Type 1 Diabetes

A Summary of ADA’s Recent 2018 Standards of Medical Care in Diabetes

Fit4D CDE, Andrea Zuwarski summarizes ADA's newly released 2018 Standards of Medical Care in Diabetes, an informative read for both CDEs and diabetes patients.

One is the Loneliest Number: Who are your healthcare team members and why are they important?

Many people with diabetes feel alone in their journey, but it doesn’t have to be that way. Nancy Barton, RN, CDE, profiles the players on your diabetes support team and how they address different aspects of your experience.

Overcoming Barriers to Nutrition with Jane Abbey

In order to eat the foods you love with your diabetes, it's important to understand nutrition. Jane Abbey RN CDE, shares resources for gathering this knowledge. 

Preventing Self-Sabotage; Can Keeping a Journal be the Answer?

Preventing Self-Sabotage; Can Keeping a Journal be the Answer?

What to do when you're falling into old, bad habits? Fit4D CDE and RDN, Erin Spitzberg recommends keeping a journal to identify and overcome hurdles and achieve optimum diabetes control!

Your Top 10 Nutrition Questions Answered!

Your Top 10 Nutrition Questions Answered!

Fit4D CDE and RD, Jennifer Bonczek, answers 10 common nutrition questions for Nutrition Month, with links to helpful resources such as recipes. 

Are Two Hats Better Than One?

We all have many hats that we wear in our lives– parent, partner, colleague, community member etc. For me, two of my most important roles are that of being a mother and a Diabetes Educator.  The fact that my son has type 1 diabetes means that these roles intersect and overlap on a regular basis.

I often wonder how my job affects the way I parent and vice versa, and I often ask myself; is all this overlap a good thing?

As a diabetes educator, learning about and working with the latest diabetes management technologies and insulin therapy options are part of my daily routine. This gives me the opportunity to get detailed information about different diabetes self-management tools and regimens and make assessments about which ones fit well with my son’s diabetes management.

The “Holy Grail”

When I first started my career as a diabetes educator, I found myself thinking that I could outsmart this disease. If I learned enough, incorporated the latest tools, managed things closely – I could achieve “target” blood sugars for my son and protect him from any potential complications.  As I got further in my diabetes education, I came to truly understand why achieving the holy grail of blood sugar management, the “perfect blood sugar”,  with today’s treatment options just was not realistic.

The pancreas is an amazing organ and able to seamlessly manage the 28+ factors that influence our blood sugar levels. To say that being the pancreas for your child from the outside-in is hard would be the understatement of the century.  Not only is it hard, but it is near impossible to do it perfectly.

So while I know that keeping blood sugars in the target range for the majority of the time will protect my son from diabetes complications, I now use my knowledge as a diabetes educator to inform my decisions and expectations about realistic diabetes management goals for a nine-year-old boy. For instance, changing the lancet every time he checks his blood sugar isn’t one of them. Never having blood sugars spike above 200 isn’t one of them.  

Turning Emotions into Manageable Data

I’ve learned to emotionally distance myself from individual blood sugar readings and look at them as data points with patterns and trends that I can use as a basis to make adjustments to pump settings, timing of insulin or food choices. 

Experiencing the day-to-day challenges and frustrations of diabetes management allows me to connect with my patients from a place of “knowing what it’s like”. I believe the fact that I really do know how hard DM can be helps me form a partnership with my patients to reach their DM health goals. This feels way different than just looking at the numbers or policing their food intake.

Perspective

But there’s another side to wearing the two hats of mother and diabetes educator.  As an educator working on the endocrinology unit at a children’s hospital in a major city, I’ve seen and worked with kids in intensive care due to Diabetes Ketoacidosis (DKA).  Sadly, many of them I see time and time again. I’ve had to see firsthand the devastating impact of severe hypoglycemic events.

Even when we’re in a “smooth” diabetes period at home (proving that everything in life is relative), working in the hospital reminds me how quickly things can go wrong with diabetes management. I know that most kids living with type 1 diabetes are happy, thriving and living life exactly as they were meant to live it. But logic doesn’t always win – the reality is, every time I work with a child struggling with life with diabetes I can’t help but worry about my son and experience a moment of grief that he has to rise to face this challenge every single day – no exceptions, no vacations.

 
It’s All About Community

Whether I was a CDE or not, I believe I would be actively involved with the diabetes community. Being part of the community is a great source of emotional strength. There is so much to be gained from the resilience and energy of others and the knowledge that you’re not in this alone.

I feel that staying connected with other type 1 parents (who aren’t CDEs) helps me stay grounded first and foremost in being the best parent I can be for my kids – with and without diabetes. No one knows your child like you do and learning to trust your instincts – even when it comes to diabetes management decisions – is critical. 

There is no single perfect way to do diabetes management. The best gift you can give your child with diabetes is to become their advocate in finding the diabetes management plan that best fits their life and not to make them slaves to the latest study of best practices of diabetes management.

Studies may show that overall, people wearing insulin pumps have better blood sugar control than those who use multiple daily injections but if it’s bathing suit season and you have a teenage daughter – you may find that wearing an insulin pump that sits in the pool bag all day isn’t the way to go. Kids first – diabetes second. 

Life with diabetes is a marathon – not a single three-month A1c test. Let your kids make choices where you can and push your diabetes health care team to provide you with options so you can make decisions that will allow your kid to continue to pursue what’s important to them while managing their blood sugars.

As a mom, I can imagine a conversation some years in the future where my son tells me that he and his wife have discussed it and they feel it’s inappropriate for me to continue to come over to change his infusion sets. As a diabetes educator, I know that my ultimate goal is to equip him, and my patients, with the best self-management skills and the confidence to become their own health advocates 

At the end of the day, it’s a tremendous honor and responsibility to wear these hats and I’m grateful to have the benefit of dedicated experts, patients and parents to help me on my journey to improve the lives of people living with diabetes.

Diane Herbert MSS, LSW

Fit4D Clinical Manager

Pump Therapy, Is It Right For You?

There’s a lot to think about when you make the decision on whether or not to transition from injections to pump therapy.

  • Less injections. Most people with diabetes would say the biggest advantage to using an insulin pump is the elimination of multiple daily injections of insulin.  Instead of being “poked” two to four times a day or more, you are able to change your pump infusion site once every two to three days – drastically decreasing the number of times a needle must pierce your skin.  This could be enticing as you deal with the day-to-day tasks necessary to properly manage your diabetes.
  • Flexibility.  Pump therapy also allows you more flexibility in what you eat and what times you are able to eat.
  • Precision. Your dosing can be more precise with custom basal rate settings as well as having the ability to adjust how quickly your insulin is delivered.  This usually helps cut back on the variability of your blood sugar numbers on a daily basis and can also decrease your frequency of low blood sugars.

On the flip side, there can be some disadvantages.

  • You still need to test.  Pump therapy does not eliminate the need for close monitoring of blood sugar levels, and if you struggle to remember to check your number you could still struggle even with adding pump therapy.  It can actually be more dangerous for you to skip blood sugar checks while using a pump because if there is a malfunction with the pump – such as a kink in the tube – you have no long acting insulin in your system and you can develop dangerously high blood sugar levels rapidly.
  • Cost.  Pump therapy can also be expensive depending on insurance coverage.  You will want to investigate the cost before making the decision to get a pump.
  • You’re attached.  Also, you may not like the idea of having a medical device attached to you twenty-four hours a day, seven days a week.

Type 1 or Type 2?

While pump therapy is mostly used for people with type 1 diabetes, more physicians and diabetes teams are recommending pump therapy for those with type 2 diabetes.  The results have been positive.  One study* showed a decrease in A1c of 1.1% with pump therapy compared to just a 0.4% decrease in people with diabetes using multiple daily injections.  This decrease was also achieved without episodes of hypoglycemia.  They were also able to decrease their total daily dose of insulin by over 20%. This is not surprising as insulin infused continuously has been found to be more efficient than periodic injections.

Advancements in technology have brought many new and exciting options to people with diabetes.  Pump therapy can be a great option, and there are several different types of pumps with a variety of features available.  Before deciding what kind of pump features best suit you, first decide if pump therapy itself will work for your lifestyle and personality.  Talking to an endocrinologist or certified diabetes educator is a great way to find out more information and make the best decision possible!

Gabrielle Kemble, RD, CDE

Fit4D CDE

*http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61037-0/abstract