Jane K. Dickinson, RN, PhD, CDCES

Words that don’t help

Posted on March 15, 2013 by janekdickinson

I was meeting with a patient recently when we started discussing how it feels to meet with health care professionals. This patient told me that so many providers say to him, “why don’t you just…” Why don’t you just stop eating so much? Why don’t you just exercise? Why don’t you just quit smoking?

It’s not just health care providers who use these words. We often hear them from family and friends as well. It seems pretty easy and straight forward for someone without diabetes to suggest making changes. It’s pretty simple for a non-smoker to suggest quitting. It makes sense to an active person that someone should exercise.

But what if they were talking to someone with a severe needle phobia – why don’t you just take the insulin? Or someone who can’t pay for their blood glucose monitoring strips, or is afraid to see the number – why don’t you just check your blood sugar?

It’s important to know the person – the whole person – before jumping to “suggestions.” It’s easy to assume that all the pieces are in place and someone can just do what they’re supposed to do. But we are all humans, and there’s so much more involved.

We all probably say the words why don’t you just from time to time (I’m sure I’ve done it to my husband and kids). Why don’t we just stop saying that?

Posted in about diabetes | Tagged diabetes, language, terminology | Comments Off

Health Websites

Posted on March 13, 2013 by janekdickinson

As I’ve mentioned previously, choosing a website for health information can be a daunting task. Luckily, others have already done the work.

Here is some information about a few more sites:

CaringBridge: “We’re here for anyone who is coping with illness: big or small, short term or long, for as long as you need. CaringBridge is online 24/7, accessible to anyone, anywhere. CaringBridge eases communication and encourages love and support when it matters most. You can share as much or as little as you choose on your protected site. Tap into your community of support during a health event. It’s your very own health social network.”

What Matters Now “provides free personal websites for people whose lives have been affected by serious illness or injury. Our intention is to help people be surrounded by the love and support of family and friends, and have space for reflection when facing a life-changing situation. What Matters Now is offered by The Samvara Project, a 501(c)(3) nonprofit organization.”

Medivizor: “Founded by an interdisciplinary team of entrepreneurs with medical and information technology expertise, Medivizor is the first to provide truly personalized information updates for people with serious medical conditions.” (And here is a good article about Medivizor.)

CaféWell “was created to provide a safe, secure and anonymous health care destination that connects you with other people who share your health care interests and needs. Caféwell is the only destination that exists for one reason “health.” The Caféwell Community is there to address your needs, from chronic condition support, to healthy lifestyle tips and challenges. CaféWell understands how complex and difficult the health care system is to navigate. We make it easy to get the health information you need, when and where you want it.”

Posted in health information | Tagged diabetes, health websites, online health information, reliable health information | Comments Off

Cholesterol and Diabetes

Posted on March 11, 2013 by janekdickinson

People with diabetes have a higher risk for heart disease, and high cholesterol can be a precursor for heart disease. On the other hand, cholesterol has many important functions, including waterproofing for the skin, serving as a component of cell membranes and bile, and a precursor for some of the steroid hormones.

While cleaning my office (an ongoing endeavor), I came across an article about cholesterol myths. The article was from 2000, so I’m hoping many of the myths have already been dispelled, but just in case, here are the myths:

Avoiding high-cholesterol foods can lower people’s risk for heart disease.

Dietary cholesterol and blood cholesterol are the same thing.

People with diabetes should limit eggs to no more than four per week.

Dietary cholesterol and blood cholesterol are not the same thing. Dietary cholesterol only accounts for about 20% of the cholesterol in our bloodstream; the rest is made by the body from saturated fats that we eat. This is why it is the amount of saturated fats, and not dietary cholesterol, that makes a difference in risk for heart disease. As a result, eating one egg per day is typically ok.

LDL stands for “low density lipoprotein.” LDL carries cholesterol out to the tissues of the body. Because this cholesterol can end up causing “plaques” in the arteries, it is often called “bad cholesterol.”

HDL stands for “high density lipoprotein.” HDL takes excess cholesterol from the tissues of the body and carries it back to the liver where it is stored or excreted. Therefore, HDL is often called “good cholesterol.”

Making healthy choices – eating healthy foods and exercising – can help keep total cholesterol, LDL, and HDL in a healthy range.

Source: Zelman, K. (2000). Bio Science Reports Highlights from the American Association of Diabetes Educators 27th Annual Meeting, page 5.

Posted in health care | Tagged cholesterol, diabetes | Comments Off

Diabetic

Posted on March 6, 2013 by janekdickinson

Several years ago the professional diabetes community started working on not using the word “diabetic.” Interestingly, the idea was to stop using “diabetic” as a noun, but it was ok to use it as an adjective. I’ve mentioned before that I avoid using the term altogether, because I don’t find it useful.

I do find it interesting to observe when other people use the word “diabetic.” I wonder if parents who call their kids “diabetics” only see the diabetes when they look at their child; it is a major focus in their life, and I imagine they don’t ever stop thinking about it. I wonder if people who call themselves “diabetics” do so because it helps them remember to keep diabetes at the forefront and take care of it. Or maybe it makes people feel like part of a community.

Or is it just easier? For sure, our language has evolved into one of convenience, and it’s far simpler to say “diabetic” than “person with diabetes” or “people who have diabetes” or “someone living with diabetes.”

Besides not liking labels, I have chosen not to use “diabetic” because for me it’s not uplifting. I was having this conversation with a woman who has diabetes recently and she said when she hears the word “diabetic” she thinks “less than.” That just about summed it up for me! Wow. In fact, we are so much more than diabetes! Diabetes is just one small part of who I am – an important part that I take care of, but not the most important part.

So if you call yourself a diabetic, I support you in that. Maybe that’s all you’ve ever heard and you don’t even think about it. My only hope is that you know that you are more than diabetes.

Posted in about diabetes | Tagged diabetes, diabetic | Comments Off

Healthy Snacks

Posted on March 1, 2013 by janekdickinson

What are some good snacks for people with diabetes? I get this question a lot. Certainly fruits, vegetables, and nuts (or other plant based fats) are great snacks. As far as chips, crackers, ice cream, cookies, baked goods, sweetened drinks, and so on, it’s the same message for everyone: stick with whole grains, low fat dairy, fruit and lots of vegetables; limit trans fats (found in packaged foods), and watch saturated fats (found mainly in animal-based fats).

So what about Greek yogurt? It’s all the rage these days. I’ve never been a big yogurt person, but every once in a while I’ll have some. I decided to try Greek yogurt recently and I’d say it’s ok. It’s not horrible, but as a non-yogurt person I wasn’t blown away. What did impress me, however, is that there was no (zero) fat, and only 16 gm carbohydrate in one cup (serving). It’s gluten-free, and has live and active cultures that can enhance gut health. So my thought is that if you like yogurt, Greek yogurt is a healthy snack choice. Who knows, it just might grow on me! Here’s some more information on the benefits of Greek yogurt.

Do you eat Greek yogurt?

Posted in about diabetes, diabetes care | Tagged diabetes, healthy snacks, snacks | Comments Off

What is type 2 diabetes?

Posted on February 27, 2013 by janekdickinson

Earlier I wrote about type 1 diabetes, so now it’s time to discuss type 2 diabetes (formerly referred to as Type II, “adult-onset,” or “non insulin-dependent” diabetes mellitus). Type 2 diabetes is not as straight-forward as type 1. Type 2 is often characterized by “insulin resistance,” a situation where cells in the body don’t recognize insulin. As a result, glucose can’t get into the cell (to make energy), and the liver releases glucose into the blood stream. Insulin resistance typically shows up as elevated blood glucose first thing in the morning before eating.

For a long time we thought of type 2 diabetes as occurring in adults, but now we know that it can happen any time. More and more children are being diagnosed with type 2 diabetes. We also know that while lifestyle can contribute to the onset of type 2 diabetes, there’s more to it than that. There are genetic factors involved, and scientists are uncovering more clues about type 2 diabetes all the time.

As hard as a diagnosis of type 2 diabetes is, one of the most important things is to free oneself from anger and guilt and move on. Learn about how to manage the disease, and prepare to make changes (small changes are great, in fact, I prefer to call them adjustments!).

The purpose of managing type 2 diabetes is to keep blood glucose levels in a healthy range in order to avoid damage to the blood vessels. People manage type 2 diabetes with a variety of approaches – some keep blood glucose levels stable with lifestyle changes, while others take medications. This is not a reflection on the person, but how their body responds to the disease.

Type 2 diabetes is complex, and no two people with type 2 are the same. With dedication and a positive attitude, people can live long, healthy lives with type 2 diabetes.

Posted in type 2 diabetes, what is diabetes | Tagged adult-onset diabetes, non insulin-dependent diabetes mellitus, type 2 diabetes, type II diabetes | Comments Off

Relax! With Diabetes?

Posted on February 25, 2013 by janekdickinson

Have you ever gotten so stressed out that when people tell you to relax it makes you angry? You know that feeling of barely keeping your head above water? Constantly trying to keep up or catch up? And then you get an article in your inbox that says Relax! You’ll Be More Productive! Or another one that says chronic stress leads to diabetes. Great!

We know that the body’s normal response to stress is to raise the blood glucose. It does this by sending out hormones that help the liver release glucose into the blood stream. Yet this is the last thing we need, since we are probably going to overeat in response to all the stress anyway!

There are many ways to relax and get some stress relief each day. The thing is, you have to decide what works for you. Knowing what pushes your buttons (like having someone tell you to relax) and then figuring out how to handle it may help a lot. I’ve been away for the last week, so I have to go deal with re-entry now. That’s relaxing – not!

Posted in about diabetes | Tagged diabetes, relax, stress | Comments Off

Diabetes “Control”

Posted on February 22, 2013 by janekdickinson

Can you blame women with diabetes, who just had a baby, for having worse “control” after delivery?? Notice I put “control” in quotes. I’ve written previously about why I don’t like to use that word, but I’m using it today for emphasis (and because I’m quoting a study).

There are many reasons why it makes sense to me that women with diabetes would have less than ideal blood glucose levels after giving birth. Pregnancy with diabetes on board is a lot of work. It’s exhausting to be pregnant baseline, and then add all the finger sticking, medication dosing, health care provider visits, food choices, constant worry (and quite a bit of guilt), low blood glucose treating and more. And of course, it’s all for a good (amazing) cause!

Self-care goes out the window for most new moms (with or without diabetes). The last thing a new mom is thinking about is her blood glucose or remembering to take medications or exercise. She has only one thing on her mind: BABY.

Once a woman delivers that beautiful baby, low blood glucose kicks in because there are no more pregnancy hormones, and if she’s breast-feeding that can cause lows as well. And can you just imagine how badly she wants a hot dog or a Margarita or whatever else she didn’t eat/drink for up to 40 weeks?

So I propose a new approach for post-partum women with diabetes. I think there should be a “relaxation window,” where women have a slightly higher A1C target, and while being encouraged to take care of themselves, they are not harrassed or made to feel guilty.

This goes for moms with diabetes who have just adopted a baby and new dads with diabetes as well, by the way!

Posted in about diabetes, diabetes care | Tagged diabetes, new baby, newborn, post-partum, pregnancy and diabetes | Comments Off