How Type 1 Diabetes Brought My Father and I Closer Together

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

By Samuel Frank

Lifelong Reality

I have no memories of my father without diabetes. My father was diagnosed with type 1 in 1989 when I was 3 years old. Diabetes and Papa Frank were always hand in hand, one and the same. As a chemistry professor and academic, he seemed to get a thrill from stable numbers and consistent control and he would never shy away from talking about it.

My father is incredibly loving, especially to his family. He loves to share a story or an exciting idea. I’m blessed to have grown up with such a loving, kind-hearted father — at no point were aggressive assertions of masculinity expected from me nor my brother. He is also very particular, specific, and regimented — presumably from having type 1 for so many years, or maybe, that’s just how he is.

Growing up, my father would work as a professor and come home around 5:00 p.m. And he had a list of maybe ten meals he would prepare, with occasional variations. He developed a “square meal” that was his baseline, average, expected, protein-and-vegetable rich meal. No snacks or sugary beverages, caution and restriction while eating out — all told, a marvelous diabetic. As a child, I don’t recall a moment when his health was in danger or his diabetes management was questioned. And it wasn’t a mystery; my father loved to disclose his diabetes management. A dinner out would often end with a round of, “Guess what my blood sugar is?!” And as a child, I knew enough about the symptoms of hyper- and hypoglycemia to make a prediction. When my father was on target after dinner, he was almost elated. The 115 mg/dL was a symbol of harmony for me. If my father was happy, I was too.

Kindred Spirits

I always saw myself in my father and he was always quick to relate to me. We both had one older brother, which created a powerful and unique dynamic of understanding. But it wasn’t just this. My father loved identifying our similarities and I loved being recognized, being seen, and losing that feeling of being alone. Today, I am 33, and this has remained ever so consistent. There have always been physical and emotional similarities between us. So, echoing my father, throughout my life, I imagined what it would be to have type 1. The poking and prodding of needles appeared horrific. And I often wrote it off, as he would be the first to remind us that he was 44 — later in life — when he was diagnosed. It happened the same way with his aunt and grandmother.

Samuel

Image source: Beyond Type 1

But it happened to me at 27, earlier than the other members in my family. I was in my second year of graduate school for social work and marvelously stressed. I went into DKA on December 27, 2013 while visiting my family in Fresno for the holidays. At one point in the weeks prior, I recognized some of the symptoms but attributed them to stress from graduate school and chose to ignore them. My family didn’t recognize the DKA since no one they knew had experienced it before, but they followed their instincts and my parents took me to the ER as I continued to get worse.

While traumatizing, it couldn’t have happened at a better time of year. After 3 days in the hospital, I took a week off from my internship in San Francisco and stayed home with my parents, acting as my father’s diabetes mentee. It was emotional and challenging and confusing, but I was so thankful not to have to do this alone.

So during that week, I dove into diabetes management, meals, and lifestyle adjustments. After meeting with a few endocrinologists and health educators, I learned about carb counting and daily totals. My father doesn’t carb count; since he has such a solid meal regimen, he knows how many units of insulin to take to maintain a functional rhythm. As I was learning how to bolus, he would lean over my shoulder, look at my plate, and create an approximation. My father owns his decision to use his square meal method instead of carb counting, stating, “I see it not as a calculation, but as an art.” I don’t think he’s wrong, but it felt divergent from the messaging I received from medical professionals. The nurse would tell me one thing but my Papa would tell me something else. I needed to make my own way.

The Same but Different

We were never apart, but diabetes brought my father and I closer together. To this day, it gives us something to talk about. I’m often captivated by his stories of obscure blood sugars at an inconvenient time, and I can share mine. When I’m fed up with abnormalities, my father is always there for support and advice. We learn together about modern technology to help our management and share information. Plus, most importantly, by growing up with a diabetic parent, he normalized the subject matter. I speak about my disease, my insulin pump, and management style with glee to my coworkers and friends. I think I notice a little bit of my father come through when I speak with good friends about a successful bolus for a carb-heavy meal.

Don’t get me wrong, we are also different people. I’m now 33 and don’t have children, so my lifestyle remains much more variable than my father’s ever appeared. My mealtimes are quite inconsistent, and my diet often fluctuates; I drink, I travel, I stay up late. But to this day, when he and I are eating the same meal and the same portion, it’s nearly the exact same size bolus that we give ourselves. I truly have my father’s disease. And that means I carry my family line ever so truly.

It always meant so much that I didn’t have to learn this alone. I wish for every parent of a child with diabetes to not just have compassion, but empathy and robust understanding, to normalize frustrations of the disease and its limitations for that child. I learned recently that type 1 isn’t always genetic, and often diagnosed earlier in life. The Frank family pancreas seems to just give out after a while, leaving us diagnosed later in life. But that makes our situation all the more unique, rare, and maybe even, special.

Source: diabetesdaily.com

Was Your Medicare Claim Rejected? Here’s How to Appeal

This content originally appeared on diaTribe. Republished with permission.

By Kara Miecznikowski and Eliza Skoler

Learn how to appeal a Medicare claim rejection under traditional fee-for-service Medicare, a Medicare health plan, or Medicare prescription drug coverage

A health insurance claim is a bill for your healthcare services, medications, or medical equipment that you think should be covered by your insurance plan. If you have Medicare health insurance, your healthcare practitioner will usually submit claims directly to Medicare for payment. If Medicare decides to reject the claim, you can challenge the decision. This is called an appeal.

In the United States, people have the right to appeal a denied claim for up to six months after hearing about this decision. Appeals can often be successful – a 2018 report showed that 75% of Medicare Advantage denials were overturned in the appeals process – which means that challenging a denied claim could save you money. This article will explain how to appeal a Medicare claim rejection.

To learn more about the appeals process in the United States – especially if you have a different health insurance plan – read our article, “When Insurance Gets Turned Down: Appeals Explained.”

How do Medicare appeals work?

You can appeal a decision made by the national Medicare fee-for-service program (Parts A and B), your private Medicare health plan (Part C), or your Medicare Prescription Drug Plan (Part D). Learn more about the different types of Medicare here.

Click to jump down to:

Appeals under Medicare Part A or B (“Original Medicare”)

Appeals under Medicare Part C (Medicare Advantage health plan)

Appeals under Medicare Part D (prescription drug plan)

Here are some common situations for appealing a claim rejection:

  • If you have already received the service, medication, or medical supplies. Example: your doctor gives you lab tests during a visit, but then Medicare rejects the claim.
  • If your doctor requested the service, medication, or medical supplies for you. Example: your doctor says you need an insulin pump and Medicare decides that is not medically necessary.
  • If you and your doctor request a change in price for your medication, based on what treatments work for you. Example: generic drugs do not work for your condition, so your doctor asks for a discount on the more expensive drug.

The appeals process is different under Medicare Part A, B, C, or D. There are five levels to the appeals process. If you disagree with the appeal decision at level one, you can continue to appeal the decision again at every other level.

With each appeals processes, write your Medicare number on every document you submit for your appeal, and keep a copy of all the materials you send in.

Filing an appeal under Medicare Part A (hospital insurance) or Part B (medical insurance), often called “Original Medicare:”

  • Your bill will be sent directly to Medicare.
  • The appeal must be filed within 120 days of receiving the Medicare Summary Notice (MSN) that shows that your claim was denied.
  • If you disagree with a Medicare coverage decision in the MSN, you can appeal the decision.

A Medicare Summary Notice (MSN) is a summary of the health care services you have received over the past three months, sent to you by mail.  It shows what Medicare paid for each service and what you owe for the service, and it will show if Medicare fully or partially denied a medical claim. The MSN also contains your appeal rights and step-by-step directions on when and how to file an appeal for a claim rejection.

Did you sign an Advanced Beneficiary Notice of Noncoverage (ABN) before you received the treatment? An ABN is a notice that your healthcare provider will give you if they think the health services they are recommending might not be covered by Original Medicare. Your ABN will list the items that Medicare is not expected to pay for, as well as the estimated costs of those health services. The ABN can help you decide if you would still like to receive the treatment, and if you will pay for it if Medicare declines to cover the cost.

When you sign an ABN you can ask your healthcare provider to submit the claim to Medicare (before billing you), asking Medicare to cover the cost. If Medicare rejects the claim, you can appeal the decision. If your healthcare provider did not give you an ABN before treatment, you might not be responsible for paying for the health service. Learn more ABNs and appeals here.

There are three different ways to file an initial appeal under Original (Part A or B) Medicare:

appeals

Image source: iStock Photo

  • Fill out a “Redetermination Request Form” with information from your MSN; send the form to the address provided on your MSN
  • Follow instructions on your MSN for filing an appeal without using the form:
  1. Circle the claim that you disagree with on your MSN
  2. On a separate piece of paper, explain why you disagree with the decision
  3. Write your name, address, phone number, and Medicare number on the MSN, and sign it
  4. If you have any other information that will support your case, include it; you can ask your doctor or other health care provider to help you
  5. Send all of the above materials to the address listed under “Appeals Information” on your MSN
  • Or, send a written request to the company that processes Medicare claims. Include:
  1. Your name and Medicare number
  2. The item that you disagree with on the MSN
  3. An explanation of why you disagree with the decision
  4. Your signature
  5. Send all of the above to the address provided under “Appeals Information” on the MSN

You should receive a decision within 60 days of your request, unless you submit extra information after you first file the appeal (which may delay the decision).

For more information on the Original Medicare initial appeals process, see the Medicare webpage. If you disagree with the appeal decision at the first level, you have 180 days to file an appeal at the second level; information on the appeals process beyond level one can be found here.

Filing an appeal under Part C (Medicare Advantage health plans):

  • The initial appeal must be filed within 60 days of receiving the claim rejection.
  • You must send a written request (unless your plan allows you to file a standard request by phone, fax, or email instead).

In your request, include:

  1. Your name, address, and Medicare number
  2. The item you disagree with, the date that you received the service, and an explanation of why you disagree with the decision
  3. Any other information that may support your case

You should receive a decision about your appeal within 60 days, unless Medicare needs more time to obtain information from your healthcare provider. If waiting for a decision will hurt your health, your appeal decision will be made within seven days.

If your appeal is rejected (fully or partially), your request will automatically be sent to level two of the appeals process. More information on the initial appeals process under Medicare Part C can be found here. For information on the process after level one, click here.

Filing an exception request or appeal under Medicare Part D (prescription drug plans):

  • Reasons to request an exception to your Part D drug plan:
    • If your plan decides not to provide a medication you think should be covered.
    • If cheaper versions of your medication don’t work for you, you can ask for a discount on the more expensive medication.
    • If a drug you need is not on your plan’s drug list, you can ask for an exception.
  • An exception request must be submitted first; if your exception request is denied, you have 60 days to appeal the prescription drug claim rejection.
  • You must send a written request (unless your plan allows you to file it in another way).

An “Evidence of Coverage” document explains your rights with your Medicare prescription drug plan. You have the right to ask your plan to pay for a medication you think should be covered, and you have the right to request an appeal if you disagree with your plan’s decision to provide it.

appeals

Image source: iStock Photo

Before appealing a claim rejection, you will request an exception:

  1. Fill out a Medicare Prescription Drug Coverage Determination request form through your insurance plan sponsor
  2. Ask the healthcare provider who prescribed your medication to write a letter explaining why you need this medication
  3. Send the documents to your Medicare health plan

You should hear back about your request within 72 hours. If your exception is denied, you can appeal the claim rejection. To submit a written appeals request, include:

  1. Your name, address, and Medicare number
  2. The drug you want your plan to cover
  3. An explanation of why you are appealing the coverage decision.
  4. Any other information that may support your case, including medical records
  5. Send the documents to your Medicare health plan

You should receive a decision within seven days. If waiting for a decision will hurt your health, your appeal decision will be made within 72 hours.

More information on the initial prescription drug appeals process can be found here. If your request is not met (fully or partially), you have 60 days to appeal the decision at the next level; learn about further appeals here.

How can I get help filing an appeal?

You can have someone else file an appeal for you. This can be a family member, friend, lawyer, doctor, or anyone else that has agreed to be your representative. For more information and the representative form, see the Medicare website page on how to appoint a representative. For prescription drug appeals, your doctor or prescriber can request an initial appeal for you; you do not need to first fill out a form.

For more help with appeals, especially appeals beyond level one, contact your State Health Insurance Assistance Program (SHIP). SHIP is a network of free counseling services that help people navigate Medicare; find the SHIP program in your state here.

diaTribe Series

Image source: diaTribe

This article is part of a series on access that was made possible by support from AstraZeneca. The diaTribe Foundation retains strict editorial independence for all content. 

Source: diabetesdaily.com

My Dos and Don’ts for People Without Diabetes

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

By Erika Szumel

Managing type 1 diabetes (T1D) means insulin calculations, getting plenty of exercise, and making strategic meal plans. But it also means awkward moments, unnecessary advice, and lots of looks from people who don’t live with diabetes.

While we might be well-equipped to take care of our disease, we aren’t always ready for these awkward moments with strangers, friends, and family who might not understand what we live with.

Here are the dos and don’ts of diabetes etiquette for those without diabetes, written by a T1D.

Do Ask Questions.

If you’re speaking to someone with type 1 diabetes, ask questions about the condition. I believe that 9 times out of 10, when the question is asked kindly, that the T1D will be happy to answer you. At the end of the day, we’d rather you understand better than continue to walk around with misconceptions.

Don’t Ask Loaded Questions.

Is it the bad type?
So you just have to watch your diet, right?
Did you eat too much sugar as a kid?

When people with T1D hear questions like this, it can be enlightening and frustrating at the same time. Enlightening because I am surprised to hear people still make these assumptions or have these ideas. Frustrating because these people still make these assumptions or have these ideas. Try phrasing a question like, “Can I ask you something so I understand type 1 more clearly?” or “Do you mind telling me more about it?”

Do Be Supportive.

What does being supportive really mean to you? For someone with type 1 Diabetes, it’s nice to know that others sort of understand what’s going on and that they are willing to help if needed. This could simply mean checking in on your friend or helping them find a snack when they are low. Showing your support displays itself in various ways.

Don’t Tell Us Horror Stories About Your Relatives.

The general public tends to have the idea that telling someone with T1D about your grandfather who lost his foot because of diabetes is, I don’t know, helpful? Most patients diagnosed with T1D are aware of the possibility of complications and their effects on the body caused by T1D. Please do not feel like it is your duty to remind us of the things that can happen to us (or may have already started) when you don’t know! Bring this into the conversation if the person with T1D has started talking about it or asks you a question.

Do Help Us Be Prepared for Lows.

Whether you’re a spouse, friend, or coworker, helping us be prepared for lows is such a kind gesture. That simply means knowing where snacks or low treatments are in the home or office and helping us get them when we need them.

Don’t Shrug Us off Simply Because What’s Happening Is Invisible.

Type 1 diabetes is an autoimmune disease that can have some serious consequences. The scary part: it’s mostly invisible. Other than my insulin pump and continuous glucose monitor (CGM) and their respective sites, you cannot tell that people with T1D are any different than you – with the exception of seeing us test our blood sugar or give a manual injection with a syringe or insulin pen.

I think one of the worst feelings I encounter having this condition is feeling like it means nothing to those around me – and this is usually solely because of ignorance or lack of understanding. Please don’t shrug it off as the “take insulin, watch what you eat” disease, because it is so much more complex. Be mindful of those with T1D, and be willing to offer a helping hand if they need something.

Do Help Us Stop the Stigma.

If you’ve been around a T1D for some time and have learned enough about it, then help us stop the stigma. When you hear comments or jokes about it, do your best to raise awareness for what is true about this condition.

Don’t Ignore the Jokes.

I think a huge part of raising awareness for type 1 diabetes is simply stopping jokes and memes dead in their tracks. I think people will remember when you stop them in that moment and say “Hey, that actually isn’t how it works” or “It’s actually a lot more serious than that.”

At the end of the day, there are a few things you should and shouldn’t do as a good friend, partner, or stranger to the millions of people affected worldwide by type 1 diabetes. Hopefully, this list will help you do just that.

Source: diabetesdaily.com

Ways to Save Money on Diabetes Expenses

Diabetes is an expensive disease. According to the Journal of the American Medical Association (JAMA), diabetes is the costliest disease in the United States. In 2017 alone, over $327 billion dollars was spent on people with diabetes and their needs, and that number has only increased since, as prevalence and incidence of the disease have risen as well.

Diabetes is also expensive, personally. Between medications, doctors’ appointments, time off work and school, buying healthy foods, and committing to an exercise routine, it can be troublesome to keep on top of all the bills and expenses. A landmark Yale study recently showed that as many as 1 in 4 people with diabetes have rationed their insulin, simply because it’s too expensive.

So, how do you prepare for the cost of a new type 2 diabetes diagnosis? In part 2 of our 4-part series, we dive into how to protect yourself from the high costs of diabetes.

Prescription Assistance Programs

Talk with your doctor or pharmacist about prescription assistance programs. They can help you get free or lower-cost drugs, especially if your income is low or you don’t have health insurance. Online resources, such as RxAssist, can also point you in the right direction towards prescription drug cost relief.  You can also get lower-cost care at a Federally Qualified Health Center, if you meet certain eligibility requirements.

Take Advantage of Your Employer’s Section 125 Plan (If They Have One)

These flexible spending arrangements let you contribute up to $2,650 per year (pre-tax!) to spend on out-of-pocket expenses for things like prescription drugs and copays for doctor visits. These plans usually adhere to a “use it or lose it” policy, so make sure you’re spending down anything left over in these accounts towards the end of your enrollment year (usually in December every year).

Enroll in Medicare

Many people 65 and older are not enrolled in Medicare, but if you’re diagnosed with diabetes, it’s highly recommended that you take advantage of this program. Medicare Part B covers a portion of bi-annual diabetes screenings, diabetes self-management education classes, insulin pumps and glucometers, and regular foot and eye exams. Medicare Part D covers insulin expenses. Learn more about the Medicare application process here.

Mail Order Your Supplies

If you’re able, use mail order to get recurring medications and supplies (you can sign up through your existing pharmacy). Oftentimes, you can buy a 90-day supply of your medicine for a single copay, instead of three separate copayments for three separate months. Mail-order supplies are bulk packaged and shipped to your home. This can be an excellent alternative if it’s hard to leave your home, and if you know you’ll need the same medication consistently, for months at a time. It’s also helpful in saving you money. Additionally, a lot of (over the counter) supplies can be bought in bulk from online retailers like Amazon for a fraction of the price you’d pay at a traditional pharmacy.

Ask Your Doctor About Generic Drugs

Although there is no generic form of insulin, many pills taken for type 2 diabetes are available in generic form. A bottle of Glucophage (60 tablets) costs around $80, but the generic form (metformin) will cost you about $10. Talk to your healthcare provider about generic options that are available to you.

Taking these small steps can add up to big savings over time, and can help you to live a long, healthy life, without the threat of complications. Plus, saving money on your diabetes supplies can help you invest in other (more fun) areas of life!

Have you found ways to better budget for your diabetes? How have you saved money for this costly condition? Share this post and comment below!

Source: diabetesdaily.com

Research Trends with Dr. Maria: Cholesterol Benefits & More

Dr. Maria Muccioli holds degrees in Biochemistry and Molecular and Cell Biology and has over 10 years of research experience in the immunology field. She is currently a professor of biology at Stratford University and a science writer at Diabetes Daily. Dr. Maria has been living well with type 1 diabetes since 2008 and is passionate about diabetes research and outreach.

In this recurring article series, Dr. Maria will present some snapshots of recent diabetes research, and especially interesting studies than may fly under the mainstream media radar. Check out our first-ever installment of “Research Trends with Dr. Maria”!

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Allergen in Diabetes Tech Adhesives

Diabetes technologies, like insulin pumps and continuous glucose monitors, are steadily gaining popularity, especially among patients with type 1 diabetes. While the technological advances have shown considerable benefit in improving patient outcomes and quality of life, one common issue is the unfavorable reactions to adhesives. A recent study published in Diabetes Technology & Therapeutics identified that a common culprit of these allergic reactions to adhesives may be a chemical called colophonium, a commonly-used adhesive, which was shown to be an allergen in over 40% of patients in the small study. Read more about the study and the use of this adhesive in medical products here.

Bariatric Surgery May Worsen Retinopathy

Retinopathy (eye disease) is a common complication of diabetes, and can be serious, leading to severe visual impairment and even blindness, especially when left untreated. A recent study published in Acta Ophthalmologica has uncovered a potential link between patients who undergo weight loss surgery and worsening retinopathy. Researchers adjusted for confounding variables, including glycemic control (A1c) and found that those who underwent bariatric surgery experienced worse retinopathy outcomes. Although the sample size was small, the data showed a significant worsening of eye disease in those who underwent surgery as compared to controls. Learn more about the study and outcomes here.

Super Healthy Probiotic Fermented Food Sources

Photo credit: Adobe Stock

Benefits of Probiotics for Type 2 Diabetes

The relevance of the gut microbiome in various health conditions, including diabetes, is gaining more and more attention. A recently published meta-analysis in The Journal of Translational Medicine discusses what we currently know about the effects of probiotic supplementation in patients with type 2 diabetes. Excitingly, probiotics can improve insulin resistance and even lower A1c! Learn more about exactly what the clinical trials have shown here.

Herbal Therapies Gaining Attention

With most modern medicines derived from plant compounds, it is not surprising that more research is being geared toward examining the effects of various herbal remedies on blood glucose levels and insulin sensitivity. A recent review published in The World Journal of Current Medical and Pharmaceutical Research summarizes the effects of some medicinal plants with potential anti-diabetic properties. Learn more about what is known about commons herbs and how they may be beneficial for glycemic control here.

Low HDL Cholesterol Linked to Beta Cell Decline

Research has previously suggested that higher HDL cholesterol levels may be protective of beta-cell function. A longitudinal study recently published in Diabetes Metabolism Research and Reviews indicated that patients with lower levels of HDL cholesterol were more likely to experience beta cell deterioration and develop type 2 diabetes than those with higher HDL cholesterol levels. Learn more about this study here.

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Please share your thoughts with us and stay tuned for more recent research updates!

Source: diabetesdaily.com

100 Things You Can Do This Year for a Better Life with Diabetes

The New Year is here and many of us are hoping to make those resolutions stick. Keep in mind that there are many ways you can influence change, and some steps you can take may seem small but are very effective nonetheless. Please note that anytime you make changes to your diet or exercise routine, it’s also a good idea to check in with your doctor and plan ahead for any necessary medication adjustments.

Without further ado, check out this list of 100 simple things you can try to do this year for a better life with diabetes:

  1. Change your lancet.
  2. Eat lower carb.
  3. Take the stairs.
  4. Join a gym.
  5. See your eye doctor.
  6. Try a new vegetable recipe.
  7. Pack your lunch.
  8. Cut back on alcohol.
  9. Quit smoking.
  10. Invest in comfortable shoes.
  11. Buy a scale to keep accountable.
  12. Check your blood pressure.
  13. Stand while working.
  14. Go for a walk after lunch.
  15. Give gardening a try.
  16. Grocery shop the perimeter.
  17. Stretch.
  18. Keep a blood sugar log.
  19. Try a new diabetes app.
  20. Consider a continuous glucose monitor (CGM).
  21. Check your blood sugar more often.
  22. Don’t reuse your needle/syringe.
  23. Use alcohol swabs for injections and site changes.
  24. Read a book about diabetes.
  25. Join a diabetes support group.
  26. Choose green veggies over starches.
  27. Visit your endocrinologist.
  28. Do basal testing.
  29. Track your cycle.
  30. Count carbohydrates accurately.
  31. Try a half-unit syringe or pen.
  32. Consider trying an insulin pump.
  33. Ride a bike.
  34. Consider getting a pet.
  35. Eat more real food.
  36. Cut back on dessert.
  37. Try a flour substitute.
  38. Try a sugar substitute.
  39. Track your macronutrients.
  40. Track your steps.
  41. Educate about diabetes.
  42. Start a fundraiser.
  43. Attend a diabetes event.
  44. Sign up for our newsletter.
  45. Participate in diabetes surveys.
  46. Treat lows only with glucose.
  47. Eat consistent meals.
  48. Consider intermittent fasting.
  49. Ditch the foods that don’t work well.
  50. Invest in quality proteins.
  51. Eat more plants.
  52. Eat less processed foods.
  53. Ice skate.
  54. Try canoeing.
  55. Go hiking.
  56. Spend more time in nature.
  57. Shovel snow.
  58. Go swimming.
  59. Try ziplining or tree-to-tree.
  60. Get your A1c checked.
  61. Lower the high alert on your CGM.
  62. Eat more probiotics.
  63. Get more fiber.
  64. Swap juice and soda for more water.
  65. Sign up for a “couch to 5k” program.
  66. Jog.
  67. Go rock-climbing.
  68. Rotate your injection sites.
  69. Change your pump-site regularly.
  70. Change your CGM sensor regularly.
  71. Wear your CGM more.
  72. Review your CGM report regularly.
  73. Get a primary care physician.
  74. Get your flu shot.
  75. Figure out if you’re a moderator or abstainer.
  76. Jump rope.
  77. Meditate.
  78. Start a journal.
  79. Keep a food log.
  80. Create a 504 plan for your child.
  81. Speak with your child’s school about non-food related celebrations.
  82. Advocate for yourself or your child better.
  83. Ditch the scale if you’re obsessing.
  84. Take before photos (you will want them!).
  85. Figure out what self-care means to you and practice it daily.
  86. Seek out a friend or therapist if you feel you need help.
  87. Give back to the community by volunteering your time.
  88. Try a sport or activity you never tried before.
  89. Have more grace with yourself.
  90. Surround yourself with positive influences.
  91. Try to see the big picture more often.
  92. Create a healthy work/life balance.
  93. Appreciate the little things.
  94. Don’t be so hard on yourself.
  95. Check in with friends who may need it.
  96. Spend more time with family.
  97. Take the time to thank others and let them know they are appreciated.
  98. Take more deep breaths.
  99. Target things you feel you can change and start with those.
  100. Remember to be grateful for another year around the sun.

Do you want to add anything that has worked well for you? Please share your tips in the comments below.

Source: diabetesdaily.com

Banned from Policing Due to Diabetes

Meet Craig Roth. He’s a fit, formidable man. By day, he helps to keep people safe from violence, crime, and illegal activities that often plague city streets. By night, he’s an active, well-respected, and engaged citizen. He loves his community, and they, him. He’s also been living with type 1 diabetes (T1D) since 1999.

This is Craig’s story, and it’s sadly not that unique. People with diabetes are often told that they can do anything, and having the grit and fortitude that we do, we believe them. We run track, we excel in school, we apply to colleges, we have first kisses, we make varsity, we travel abroad, we run marathons–we do a lot. But there’s still a lot that we can’t do, some barriers that we haven’t been able to crush. For Craig, becoming a Nassau County Police Officer was one of those barriers.

People with diabetes can be police officers. It varies by state, but minimum qualifications typically include being at least 21 years of age with United States citizenship and state residency (of where you’re applying), possessing a high school diploma or GED and a valid driver’s license, and demonstrating strong moral character. For people with diabetes, a medical doctor must also approve of the applicant prior to attending the police academy. The process is grueling, and the checklist is long:

  1. Meet the aforementioned minimum qualifications for prospective officers
  2. Complete an online application and self-assessment
  3. Take a written and video test and submit a background history packet
  4. Complete language skills and written suitability tests
  5. Pass the polygraph examination
  6. Attend an interview with a psychologist for psychological screening
  7. Pass the physical agility test
  8. Pass the background investigation
  9. Attend at least one formal interview with representatives from the police department
  10. Pass the background investigation
  11. Complete fingerprinting, a drug screen, and a medical exam
  12. Complete a second psychological exam
  13. Attend police academy training
  14. Complete field training as a probationary officer
  15. Begin working as a police officer

Craig Roth excelled at every step of the way, except the county medical exam.

After applying through the Nassau County Civil Service Commission (who’s in charge of hiring police in that municipality) in January 2015,  he was told that his application was on hold and that he needed to supply additional information regarding his type 1 diabetes, and also to undergo a cardiovascular stress test. This wasn’t all that abnormal, and he willingly complied.

By all accounts, Mr. Roth is healthy and fit. He wears an insulin pump, and maintains his HbA1c below 8%. He likes to run and stay active. But he, and other people with diabetes, are held to a higher standard when it comes to their health. The world expects excellence, perfection. A misstep, a low blood sugar, a seemingly innocuous pump failure, and we’re judged harshly.

In April 2015, his application was denied by the civil service commission. The reason given was, “endocrine condition which precludes ability to fulfill the physical requirements of a police officer,” according to official documentation. He appealed and submitted documentation from his endocrinologist proving that he was fit to serve. Due to his appeal, he was then referred to a county doctor, hired by the commission, for an additional health screening.

Despite having well-controlled glucose levels, normal heart rate, blood pressure, lung capacity, eyesight, hearing, mental agility, weight, and all normal blood draws, when Mr. Roth had his medical exam, the county doctor assigned to his case became concerned that “extreme physical exertion” required of police officers would cause “glycemic instability” in the patient, according to his deposition. In layman’s terms: exercise causes low blood sugars. The doctor was also concerned that the job could damage his insulin pump. He wasn’t “fit” for the job. Roth was ultimately rejected from the position.

We trust doctors. They save lives every day. But the problem here is that Craig Roth was 23 at the time of his medical examination, and had been living with diabetes for over 16 years at this point. Additionally, he had also previously been both a Long Beach Police Officer, a New York City Police Officer, and a security detail with the Nassau Community College, and never had any issues on the job. His endocrinologist gave him the green light to be a police officer. He was young, motivated, and in the prime of his life. He just wanted the opportunity to do what he loved.

Despite all of that, Mr. Roth was denied employment by Nassau County Civil Service.

Craig Roth

Photo credit: Craig Roth

In chatting with him for this story, Mr. Roth has said that he’s met many other women and men who have been denied the opportunity to become police officers simply due to their diabetes diagnosis. Dr. Marlaine Tapply, a doctor who works frequently with the civil service commission, found that Roth was only ever the third person with type 1 diabetes to apply as a police officer with the Nassau County Police Department. All three applicants were rejected.

Dr. Tapply said in her deposition that Roth was denied a job because of, “how brittle and fragile his diabetes was.”

These county doctors people are referred to oftentimes don’t know the patients, their histories, or their stories. They don’t specialize in diabetes (usually, they’re family doctors or internists). They’re often times unfamiliar with the nuances of type 1 diabetes. They simply see them for a 15-minute exam and make a determination that changes the course of their lives. Despite having adequately controlled HbA1c levels, and no complications, doctors can sometimes let their fear of the unknown and common stigmas around diabetes dominate their decisions to approve medical examinations for police officers, intelligence officers, the military, Peace Corps volunteers, pilots, and other professions that people with diabetes can have trouble accessing.

Wanting his story to prevent future issues for other people with diabetes, Mr. Roth says, “With additional light, I hope that people can understand that discrimination is alive and well against diabetics – however people turn a blind eye and choose not to care.”

In filing a lawsuit against Nassau County, Mr. Roth unfortunately lost. Nassau County offered a small cash settlement, albeit requiring he never be employed by the civil service commission in the future. He did not accept the terms. Appealing to the United States Supreme Court, they have decided not to hear the case.

This seems to only have fueled his passion, “I want people to know how the current system stands. Fighting this as a T1D is an uphill and costly battle, and needs to change.”

Mr. Roth has since found employment with another police precinct and hopes his story helps to spread awareness of the struggles people with diabetes face when seeking employment, even in 2020.

In Mr. Roth’s case, many turned a blind eye, and few were willing to help him seek the justice he so desperately deserves. Issues like these can arise when there are no standard hiring procedures around people living with a chronic disease, and determinations are made on a case-by-case basis, or “feeling.”

According to court documents, hiring officials homed in on five 911 calls made by the Roth family due to episodes of hypoglycemia, that Craig experienced while sleeping, over 3 years ago (at the time of his employment application). Only one resulted in Roth needing transport to a medical facility. At the time, Craig was not on a Continuous Glucose Monitor (CGM). He is now.

Little did his family know that those calls would change the course of their son’s future.

These are people’s real stories, and they need to be told. Our voices need to be amplified. We need to spread awareness of what’s going on, even in 2020, so that we’re finally listened to.

We thank Craig Roth for sharing his story and hope that someday he can find justice and peace.

If you feel that you have been discriminated against in the workplace, you can file a complaint with the U.S. Equal Employment Opportunity Commission.

You can file an Americans with Disabilities Act complaint alleging disability discrimination with the U.S. Department of Justice.

Have you ever been barred from a job because of your diabetes? Share this story and comment below!

Source: diabetesdaily.com

Treating Type 1 Diabetes in Bangladesh: Dr. Kaufman and Life for a Child

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

By Francine R. Kaufman, M.D.

Greetings from Dhaka

Traveling over the city by air and then languishing in traffic forever to get to the hotel, I see what now seems typical of a developing country: cars, motorbikes, rickshaws, and people at a standstill jammed up in traffic with horns blaring like a discordant symphony; people living on the streets; old buildings with new structures next to them supported by cranes and rebar trying to reach for the sky.

Yesterday, I was at the main diabetes hospital all day seeing patients. I was with Graham Ogle, who runs Life for a Child and continues to deserve sainthood for his global work in bringing care, education, supplies, and life to close to 21,000 children around the world who likely would perish without his efforts. Graham is so humble and focused; he seemingly knows everyone and everything about the care of children with diabetes in Dhaka, as well as everywhere Life for a Child collaborates with local health care providers in over 40 countries.

Kid

Image source: Beyond Type 1

The diabetes hospital – called BIRDEM – is run by Dr. Bedowra Zabeen, an amazing woman and endocrinologist who is known worldwide for her work throughout Bangladesh. They follow over 7,000 children with diabetes (there are 9,000 total in all of Bangladesh); hundreds come in each day for outpatient care or to be admitted. The Life for a Child program follows 3000 children and young adults (up to age 26) and the Novo Nordisk program helps with another 3000 children. This means few can afford to buy insulin and supplies on their own since there is still insufficient support by the government or insurance programs in this country. From Life for a Child, they can only get regular and NPH insulin and 1-2 blood glucose strips per day. This is how I practiced pediatric diabetes 25-35 years ago. There are a few using newer insulins and even a few with insulin pumps, so if there are resources, families can buy better diabetes care than what is offered by these free charity programs.

Work to Be Done

The patients come through like a torrent. First, a newly-diagnosed child, so emaciated and weak, she could barely stand up. Then 4 children who seemed to be about five-to-six-years old, not adequately treated because they don’t have enough glucose strips, and as a result no chance to appropriately adjust insulin doses. School was a problem for each, either they had to miss a lunch shot or their mother had to come to administer it – most often without first doing a blood test. One was very hyperglycemic because her parents were unable to deny her anything she wanted to eat.

There were also two adorable 17-year-old twin girls, diagnosed within a year of each other, who had just graduated from high school and were waiting to see if they could go on with their education. Despite sleeping late, missing shots, and pretty much de-prioritizing diabetes (the universal story of adolescence and young adulthood), their A1cs were still good, mainly because they had way too many low glucose levels. There were many more routine cases: children taking only two insulin shots per day, having too few blood tests, not having refrigerators to store their insulin (they use clay pots instead), and feeling stigmatized and ostracized.

Then came the really hard cases: a child with severe insulin resistance (likely a gene defect due to too many consanguineous marriages in this country) taking 200-300 units of insulin per day, a child with dermatomyositis (a severe autoimmune disease of the skin and muscles) taking 500 units or more a day and chemotherapy and suffering the crippling joint effects of this rare disease that is most often complicated by diabetes. The fact that her hands were stiff and crippled made it all so much more amazing that she is an artist.

There were a number of pubertal children and even prepubertal children with type 2 diabetes – it’s hard to find someone who is not overweight/obese in Dhaka City, and the children appear to be the most affected. Bangladesh has one of the highest rates of diabetes: 8-10% of the population is affected and it is expected to quickly increase to 13% – and this is mainly Type 2. There are higher rates of kidney complications, but the most difficult aspect of having diabetes in Bangladesh is the stigma, the lack of education concerning its cause (children and their mothers are blamed), and the chance that anyone – particularly a child – can succeed with this disease.

Why We’re Here

Our type 1 diabetes workshop in Dhaka was sponsored by Life for a Child, the Bangladesh Diabetes Association, and ISPAD (the International Society for Pediatric and Adolescent Diabetes), and was organized by Dr. Zabeen. Forty-five physicians and nurses, dietitians, and psychologists from 11 cities and areas across Bangladesh attended our lectures and presentations. Some of the participants flew to Dhaka from the north, took trains for hours, and then battled the Dhaka City traffic to get to the Dhaka Club. It was a parade of brightly colored, sparkling saris since most of the attendees were women; many of the men had red hair and beards from henna staining.

Kid

Image source: Beyond Type 1

Our lectures were intermixed with lectures delivered by Dr. Zabeen, Dr. Azad (who started the field of pediatrics in Bangladesh), and a few other physicians who related the Bangladesh experience in childhood diabetes, pregnancy and diabetes, Ramadan and diabetes, and nutrition and diabetes. They discussed the struggles of managing this difficult disease in an area of our world with unimaginable poverty, very limited access to lab testing, supplies and medications (all with no way to pay for them short of a charity program, like Life for a Child), and in a culture deeply rooted in both prejudice and misunderstanding about diabetes. Schools make no concessions for the children at all, blame is placed on mothers and the children themselves, and they are often denied basic opportunities.

A young, 26-year-old woman who was diagnosed with type 1 diabetes (T1D) at 7 years of age came to speak to the seminar attendees. As a result of having diabetes, she was devalued so her father married her off at age 14. As usual in the villages, she went to live with her husband’s family. Since she arrived 12 years ago, her mother-in-law has not allowed her to have food unless her husband is home – and he works all day. So she fasts all day long, gets frequent and severe hypoglycemia, and often takes no insulin at all. Somehow in the midst of this all, she had a baby 5 years ago, and this little 5-year-old girl was skipping and running around, and adorable.

After our lectures each day, we took selfies with the attendees, and we even danced after my lecture on physical activity. The sway of the saris was mesmerizing and the joy and laughter totally infectious. Amidst it all, their questions and comments revealed how committed they all are to advance diabetes care for children in Bangladesh despite all of the obstacles. It was a struggle to go to the airport, but I somehow sat in the backseat and resigned myself to the stop and go traffic, the veering of cars from one lane to the other, and the constant cacophony of horns. It seemed to fit with my simultaneous feelings of despair and hope – with a great belief in Dr. Zabeen and her teams of amazing health care providers and her patients willing to share their stories.

Source: diabetesdaily.com

Time Flies! Don’t Wait to Use Your Year-End Insurance Benefits on a New Insulin Pump

Time for a new insulin pump? Regardless of the time of year, with the t:slim X2™ insulin pump, you won’t need to replace it when the next big features arrive. Stacey Simms shares how using your year-end insurance benefits can be your best option to pay less.
Source: diabetesdaily.com

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