes healthcare provider (HCP) once per month for 20 mins, that’s only 240 minutes per year. Yah, it’s all you. Give yourself a high five – this is hard work! Regardless of the type of program, a peer community can help you in so many different ways. Emotional support, stress relief, guidance, learn to advocate for yourself, exposure to various management tools, techniques, devices, and medications, and the list goes on! Being around like-minded people going through the same thing – just.makes.sense.

Myth #2: I don’t need it – my diabetes is well managed. 

That’s awesome and we’re excited to hear that! Over the years, I’ve often heard the comment, “I didn’t know I needed it until I was there.” A peer program, whether that be an event or group, can fill a gap you didn’t know existed.

We can learn things from our peers that we just can’t from our team of doctors and nurses. For example, you might not be aware of specific tips and tricks that people with diabetes use concerning their devices, medications, insurance plans, or assistance programs. Peer groups can also help us fine-tune our diabetes management in different ways than our healthcare teams can. They are there when the going gets tough, and you need someone who “gets it.”

A good friend of mine, doing well and happily managing his diabetes, had no desire to use CGM (continuous glucose monitoring) technology. He attended an event and saw his friends using one and realized he could fine-tune things even more. It was because he saw others using it and was able to speak to them about their experiences; he decided to give one a try. Six years later, he’s still using one and doing better than ever.

Myth #3: I only need a peer community or mentor when first diagnosed.

Having someone walk you through what to expect or be there with you as learn can be impactful. But diabetes is lifelong, and that means it can change over time. Life ebbs and flows, and so can our management and ability to focus on it. Having people who “get it” and you can turn to can be beneficial at any stage!

Myth #4: A peer program is all about complaining. I don’t want to be part of a pity fest. 

We hope not! I know in my peer group I can post funny anecdotes (those things that only people living with diabetes would get a laugh out of), ask questions, figure out what to make for dinner, but yes, also vent if I need to.

The way I’ve managed my diabetes has changed over time throughout my life, and my peer group has been so helpful and empowering along the way. We hope our peer mentorship program will be a source of positive relationships and interactions.

Myth #5: My diabetes will be reversed if I join a mentorship program.

We wish this were always true. According to a small study 3, people diagnosed less than four years ago with type 2 diabetes found that drastic calorie reduction normalized blood glucose and insulin resistance. Thus, stopping diabetes in its tracks. However, this study did not include anyone using medication and had strict exclusion criteria. Therefore this result may not be true for everyone. Alongside lifestyle changes (nutrition, exercise, sleep, and stress reduction), sometimes medication is needed to help the body work more effectively and efficiently. Joining a program or group can help you find the resources and support you need to make those necessary changes and stay the course.

Myth #6: I will be shamed or judged for my choices or medications I’m using or not using.

We’re sorry to hear if that’s the experience you’ve had previously! For many communities and programs (including Facebook groups), most have guidelines each person must adhere to in order to participate. In our forum, there are Community Guidelines (rules for posting). Our Peer Mentorship Program encourages empowering language and not “shoulding” each other (“You should or shouldn’t do this.”) Instead, we speak from our own experiences, what has and has not worked. Each person is on their journey, and it takes time to reach your goals. What works for one person doesn’t necessarily mean it will work for you (diabetes would be SO much easier if we could all do the exact same thing and get the same results!) Most times, you’ll need to experiment to find the combination of things that work for you, whatever those things may be. One step forward at a time.

Myth #7: It’s too much time. I don’t want to spend more time talking about diabetes.

via GIPHY

We totally get it! Joining any program involves a time commitment, but what you put in, you get out. We know that talking about our experiences creates a sense of connection and belonging, which can help us cope during difficult times. It can also be more efficient to talk about options and choices with real-life users before starting something new or making changes. Sharing what is going on, asking questions, learning from other’s challenges, and helping others can pay you back in dividends.

Myth #8: These types of programs don’t work.

We hope they do, and research shows they do work! Peer programs are an option or piece of a larger puzzle. It’s one area that can help you manage your diabetes, but you have to show up and participate. Specifically, in the Diabetes Daily peer mentorship program, we ask that you set some goals to work towards them and use the community for help. You create the goals, and they can be as small or grand as you like.

See what our previous program participants had to say:

“I really enjoyed my time chatting with others and seeing how others managed their diabetes. It [the program] gave different perspectives but I always felt very supported. I felt I also helped my mentor with their diabetes.” 

 

“I learned so much from my mentor! He had tons of knowledge and I changed a lot of my lifestyle based on information from my mentor and the group.” 

 

“I learned about diabetes technology that I would have not known about.” 

 

“I was very introverted and not ready to accept my diabetes. This program made me realize how important it is and that I can’t ignore it.” 

Myth #9: All of these programs are the same.

Every program is different and unique. Take Weight Watchers; for example, it previously focused on in-person group weigh-ins and meetings. Now, the program uses an app and online support to help members reach their weight loss goals. Alcoholics Anonymous (AA) is composed of in-person group meetings and a one-on-one sponsor relationship. Cancer support groups often meet in person with a social worker, mental health professional, or facilitator to discuss their experiences, feelings, and emotions. Diabetes Daily has an anonymous online forum where you can freely post your questions and answer other people’s. The re-launch of our mentorship program is more similar to AA, where you have a partner to connect one-on-one with and group sessions where you can learn from others’ experiences and stories.

Myth #10: It’s a diabetes education program.

Yes and no. It’s what we call peer support and peer education. By listening to others’ successes and their challenges, you learn about real-life experiences. For example, it’s invaluable to hear about a medication’s common side effects and address these with your doctor before trying something new. Not everyone will react the same, but we know sharing your tips and tricks can help others. Continuing to work with your healthcare team is vital as they are the ones who will address medications and any changes to those.

To learn more or join our peer mentorship for people living with type 2 diabetes, head to our Mentorship page. Registration closes August 28th, 2020, and the program begins September 1st. We hope you’ll join us!

References

1. Fisher, EB, Boothroyd, RI, Elstad, EA; “Peer support of complex health behaviors in prevention and disease management with special reference to diabetes: systematic reviews” (2017) Clinical Diabetes and Endocrinology DOI: 10.1186/s40842-017-0042-3  Accessed: 8/21/2020 https://clindiabetesendo.biomedcentral.com/articles/10.1186/s40842-017-0042-3  

2. Warshaw H and Edelman D; “Building Bridges Through Collaboration and Consensus: Expanding Awareness and Use of Peer Support and Peer Support Communities Among People With Diabetes, Caregivers, and Health Care Providers” (2018) Journal of Diabetes Science and Technology DOI: 10.1177/1932296818807689 Accessed: 8/21/2020 https://journals.sagepub.com/doi/full/10.1177/1932296818807689#

3. Lim, E.L., Hollingsworth, K.G., Aribisala, B.S. et al. “Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol” (2011) Diabetologia 54 DOI: 10.1007/s00125-011-2204-7 Accessed: 8/21/2020  https://link.springer.com/article/10.1007/s00125-011-2204-7#citeas

Source: diabetesdaily.com

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