Code Red Alert

Why Aren't Physicians Being Trained to Treat Diabetes
(click on article to open link and read article)

The article "Why Aren't Physicians Being Trained to Treat Diabetes" is a code red alert for anyone with diabetes.  If we can't trust health care providers to have the knowledge and skills to treat people with diabetes then who do we trust?  When patients challenge me and make comments about what their doctors did or did not say or do I address their concerns and I also politely respond "you are your own best advocate".  I am in no way making excuses for physicians or any health care provider to not be knowledgeable about treatment for diabetes but there is a wealth of information available for patients with diabetes, even for patients with low literary comprehensive skills.  Diabetes is a multi-faceted disease and require skills beyond physician management.  Learning self-care management skills is also an important aspect of diabetes care.  Health care has changed and it is not always for the better so be proactive.  If your physician does not know how to treat your diabetes then find another physician.  Also, attend a diabetes education class every 3-5 years, attend a local diabetes conference, join the American Diabetes Association or at least access their website for free, join a diabetes support group, ASK for a referral to a dietitian and a Certified Diabetes Educator, etc., etc.  In other words, don't let a physician or any health care provider be a barrier to your care because if you do, you alone may be the one to suffer the ill-fated consequences of poor diabetes control.  Take care of yourself and be proactive so that you will live a long, healthy, comfortable life.  Peace!

Hypoglycemia Unawareness

I am a Nurse Practitioner and Certified Diabetes Educator.  I also have type 2 diabetes and today my blood sugar was 59 mg/dL!  I was shocked at my blood sugar reading because I did NOT feel bad at all.  I take Metformin for my diabetes.  Three hours prior to checking my blood sugar today I had eaten banana-walnut pancakes with regular syrup.  I have not had any changes in activity, food intake, or medications, I  have not consumed any alcohol, and I am not stressed or depressed.  In other words, I could not think of any reason why my blood sugar was so low.  I last checked my blood sugar 2 days ago and over the past several weeks my blood sugars have consistently ranged in the 80s to low 100s range.  

Hypoglycemia unawareness is defined as a low blood sugar that occurs without any of the physical warning symptoms of a low blood sugar (i.e., shaking or nervousness, headaches, sweating or clammy wet skin, confusion or anxiety, palpitations, etc.).  It occurs more frequently in patients on insulin therapy (patients with type 1 diabetes and patients with type 2 diabetes that require insulin) but it also occurs in patients with type 2 diabetes such as elderly patients, patients that have had diabetes for several years, patients that consume alcohol, patients with diabetic neuropathy (nerve damage), and patients that take beta-blockers for heart disease and/or blood pressure control.  Hypoglycemia unawareness is potentially life threatening because low blood sugars (especially blood sugars less than 50 mg/dL) can lead to loss of consciousness, confusion and behavior changes, coma, seizures, and death.  Usually when blood sugars are low our body hormones send out physical warning symptoms that we recognize and can act upon to immediately raise our blood sugar.  With hypoglycemia unawareness we lose this response and do not experience those physical warning symptoms.  

Today was an anxiety-provoking experience for me because prior to checking my blood sugar I was preparing to travel in my car.  Had I not checked my blood sugar I could have potentially had a fatal accident and killed or injured myself, my daughter and other people.  This is why I advocate people with diabetes to check their blood sugars, including patients with type 2 diabetes that are not on insulin.  Talk to your health care providers about how often you should check your blood sugar and what blood sugar ranges are safe for you.   

Click on the following links to learn more about hypoglycemia and hypoglycemia unawareness:

http://visionsofcontrol.com/AcuteComplications.aspx

http://www.diabetesnet.com/diabetes_control_tips/hypoglycemia_unawareness.php#axzz1As2yTKLx
http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hypoglycemia-low-blood.html

Refuel, Reshift, Refocus

It's 2011 and we made it here!  Whew, 2010 was some kind of year.  Some of us excelled, some of us were status quo and some of us were deeply challenged.  Every new day is an opportunity to refuel and overcome our challenges and we can make 2011 our best year yet.  The festive holidays have ended and most of us have returned back to work or at least re-established our daily routines.  What now?  How do we refuel, reshift, and refocus?  How do we get from the "thinking" mode ("I need to ...") to the "action" mode.  I propose 3 actions:

• Take a few minutes every day to reflect on WHY it is important to gain and maintain good blood sugar control.  Do you desire to live a long, healthy life free of complications?  How important is it to you to be able to continue to drive your own self to the places that you desire?  Do you wish to fulfill your plans to travel, shop, and enjoy your future grandkids?   What are your goals?

• Find out where you are (realistically, no guessing).  What are the values for your A1C, blood pressure, cholesterol, weight, and BMI?  This may require a visit to your health care provider.  We make time to do the things that are important to us so why not start with making your health a priority in 2011.  

• Start with where you are.  We have different challenges but everyone has challenges that can be overcome.  Maybe one person needs to complete their eye exam.  Maybe one person can stop eating cookies (That would be me ... thank God that all of the holiday treats are gone!).  Maybe one person needs to refill a prescription.  Maybe one person needs to restart home monitored blood sugar checks.  What are your challenges?

It's okay that you fell off the bandwagon in 2010.  The 2011 wagon is 

coming along so jump on, refuel, reshift, and refocus!  Peace!