David’s Journey to Becoming a Certified Diabetes Educator

We spoke to someone with type 1 diabetes who is working on earning their Certified Diabetes Care and Education Specialist (CDCES) credential, formerly known as Certified Diabetes Educator (CDE). David shares some of his journey and explains more about this educational process. 

Hi David, thank you so much for taking the time to speak with me. So many people living with diabetes are passionate about our cause and choose a profession related to our condition. I am always seeing questions within the community about how to become a Certified Diabetes Care and Education Specialist (CDCES) and I thought it would be helpful for our readers to have someone walk us through their journey on becoming a CDCES.

When were you diagnosed with type 1?

I was diagnosed with type 1 diabetes on October 13, 2008 when I was 11 years old.

How did you handle it growing up?

I didn’t know how to handle it as a kid, honestly. I hadn’t fully accepted my disease until I turned about 14 years old when I began to take this disease into my own hands in a more responsible fashion. Once I fully accepted this disease, I handled it very well, in a positive light!

Have you always wanted to become a CDE or did you start down a different path?

No! I actually didn’t want to be a certified diabetes educator until my junior year of college. I was choosing to go on several different routes. I started out majoring in biomedical sciences/pre-med to become an endocrinologist, then changed to pre-dentistry, and then I lastly switched to graphic design. I was convinced I wanted to be a graphic designer, up until I was in my third year of college, I realized my calling to become a diabetes educator, as I realized my passion for educating others on diabetes and tackling some of the common misconceptions behind it.

I then dedicated all my design work to becoming centered around diabetes education and stereotypes and then graduated with my BFA in graphic design, emphasis in photography and digital illustrations, creating a final Senior Gallery Exhibition where I was able to hold a display in a gallery of design work 100% related to type 1 diabetes. Now, a year later, I am getting my master’s in public health, majoring in health education and wellness coaching to eventually become a Certified Diabetes Educator, all with a designer’s twist to it!

Did you have any mentors (like a diabetes educator) who helped you with diabetes management? 

I would say first and foremost, my very first (pediatric) endocrinologist who diagnosed me as a type 1 diabetic and was very encouraging to me that I could lead a normal life with type 1 diabetes. I also have been inspired by several active members and leaders in the diabetes community who have truly shaped my passion and experience in this diabetes space.

Photo credit: David Mina

Did you have any positive or negative experiences with educators that shaped your perspective of how to best approach helping others with the condition?  

Yes! Absolutely. When I was about 13 years old and began caring for my diabetes on my own terms, I wasn’t caring for my diabetes in a responsible way, which led my hemoglobin A1c to skyrocket and be at the highest it had ever been. Once I went in for my 3-month check-up with my endocrinologist and diabetes educator, my diabetes educator sat me down and gave me a very mean and stern lecture as to how I was not caring for my diabetes and if I kept that up, I would be facing some very serious consequences, such as amputations, heart problems, and vision loss.

After that appointment, as scared and depressed as I was, I took that anger and frustration and proved not only my diabetes educator wrong, but I also proved to myself that I could reach a certain level of peace and stability over my own diabetes management. Though my diabetes educator hurt me with the words she used and her strict demeanor, I thank her for instilling that drive in me to fight against my diabetes and create a world where diabetes does not have to be the “worst case” for anyone! That is when I chose to start up my social media brand, @type1livabetic, where I try to encourage others to view their diabetes with positivity, rather than negativity!

What was the first step you took in order to get closer to your goal of becoming a CDE?

The very first step I took in order to get closer to my goal of becoming a CDE was to finish my undergraduate degree in graphic design, create a full body of work related to type 1 diabetes, then apply into a masters program that would grant me a Masters in Public Health (MPH). Once I finish my master’s program in December of 2020, I will be one step closer to earning my title as a Certified Diabetes Educator (CDE).

I understand you are more than halfway through the Health Education & Wellness Coaching Program through the School of Public Health. Congratulations! How has that been? I know you mentioned you liked to incorporate type 1 into class discussions and assignments, can you give us an example of something you did?

So far, my program has been pretty enjoyable for the most part. My biggest challenge thus far has been transitioning from design school and being a graphic design major, where I was so used to projects, rather than studying for tests and doing assignments. So now, being in a more health-related field, I am having to adjust my whole mentality in terms of how to go about studying and applying real-life health situations into my program.

When I get the chance, I always make sure to incorporate type 1 diabetes into any class discussion and/or assignment. At certain points in my program, we would have an assignment for class discussion and the topic would be diabetes that week. I chose to share my experiences with diabetes and try to educate my classmates at the same time, as I am aware that many still have some ideas about diabetes that may not be true, so I find as we all make it our mission to become health care professionals, I am able to help them gain a better understanding on what diabetes actually is, both type 1 and type 2, through simple lectures, class discussions, and assignments.

Photo credit: David Mina

What type of schooling do you need to have before you can go on to become a CDE? And are there different options?

The traditional route, from what I have heard, is that most CDEs have a background in nursing, nutrition, and/or dietetics, however, the type of schooling I need, based on the unique path I am going towards, is that I will need to gain my MPH degree, then obtain a certain amount of internship hours in the field of diabetes afterwards. After that, I will take the CDE exam and hope to become an official CDE finally!

Have you found other people living with diabetes going through your program?

I honestly have not, as my path is very unique, however, in sharing my own journey and experiences with this program, I have found a handful of my type 1 friends and followers showing interest in going through my program, which is amazing!

What have you found to be, or think will be, the most challenging part of becoming a CDE?

I believe that given I am a type 1 diabetic myself, I will be able to have a stronger impact on my patients as a CDE, making it easier for myself and for others, however, I believe the hardest or most challenging part will be having to learn how to work with others from a variety of different backgrounds and be able to still help them and connect with them on a very personal level.

I understand you need a certain amount of hours interning, how many exactly and where do you hope you can spend that time learning? In a hospital setting? Private office on-line coaching, etc?

Yes, I am not entirely sure of the exact amount of intern hours needed, however, I do know it is somewhere between 1,000-1,600. I feel as though it can vary depending on which program I go towards. I plan to somehow connect with a diabetes-based company or organization, whether a medical device company or a certain organization, and help in interning as a designer, educator, or any outreach/marketing professional in their space, as a way to practice my educating degree, as well as my degree and strong passion of design.

Now, more than ever, providers are making use of telemedicine as much as possible? How do you feel this affects patient care? Are there pros and cons to an online educational setting? 

I personally have had a few medical (diabetes-related) appointments through a telehealth system and have found them to actually be very nice and convenient, from a variety of different perspectives. For the most part, it is nice to be able to see a doctor from the comfort of my own home and still be provided with the exact same patient care I know I need. I believe that this can affect some patients in a way that some may feel they receive better care in person with a doctor and are able to gain more from that face-to-face interaction. In this case, I would say that the pros and cons to an online educational setting truly depend on the patient as everyone is different and may require or desire a different degree of medical attention.

How has this education impacted you financially? Is it manageable, do they have any special programs or resources you can recommend to anyone who is interested but may not feel like they can afford it?

This form of health education has not impacted me financially, only in the sense that my insurance at the moment has been great and has helped me in receiving the care I desire. However, many organizations or medical offices have been great, especially these days, in providing a discounted program for patients who need to see their doctors regularly, but cannot afford it these days, given the current state we are all living in. I think it is always worth it to ask a doctor for any recommendations they may have for patients who may not be able to afford certain online care, such as a savings card, insurance coverage, or any local telehealth programs that allow a patient to receive the same type of care they normally would have, only online now.

What advice would you give someone just starting on their road to becoming a CDE?

Stick with it. I know it may seem a bit discouraging now, but think of the big picture. You are needed in this field to change the way we discuss and manage diabetes as a society. Think of yourself when you were newly-diagnosed with type 1 diabetes (if you have diabetes), and how you could have benefitted from having a certified diabetes educator, just like you! Do it for yourself and do it for others as well!

Source: diabetesdaily.com

A Diabetes Educator Walks Us Through a TeleHealth Endo Appointment

With our country slowly heading back to our “new normal,” we will likely have to go back to our regularly scheduled lives, which includes being diligent about keeping up with all our routine doctor visits. It is even more important when living with diabetes to have annual eye appointments, physicals, dental appointments, and of course, our endo and diabetes educator appointments.

Since many are apprehensive about this new set up and wondering how exactly it will work, I thought it would be great to talk to Dawn, a nurse practitioner and certified diabetes educator who works in an endocrinologist office and have her walk us through the process and what we can expect.

Thank you, Dawn, for taking the time to talk to me today! How long have you been living with type 1 diabetes? 

24 years at the end of this month. 

Did living with diabetes play into your decision to become a CDE?

I had a great CDE in 1995 in a rural town which was unheard of. Then in college, I had a great nurse practitioner (NP) that I still look up to as a mentor for my practice. She talked to me like a person. She talked to me without pressure, shame, guilt, accusations and disappointment. She helped me come to terms with my diabetes and I will forever be in debt to her. I want to pass on that experience to other people living with diabetes.

How has your endocrinologist office responded to COVID-19? Have you closed down? How did you prepare for seeing your patients virtually?

We stopped seeing patients in the office at the end of March. We do still need labs so our lab is open but that significantly reduces foot traffic. We are only ordering labs that are necessary and will dictate current decisions. If they are not needed right now, then they can wait. We have two practice locations and staff are staying at one location. This way, if one office is quarantined we still have the other office to ensure patients have medical support.

We transitioned to virtual visits using the telehealth visit option within our EMR (electronic medical record) and we are using doxy.me as well. We are calling patients ahead of time to let them know about the change in the appointment and encouraging them to try to log in and make sure it works prior to their appointment. This would give you the chance to troubleshoot technical issues prior to your appointment.  We have had a few patients who still needed to be seen in person but almost all of our visits can be completed via telehealth.

I know many patients are curious about how an appointment like this will work. Is there anything the patient needs to do prior to the appointment? I know my son has an upcoming telehealth appointment and we had to download a certain app.

I would recommend as listed above making sure your means of communication works. Do a trial run at the location you plan to be at. If you will be at work during the call, make sure it works at work. If you are at home, then make sure it works at home. Will you use a computer or a smartphone? Do you know how to troubleshoot the speakers, video and microphone? Do you have a pump, continuous glucose monitor, or meter to download ahead of time? If you do, then get these downloaded at home prior to your appointment. Do a practice run a week ahead of time so if you need to call for help you have time to do so.

Having blood sugar readings and pump downloads ahead of time has streamlined my practice. I can view them prior to the appointment and focus on key items to make the appointment more productive. We are encouraging all patients to download at home, but we have made the exception for a few (elderly) to come and download at the office.

Can you walk us through what to expect during the appointment?

My wonderful medical assistants (Ariel, Tonya, and Whitney) have been calling patients to go over medications, any new changes to medical history just before the appointment and checking to make sure the telehealth app or doxy.me is working. Hopefully, I have already reviewed blood glucose logs and pump downloads ahead of time. If not, I will encourage the patient to get that for me.

What are some of the drawbacks of a telehealth appointment? I know my endocrinologist usually examines my thyroid, heart, etc. How will the doctor be able to check vitals as well as other routine measures? 

Yes, not being able to physically assess a patient sometimes is tough. However, if I am concerned enough that we need an in-person assessment ASAP, then they likely should have an urgent appointment with their primary care provider. If someone is complaining of an enlarged thyroid, with a keen eye, we can visualize that in most people via video. However, nothing replaces a hands-on assessment. We will see a patient in the office urgently if needed.

Do you find that overall providers have more or less time to spend with their patients this way?

When we have data (CGM/BG/Pump/labs) there is more time for providers to spend having meaningful conversations with patients. This streamlines appointments.

As a medical professional, how are you finding the telehealth appointments? What do you find most challenging?

  • When I have the data prior to an appointment, I love telehealth. I also love that I can go over reports with the patient and educate them on what I am seeing.
  • The most challenging part is obtaining data prior to the appointment. My medical assistant makes 2-3 calls prior to an appointment trying to prepare each patient. If I don’t have data, then essentially we are making an educated guess about what medications need to change.
  • For example, a patient can complain of afternoon hypoglycemia. However, it could be a reduction in basal insulin needs, overcorrection of pre-lunch blood glucose, or a too aggressive carb ratio. If we do not have data (CGM/BG/Pump) information, there is no way to tell for sure. So we ask questions around and around to try to figure out the most likely scenario but if we are wrong, you may have less hypoglycemia but BG will run higher. I know I do not want my provider to essentially guess at what needs to change.
  • Another example is a high A1c and the provider increasing the long-lasting insulin (basal) or basal rates unnecessarily causing low blood sugar in the middle of the night. I see this often when providers are grasping at straws trying to improve blood sugar control. When the real reason may be significant after-meal blood sugar spikes.

For someone who is unfamiliar with Zoom and other related apps, it may present a novel challenge. Have you found patients are having trouble with the new set up? Do you provide explicit directions on how to get set up for the appointment?

Most patients who have reliable internet access and have a smartphone or computer with a camera the platforms we use work beautifully. Doxy.me just requires the patient to click on the link we provide in an email. Click and then wait for me to start the appointment.

What do you think the patients will find the most pleasant about the virtual appointment? And what about the worst aspect?

The best part is that you can sign on from anywhere with cellular service or Wi-Fi. So your time away from work or other commitments is minimal. The worst part is that you are still at work or home and there are often other distractions. For example, if children or a dog are disrupting the appointment, this can be distracting and cause the appointment to take longer. It is also not a good idea to have an appointment while driving.

What can you tell us about privacy compliance? How can patients be sure their information is safe?

When using the Healow app or Doxy.me, the voice and video access is encrypted, keeping the visit private. The actual video does not access the patient chart in any way.

Looking forward, what do you think our medical system will look like after COVID-19? What about in 10 years?

I have no idea. I have learned to never assume anything in medicine because just when we think something will happen, the opposite occurs. I am hoping this opens doors allowing more rural telemedicine. This will provide medical care, especially those with chronic diseases, living in rural areas that travel 1, 2, or sometimes 3 hours for appointments. Historically, telehealth is not covered by insurance and the cost falls onto the patient. This hopefully will allow for proper insurance billing of these appointments to be more cost-effective and convenient.

Thank you so much, Dawn, for taking the time to walk us through what a telehealth appointment will look like. I have had two so far and they both went successfully! Best of luck and thank you for what you do!

Source: diabetesdaily.com

$35 Insulin on Medicare Pilot: Is This the Beginning of Affordable Insulin for All?

On Tuesday, President Trump held a press conference announcing a new pilot program for seniors on Medicare that would cap the monthly co-payments of insulin to $35. The announcement was attended by senior executives of two main insulin manufacturers, Eli Lilly and Novo Nordisk, and staff from the American Diabetes Association, as well as the Surgeon General, Jerome Adams.

In typical Trump style, midway through his announcement, he proclaimed, “I don’t use insulin. Should I be? Huh? I never thought about it, but I know a lot of people are very badly affected.” While this comment has created a wave of groans and eye-rolls throughout the diabetes online community, the core of his message is more important: seniors in America will now be more able to comfortably afford their insulin.

For everyone on earth, insulin is a necessary hormone to live. People without diabetes produce insulin endogenously, whereas people with diabetes must take insulin exogenously. Without adequate access to affordable insulin, people with diabetes face serious complications, such as kidney failure, blindness, amputations, and premature death. Unfortunately, the rising costs of insulin over the past few decades have become a major barrier to appropriate management of diabetes. American seniors are some of the hardest hit by the rising costs, who are partially-retired or out of the workforce completely, often trying to survive on smaller, fixed-incomes.

Trump remarked, “Today I’m proud to announce that we have reached a breakthrough agreement to dramatically slash the out-of-pocket cost of insulin. You know what’s happened to insulin over the years, right? Through the roof.”

The pilot program will take effect starting in 2021, and would be part of the enhanced Medicare Part D Senior Savings Model, to which over 1,750 standalone Medicare Part D and Medicare Advantage plans have applied to participate in, according to the Centers for Medicare and Medicaid Services (CMS).

s$35 Insulin on Medicare Pilot

Photo credit: Adobe Stock

This is a welcome respite from the high cost of insulin for American seniors on Medicare, who, despite being covered by health insurance, sometimes have to pay hundreds if not thousands of dollars for their monthly insulin prescriptions.

Despite the multitude of executive orders and policy decisions the Administration has made to chip away the Affordable Care Act, this enhancement of American’s largest healthcare social safety net was met with applause from seniors all across America, many of whom have cooled their support of the President since the beginning of the COVID-19 pandemic and our nation’s response to it. This is an excellent first step to ensuring that our aging Americans can afford the insulin they need to take care of themselves.

It is estimated that Medicare beneficiaries (generally Americans over the age of 65) who use insulin and join a plan participating in this pilot could see average savings of $446, or 66% for their insulin every year. The pilot is funded in part by insulin manufacturers who will pay $250 million in discounts over the five years of the pilot. There has been a positive response from Medicare Part D plans nationwide, and CMS predicts coverage in the pilot will be available in all 50 states, D.C., and Puerto Rico. Medicare beneficiaries will be able to enroll in a pilot-participating plan during traditional Medicare open enrollment, which is October 15th-December 7th, 2020, for Part D coverage that begins on January 1, 2021.

1 in 3 Medicare beneficiaries has diabetes, and over 3.3 million Medicare beneficiaries use one or more types of insulin, so this change isn’t insignificant. Out-of-pocket spending on insulin by seniors in Medicare Part D quadrupled between 2007 and 2016, from $236 million to $968 million, putting a harsh burden on millions.

Seema Verma, administrator of the Centers for Medicare and Medicaid Services said, “We think that this creates a foundation and a platform to fix some of the problems that we have in the Part D plan (of Medicare). It’s time for that program to be updated.”

While this is a great first step, the pilot is only slated to last for five years, and it will only apply to the Medicare population- generally, people living with diabetes who are 65 and older. This begs the bigger question: how do we afford our insulin before we are eligible for Medicare? How can we ever hope to make it to that point, if insulin is unaffordable every step of the way? Men with type 1 diabetes have an average life expectancy of 66 years, compared with 77 years among men without it. Women with type 1 diabetes have an average life expectancy of 68 years, compared with 81 years for those without diabetes. Realistically, this may not even help people who have diabetes for very long.

We can only hope that this initiative creates enough momentum for the federal government to start capping the actual price of insulin, for the other 7 million Americans who rely on it every day to survive.

Source: diabetesdaily.com

Charlie Kimball and His Driving Force to Success

The COVID-19 outbreak presents unique challenges for those of us living with diabetes.  Charlie Kimball, a professional IndyCar driver and father of two and lives with type 1 diabetes. His sport (and job!) is now on hold, and he is home trying to manage his diabetes, eat healthily and stay fit, all the while adjusting to life as a family of four. Charlie and his wife just had a baby in March, amidst the COVID-19 pandemic. I thought it would be nice to talk to Charlie about how he is managing despite what is going on in the world.

Charlie, congrats on your new baby! And thank you for taking the time to talk to me!

How long have you been living with type 1 diabetes?

It’s hard to believe that I’ve been living with type 1 diabetes for 17 years. At age 22, my diagnosis felt devastating and I stopped racing mid-season, unsure of how I could possibly continue to pursue a career as a professional racecar driver.

Each year on October 16, when I celebrate my “diaversary” (that is, the anniversary of my diabetes diagnosis), I reflect on the support I’ve received from the diabetes community. They, along with my wife, my healthcare team and my IndyCar family, all play a role in how I navigate and manage my diabetes.

Did your diagnosis play into your choice of becoming a professional race car driver?

Although I was actively pursuing a career as a professional racecar driver before my diagnosis, I believe racing with diabetes empowers me to be an even better driver. Physically, I have become even more in tune with my body and more connected with my team since my diagnosis. I’ve also found it really rewarding to represent people living with diabetes as part of the Novo Nordisk Race with Insulin program to reinforce the idea that diabetes doesn’t have to stop you from following your dreams.

Charlie Kimball, A.J. Foyt Enterprises Chevrolet

What challenges did you face in this profession due to your type 1 diabetes?

At the time of my diagnosis, it was mid-season while I was racing in Europe and I took some time off to figure out blood sugar testing, insulin management, and how to get back on the track. Thanks to my amazing support system, I was back in a race car three months later and claimed a podium finish in my first race back.

When I decided to move back to the US and race in IndyLights (the feeder system to IndyCar), my endocrinologist, Dr. Anne Peters, met and worked with the IndyCar medical staff to create a plan to get me back behind the wheel.

With the recent news of the first person living with diabetes to be certified by the FAA for a First Class Medical, how great does it feel to know you are the first licensed driver in the history of IndyCar racing?

I first raced in go karts at nine years old and I come from a motorsports family. When I was first diagnosed, a friend helped me to put everything into perspective by pointing out that, while I’d need to manage my diabetes for the rest of my life, it was important – and possible – to get back behind the wheel. I’m really proud of my role as the first licensed driver with diabetes in the history of IndyCar racing, and I’ve never shied away from talking about living with type 1 diabetes. Now, I’m glad to see other drivers out there who are also living with diabetes on the track!

I know from my travels that there are incredible people with diabetes doing inspiring things all over the world. It never ceases to amaze me when I see people with diabetes following their dreams -– whether they are making history in their profession or they are simply accomplishing goals that they may not have considered possible, like running a half marathon

Photo credit: Charlie Kimball

When you heard the virus was picking up speed, what were your first thoughts? Fears? How did you prepare for staying at home?

We recently welcomed my son in March, so we were impacted by some of the same considerations new parents are facing during this time. But, when I held my baby boy for the first time, it was hard to think about anything else other than the love I had for my new family of four.

There have been a lot of changes over the last few weeks and while I’d love to be racing right now, this has been a good time to connect with my family, and an opportunity to plan for future races with both my healthcare and race teams.

Even though I am home, I am still committed to staying active, eating healthy and paying close attention to my blood sugar. Also, right now, a crucial part of my management plan, is making sure that I have enough medication at home and keeping track of when I need to reorder. Having a supply of insulin on hand is not a luxury. It’s a necessity, especially at this time. My partners at Novo Nordisk are working very hard to ensure patients still have access to their medicine. If anyone is having problems affording their medicine during this time, please visit NovoCare.com for information on how Novo Nordisk can help

I’m sure racing comes with a lot of stress and adrenaline. How do you recommend people handle unpredictable blood sugars due to the stress during this time?

Yes, you’re right, racing does come with a lot of stress and adrenaline. I manage that through careful planning every race weekend to ensure that my blood sugar remains in range. But everyone has their own stress and we all handle it differently. The everyday realities of work, family, and life inevitably create that, and I encourage everyone to just have a plan in place for all different situations.

As for our current situation, I’ve found that I’m handling it like everyone else, by washing my hands often and practicing social distancing. It’s been important for me to stay in constant contact with my healthcare team, so they can help me to adjust my diabetes management routine appropriately.

I keep a close eye on my continuous glucose monitoring (CGM) and that allows me to make small adjustments throughout the day if needed. I also take time to exercise, laugh with my wife and children, and connect with people who matter to me – albeit virtually these days. This all helps reduce that stress.

Charlie Kimball, A.J. Foyt Enterprises Chevrolet

How do you plan ahead for a race so that your blood sugars won’t get in the way?

I work very closely with my healthcare team on my plan for each race. We track everything from my workouts that week to my meal before I get on the track. Using this data to make a plan comes naturally to me – it’s the same way I approach driving a race car. On the track, my race engineers, strategists, and I utilize around 50-70 sensors that feed into the central brain of my car. They are calibrated so that I can monitor every detail during a race – think g-force, speed, throttle, RPM, tire pressure – and, importantly, my blood sugar levels. My blood sugar levels from my CGM are tracked and displayed on a custom screen that sits on my steering wheel and is relayed back to my team in the pit lane so that we can make adjustments as needed.

With IndyCar racing on hold, what are you doing to stay active and healthy? Both mind and body?

I’ve partnered with my team to develop a modified workout routine while I’m at home. While I’m not racing, it’s still so important for me to stay in shape so I can do my best when I’m back on the track. Beyond staying active, I’m focused on eating nutrient-rich foods, tracking my blood sugar levels, and taking my medication.

Technology has always been an important part of my diabetes management. With it, I’m able to monitor calories, carbs, hydration, and of course, my blood sugar. Lately, while I’m at home, using my CGM has been a helpful way to watch my blood sugar in real time throughout the day. For me, keeping a close eye on my numbers and taking a mindful, disciplined approach to my diabetes management has been the key to my success during this time.

I am also using this time to connect with my family as we adjust to life as a family of four. I’m especially grateful for my wife and mid-morning naps for keeping the Kimball household happy and healthy during this time!

Thank you so much for taking the time to talk to me, Charlie. Congrats on your success as an IndyCar driver and as well as on becoming a family of four!

Source: diabetesdaily.com

How to Speak Your Partner’s Love Language

You’ve probably heard of the five love languages before. They are based on Dr. Gary Chapman’s 1992 seminal book, “The Five Love Languages: How to Express Heartfelt Commitment to Your Mate.” The book outlines five of the best ways people can effectively communicate and bond with their mates for better relationships.

Chapman argues that all five love languages are enjoyed by all people to at least some degree, but every person has a primary love language and a secondary love language, that they feel the most loved when spoken to and communicated with in that way. People who read his book and take the profile test at the end can figure out their love language, but most people know theirs intuitively.

The most successful relationships, Dr. Chapman argues, are when both partners speak each other’s love languages fluently, and give and receive love according to their partner’s wants and needs. Remember, most people’s preferred love language (how they like to be treated) is also how they speak their own love language (the love language they use to treat their partner), but learning your spouse’s preferred love language and speaking to them that way is the best recipe for success.

Dr. Chapman is a world-renowned speaker, preacher and author whose works have touched millions of lives, and while living in quarantine it’s more important than ever to communicate effectively (and not want to kill) your spouse. So, what are the five love languages, and how do you speak your partner’s love language in quarantine? Read our suggestions, below!

Photo credit: Silviarita (Pixabay)

Words of Affirmation

If your love language is words of affirmation, you love communicating your feelings, sending and receiving text messages, and a handwritten love letter sends chills down your spine. If you or your partner’s love language is words of affirmation, we suggest:

  1. Leaving love post-it notes around the house with reasons why you love them
  2. Writing them a love letter and leaving it on their pillow to discover later that day
  3. Telling them one thing you appreciate about them every day
  4. Writing about your experience together during this time in a gratitude journal
  5. Sending them an extra “I love you!” text once in a while, even if you’re sitting across from each other every day working from home together

Quality Time

People whose love language is quality time love creating memories with those they care about. Quality time can mean playing a board game together, or baking brownies as a couple; sitting mindlessly together while you’re both on your phones, unfortunately, doesn’t count. Some ways to show love if your partner’s love language is quality time include:

  1. Baking a special brunch together once a week
  2. Dressing up together, setting a fancy dinner table, and having a romantic dinner at home (include candles!)
  3. Having a board game and/or puzzle night (no electronics or distractions!)
  4. Dusting off the bikes from the garage and go biking to a park (pack a picnic for a sweet surprise)
  5. Ordering several of their favorite wines and do a wine and cheese pairing event at home

Receiving Gifts

People who speak the love language of receiving gifts aren’t selfish, they love to both receive and give gifts. This need not be fancy or expensive gifts, but thoughtful intentions from the heart count the most. Some ideas to speak their love language during quarantine include:

  1. Creating a special “Quarantine Mix” on your Spotify of their favorite songs. Better yet, burn a CD for them to jam out to for a future drive!
  2. Ordering them a special treat when you do your weekly InstaCart order (mint chip ice cream, anyone?)
  3. Making them a special “Quarantine Care Package” for a spa night at home- think face masks, nail polish, bath bombs, a juicy novel, and maybe a delicious dark chocolate bar
  4. Donating to their favorite charity in their honor
  5. Taking a peek at their Amazon Wish List and ordering something they’ve been eyeing for a while

Acts of Service

If your love language is acts of service, you enjoy it when your spouse takes out the trash, but you also may show love by doing the same. Nothing says romance like a freshly cleaned house and groomed pet. Some ways to speak your spouse’s love language of acts of service include:

  1. Letting them sleep in and cooking breakfast/doing dishes for the children one morning
  2. Washing and vacuuming their car
  3. Tuning up their bike (oiling the chain, fresh air in the tires) and encouraging them to enjoy some alone time with a solo ride
  4. Taking over dish duty after dinner for a few nights per week
  5. Surprising them by tackling the ever-growing laundry pile

Physical Touch

If your spouse’s love language is physical touch, they feel most connected to you when you’re cuddling, snuggling, and generally in close proximity, especially but not limited to sharing moments of physical intimacy. Some ways to speak their love language include:

  1. Allowing for extra snuggle time by sleeping in together on the weekends
  2. Giving them a back massage
  3. Randomly approaching them and hugging them throughout the day
  4. Putting the kids to bed early one night and cuddling up on the couch together to watch a good movie
  5. Having a good ol’fashioned make out session

These pandemic times can be especially tough, but learning to speak your partner’s love language can make all the difference between growing and thriving as a couple during this time, and seriously getting on each other’s nerves. Have you found ways to better connect with your partner during this time? What strategies have worked for you as a couple? Share this post and share your stories below; we love to hear from our readers!

Source: diabetesdaily.com

Minding Your Mental Health During COVID-19

I recently saw someone on social media refer to this as a “great pause’ and while I think it is wonderful that many people are viewing this time as an opportunity to spend more time with their family and to appreciate the simpler things that life has to offer, there are many people going through a very different, and traumatic, journey.

In just the United States alone, 1 out of every 5 people suffer from a mental illness and 1 out of every 25 people suffer from a severe mental illness. For those who are afflicted, it is oftentimes difficult to get through the average day without feelings of anxiousness, irritability, depression, etc. Add in a global pandemic and many of what they were told were “irrational” fears have now come to life. The feelings of isolation, fear, grief, loneliness, financial worry are all very real right now and we need to find a way to cope.

So how do we take care of our mental health while also acknowledging that it is a very scary time and that there is a lot that we don’t know? That is an uneasy feeling for anyone, let alone someone who struggles with mental health issues. Like all other things in life, I do believe it comes down to balance.

Routine

“The secret of your success is found in your daily routine” by John C. Maxwell is a great quote that is quite applicable at this time. I find that if I get up and get dressed, I have a more productive day than if I lie around in my pajamas. Also, keeping to a schedule (while of course allowing flexibility) for meals will not only keep you focused on what you are doing but can also make for more predictable blood sugars. Just these small steps can lead to less mental anguish.

Prescribe Yourself a Daily Dose of News

Try to limit your news consumption to a level that works for you. Many of us wind up leaving the television on and that can be very unhealthy to listen to and watch all day long. Either allow yourself a certain amount of time watching or pick a few times throughout the day to do a quick check-in. Also, make sure you pick one or two reliable sources that you trust and stick to those news mediums.

Stick with Your Mental Health Care Plan

If you are on medication, make sure you continue to take your medication as prescribed by your healthcare provider. If you are experiencing difficulty or feel the medication isn’t working properly, make sure to call your doctor as they are still available to take their patient’s phone calls and available for teletherapy. And if you haven’t sought professional help in the past but feel the need to do so, check with your health insurance to see what affordable options are available to you. There are also free hotlines that you can use:

  • Mental Health America Hotline: Text MHA to 741741. Mental Health America is a nationwide organization that provides assistance through this text line. You will be linked to someone who can guide you through a crisis or just provide information.
  • National Suicide Prevention Lifeline1-800-273-8255. Crisis intervention and free emotional support are available, which is helpful when you need confidential assistance during a time of emotional distress for you or a loved one. The helpline is open 24/7, and a live online chat is available as well.
  • Crisis Text Line: Text CONNECT to 741741. Specialized crisis counselors are just a text message away on this free, confidential 24-hour support line. To further protect your privacy, these messages do not appear on a phone bill. The text line also provides services and support if you are upset, scared, hurt, frustrated, or distressed.

Control What You Can

Many of us are sitting at the edge of our seat on a daily basis waiting for the next big piece of news to be released. Will there be antibody testing available soon near me? Are they opening my state sooner than I’d like? Are my children’s schools going to open back up this year? While these are all valid questions and concerns, we cannot allow them to take up too much space in our minds. Whatever the case will be, you will navigate the situation and do what is best for you and your family. A great quote to remember is “If it’s out of your hands, it deserves freedom from your mind too.” – Ivan Nuru ”

mental health

Photo credit: Sandis Helvigs (Unsplash)

Keep Your Mind and Body Active

This hasn’t been easy for any of us despite what your experience has been. Whether you’re dealing with the loss of a loved one or simply needing a ten-minute break from your toddler, your emotions are valid. Give yourself a few minutes a day to have a small pity party but then try to move on. Get active by taking a bike ride, going for a walk or take a road trip and get lost on a new adventure.  Exercise your mind by staying connected to friends and family. And when you’re alone, try out a challenging crossword puzzle or start a journal. Keeping busy will not only keep you from feeling lonely, but it will also be beneficial to your overall wellbeing.

This pandemic is affecting us all differently but there is no doubt it has been mentally and emotionally challenging for all. Make sure to acknowledge that while mental illnesses may be invisible, they are very much real and should be treated with care. You owe it to yourself and your loved ones to make yourself a priority during this challenging time.

Source: diabetesdaily.com

How to Avoid the Quarantine 15

As most Americans approach their second full month of quarantine (with widespread shelter-in-place orders in all but a handful of states), with playgrounds, pools, recreational centers and gyms closed, many may be wondering how they can avoid the dreaded, “quarantine 15” that people have been joking about on the internet lately.

If you’ve been consumed with stress-eating and low step counts are haunting your days, take heart: there are some simple ways to get you back on track (and fitting into jeans again soon). Here are our top tips to stay healthy during this time:

Adhere to a Regular Eating Schedule

If you have kids at home that you’re trying to homeschool, pets that need attention, and competing Zoom schedules with your spouse, nothing feels normal. It’s easy to slowly slide from your regular routine of, “quick workout, small breakfast, shower” to drinking coffee and panic reading the news ‘till noon, and then storming the kitchen once mid-afternoon hits. If you can stay on a regular eating schedule for breakfast, lunch, and dinner, by the time evening (and Netflix) time hits, you won’t be starved for calories and make poor choices.

Don’t Treat Every Day Like a Friday Night

If you’re like me, you eat remarkably healthy during the week, but definitely look forward to your Friday night glass of wine, as well as relaxed eating standards during the weekend (I can never say no to a Saturday ice cream outing). Once shelter-in-place orders hit, I started treating every day like a Friday night: wine and nachos one day, a margarita and pizza the next. This wasn’t good for my blood sugars or waistline. Even though these times are not normal, if you can carve out space for little treats only once in a while to retain some sense of normalcy, you’ll feel a lot better in the long run, and your blood sugars will also thank you.

Get Movement Every Day

Gyms may be closed, but no one has canceled nature. One silver lining of this pandemic is that it’s hitting during the most beautiful time of year. Flowers are blooming, and temperatures are mild and warm. This is the perfect time to take a bike ride, go on more jogs, or take a nightly walk after dinner. There are also plenty of online options for yoga, pilates, or cardio classes on YouTube. Take advantage of time saved from no commute, and cultivate a morning exercise routine instead!

Get Creative in the Kitchen

It might be tempting to get pizza every day or order takeout (and hello, it’s way easier!), but try and take advantage of this time at home by getting creative in the kitchen. Remember that Vitamix you got as a wedding gift that’s collecting dust in the basement? Or that juicer you ordered during a cleanse phase that you’ve never really touched? Try and buy one new vegetable a week and create a brand new recipe around that. Or order a recipe book online and work your way through it with your family. Vegetables like garlic scapes, jicama, watermelon radishes, and fiddlehead ferns are just a few delicious vegetables begging to be tried that you may have never even heard of!

Photo credit: Katee Lue (Unsplash)

Find an Outlet for Your Stress

Often times when we go to snack, we’re not *actually* hungry, but bored, tired, or stressed. Try, for a few days, to respond to hunger cues, eating only when you’re hungry and stopping when you’re full. This can be hard, because as people with diabetes, we normally eat in response to a high or low blood sugar, and not to our hunger cues, but try it out. Also, supplement your outlet for stress from eating to a healthy activity like meditation, journaling, or gentle yoga. Other outlets for stress can be listening to a podcast, painting, or dancing in your kitchen. Even if you’re not looking to lose weight, your mental health will thank you. This will also become especially helpful when treating lows; if you have an existing outlet for unwanted stress, you’re less likely to over-treat them, and can prevent the blood sugar rollercoaster.

Have you noticed weight gain since the start of COVID-19, or are you healthier than ever? How has quarantine affected your lifestyle? Share this post and comment below; we love hearing from our readers!

Source: diabetesdaily.com

Georgia D-Mom Shares Concerns as Economy Reopens

As the country slowly resumes activities and finds its “new normal,” this could look different for everyone. We spoke to one mom who parents a child with type 1 diabetes about what the transition may look like for their family. 

Hi Teresa, thank you so much for taking the time to talk to me. The COVID-19 pandemic has left us all in fear, especially for those who are elderly or have pre-existing conditions…and for those who love them. Knowing that your son, Bauer, fits this demographic adds an extra layer to this difficult time.  

I know that you live in Georgia and your state has reopened the economy. This means life is going back to “normal.” I thought it would be nice for our readers, especially those who are “type 3” and love someone who is living with diabetes (and other conditions)  to hear a perspective of a mother who is navigating her new normal while also keeping her son’s condition of utmost concern.

At what age was your son, Bauer, diagnosed and how old is he now?

Bauer was diagnosed just after his sixth birthday, and right before starting 1st grade. August 2015. It will be five years this August.

How did your family initially handle the diagnosis? How involved is your son is his diabetes management?

I was in shock. He had been visiting his dad for four weeks over the summer and when he came back he exhibited what I know now are classic symptoms–weight loss, excessive thirst, peeing all the time… I looked up his symptoms and didn’t believe what I was seeing. Though I knew people growing up who had type 1, my diabetes knowledge was mostly based on type 2. I took him to the doctor who immediately admitted him with a blood sugar of over 700. I was terrified and shocked that there weren’t some better treatments for diabetes than shots and finger pokes. 

My son has been attending diabetes Camp (Camp Kudzu) since the beginning. That has really helped him take some ownership over his management. He has good days and bad days, like everyone. I try to strike a balance, where he is empowered to manage but knows he has me to help him. It’s a huge burden for a child.

Once you heard COVID-19 was picking up speed in your area, what was the first thing you did to prepare? 

The first thing I did was get refills of Bauer’s prescription for 90 days.  I had read that there would be no disruptions with supply chains, but that insurers had also loosened guidelines regarding getting scripts early. Since at that time, I was not sure what a lockdown would look like, I wanted to make sure we had everything he needed.

What extra precautions are you taking given that Bauer is living with type 1 diabetes?

Though I have seen some kids playing in the neighborhood, Bauer has not played with others except his siblings. He has seen neighborhood friends from a distance. Since the state is one of the first to open, I am waiting for another couple of weeks to see if there will be a second surge. I not only have to protect Bauer, but also my 82-year-old mom who lives with us.

Bauer doing “home school” | Photo credit: Teresa Acosta

I know this is a scary time for all and especially for children. What have you told your son about what is happening and how is he handling it?

We have talked about what is going on, but have avoided the news. Several times, Bauer has come to me in tears, scared about getting coronavirus. I assure him that we are taking all the precautions and that we just need to keep doing what we are doing–social distancing and washing hands. And we cuddle a lot. We stay pretty busy and distracted during the day, so these moments happen usually around bedtime.

I am sure you have been very diligent about protecting your family and your son’s health up to now. Since Georgia is back up and running, how do you feel about going back to living your lives? 

I have moments of feeling confident that everything will be OK, and moments of pure anxiety. Things changed so rapidly and we still have no vaccine or proven treatments, I’m not sure we will really get back to normal. My job has been affected–I am furloughed for 2-3 months and the kid’s schools are closed and camps have cancelled sessions through June. “Normal” events like swim team are cancelled.  It will take me a while to do things like eat in a restaurant and we will avoid situations where we gather with people we do not know well.

You must have mixed emotions about people going back to their everyday lives. What have you observed so far, are people out and about? Obeying social distancing rules?

I have noticed an increase in traffic and also stores are again limiting the number of items you can buy of meat and hand soap, and sanitizer. I have also noticed an alarming number of people who do not wear any face covering or mask and do not respect the 6 feet apart rule.  People seem very comfortable while the number of new diagnoses looks to be increasing. I don’t think the majority of folks are “going back to normal,” but I think people are more inclined to get together with friends and neighbors outside while respecting the social distance rules. On my Facebook feed I see people going hiking, boating and kayaking and enjoying the nice weather we are having. There was less of that just a few weeks ago.

Will you be going right back to your daily routines or will you take extra precautions and if so, for how long?

We will continue taking precautions. Although I think cases will go down in the summer, I think we will be right back in a difficult situation come flu season.

Are you fearful of there being a second wave of COVID-19 in your area?

Absolutely. We are maintaining shelter at home rules for at least the next 2 weeks until I can see what will happen now that the state is opening up.

Are your schools opening back up? How does your son feel about going back? 

Schools are closed for the remainder of the year.  He does not like school–so it has been a relief for him to be able to stay home.  Stressful for me–but less for him.

Has your son’s school communicated any new practices to prevent transmission? 

We have not been given any information about schools opening in August. Depending on what happens with my job, I may consider looking at some of the state’s online school options.

I am sure this time has been very trying for you personally. How do you make sure to take care of your own wellbeing? What advice can you give other caregivers in your situation?

I think it is incredibly important to take time for self-care.  I try to take a walk every morning before the kids wake up and spend time connecting to friends or watching a TV show by myself, reading a book out on the patio–things I find relaxing. It’s important to take care of your own mental, physical, emotional and spiritual health.

Is there is one piece of advice you would offer to spouses, parents or anyone else with loved ones with preexisting conditions or other health issues who are going through the same thing?

I would say do the important things like avoiding crowds and hand washing and wearing some kind of face-covering when doing necessary things like grocery shopping, but don’t live in fear. Find ways to connect to others, get lots of fresh air and sun, exercise and be creative. Try something new you have wanted to try, but maybe not had the time. Something that has really helped us is trying a new hobby as a family. Bauer and I have done a lot of gardening together. My daughter has taken up painting. My other son is riding his bike a lot. I think finding something to give purpose to your day is important. Cut each other some slack. We all deal with stress differently. And don’t be afraid to ask for outside help. Many counseling centers have shifted to telemedicine.

Bauer planting his favorite veggies | Photo credit: Teresa Acosta

If there is one positive to come out of this crisis, what would it be? I think we could all use a silver lining!

This whole situation has been tough for sure. But it has also made us stop and enjoy some of the most important things in life. In the spring, I would normally be rushing everywhere. Rushing from work to soccer practices as a mom and as the coach, rushing to AM and PM swim team practices, securing sitters to watch Bauer when I cannot be there, preparing for neighborhood events like the pool opening, spending every weekend at soccer fields and trying to get a load of laundry done in between everything, often eating on the run because there was no time to cook. It has been a blessing for us to slow life down, enjoy our home, and eat meals that I actually cook. I am not sure I ever want to return to an overcommitted schedule!

Thank you so much for taking the time to talk to me. I hope you and your family continue to remain safe and healthy!

**

What will your transition to the “new normal” look like? Will you be more cautious than what is recommended? Do you feel confident in returning to some activities? Please share with us in the comments!

Source: diabetesdaily.com

How to Extend the Dexcom G6 Sensor Beyond the Ten Day Hard Stop

Some clever technologists have discovered how to restart a Dexcom sensor to extend its life beyond ten days. The process works by exploiting a bug in the sensor pairing process.

Katie DiSimone walked us through the process. Katie is involved in the community of people who are building homemade automated insulin delivery systems using current insulin pumps and continuous glucose meters. Since the original article was written, Katie has joined the Tidepool organization which is dedicated to making diabetes data more accessible, actionable, and meaningful for people with diabetes, their caretakers and for researchers as well.

Since our last update, new transmitters have been released. These newer models are more stubborn and are more challenging to “hack”. The specific transmitter ID  will dictate which restart sensor method you should use.

Please see Katie’s instructions to determine which is the preferred method for your transmitter ID.

The method that seems to be working amongst the diabetes online community (and myself; I currently have the transmitter starting with “8G”) is the “pop-out method.” This means you need to physically pop out the transmitter, which can be a little tricky but doable. Here is a video on how to do it, I have had luck with an old credit card.

For this method you will need to:

  • Stop session (it does not matter if the sensor expires on its own first or not)
  • Pop out the transmitter (Some people cover the site during the 30 min period or even insert an old transmitter to prevent stuff from getting in there/ also the wire moving, as the transmitter holds it in place)
  • Set a timer for 30 minutes (I’ve heard that 15-20 minutes works, but have not tried this)
  • Pop the transmitter back in
  • Restart the sensor (make sure to save the previously used code; I snap a picture of it so this way you will not have to calibrate)

There are instructions on how to restart the sensor using the receiver so that you continue to receive current glucose values throughout the 2-hour wait. Here are the instructions on how to do so.

Caveats

The Dexcom G6 has not been tested or approved by the FDA for restarting sensors. There is no guarantee of sensor accuracy. Extend the sensor life only at your own risk.

A previous version of this post has been updated.

Source: diabetesdaily.com

Type 1 Diabetes Educator Donates Plasma After Recovering from COVID-19

We spoke to someone with type 1 diabetes who recovered from COVID-19 and is now helping by donating her plasma.

Hi Ashlee, thank you so much for taking the time to talk to me. The COVID-19 pandemic has left us all in fear, especially for those who are elderly or have pre-existing conditions. Knowing that we, or someone we love, fits this demographic adds an extra layer to this difficult time.  It is more important than ever to come together and help each other through these uncertain times. I thought it would be nice for people to hear from someone who recovered from COVID-19 and now is helping others to do the same!

How long have you been type 1?

I was diagnosed 16 years ago at the age of nine.

What do you do for a living and did having type 1 diabetes play into your decision?

I work as a diabetes educator in the pediatric clinic at the Barbara Davis Center in Denver, CO. I wanted to be a nurse from a young age but while participating in research through the center in college I knew I wanted to work there after graduating.

When you heard about COVID-19 heading our way, were you nervous? For your family? And for your work as a nurse during this pandemic? Did you feel your hospital was prepared for the outbreak?

After being diagnosed with COVID-19, I was initially concerned for my family and if COVID-19 would affect them. I was not nervous about myself because of how mild my symptoms were.

At what point did you think that you may have contracted COVID-19? Did you know how you may have caught it?

My symptoms were very mild and didn’t present as the typical symptoms that most have. I had a headache, mild congestion, loss of taste, fatigue, and some shortness of breath after walking upstairs. It presented as a mild cold. I actually didn’t even pay attention to my symptoms until I got a message from a friend saying that I had been exposed a week prior to someone who tested positive. Given the fact I work in healthcare and have type 1 diabetes (T1D), my primary care physician (PCP) decided to have me tested. I never had a cough or fever.

Did you call your doctor? Head to urgent care? What do you recommend people do if they fear they may have it?

Since my symptoms were mild, I did not need to be seen by my provider. I knew I could handle them at home. If my symptoms would have worsened I would have changed my game plan. People should be in close contact with their PCP for instructions on when to seek medical attention.

How were your mild symptoms treated? 

I only took one Tylenol for a headache at the start.

How were your blood sugars while you were sick? Did you have to manage things any differently?

My blood sugars were quite manageable throughout my illness. In fact, I had some of my best days of control during my illness. I personally did not notice an increase in my insulin needs which was surprising.

Photo credit: Ashlee Ernst

Is there anything to have on hand that you would recommend for people living with diabetes? 

My best advice for others with T1D is to focus on caring for themselves. The best way to fight off a virus is to have good blood glucose management. I encourage everyone to reach out to their care team for advice if they are needing help with insulin dose adjustments.

Were you nervous you infected anyone else? How long did you have to quarantine yourself? 

There were some fears of the impact of exposing others. Thankfully, the people around me never developed symptoms and/or tested negative. I was instructed to quarantine for 3 days after my last symptom or 7 days after my first. Whatever was longer. My health department was the one who told me when I could end quarantining.

What are your biggest fears of COVID-19 (both short term and long) both as a diabetes educator and as someone who contracted it? 

My short term concerns while having COVID-19 was the impact my positive diagnosis could have on the people around me. As far as long term, I am concerned of the impact this could have on my friends who have T1D and their ability to access healthcare with the unemployment rate.

I understand that you donated your plasma so that you could help others fight this deadly virus, how was that experience?

In the beginning there was a lot of news circulating about donating plasma to patients but there wasn’t a system in place. A couple of weeks after I recovered, the Children’s Hospital of Colorado announced that they had set up a program. I had to answer a long list of questions to be sure I was eligible. I then had to send in my test showing that I was positive. Once that was completed they had me swabbed again to be sure that I was negative for COVID-19. Those results took 24 hours to receive back. Once the results were negative I was able to donate plasma. I was able to donate on Easter and the whole process took less than two hours.

Many are suffering mentally and emotionally from this pandemic. How do you recommend they take care of their mental health both as an educator and as someone who has fallen ill from this deadly virus?

The impact of COVID-19 on one’s mental health can be significant. It is so important to reach out and connect with friends and families. They are probably in similar situations and would appreciate the company. I have also enjoyed taking walks to get a daily dose.

Thanks so much for taking the time to talk to me, Ashlee. I am so glad you are recovered and thank you for taking the time to donate and help others!

Source: diabetesdaily.com

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