Diabetes-related Ketoacidosis

Posted on May 27, 2014 by janekdickinson

Our bodies must have energy to survive. Typically we burn glucose to make energy, but when glucose is not available, or when the body cannot burn glucose for any reason, fat is the back-up fuel. And ketones are a by-product of fat metabolism. So when we burn fat to get energy, our bodies make ketones, which are acid bodies that enter the blood stream.

Because our blood is neutral (not too acidic or too alkaline) when we are healthy and everything is working properly, ketones can really throw things out of whack. When our blood becomes too acidic, we can become very sick. Typical signs of ketoacidosis are fruity odor and deep, labored breathing.

When there is not enough insulin available for the body to break down glucose, fat metabolism and ketone production can occur. People who experience diabetes-related ketoacidosis may have nausea, vomiting, abdominal pain, and even loss of consciousness.

This can happen for many reasons; here are some examples:

  • exercising with a high blood glucose level and not enough insulin working (blood glucose will actually go higher and not lower)
  • not taking enough insulin either by accident or on purpose
  • running out of insulin (for instance, not ordering in time or being away from home and not bringing enough insulin)
  • running out of insulin in an insulin pump
  • having a bad infusion set/connection and not having insulin delivered by insulin pump
  • using insulin that has gone bad (exposed to extreme temperatures or expired)

Usually only people with type 1 diabetes are at risk for ketoacidosis; however, some people with type 2 diabetes can have it happen as well. Be sure to check with your health care provider to find out if you are at risk for ketoacidosis and how you can lower that risk.

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Diabetes Issues

Posted on May 15, 2014 by janekdickinson

???????????????????????????????????????This week is dblog week, where literally hundreds of diabetes bloggers write about certain topics each day (I counted 203 participants in this year’s list!). I participated in dblog week in 2011, 2012, and 2013, but this year time got away from me and I didn’t even realize it was the week until last night. I was looking at the topics and decided I’ll write about some of them anyway – in my own time (because they are good and/or fun and/or interesting).

Monday’s topic was to discuss diabetes issues that get me fired up. I admit I can get fired up about a lot of things (I like to say I’m passionate about things…). One of the biggest things for me is the apparent gap between diabetes health care professionals and people living with diabetes. I see and hear comments about it on social media pretty consistently and it makes me sad, frustrated, and concerned. As someone living with diabetes, and as a diabetes health professional, I take this very seriously. I want good care for myself and I want it for everyone else who has diabetes.

It’s bad enough that many, many people with diabetes don’t get care at all (for a variety of reasons), and we need to work on that also. But in the meantime those who do, should definitely get good, effective care from providers who listen and work as a team. The “compliance” model is outdated and useless. We’ve been talking and writing about the “empowerment” model for about three decades, and yet we are not truly there yet. And I think that’s pathetic.

In order to deal with my fired-upness, I work to help others live well with diabetes and help diabetes professionals take a closer look at how they deliver care, more specifically how they work with people living with diabetes.

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How to store insulin

Posted on May 13, 2014 by janekdickinson

DSCN2322Here’s my motto for storing insulin: if I’m comfortable, my insulin is comfortable. Insulin is a protein, so it can’t get too hot or too cold or it will denature (change shape and not work the way it’s supposed to – think of an egg when you boil or fry it). Insulin should never be left in a car (cars can get very hot or very cold), placed in checked baggage (cargo gets extremely cold), or stored in any location with extreme temperatures (radiator, freezer, directly on ice, by a bonfire, you get the idea).

Insulin should be stored in the refrigerator until you are ready to use it. While in the refrigerator, unopened, insulin is good until the expiration date stamped on the box. Once you open a vial of insulin, it is good for approximately 30 days. Opened vials of insulin can be kept at room temperature for the 30 days. While it’s OK to do so, it is not necessary to keep the insulin you are currently using in the refrigerator, and cold insulin hurts more going in.

If you are using the insulin to fill a pump cartridge/reservoir, bringing it to room temperature first actually helps to reduce the risk of bubbles. The only time I keep the insulin I’m currently using in a refrigerator is if I am traveling to a place that it very hot. In some cases, it may be a good idea to keep insulin in a cool pack, for instance, if you are hiking in an extremely hot climate, or at the beach.

Once you open an insulin pen, it is good for the number of days indicated on the package, and it is kept out of the refrigerator (leave the remaining unopened pens in the refrigerator).

Most insulin is clear. NPH is the only cloudy insulin available in the US, and because it is a suspension, it needs to be mixed evenly (by rolling the bottle upside down between your palms) before using. All the other types of insulin available are clear – if your clear insulin suddenly appears cloudy or if any insulin has crystals or clumps in the bottle, discard it immediately and open a new vial/pen.

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Advertising and the Self-Control Muscle

Posted on May 8, 2014 by janekdickinson

Psychologists say that self-control is like a muscle that can be exercised and strengthened.

I read an article online about exercise and sleep, both of which are critical to managing and living well with diabetes. On the side of the page was an advertisement for Little Debbie Swiss Rolls, complete with a photo of the delicacies and a “find a store” tab.

Self-Control-Is-Knowing-T-A63043_LI found myself staring at the Swiss Rolls and wondering how many people would have the self-control to continue reading about exercise and sleep (on the left) vs. clicking on the tab and finding a store with Little Debbie snacks (on the right). Great opportunity to work on strengthening that self-control muscle!

But seriously, just when we thought we were saved from advertisements on TV (thanks to the “pause” and “fast forward” buttons), now we have to see them on the Internet. It was bound to happen, but still a bummer. Hopefully we’ll take advantage of this opportunity and get stronger at self-control.

PS I love this quote, which I found here, because it is such an important message. It’s not about can or can’t – it’s about choices.

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I Am A Nurse

Posted on May 6, 2014 by janekdickinson

JanenursephotoToday is National Nurses Day (May 12th is International Nurses Day and the anniversary of Florence Nightingale’s birthday), and I just want to say that I am honored to be a nurse and to have worked with and learned from some amazing nurses.

Today I am thinking about nurses who made an impact on my profession and me:

  • Florence Nightingale
  • Virginia Henderson
  • Sue Adamczyk
  • Judy Krauss
  • Mary Young
  • Jennifer Hawke-Petit
  • Wendy Mackey
  • Melanie David
  • Hannah Chatillon
  • Robin Froman
  • Cheryl Beck
  • Peggy Chinn
  • Carol Polifroni
  • Maureen O’Reilly
  • Cheryl Kindred

I’m sure there are many more!

Although I work in diabetes education, which is a multidisciplinary specialty, my foundation is nursing. I will never forget the nurses who paved the way and those who taught me how to be a nurse. Most of all, the people I’ve worked with have shaped who I am as a nurse. Thank you and Happy Nurses Day!

PS The photo is me in a Jr. High play long before I knew I’d become a nurse in real life.

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My Diabetes Street Sign

Posted on May 1, 2014 by janekdickinson

street signThe other day I was having a conversation with a friend and she randomly asked, “What if we had to come up with a street sign name for our life?” I said, what a great idea for a blog topic!

So I’ve been giving it some thought, and I’m working on coming up with a good street sign name that represents my diabetes life. Here are some ideas:

Don’t Stand In My Way

I Can Do This Drive

I Often Check Before I Drive

Well On My Way

Positive Path

What would your diabetes street sign say??

 

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Good Diabetes News

Posted on April 29, 2014 by janekdickinson

Did you see my recent post about hope? Today I read a report on rates of complications related to diabetes – good news! Check this out:

Since 1990 there was a 68% decrease in the rate of heart attacks and a 64% drop in deaths from high blood glucose; risk of lower limb amputation and stroke decreased by about 50%; and kidney disease requiring dialysis or transplant decreased by about 28%. These numbers are based on complications occurring despite the fact that the actual prevalence of diabetes has increased – by three times! So there are more people with diabetes, but fewer of them are developing complications.

That, my friends, gives me hope. Now we just have to figure out how to decrease the number of people getting diabetes in the first place.

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Hope and Diabetes

Posted on April 17, 2014 by janekdickinson

Diabetic-Hope-Conference-2014-Facebook-Cover-Image-300x111

We can’t live without hope. If we really stop and think about it, life runs on hope. Sometimes our hopes get dashed, but then we think of something else to hope for. Whether it’s personal achievement (school, work, athletics, performance), or a greater vision (a service organization, faith community, government, the world), hope drives us.

Without hope we have nothing.

Living with diabetes we certainly experience hope. We hope for target blood glucose levels and for discipline around food or exercise. We hope for a breakthrough in medication, technology, or the artificial pancreas. And somewhere underneath it all (or on top for some) is a continuous thread of hope for a cure.

Last year a new tradition was started: the Diabetes Hope Conference. This event will take place again this year on May 20th at 11 am Central (12:00 noon Eastern Time). Visit this website to register for the conference.

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Optimism is Healthy

Posted on April 15, 2014 by janekdickinson

I’m a big fan of a positive approach – to life, to living with diabetes, whatever.

I do, however, acknowledge that living with a chronic condition is not always easy or fun. Many people have a very hard time managing diabetes for a variety of reasons. So I must admit that sometimes I feel a little guilty about always being positive or putting a positive spin on diabetes topics. But then I don’t want to get bogged down in negative thoughts, so I say, “forget it, I’m just going to continue being positive.”

I even heard someone once say, “If you are doing well with your diabetes, that’s great, but keep it to yourself.” WOW! I have to say I felt negative about that statement for a few minutes (and a few more minutes every time I remember it). But I can’t keep a positive attitude to myself because I feel it’s my job to spread the message that being positive makes people happier, healthier and leads to more quality of life (and potentially longer life).

Anyway, I came across an article that basically says people don’t have to be optimistic, but that if they exhibit traits of optimism, they will be more likely to adopt healthy behaviors. How cool is that? So people who want to can keep being grumpy, and if they focus on happy-people skills, they can still make healthier food choices, exercise more, quit smoking, etc.

Some examples of these skills include consciously choosing what you do or eat and channeling frustrations into healthier activities. It really goes back to slowing down and being mindful – being aware of ourselves and our choices. Sounds easy, but definitely takes practice (and self-forgiveness)!

To-pay-attention-this-is

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Looking at Low Carb from a Different Angle

Posted on April 10, 2014 by janekdickinson

DSCN2308There’s been a lot of talk about low carb meal plans for many years now. We evolved from Adkins to South Beach to Paleo and now State of Slim (with many others in between). There is science to back up the cutting back on carbohydrate foods, especially the ones that lack nutrients (white bread, white rice, etc.) or have unhealthy ingredients (packaged, processed foods). I am a big supporter of plant-based foods, so fruits and vegetables – even the ones with carbohydrate – are a huge part of my own eating plan.

So far the thinking about carbs has focused on blood glucose and weight, but today I read an article that also looked at the financial investment side of carbs. I thought that was very interesting. The article says consumers’ move away from carbohydrate foods has “staying power,” and that companies producing mostly grain-based processed foods will have an “uphill challenge.”

Once again, the message is the same for those with and without diabetes (everything in moderation, low fat dairy, mostly plants, and get the carbs you do eat from whole grains, legumes, and fruits): find a healthy eating plan you can stick with. For many people, cutting back on (not cutting out) carbs is helping with weight and blood glucose levels.

Thinking about the food choices we make can actually be an investment in our health and our financial future!

 

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