Remote health care

remote health careI’m a huge believer in doing things remotely – work, meetings, and now health care!! It seems that the Centers for Medicare and Medicaid (CMS) are looking at paying physicians for non face-to-face encounters with patients who have chronic diseases. Hopefully this will lead to payment for all providers (nurse practitioners and physician assistants) as well as diabetes educators, someday.

Last year I was interviewed by Hope Warshaw as part of PresentDiabetes.com’s AADE program. One of the questions Hope asked me was whether diabetes professionals are willing to use technology and I responded at the time that while I believe many – if not most – are ready and willing, until the health care system gets on board with it, it’s not going to happen at the level patients deserve. Diabetes educators, by nature, would work for free. That’s how much they care about people with diabetes. But it’s not realistic – diabetes professionals still have to put food on their tables and keep the lights on.

Remote care and education are wonderful and much-needed options, and figuring out a way to provide reimbursement for diabetes services through these media is a priority. It’s exciting to see that CMS is at least discussing this important approach. I hope it will continue to grow until all people, regardless of location, can receive the services they need.

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Limiting Carbohydrate

I recently spent a few weeks eating fewer carbohydrate foods. While I don’t like most sentences with the word “limit” in them, it was my choice to limit the carbs I ate, so I’m using that term for now.

During this process I learned the following: 1) I have a tendency to be a carb junkie! 2) When I eat fewer carbs, I crave fewer carbs, and 3) Having no carb at breakfast just didn’t work for me.

As far as carb intake, here’s what I did: 2 carb servings for breakfast plus fruit at lunch and dinner. Non-starchy vegetables, in large amounts, can also add up to some carb. I sometimes had additional carb foods at lunch or dinner, and whenever possible, they came from plants. For example, hummus (garbanzo beans) or corn on the cob, or baked beans. I would like to to try some new, plant-based items as well, in the future.

Other observations

  • When I “limit” carbs, I’m actually getting plenty of healthy carbohydrate in my meal plan.
  • There’s a lot of preparation involved with eating so many vegetables!
  • Cutting out breads and crackers, leads to cutting out cakes, cookies, and other high-calorie carbs.
  • I need to keep trying new things, because I start to get a little bored (and that has a tendency to lead me back to old ways of eating).

Most important, I have found that eating fewer carbs, while not cutting back completely or even drastically, has made it easier to achieve my target blood glucose level most of the time and with less work (and less insulin).

Note: After this experiment I went on vacation and ate carbs until the cows came home. I’ll write about that another time. Now I’m home and back on track.

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Which “diet” is best?

badge_wmI listened to a wonderful lecture by David Katz, M.D., recently. Dr. Katz is an expert in nutrition and wellness, along with adult health and disease prevention. He repeated what we’ve all been hearing a lot lately: plant-based eating plans are the healthiest for us. If we can eat mostly foods from plants, we will do our bodies a huge favor.

We are constantly hearing mixed messages from friends, colleagues, the media, and even health care professionals: more protein, less protein; high fat, low fat; low carb, vegan; and on and on. Just when we think we have it down, the message changes. What to do?

Personally, my approach is everything in moderation. And a lot of exercise. My favorite part of Dr. Katz’s lecture was during the Q and A period when someone asked: Which “diet” is best? And he answered, The one you’re willing to do.

As long as we are eating healthy amount of foods – many, if not most from plants – we are following the “best diet.” And we’ll know it’s a healthy amount of food when our blood pressure and lipids are in a healthy range, when we have energy and strength, and feel good.

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More options for positive diabetes energy

On Monday I posted a guest blog by Ally Ertel. She wrote about using journaling and other ways to redirect negative energy and focus on what’s going right in our lives.

Personally, I have never been a journaler (is that a word)? I find that ironic, since I now write a blog, which is essentially one big, public journal. I do like journals, by the way. I have a few. I think they are very pretty books, and I typically use them as a place to write lists.

Anyway, if you don’t get into writing in a journal, there are other options: meditation, prayer, breathing, yoga, exercise. Lately I have been thinking about the four agreements from the book “The Four Agreements.” Have you read it? I actually listened to it on CD in the car (on the suggestion of my husband!). The four agreements are 1) be impeccable with your word, 2) don’t take anything personally, 3) don’t make assumptions, and 4) always do your best. Believe it or not, these “agreements” can be applied to anything, even diabetes management and a healthy lifestyle.

Make an agreement with yourself – perhaps about how you’ll take care of your body. And then keep your word with yourself. And when you don’t get the results you’re hoping for, don’t take it personally (don’t beat yourself up), but keep doing your best. And we all know what happens when we assume anything…

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Redirecting negative diabetes energy

Today I’d like to share a guest post by Ally Ertel. Ally, a model in New York City, graduated with a degree in Women’s Studies with Honors from University of Florida, and is a regular contributor to SusanMinerBeauty.com. When I read Ally’s post I felt she was echoing exactly what I’ve been saying on my blog for almost two-and-a-half years.

Sometimes, you’re just having a rough day. Nothing seems like it’s going right…you wake up exhausted, your hair is a mess, you forgot you have to stop at the store before work, and you rush out the door only to realize you forgot your umbrella and it’s pouring outside.

And all day you rehearse these moments of frustration thinking thoughts like, “I wish this didn’t happen” and feeling a constant annoyance. You’re practically expecting more things to go wrong as the day goes on. How do you feel at the end of a day like that? Probably not very happy…that’s for sure!

I was having one of those days this week. But instead of rehashing the whole awful day in my head, I remembered I had a choice in what I wanted to focus on. So, I reached for my journal and I redirected my energy on what DID go right in my day.

“Energy flows where attention goes.”

The more you think about all the frustrating things that happened in your day, the worse you will feel. And the worse you feel, the more of those frustrating situations you will create in your life. Because if you’re expecting your day to continue terribly, it will. You’re much less likely to see a possible opportunity in the chaos and be a creative problem solver with thoughts like that.

We always have a choice to pay attention to our thoughts, interrupt them, and consciously re-direct them towards what we want whenever we notice this pattern.

You definitely don’t have to wait for the end of the day to do this. As soon as you notice yourself going to that awful mental place, you can choose to refocus your energy on something positive, something that makes you smile no matter how bad your day is going. You may have to dig really deep sometimes but there is always something to be grateful for to shift your energy. Maybe all you need is to just interrupt the pattern of negative thinking for a few minutes and you’ll see it from a different angle.

This exercise of paying attention to your thoughts and purposely re-focusing your energy is a constant exercise and it’s definitely not easy! But the more you do it, the easier it becomes.

Journaling is one of the best ways I’ve found because it physically forces me to refocus my energy. But maybe it isn’t the route for you. Instead, you could try:

Talking with a friend/mentor to help you see the positive side of a difficult situation.

Moving your body! Run, walk, do a 1 minute silly dance and you’ll likely feel even just a little bit better.

Even better, try some energy work. Find a 5-minute calming meditation online…or try a few of the exercises on previous blog posts (Wayne Cook posture, Anxiety meditation, etc.). Even just three solid deep breaths are often enough to leave me feeling calmer and more centered.

With light and love,

Ally

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Survey for Diabetes Technology

The folks at DiabetesMine are conducting a survey in preparation for their Innovation Summit in November. They are looking for information to share with industry leaders on what patients feel about/want from diabetes technology. Please participate!

Here’s the link: https://uscannenberg.qualtrics.com/SE/?SID=SV_b48CztEO9KIL3Cd

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Vitamin B12 and Neuropathy: a vicious cycle

feet_1Stay with me on this one:

1.) Vitamin B12 deficiency (low levels) can lead to neuropathic symptoms (numbness/tingling or pain in the feet).

2.) Neuropathic means disease of the nervous system.

3.) Metformin (a diabetes drug) can lead to B12 malabsorption.

4.) If you are not absorbing B12 properly, it doesn’t matter how much you take – it won’t work.

5.) High blood glucose over time can lead to neuropathy (nerve disease).

So what happens if someone has symptoms of nerve disease and it is blamed on diabetes, but it’s really poor absorption of B12 from long-time metformin use? This is precisely why we have to be aware of these things and ask questions. If you are experiencing strange sensations in your lower extremities and you have diabetes and you take metformin, be sure to ask your health care provider about vitamin B12 malabsorption. There may be effective ways to turn this around. It’s worth finding out, because

1.) if your feet are bothering you

2.) you are less likely (or able) to exercise

3.) which can lead to higher blood glucose levels

4.) which can lead to further problems with your feet.

Let’s stop this vicious cycle!

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Solutions for stress eating

STRESS-EATINGI recently met a woman who is a self-described “stress eater.” She told me she has changed her ways and taken off 30 pounds. I asked what she does to avoid stress eating, and she said, “I take the dog for a walk. And the great thing is that she (the dog) never says no!” What a great way to handle stress and avoid stress eating.

But not everyone has a dog. So here are some other ideas: instead of eating treats at work, walk up and down the staircase. Walk laps around the mall or parking lot instead of visiting the food court. Bring a jump rope on road trips and do some jumping after buying gas – rather than buying some junk food in the convenience store. Start a conversation with friends at a party – choose the ones who are standing farthest away from the food table. Better yet – make a pact with yourself to talk to every person in the room before you leave (you won’t have time to eat!).

Here’s an interesting article on stress eating. One thing they mention is that walnuts are a healthy snack. I actually bought a walnut-dried cranberry-dark chocolate soy bean snack mix and I eat some of that if I need a little something. It’s healthy, satisfying, and I don’t need (or want) a lot.

What do you do to avoid stress-eating?

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More food and diabetes

ss_1_101400272A recent study found that carb counting is not much better than other meal planning approaches in managing type 1 diabetes. I have mixed feelings.

Drawbacks to carb counting include giving a message of “eat whatever you want and cover it with insulin” (not to be confused with “People With Diabetes Can Eat Anything,” which is a completely different message). This practice can lead to weight gain and all the health conditions that go along with it. In addition, carb counting typically does not focus on protein and fat, which can lead to over- or undereating these nutrients.

What carb counting does well, however, is give us well-deserved freedom. As long as we are well-informed and making healthy choices (most of the time), freedom is a good thing. Freedom means not having to take insulin and eat meals at certain times. It means not having to eat when we aren’t hungry or not eat when we are hungry. It allows us to respond to our bodies’ signals, sleep in if we want to, exercise with much more ease, and generally live our lives the way we want to. Carb counting, in many ways, removes the shackles of have to and replaces them with choose to. And that, my friends, is empowering. And empowerment, in my humble opinion, leads to better attitudes, which lead to better outcomes.

The thing we can’t forget, however, is that it’s the insulin that has made carb counting possible. Fast-acting insulin is what gave us freedom – from late lows and required snacks. We can choose to follow whatever meal plan works best for us – carb counting or otherwise – and use the “fancy” insulins that are available to make it all work together.

The most empowering part of all is that we get to choose.

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Do we value health?

value-investorWe are currently having a discussion in a course that I teach, that I’m finding fascinating. The discussion is on group vs. individual diabetes education (funny I just blogged about this on Friday). We have two students who work in diabetes education programs that are offered to patients at no cost, which is somewhat unheard of in the U.S. health care system.

We talked about whether paying something toward the class(es) – and perhaps getting the money back upon completion – would increase the value. And/or would it entice people to complete all the classes? Then the point was made that we need to shift the value to health itself, and not money. And how do we go about doing that?

Our health care system is slowly, but surely, evolving. As changes take place, there is a critical need for all of us to put a greater value on our health. To me that looks like partnerships.

As people with diabetes, we can partner with our health care providers to seek and receive the best care possible. By investing in our health, we get the best return!

As health care professionals, we can connect with our patients, help them figure out what motivates them and what brings value to them in terms of their health. We care about our patients and want them to have the best health outcomes. At the same time we need to remember that we are simply facilitators – it’s not about us.

By creating partnerships between patients and providers, we can identify the value and make it possible.

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