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Anger

Friday, October 5th, 2007

Diabetes is the perfect breeding ground for anger. Anger can start at diagnosis with the question, “Why me?” You may dwell on how unfair diabetes is: “I’m so angry at this disease! I don’t want to treat it. I don’t want to control it. I hate it!”

One reason diabetes and anger so often go hand in hand is that diabetes can make you feel threatened. Life with diabetes can seem full of dangers – insulin reactions or complications. When you fear these threats, anger often surges to your defense.

While it’s true that out-of-control anger can cause more harm than good, that’s only part of the story. Anger can also help you assert and protect yourself. You can learn to use your anger. You can even put it to work for better diabetes care.

Anger and Self-Care

Anger worked against Mary H., a woman in her mid-fifties who was diagnosed with diabetes six months ago. She was furious. She saw diabetes as not just a threat to her health, but also to her whole way of life. A very proud woman, active in community and social affairs, she found it impossible to be open about her “weakness.” She didn’t want her friends to prepare special foods for her. She even felt her husband now saw her as an “invalid” and that she was “less of a woman” to him. Denial fueled Mary’s anger at diabetes.

The Anger Circle

Mary was stuck in an anger circle. She was angry at diabetes for changing her life. She refused to face her health care needs because she refused to change her life. Her diabetes went uncared for and her blood sugar levels stayed high. As the disease went on poorly controlled, Mary felt worse. Her anger at diabetes grew.

If you find yourself in an anger circle, like Mary, you don’t have to stay stuck. One way to break the circle comes from Dr. Weisinger’s Anger Work Out Book by Hendrie Weisinger, PhD. He suggests you do three things:

1. Figure out what’s making you angry. How is that anger affecting your life? Keep track of when you feel angry. Each evening, think back over the day. When were you angry? What time was it? Who were you angry at? What did you do about it?

After several weeks, read over your notes. See any patterns? When Mary read her anger diary, she learned that social situations made her angry. She did not like talking about her diabetes in public. She felt angry if friends asked her what she could eat or made special food. When she and her husband tried to go out with friends, she felt her diabetes was the center of attention.

2. Change the thoughts, physical responses, and actions that fuel your anger. Look for warning signs that your anger is building. Do you feel tense? Are you talking louder and faster? When you feel anger taking over, calm yourself by:

  • talking slowly
  • slowing your breathing
  • getting a drink of water
  • sitting down
  • leaning back
  • quieting yourself. Silence is golden in these situations.

These steps don’t mean you stop feeling angry. Instead, they mean you are taking charge of your anger.

3. Find ways to make your anger work for you. Your anger diary can help. Read your notes again. Look at each situation. Ask yourself – How was my anger helping me cope? Mary decided her anger was helping her avoid talking about her diabetes with others. She decided to try answering questions in a matter-of-fact way. But she found that talking about diabetes in public still made her furious.

Mary’s anger told her something very important. She still hadn’t accepted having diabetes. To get more support, she joined her local American Diabetes Association. Meeting other people with diabetes helped her feel less alone. She also realized that having diabetes did not make her less of a person.

Slowly, she was able to enjoy her friends again. She was able to talk openly about her disease and also tell her friends that she didn’t want special treatment.

Let anger be your ally

The goal is not to get anger out of your life. You may go on feeling angry about the same things. When you feel threatened, afraid, or frustrated, anger is a normal response. But you can put your anger to work for you. Your anger may be a signal that you need to take action. A few sessions with a skilled counselor might help.

Anger can be a force for action, change, and growth. The better you understand your anger, the better you will be able to use it for good self-care.

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Denial

Friday, August 31st, 2007

Denial is that voice inside repeating: “Not me.” Most people go through denial when they are first diagnosed with diabetes. “I don’t believe it. There must be some mistake,” they say.

That first reaction is not the real problem. In fact, it’s so common that some doctors think it’s part of the process of accepting the diagnosis.

The trouble comes when you keep on denying your diabetes. Long-term denial stops you from learning what you need to know to keep yourself healthy.

Why deny?

Sometimes denial serves a purpose. It is a way of coping with bad news. It can keep you from getting overwhelmed and depressed. It lets you accept news little by little, when you are ready.

But denial can return later on because it seems easier. Denying that your diabetes is serious lets you avoid self-care. It shields you from the fact that diabetes is a lifelong, chronic illness, which, if left untreated, can result in complications. Denial also lets your family and friends pretend that “nothing is wrong.”

Doctors who do not specialize in diabetes care may fuel your denial. They may talk about a “mild” case of diabetes or say there is “just a touch of sugar” in your blood. Though well-meaning, these terms send the wrong message. What you hear is “Don’t worry. Your diabetes is not serious enough to hurt you.”

Spotting denial

Denial has a few catch phrases. If you hear yourself thinking or saying them, you are avoiding some part of your diabetes care.

  • One bite won’t hurt.
  • This sore will heal by itself.
  • I’ll go to the doctor later.
  • I don’t have time to do it.
  • My diabetes isn’t serious. I only have to take a pill, not shots.

Hidden Danger

Because denial can creep into any aspect of diabetes self-care, it can be dangerous. Any denial sabotages your health care.

Not testing It can be a bother to check your blood glucose regularly. You may decide you “know” what your blood glucose is by how you feel. But a meter is a much better measure of blood glucose than feelings are.

Ignoring your meal plan Changing eating habits and food choices is tough. When your doctor told you to see a dietitian, follow a meal plan, and change your eating habits, maybe you thought to yourself:

  • It’s too expensive to see a registered dietitian.
  • I can’t ask my family to change what they eat. I don’t want to eat alone or fix two meals.
  • There’s no place to buy healthy food where I work.
  • It’s too hard to bring my lunch.

Eating right may not be as difficult as you think. A dietitian can help you put together a plan that meets your personal needs.

Forgetting your feet You know you should check your feet each day, but it takes too much time. Or you forget. Or you have limited mobility and it’s too hard. Washing and checking your feet for signs of trouble every day is essential to avoid serious injury. This is true no matter what type of diabetes you have.

Smoking You might tell yourself, “I only take a few puffs.” You may say smoking keeps you from eating too much. “If I quit, I’ll gain weight.” Smoking and diabetes are a deadly duo. Smoking increases your risk for complications. Quitting is one of the best things you can do for your health.

Avoiding denial

Denial is human. It’s bound to crop up from time to time. When it does, you can recognize what’s going on and fight back.

Write down your diabetes care plan and your health care goals. Understand why each item in your plan is important. Accept that it will take time to reach your goals. If you find you are denying some parts of your diabetes care, ask your diabetes educator for help. If you have trouble with your food plan, talk to a registered dietitian. Together you can come up with solutions.

Tell your friends and family how they can help. Let them know that encouraging you to go off your plan is not a kindness. Inform them about how you take care of your diabetes – they might want to adopt some of your healthy habits.

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Flu & Pneumonia Shots

Sunday, August 12th, 2007

Flu Shots

Having the flu can be dangerous for anyone. But it is extra risky for people with diabetes or other chronic health problems.

In general, every person with diabetes needs a flu shot each year. Talk with your doctor about having a flu shot. Flu shots do not give 100% protection, but they do make it much harder for you to catch the flu for about 6 months. For extra safety, it’s a good idea for the people you live with or spend a lot of time with to get a flu shot, too. You are less likely to get the flu if the people around you don’t have it.

The best time to get your flu shot is beginning in September. The shot takes about two weeks to take effect.

If you have a cold or other respiratory illness, wait until you are healthy again before having your flu shot. And don’t get a flu shot if you are allergic to eggs.

Pneumonia Shots

People with diabetes are about 3 times more likely to die with flu and pneumonia. Yet only one-third of them ever get a simple, safe pneumonia shot. A pneumonia shot is recommended for anyone aged 2 or older who, because of chronic health problems (such as diabetes) or age, has a greater chance of getting and dying with pneumonia. A pneumonia shot can also protect you from other infections caused by the same bacteria. Consider the risks everyone faces:

  • 1 out of 20 adults who get pneumonia (a lung infection) dies
  • 2 out of 10 adults who get infection of the blood (bacteremia) die
  • 3 out of 10 adults who get infection of the covering of the brain (meningitis) die

About 10,000 people die each year because of these bacterial infections. A pneumonia shot, however, can help protect you against getting these illnesses. In fact, it is about 60% effective in preventing the most serious pneumonias, meningitis, bacteremia and death.

You can get a pneumonia shot anytime during the year. For most people, one shot is enough protection for a lifetime. People under 65 who have a chronic illness or a weakened immune system should ask their doctor about getting another shot 5-10 years after their first one.

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When You Travel

Saturday, July 28th, 2007

Planning a trip? Whether you’re camping or cruising, you can go anywhere and do almost anything. It just takes a little planning ahead to handle your diabetes.

How you prepare depends on where you’re going and for how long. Two weeks backpacking through Europe takes different planning than a week at the beach. Will you be crossing time zones? What kind of food will you eat and when? Will you be more active or less active than usual?

Getting Ready

Before a long trip, have a medical exam to make sure your diabetes is in good control. Schedule the exam with enough time to work on your control before you depart. Get immunization shots — if you need them — at least one month before you leave. If the shots make you sick, you’ll have time to recover before your trip.

Before any trip, get two papers from your doctor: a letter and a prescription. The letter should explain what you need to do for your diabetes, such as take diabetes pills or insulin shots. It should list insulin, syringes, and any other medications or devices you use. The letter should also list any allergies you have or any foods or medications to which you are sensitive.

The prescription should be for insulin or diabetes pills. You should have more than enough insulin and syringes or pills to last through the trip. But the prescription may help in case of emergency. In the United States, prescription rules may vary from state to state.

No matter where you go, wear a medical ID bracelet or necklace that shows you have diabetes. If you’re leaving the country, also learn how to say “I have diabetes” and “sugar or orange juice, please” in the language or languages of the countries you’ll visit.

Packing Tips

The second rule of travel for a person with diabetes: pack at least twice as much medication and blood-testing supplies as you think you need. Pack at least half in your carry-on bag so that your medication is always with you.

Whether you travel by car, plane, boat, bike, or foot, you’ll want to keep this “carry-on” bag with you at all times. Pack this bag with:

  • all the insulin and syringes you will need for the trip
  • blood and urine testing supplies (include extra batteries for your glucose meter)
  • all oral medications (an extra supply is a good idea)
  • other medications or medical supplies, such as glucagon, antidiarrhea medication, antibiotic ointment, antinausea drugs
  • your ID and diabetes identity card
  • a well-wrapped, air-tight snack pack of crackers or cheese, peanut butter, fruit, a juice box, and some form of sugar (hard candy or glucose tablets) to treat low blood glucose

Eating in the Air

When you fly, you can request a special meal low in sugar, fat, or cholesterol. Make your request at least two days before the flight. If you take insulin, wait until you see your food coming down the aisle before you take your shot. Otherwise, a delay in the meal could lead to low blood glucose. To be safe, always carry some food with you. If your meal is delayed or an order is mixed up, you won’t be stuck with an empty stomach.

Have Insulin, Will Travel

When you travel with insulin, give some thought to where you’ll be storing your supplies. Insulin does not need to be refrigerated. But insulin stored in very hot or very cold temperatures may lose strength. Don’t store your insulin in the glove compartment or trunk of your car. Backpacks and cycle bags can get quite hot in the direct sunlight. If you plan to travel by car or bike or to be out in the elements, take steps to protect your insulin. Many travel packs are available to keep your insulin cool.

In general, you should stick with the exact brand and formulation of insulin that you have been prescribed by your doctor. However, if you run out while you are on the road, and your regular brand is unavailable, you may substitute another brand’s equivalent formulation (for example, NovoLog for Humalog, Humulin R for Novolin R). Changes in formulation (for example, from rapid-acting Humalog to to short-acting Humulin R) require medical supervision.

Insulins used in the United States are all of the strength U-100. In foreign countries, insulins may come as U-40 or U-80. If you need to use these insulins, you must buy new syringes to match the new insulin to avoid a mistake in your insulin dose. If you use U-100 syringes for U-40 or U-80 insulin, you will take much less insulin than your correct dose. If you use U-100 insulin in a U-40 or U-80 syringe, you will take too much insulin.

Crossing Time Zones

If you take insulin shots and will be crossing time zones, talk to your doctor or diabetes educator before your trip. Bring your flight schedule and information on time zone changes. Your doctor or educator can help you plan the timing of your injections while you travel.

Remember: eastward travel means a shorter day. If you inject insulin, less may be needed. Westward travel means a longer day, so more insulin may be needed.

To keep track of shots and meals through changing time zones, keep your watch on your home time zone until the morning after you arrive.

If you inject insulin while in flight, frequent travelers suggest you be careful not to inject air into the insulin bottle. In the pressurized cabin, pressure differences can cause the plunger to “fight you.” This can make it hard to measure insulin accurately.

Checking your blood glucose while traveling is as important as when you’re at home. Also, check your blood glucose level as soon as possible after landing. Jet lag can make it hard to tell if you have very low or very high blood glucose.

Welcome

After a long flight, take it easy for a few days. Check your blood glucose often. If you take insulin, plan your activities so you can work in your insulin and meals. If you are more active than usual, your blood glucose could go too low. Take along snacks when hiking or sightseeing. Don’t assume you will be able to find food wherever you are.

No matter what kind of diabetes you have, it’s smart to watch what you eat and drink when traveling. Avoid tap water overseas. This includes ice cubes made from tap water. Ask for a list of ingredients for unfamiliar foods. Some foods may upset your stomach and hurt your diabetes control. But you will also find foods that give you a healthy taste of culture.

Wear comfortable shoes and never go barefoot. Check your feet every day. You should look for blisters, cuts, redness, swelling, and scratches. Get medical care at the first sign of infection or inflammation.

Go wherever your heart leads you. Just remember that you take your diabetes with you. Take your self-care along, too.

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When You’re Sick

Thursday, July 5th, 2007

Being sick can make your blood glucose (sugar) level go up very high. It can also cause serious conditions that can put you in a coma. The best way to prevent a minor illness from becoming a major problem is to work out a plan of action for sick days ahead of time. Then when you become sick, you will feel safe and secure. You will already know what to do and you will have the supplies onhand to do it.

What Happens When You’re Sick

When you’re sick, you’re under stress. To deal with this stress, your body releases hormones that help it fight disease. But these hormones have side effects. They raise blood sugar levels and interfere with the blood sugar-lowering effects of insulin.

As a result, when you are sick, it is harder to keep your blood sugar in your target range. Ketoacidosis leading to a diabetic coma can develop, particularly in people with type 1 diabetes. People with type 2 diabetes, especially older people, can develop a similar condition called hyperosmolar hyperglycemic nonketotic coma. Both conditions are dangerous and can be life-threatening.

Making a Sick-Day Plan

Prepare a plan for sick days in advance. Work with your doctor, or a diabetes educator. The plan will include when to call your diabetes team, how often to measure blood sugar and urine ketones, what medicines to take, and how to eat.

Also, attach to your plan a list of phone numbers for your doctor, diabetes educator, and dietitian. Make sure you also know how to reach them at night and on weekends and holidays. Then when illness strikes, you will be ready.

When to Call Your Diabetes Team

You do not need to call your team every time you have a sniffle. But you will probably want to call if certain things happen. For example:

  • you’ve been sick or have had a fever for a couple of days and aren’t getting better
  • you’ve been vomiting or having diarrhea for more than 6 hours
  • you have moderate to large amounts of ketones in your urine
  • your glucose levels are higher than 240 even though you’ve taken the extra insulin your sick-day plan calls for
  • you take pills for your diabetes and your blood sugar level climbs to more than 240 before meals and stays there for more than 24 hours
  • you have symptoms that might signal ketoacidosis or dehydration or some other serious condition (for example, your chest hurts, you are having trouble breathing, your breath smells fruity, or your lips or tongue are dry and cracked)
  • you aren’t certain what to do to take care of yourself

Be ready to tell what medicines you’ve taken and how much, how long you’ve been sick, whether you can eat and keep food down, whether you’ve lost weight, and what your temperature, blood sugar level, and urine ketone level are. To be prepared, keep written records of all these things as soon as you become sick.

Keep Your Notebook Handy

No matter what kind of diabetes you have, measure your blood sugar and urine ketones more often than usual. If you have type 1 diabetes, you may need to measure blood sugar and urine ketones every four hours. Measuring ketones is very important because these waste products are more likely to build up when you are sick and lead to ketoacidosis.

If you have type 2 diabetes, checking blood sugar four times a day may be enough. You might only need to measure ketones if your blood sugar is higher than 300. If you do not have a meter, talk to your diabetes educator about getting one.

Diabetes Medicines

When sick, you will still need to continue medicine for your diabetes. Even if you are throwing up, don’t stop your medicines. You need them because your body makes extra glucose (sugar) when you are sick.

If you have type 1 diabetes, you may have to take extra insulin to bring down the higher blood sugar levels. If you have type 2 diabetes, you may be able to take your pills, or you may need to use insulin for a short time. In either case, work with your diabetes team to develop your sick-day plan.

Food

Eating and drinking can be a big problem when you’re sick. But it’s important to stick to your normal meal plan if you can. In addition to your normal meals, drink lots of non-caloric liquids to keep from getting dehydrated. These are liquids like water and diet soft drinks. It’s easy to run low on fluids when you are vomiting or have a fever or diarrhea. Extra fluids will also help get rid of the extra sugar (and possibly, ketones) in your blood.

But what if you can’t stick to your normal meal plan? Your sick-day plan should contain a meal plan. Try to take in your normal number of calories by eating easy-on-the-stomach foods like regular (non-diet) gelatin, crackers, soups, and applesauce.

If even these mild foods are too hard to eat, you may have to stick to drinking liquids that contain carbohydrates. Aim for 50 grams of carbohydrate every three to four hours. Your sick-day plan may include regular (not diet) soft drinks. Other high-carbohydrate liquids and almost-liquids are juice, frozen juice bars, sherbet, pudding, creamed soups, and fruit-flavored yogurt. Broth is also a good choice.

To prepare for sick days, have onhand at home a small stock of non-diet soft drinks, broth, applesauce, and regular gelatin.

Handy Sick-Day Snacks

These foods contain between 10 and 15 grams of carbohydrates.

Fluids

1 double-stick popsicle
1 cup Gatorade
1 cup milk
1 cup soup
1/2 cup fruit juice
1/2 cup regular soft drink (not diet)

Foods

6 saltines
5 vanilla wafers
4 Lifesavers
3 graham crackers
1 slice dry toast (not light bread)
1/2 cup cooked cereal
1/3 cup frozen yogurt
1/2 cup regular ice cream
1/2 cup sugar-free pudding
1/2 cup regular (not sugar-free) Jell-O
1/2 cup custard
1/2 cup mashed potatoes
1/4 cup sherbet
1/4 cup regular pudding

From “Diabetes Care When You’re Sick,” by Rachel Gifford, RN, MSN, CDE, and Belinda P. Childs, ARNP, MN, BC-ADM, CDE, Diabetes Forecast, February 2005, page 46

Medicines to Watch Out For

You may want to take extra medicines when you are sick. For example, if you have a cold, you may want to take a cough medicine. Always check the label of over-the-counter medicines before you buy them to see if they have sugar. Small doses of medicines with sugar are usually okay. But to be on the safe side, ask the pharmacist or your team about sugar-free medicines.

Many medicines you take for short-term illnesses can affect your blood sugar levels, even if they don’t contain sugar. For example, aspirin in large doses can lower blood sugar levels. Some antibiotics lower blood sugar levels in people with type 2 diabetes who take diabetes pills. Decongestants and some products for treating colds raise blood sugar levels.

If you must go to the emergency room or see a different doctor than usual, be sure to say you have diabetes, or have your identification bracelet in plain view. List all the medicines that you are taking. Your blood sugar level can also be affected by medicines you take for chronic or long-term conditions.

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