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.

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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

Should My Child with Type 1 Diabetes Go Back to School During COVID-19?

As summer draws to a close, parents and families affected by type 1 diabetes have been plagued with the question of whether or not to send their children back to school during the time of COVID-19.

Earlier this summer, a report from the NHS was released showing that people with diabetes, especially type 1 diabetes, face significantly higher risk for both complications and death from COVID-19. This study sent shockwaves through the diabetes community, and has left many families with many unanswered questions. Should parents send their children to school and risk contracting the virus? Should families keep their children home, and attempt home-school? Is there a middle ground to help mitigate risk and viral transmission, while still enabling our children to learn well? What critical social and psychological developments would a child miss out on, should they stay out of school for a year, or two, or three? What complications would be prevented if they dodged the coronavirus (and the social ridicule of 7th grade) completely?

There is no national consensus: the President wants schools to reopen. Many colleges and universities are either going completely online, or attempting a sort of hybrid (half online, half in-person) schedule. The Centers for Disease Control and Prevention recently changed its guidance, to better adhere to the Administration’s wishes. Throughout the United States, the issue of schools reopening has largely been left up to the school district to decide, and that can be based largely on city and state politics. The decision is further complicated for families with children with diabetes, because although a type 1 patient’s risk may be higher, it’s been previously noted that most children, should they contract COVID-19, have milder cases and many do not even show symptoms. Keeping a child with diabetes home this fall risks to further ostracize and isolate them. So, how can you make the best decision for this upcoming school year?

If anything, the United States has had the benefit of time throughout the pandemic. The origins of the virus came from Wuhan, China, and Americans watched the epidemic play out and spread throughout Asia and Europe from the comfort of their homes for most of the winter. The United States had nearly 3 months to fully prepare, and the same goes for schools reopening. Many schools throughout Asia and Europe have reopened (with safety precautions) with some success and no community spread. However, no country has had as many live and active case counts as the United States when trying to reopen schools.

Although the risk of returning to school is great, sometimes the social and psychological repercussions are greater: many children have reported an increase in anxiety and depression since the pandemic started; being trapped in homes with domestic violence and abuse wreak havoc on mental health and well-being, and many families living close to the poverty line rely on the daily, free breakfast and lunch programs to help feed their family throughout the school year. Shockingly, 114,000 students in the New York City public school system are homeless; they rely on the warmth and shelter of going to school every day to get by.

Photo credit: Adobe Stock

Many families do not have enough (or any) computers at home for remote schooling, and nearly 19 million Americans do not have high speed, broadband internet at home, making remote, teacher-led learning all but impossible. Additionally, having children at home all day often requires a parent to be home, too, and many essential jobs and low-wage workers do not have the option to work from home temporarily or indefinitely. Juggling child care and work has become a critical issue for parents navigating the effects of the pandemic on their families. Furthermore, children need to socialize with other kids their age, and learn to develop social networks for support. Taking that away can and will have lasting detrimental effects.

On the other hand, given the current state of affairs and the rate at which the virus is spreading throughout the United States, children with diabetes face significantly higher risk of exposure and contraction (and complications and even death) should they return to school full-time, for in-person learning. Putting a child at unnecessary risk, in the middle of a pandemic, seems shortsighted and myopic.

Some encouraging research in the midst of turmoil: nearly half of those with type 1 diabetes who contract COVID-19 have managed to treat the virus at home, although hyperglycemia and DKA are common.

Unfortunately, lacking any national guidance for families with children with preexisting conditions like type 1 diabetes, the decision is a personal one. Considerations include your child’s age and ability to self-manage, their mental well-being and ability to cope without friends or in-person learning, your state’s COVID-19 stats and rate of viral decline/increase, and your personal feelings of safety and security with your school’s precautions in regards to COVID-19 risk mitigation. National diabetes organizations have recently released information for returning to school and general COVID-19 guidance, and a town hall was recently held to help parents navigate the decision process.

In closing, any decision you make about your child’s learning needs to be based on your personal circumstances and how comfortable you are with either remote or in-person learning. Reach out to your school’s administrators to see what their plans are for mitigating virus spread this fall: are they limiting class sizes, mandating social distancing, placing hand sanitizers and handwashing stations throughout the school, and requiring masks? Or do you feel your school isn’t doing enough, and you’re willing and able to assist your child in a remote learning situation, where they see other children occasionally for social support? Discuss your concerns and questions with your pediatrician and/or endocrinologist and get their recommendations. Do you have an essential job, where you cannot be home during the day, and you need the school infrastructure for support? Or do you feel overwhelmed with the high risk factor that is type 1 diabetes, and you’re leaning towards homeschooling until there’s a vaccine? There are no perfect decisions here: guilt should not drive your decision. Go with your gut, and what works for your individual situation, and it’ll lead you in the right direction.

Are you navigating back to school (or not!) with your child? What decision has best-suited your family? Share this post and your thoughts below! We love hearing from our readers.

Source: diabetesdaily.com

Incorporating a Latinx Lens for Mental Health

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

By Mariana Gomez

As I prepared to write this piece, I had to do my own personal research. My family and I moved from México to the United States in July 2019. We have spent a lot of time trying to learn as much as we can to better understand systemic racism in this new home of ours and learn how to work towards a difference. It is our duty not only to learn as parents, but to teach a thirteen-year-old who is watching, learning and is ready to join in any possible way to help his peers.

What I’ve learned? There is major work to be done in health policies, programs and campaigns that address social determinants of health, health disparities, risk factors, and to build health services for the Hispanic/ Latinx population alongside other ethnicities and races.

Because of a lack of easily accessible or fair health services, the Hispanic and Latinx population in the US will pay a high mental health and emotional well-being price during the COVID-19 pandemic. According to Minority Health, poverty levels among these groups will also have an important impact on emotional health.

“Poor access to care due to low rates of insurance, immigration status, language and cultural barriers in healthcare which can include differences between provider-patient in explanatory models of illness and families as the gatekeepers can limit entry into treatment.” (Cortes et al, 2008) as read in the Handbook of Multicultural Mental Health Assessment and Treatment of Diverse Populations.

Talking about Latinx population includes different sub-groups. Us Latinx are a diverse community. Most of us come from different countries and speak different languages. Yes, Spanish is the official language but some will speak native tongues as well.

I am a Mexican Diabetes Educator who believes that talking about Latinx culture in the diabetes space requires us to work on more topics besides food and language barriers in our practice. Diabetes Education must include programs that recognize our many cultural differences as well.

We need more Latinx researchers, professors and conference speakers guiding these efforts in order to build better, stronger but also culturally appropriate strategies and programs. The work we’ve been able to see so far is indeed amazing, but how about incorporating a “Latinx lens” when talking about us Latinx populations and our health needs? Addressing our emotional health is even more complex as these cultural differences should be included in the different programs designed to help.

I found Salud Latina some years ago in a twitter conversation and felt immediately drawn to their mission “to lead the creation of culturally relevant multimedia research, tools, and stories to fuel people to start and support policy, system, and environmental changes in schools and communities to improve Latino child health, reduce disparities, and promote health equity and a culture of health.”

To explore and learn more about these disparities and the way our mental health is being addressed nowadays, I spoke with Rosalie Aguilar, project coordinator for the Salud America! program at University of Texas Health San Antonio.

During the COVID-19 pandemic, is there a need for culturally and linguistically-oriented mental health care for the Hispanic/Latinx population?

Rosalie: Yes! For Latinos and other people of color, COVID-19 has caused disproportionately higher rates of cases and death, job loss, and other inequitable impacts.

Many are also experiencing more mental health issues than in previous eras, according to Dr. Madeline Aviles-Hernandez, the Outpatient Services Director at the Gándara Center.

“This crisis is making life much more difficult for those [Latinos, African-Americans and other culturally diverse populations] we serve, including those in recovery and people who have yet to be treated for such problems as anxiety and depression,” Áviles-Hernández said in a statement. “Minorities have been—and continue to be—less likely to receive mental health treatment.”

The COVID-19 outbreak has resulted in forced isolation, school and business closure, massive job loss, food insecurity, and a litany of other impacts outside of the illness itself.

These ramifications impact more than just physical health, but mental wellness, too, according to Cathi Tillman, the executive director and founder of La Puerta Abierta — a Philadelphia nonprofit providing mental health support to immigrant and refugee communities.

“People who were supporting themselves on some level now can’t,” Tillman told the Philadelphia Inquirer. “They’ve lost their jobs. They can’t congregate socially, or go to church, which is a big part of the community for many people. They can’t come into the office for therapy. For recent immigrants and refugees, the things that were already difficult are 100% more difficult now.”

How are these needs being addressed so far? What kind of help are these groups receiving and how is your organization and team working to provide support? 

Rosalie: Various nonprofits are stepping in to help fill the gap, but there’s still a huge need for mental health care services and additional social support services. There’s also a need to help address the stigma involved with accessing these services.

Our organization is not involved with providing direct mental health care services. But at the Institute for Health Promotion (IHPR) at UT Health San Antonio, the headquarters of Salud America!, we do have a team of community health workers, promotoras, who provide patient navigation and reach out to patients in the Bexar County area to check up on them, provide social support and to help them connect with their health care providers. These services have been associated with less anxiety and depression among patients and fewer hospital readmissions.

There are other groups out there at the national level like NAMI that can also help connect people to services. We really also appreciate that Informed Immigrant, Immigrants Rising, and FWD.us produced a 10-step guide to help mental health care providers respond to the distress of immigrants whose status is in flux due to ongoing changes to the Deferred Action for Childhood Arrivals (DACA) program, amid coronavirus. We wrote about it here.

Folks can also use findhelp.org or call 211 find support services in their areas. We actually got a chance to speak with the creator of findhelp.org, and tell the story of how he and his team were able to take on the herculean task of digitizing all the social services available in the United States, thus making it easy for people to find and apply for those resources.

How can us Latinx people in the non-profit and health space work and help you? 

I think the important thing right now is to continue to do all we can to prevent the spread of COVID-19 with culturally appropriate messaging and also to continue to push for health equity in Latino communities. If you offer a support service that can be helpful to Latinos let us know, because the word needs to get out.

Also, share our materials on the Impacts of COVID-19 on Latinos and solutions. We have a bilingual infographic, a landing page on “Coronavirus and Latino Health Equity” and a list of actions that could help Latino communities.

What is the biggest campaign you are working on and how can people and our readers join and help?

We are working on several things right now, including culturally aligned messaging to help stop the spread of COVID and also a campaign to help communities get their cities to declare racism a public health issue and commit to action. We know that racism coupled with the impacts of COVID-19 are detrimental to our population. Therefore, we need to do all we can to promote a culture of equity and to reduce bias.

Source: diabetesdaily.com

One Year into DIY Looping

One year ago, I built a DIY hybrid-looping insulin pump, using my Dexcom G6 and Omnipod. For those who aren’t in the know, DIY “looping” is basically “hacking” your insulin pump with a single-board computer, such a Raspberry Pi or Riley Link, to make it communicate with an existing continuous glucose monitor (CGM) to make basal adjustments accordingly.

It’s important to note that this is NOT FDA approved, but the #WeAreNotWaiting community has been sharing information on how to build your own DIY looping insulin pump for years now, and I took the plunge in 2019.

In July I celebrated one full year on my looping system, and wanted to share my thoughts on 365 days of looping.

I Still Have Diabetes

I remember when I first set up my Riley Link and switched on “auto-mode.” I had this magical vision of never counting carbohydrates again, limitless runs without lows, and forgetting what the thirst of a high blood sugar felt like. Then I realized, just as quickly, that I still have diabetes.

Even though my Dexcom continuous glucose monitor (CGM) readings now communicate with my insulin pump and make basal adjustments accordingly, the “hybrid” part means that it doesn’t anticipate, nor account for, any carbohydrates eaten. I also need to tell my pump when I’m about to exercise, and for how long. Since the insulin pump does not operate on artificial intelligence (AI), it cannot anticipate what I’ll do next.

So yes, I still have lows on runs and I still have highs when I eat something that isn’t appropriately accounted for. I still have to count carbohydrates and no, I haven’t forgotten what the Death Valley-like thirst of a 350 mg/dL feels like, although it happens less frequently.

My HbA1c Isn’t That Much Lower

I have always been maniacal about tight diabetes control. My A1cs have hovered in the low 6s for the last 10 or so years. With Loop, I immediately thought that my control would be *perfect* and I would ride out the 4s and 5s into an eternal sunset. NOPE. My latest A1c was 5.9%, which I am rightly ecstatic about, but it’s less than 1% point lower than I was on MDI and a CGM.

The key difference is that my time in range has increased from around 30% to 75%, and the number of lows that I experience has gone down from around 3 per day to 3 per week. It’s easy to have a low HbA1c when you have highs and lots of lows to average it out- it’s much harder (and healthier!) to have a lower HbA1c with few lows. And plus, I just feel healthier. And that has made all the difference.

Dexcom graph by Christine Fallabel

It’s a Mental Vacation

Being a human pancreas 24/7/365 is not easy (why didn’t anyone tell us this at diagnosis?!). In addition to running a household and having a full-time job (and texting everyone back, and maintaining some semblance of a fitness routine, and trying to eat something green at every meal), being an organ all of the time is hard work.

More than anything, a year into looping has given me the mental break I didn’t know I needed. Sure, I still have to count carbohydrates, adjust for exercise, and dose for meals, but hours can go by where I don’t think about diabetes at all, and that never used to happen. My mental distress has gone way down, and I don’t experience diabetes burnout at nearly the frequency I used to. This also helps maintain my motivation to continue to take care of myself and my diabetes.

Dosing Is More Discreet

As I make my way through my 30s, this is less of an issue (if you have a problem with me dosing in public, the problem is you, not my diabetes), but looping has definitely made checking my blood sugar (read: checking my phone) and dosing (also read: checking my phone) way more discreet in public than manually testing my blood sugar and dosing used to be. It’s also more hygienic (I change my insulin pump with plenty of alcohol swabs every 3 days from the comfort of my home), and more convenient. This is perfect when I’m out at a crowded concert, or squeezed into a small table at a restaurant.

It can also cause issues. For instance, if I’m in a public place where cell phones aren’t allowed, sometimes it’s difficult to explain that my iPhone is actually durable medical equipment (DME) that I need to survive. Let’s just say there have been some teachable moments.

Loop app screenshot by Christine Fallabel

I Am Happier

When I was diagnosed with type 1 diabetes in June of 2000, my doctor told me that the cure was just 5 years away. I thought the cure was just around the corner, we all did. And learning that the “cure” is still out of sight, 15 years hence, has been a hard pill to swallow.

I’ve dealt with anxiety and the impending depression of only someone who has a chronic disease with no cause and no cure can experience, but having something like Loop feels like someone is finally on my side, looking out for me, and making things just a little bit easier when the load becomes too heavy of a burden to carry. I can go to sleep and know that my basal will immediately shut off if I start to go low overnight. I can relax if I’m digging into dinner at a friend’s house and I don’t know the exact carb count for a meal, knowing my basal will tick up to cover the difference.

Having a Loop feels a little bit like you have a certified diabetes educator (CDE) and best friend just sitting on your shoulder, making constant adjustments, never judging, and ensuring that you have a better go of it, a little bit of help when you need it. And that help has been life-changing. The cure may never have been 5 years out, but with Loop, I finally feel okay waiting just a little bit longer.

Do you DIY Loop? How has your experience been? Share this post and comment below; we would love to hear from you. Follow the #WeAreNotWaiting hashtag on Twitter to learn more about the DIY movement.

Source: diabetesdaily.com

Summer Is Here: Are You Still Safer at Home?

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

By Julia Flaherty

States and regions across America are slowly reopening, which means social distancing guidelines have become a bit fuzzy. However, the same principles apply to ensure you are best protecting yourself and others. COVID-19 is still a threat and will remain so until we have a widespread vaccine.

It’s important to remember that whether or not you’d like to slowly emerge back into society is your choice. You can absolutely still stay at home if that makes you feel safest and you are able to. But as more businesses and workplaces reopen, you may not have that choice.

It is also completely understandable that, after months inside, you’re ready to begin weighing the risks of certain activities to maintain other physical, mental, and emotional health needs. Both mentalities are okay. But if you plan to re-emerge or have to, there are important guidelines to keep in mind.

Know Your Risks

Public Gatherings

To remain cautious, keep your social circles small. Continue to limit your interactions to the people you live with, and be mindful of any emerging illnesses among your household members. If someone in your household does get sick, the CDC advises quarantining any ill family members in a specific room of your house (if they do not have to be monitored in a medical facility) to keep everyone safe from the spread.

Experts have outlined the risk factors of certain summer activities. While hosting an outdoor barbecue in your backyard with one other household is low to medium risk, going to a beach or pool among strangers is medium to high. Experts also say eating indoors at a restaurant is medium to high risk.

There are still many safety benefits of engaging with friends and family via virtual chats, ordering takeout instead of sitting down at venues (meanwhile supporting your local economy), and enjoying the great outdoors. Experts rate exercising outdoors and camping as low-risk summer activities.

Hygiene

Keep your hands and face (eyes, nose, mouth) clean. The CDC continues to advise washing your hands after treating someone who is sick, eating, preparing food, using the bathroom, tending to a wound or sore, touching pet litter, food, or treats, touching the garbage, interacting with out-of-home surfaces, and so on. Wet your hands with clean running water each time you wash them, and lather your hands, covering all areas of them, for at least 20 seconds. Dry them well using a clean hand towel each time.

Hand sanitizer with at least a 60% alcohol volume is good to use in the interim if you do not have immediate access to soap and water, but the best method is still washing your hands, as hand sanitizer doesn’t eradicate all types of germs. Be mindful of this standard amid all of your summer activities to stay safe.

Regularly launder your clothes and shower. Cough or sneeze into a tissue or your clothing, and then throw away your tissue or change your clothing. When cleaning, use an EPA-approved disinfecting product. Frequently clean high-touch surfaces.

Masks

Though many of us are growing eager to be close to friends and family again, suffering from lockdown burnout and fatigue, it’s still important to remember that masks do not replace the six feet apart social distancing rule. If you are slowly working on re-emerging, keep in mind that not everyone will practice mask safety in a compliant fashion, which puts you at risk.

Some do not know how to wear masks properly, while others still do not have access to compliant masks, and some may choose not to wear a mask at all. To ensure your safety, continue to wear a mask in public settings, such as the grocery store or your workplace if you are returning, and keep staying six feet apart. Experts have commented there are no known grocery store linked cases, indicating that grocery store shopping remains a low risk so long as you follow social distancing guidelines.

Source: diabetesdaily.com

Using Smartphone Tracking to Identify Patients with Depression (ADA 2020)

At the American Diabetes Association (ADA) 80th scientific sessions last week, Dr. Ashutosh Subharwal, Department Chair and Director of Department of Electrical and Computer Engineering at Rice University, put together a compelling presentation that showed the benefits of using smartphone sensors to measure behavior-biology pathways and use those findings to assess, treat and improve healthcare outcomes for depressed patients living with diabetes.

Scaleable Health Labs believes that there should be a bio-behavioral sensing layer to healthcare using simultaneous, non-invasive and accurate measures to provide clinicians with data to better help their patients. They feel using quantitative data from a sensor-based automatic measurement will be more useful than asking patients questions and having their answers be based on their own perception. For example, when asking patients how often they exercise, their answer may vary drastically from the data from their sensor.

The presentation focused on 3 areas: Mobile bio-imaging, behavioral sensing, and data science for health.

Dr. Subharwal proposed two questions:

  1. Can we track depressive/anxiety states?
  2. Can we measure loneliness?

Can We Track Depressive/Anxiety States?

Depression is a common comorbidity of diabetes and is often undetected and untreated. A study explored this in adults and adolescents, using a tool called SOLVD: Smartphone and Online Usage as based eValuation for Depression, by way of a smartphone as a wearable for tracking depression.

The two clinical pilots for SOLVD consisted of the following:

  • Bi-weekly clinical visits.
  • Logging feelings in a MoodReminder Module.
  • The MobileLogger Module, which has the sensor logging social use (phone calls/texts), mobility (GPS/steps/accelerometer) and phone usage (screen time, screen light, etc.), all while being respectful to keep any conversations private.
  • A new parent app for the teenage pilot that used the parent’s feedback as a sensor to measure their children’s mental well-being.

Using this combinational sensor data allowed clinicians to track who, when and for how long the patient was speaking with or texting an individual. They were able to track where the patient was going and the duration of time spent at each location. There were also many other extracted features from the smartphones related to communications, mobility and sleep collected daily, as listed in the chart below.

Key Findings

This method proved to be a useful way to continuously track a patient’s mental state. The patients did not find it intrusive and were willing to be tracked. They saw a strong correlation between the daily self-reported moods and different diagnostic questionnaires in both teens and adults. Also, when patients had fewer phone calls/text messages and shorter frequency of these exchanges, it was predictive of higher depression symptoms. Additionally, as the number of steps walked decreased, there was an increase in the participant’s depressive state.

In both studies, there was a correlation between the data collected from the smartphone and the patient’s psychometric scores, and a noticeably stronger correlation in the moderate to severely depressed participants. The data indicate that the more depressed a patient was, the less mobile and social the person became. This information can help providers to better assess and treat their patients.

Can We Measure Loneliness?

Sociability is crucial to our overall well-being and lack of social encounters are indicators of loneliness. The traditional measures of sociability are often questionnaires, patient self-tracking, the UCLA loneliness scale but all of these require participant effort and many times the report lacks enough detail to draw any conclusions.

SocialSense, an in-person social network (IPSN) is able to track real-life, in-person interactions through audio data. This tracking device is able to detect conversations, detect social scenes and context as well as turn-taking behaviors, with no content analysis to respect participant’s privacy.

The Sociability Clinical Pilot at Baylor College of Medicine (emailed waiting for confirmation) spent 1 week audio-tracking their participants, using the daily smartphone app sensor features discussed above, along with patient baseline psychometric measures.

Key Findings

A decrease in sociability was seen among patients with depression, including fewer longer conversations and fewer social contacts. The SocialSense reports were consistent with the self-reports. SocialSense was also able to detect audio self-talk conversations amongst patients with psychosis.

Conclusions

  • Most patients are willing to be monitored via technology (>80% adherence).
  • These tracking studies are among the first of their kind to study adolescents and adults who suffer from depression. They are also the first to use the new tool for psychiatry, the parent app.
  • Data from the participant’s phone sensor and usage features correlated with symptoms of depression, which was even more pronounced in the moderate to severely depressed patients.
  • The data we can get from wearables can help better evaluate a patient’s mental well-being and develop the most appropriate solutions.

What are your thoughts on the subject? How would you feel about your activities being tracked for health purposes?

Source: diabetesdaily.com

Improving the Transition from Pediatric to Adult Care for Patients with Diabetes (ADA 2020)

At the American Diabetes Association (ADA) 80th scientific sessions, Dr. Robert Zimmerman MD, Vice-Chairman of Endocrinology and Director of Diabetes Center Cleveland Clinic, and his team discussed the importance of creating a smooth and seamless transition from pediatric to adult care.

This time of transition is considered a high-risk time for patients living with diabetes. Diabetes aside, these patients are dealing with other life stressors that often emerge at this point in their life. Coming off their parent’s health insurance, going off to college or out in the workforce, and having to pay their own bills can create a lot of stress. Because of this, patients often neglect their diabetes care. Having a transition plan in place from pediatric to adult care can help these patients feel empowered and equipped to handle their own diabetes care as they become young adults.

Key Takeaways

  • Each year, thousands of adolescents with both type 1 and type 2 transition to young adults and also from pediatric to adult care.
  • The developmental stage between ages 18-30 is defined as the period of emerging adulthood.
  • Due to life stressors, this is a period where many are distracted from their diabetes care.
  • During the first phase of transition, around age 18-24, many patients feel overwhelmed and have a tendency to reject parental control.
  • During the second phase of transition, at about age 25-30, the young adult tends to take on more responsibilities in life and usually starts to place more importance on diabetes management.
  • The period of emerging young adulthood is considered a high-risk time for patients with type 1 or type 2 diabetes.

Differences Between Pediatric and Adult Care

  • Pediatric Approach
    • Family-oriented
    • Holistic
    • Visits are with both child and parents
  • Adult Approach
    • The patient is autonomous in their care
    • Individualized counseling
    • The patient makes their own decisions regarding care

Major Risks During Transition

  • Suboptimal Glycemic Control
    • Only 32% of patients between 13-18 years old met ADA goals
    • 18% of children under 18 achieved the ADA recommendation for A1c
    • 56% of adults achieve an A1c of 7%
  • Neglect of Diabetes Care
    • Older teens and young adults tend to disengage from health care
    • Both short-term and long-term complications can occur as a result of neglecting care

Factors That Increase the Risk of Hypoglycemia and DKA

  • The loss of parental guidance
  • Less frequent doctor visits
  • Work/school stressors that take precedence over diabetes care
  • Consumption of alcohol
  • Change in physical activity
  • Different dietary patterns than once had under parental care
  • Lack of motivation to stay on top of health

Patients Face Many New Challenges During This Period

  • Psychosocial challenges include worrying about the future, lack of a plan or goal in place for managing their diabetes, feeling anxiety, or being overwhelmed with care, handling uncomfortable social situations regarding diabetes.
  • Psychological issues are prevalent during this time, although these can occur at any time while managing a chronic condition. Feelings of depression, anxiety, eating disorders and suicide are all concerns that need to be addressed during this time.
  • Pregnancy is another issue that arises during this period of emerging adulthood.
    • Contraception use is lower for adults with diabetes from the age of 20-44
    • 39% of adults with diabetes do not use contraception compared to 27% of adults who don’t have diabetes
    • An increasing number of women with pre-existing diabetes are becoming pregnant and having children
    • Only 1 in 4 women with diabetes age 16-20 were aware of the risks involved with getting pregnant with diabetes and the importance of optimizing glycemic control before and during pregnancy in order to maximize the odds of conceiving and delivering a healthy baby.
  • Other health risks that can happen at any age for people with diabetes seem to be most prevalent during these years: alcohol use, illegal drugs, smoking, driving and hypoglycemia.

Current ADA Recommendations for the Transition

  • Pediatric health care provider works with the patient and parent planning for transitioning starting up to 1 year prior
  • Preparation focusing on self-management for emerging teen
  • Preparation should include the differences between pediatric and adult care and should help guide the patient on major decisions such as health insurance, etc.
  • The provider should prepare and provide a list for the patient and new adult doctor summarizing the patient’s medications, assessment of skills, history, etc.
  • Healthcare providers need to recognize all the changes during this period can lead patients to neglect care.
  • The transferring provider should provide patients with specific referrals to adult physicians that would best fit the patient’s needs.
  • The transferring physician should empower patients and provide them with any educational materials and resources that can help them to stay on top of their diabetes care.
  • Care must be specific to the patient and strive to avoid both short term and long term complications.
  • The provider must evaluate and treat emerging teens with any disordered eating behaviors or affected disorders.
  • On-going appointments should take place every 3 months for patients on insulin and every 3-6 months for patients with type 2 who are not taking insulin.
  • Screening guidelines should be followed for both microvascular and macrovascular issues as well as the management of lipids and hypertension.
  • Birth control, drug use, driving, STDs, etc. should all be discussed with the teen and their parents by both the transitioning and adult physician.
  • Both providers should make sure the patient is getting primary and preventative health care and feels comfortable with the care and support they are receiving.

Transition Options Available at The Cleveland Clinic Foundation

  • Transition clinic: here, adolescents are taught how to manage their diabetes on their own. They are then introduced to the adult care endocrinologist who oversees the patient’s care after this first visit. The follow-up with the adult endocrinologist can happen on the transition floor or at Adult Endocrinology at the diabetes center.
  • Transition shared medical visit: In this instance, a shared medical appointment takes place instead of their traditional appointment and the goal is to make the transition as smooth as possible for the patient.
  • Adult endocrinology office visit: patient goes directly to the referred adult endocrinologist.

Cleveland came up with an Autonomy Checklist which helps patients to learn necessary information that they should have while transitioning to more autonomous care.

Group Visits

Cleveland Clinic put into place group visits that take place approximately every 3 months where they have an educational speaker, review A1cs, glucose readings and insulin adjustments to engage the adolescents as well as give individual exams.

Cleveland Clinic’s Transition Recommendations Moving Forward

  • Creating flexible appointments: nights, weekends and special availability while young adults are home from college are important. Virtual appointments and classes will likely be the main way of interacting for this group. Dr. Zimmerman stated that their office went from “1% virtual visits to 75% in approximately one week’s time”.
  • Building relationships: community support groups led by a provider, monthly events and taking advantage of organizations and apps like College Diabetes Network (CDN), where they can connect with others living with diabetes is useful.
  • Transition simulation nights where young adults going off to college can go through possible scenarios and problem-solve together as a group. Questions like “my insulin fell and cracked open, where can I get insulin in the middle of the night?” or “My blood sugar suddenly is dropping, but I am in the middle of taking an exam, what should I do?” would be addressed.

Conclusion

Young adults transitioning from pediatric to adult care are a high-risk group that needs a supportive and comprehensive system in place, where caretakers understand the unique complexities of this life stage. Creating a seamless and specific transition plan will help guide these patients to achieve optimal health during these years.

Source: diabetesdaily.com

A Letter to My 12 Year Old Self: Diabetes, 20 Years On

Dear Chrissy,

It’s June 20th, 2000, and right now you’re in the emergency department of the King’s Daughters Children’s Hospital in Norfolk, Virginia. You were supposed to be on a weeklong vacation with your siblings and parents, frolicking in the salty seawater and eating cotton candy on the boardwalk of Virginia Beach, but instead, on day three of the trip, you’ve been rushed via ambulance to the ER, feeling weak, nauseous, and on the brink of unconsciousness. You’re small. An active cheerleader in your middle school, you’ve lost over 30 lbs in a little under a month, which is striking on your lithe frame. Every nurse notices how underweight you are.

The glucometer at the Urgent Care your parents took you to this morning simply read, “HIGH”. When the nurse looks at your parents and says the words, “your daughter has diabetes”, it’s the first time you’ve ever seen dad cry. You’re completely terrified that the word “diabetes” has “die” as the first syllable. Are you going to die? Thankfully, no. Not today, and not within the next 20 years, either.

The next few years will be hard, actually, they all are. Sadly, even though diabetes is technically “manageable”, it never really gets any easier, but you’ll become tougher. You will try out four different insulin pumps before you find one, at the ripe old age of 30 (and spoiler alert, it’s tubeless). You’ll prick your tiny, fragile fingers literally thousands of times, but in 15 years (the time will fly by, I promise), you’ll use a seemingly magical machine that checks your blood sugar 288 times per day for you, without you having to do A THING, and it’ll transmit the numbers to your telephone (those things are cordless in the future, too). Eventually, but I’m getting ahead of myself now, those numbers will talk to your insulin pump for you, and make dosing decisions while you drive, or work, or makeout, or go running, or read a novel. Science is pretty neat.

Once you start the 7th grade, you won’t tell anyone about your new mystery disease. Honestly? You’re embarrassed. The only other people you’ve ever met with diabetes were your elderly next-door neighbor’s sister and Wilford Brimley, from TV. You make your mom pinky swear that she won’t tell your friends’ moms, and you promise yourself that you just won’t attend sleepovers until you go away for college. Please don’t do this to yourself. Spare yourself the heartache. Diabetes will give you physical battle scars and mental wounds, but it will also develop some of the most beautiful attributes people will love about you: your compassion for others, your enthusiasm to live in the moment, your fearlessness in the face of adversity, your humility, your grace.

You’ll be the only 13-year-old girl drinking Tab at your bestie’s summer birthday party. Don’t be embarrassed. Exotically-flavored seltzer waters will be all the rage in 20 years. You’re just ahead of your time.

You’ll grow up quickly. You were always conscientious, polite, and studious, but having diabetes will make you disciplined, strong-willed, and courageous–you won’t really have a choice in the matter. Diabetes will toughen you where you’re soft; diabetes will break you open.

You’ll become obsessed with counting carbs (trust me, this is good), and dosing correctly (also good), but will become preternaturally focused on food and nutrition. You will deny and deny and deny. You’ll eat an apple when everyone is enjoying an ice cream; you’ll swear that string cheese is more fun than cookies. This can sometimes be good in the name of a better hba1c, but please, let yourself be a child for a little while longer. You’ll cry, because having a chronic disease can be very lonely and sad sometimes, and it’s okay to be sad sometimes, too. Go to therapy. It’ll be worth it.

Your mom will make you go to diabetes camp. You will resist going at every turn. You will cry and scream, and when she drops you off at the loading dock of Camp Setebaid, you swear you’ll never talk to her again. But by night three, you will have forgotten all about the hardships of living amongst “nons”. You’ll meet some of your closest friends at diabetes camp, and they’ll last a lifetime. You’ll have camp crushes, and camp kisses, and still remember campfire songs until your mid-30s. You’ll go waltzing with bears, and do the polar bear swim, and learn how to build a campfire, and get lost in the woods under a velvety night sky, and will learn how to use a cleavus, and will eat two dozen chocolate chip cookies one night when you accidentally replace your dose of Lantus with Humalog (oops). You’ll pee your pants laughing, and cry every summer when camp ends. You’ll make many friends along the way–friends who get it, who get you, for the first time ever. You’ll lose some of them over the years, to diabetes, or depression, or both, and will weep at their funerals. Your best camp friend will be in your wedding party in 17 years.

You’ll become tough. You never asked for this life, but you sure have made a point of living it to the fullest. There will be many doctors who will try and tell you things you can’t or shouldn’t do: join the swim team, play competitive sports, travel abroad, go to college out of state, have children–and you’ll prove most of them wrong. You will learn to not take no for an answer. You’ll develop an iron will. You’ll become gritty as hell.

Diabetes will encourage your interests in health and well-being, and out of college you’ll be a social worker, eventually getting your master of public health (I don’t think this degree exists in 2000, but it’s coming down the pike). You’ll be a vegetarian. You’ll run marathons. You’ll climb something that’s called a 14er (I know you live in Pennsylvania, but someday, when you live in Colorado, this will be a very big deal). You’ll find your dream job of working in diabetes advocacy, that will take your passion and use it to help thousands of other people who struggle with the same issues you do. You’ll change lives for the better.

One day, you’ll meet a man at work, who’s sweet and kind and compassionate. One evening, still in the early days of dating, you’ll notice he bought three containers of glucose tabs and stored them in his pantry without telling you. “Just so you feel safe here,” he says. Three years later, you’ll marry him.

In 20 years, you won’t have everything all figured out, but you’ll know more about who you are, and who you want to be. And diabetes, in large part, has helped to craft that. I know you’re seeing dad cry right now, so why don’t you go give him a hug and let him know everything will be okay. Because, really, in time, it will be.

Love,

Christine

Source: diabetesdaily.com

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