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Jan 10, 2006

Well now, I'm not sure what to do with this spot but I'll give it a try.

I think one of my greatest areas of dedication (a mission) is to help people with diabetes come to terms with it and learn to deal with the many aspects of this insidious plague. Yes, plague -- you heard me correctly. The numbers of people developing type 2 diabetes is increasing exponentially. With our aging population, the increase in fast food eating, and fairly sedentary life style, the critical factors exist for developing it.

There are so many people who have diabetes already and who don't know it. The symptoms begin slowly and people think of them as just the normal aging process, or consider them as something else entirely that they may not mention them to their doctor.

A lot of diabetics are diagnosed only if their doctor requests a simple blood test along with a regular checkup. Then again -- lots of people don't get an annual checkup unless they are required to for some reason. In some countries, people without insurance simply cannot afford to see a doctor.

People die from diabetes. Yes, it can be fatal. A worst case scenario is if someone cannot afford medical care and cannot afford the medication but don't, for some reason, qualify for government assistance. This did happen in the USA. I met someone in a chat room once whose boyfriend was a type 1 diabetic (needing insulin or die) and who was in that financial situation and who died a horrible death.

I was a moderator in a chat room dedicated to diabetics. So many people came to that room who had just heard that they were diabetic and whose doctor had given them a couple of sheets of paper and told them to lose weight and take some pills. They were in shock and didn't ask questions. Unfortunately, a lot of those who did ask questions were pawned off by the doctor who really didn't know much about the subject. Most medical schools don't teach their doctors much about diabetes. Maybe they do now because of the rapidly growing problem, but what they do know deals with the physical body. They don't deal with the psychology of it. They end up with patients who sometimes don't comply with their treatment because it's just too much to contemplate.

Diabetes is a lifetime disease. No one is cured of it unless they have a transplanted pancreas or go through the new procedure of transplanted diabetes islets into the liver. Type 1 diabetics have the first chance at something like that because they have a worse case of it than the type 2's. There are a lot of misconceptions flying around which can be very confusing to a new diabetic. One of them is that of the "borderline diabetic" A person is told they are borderline when they can control their blood sugars with diet alone. It gives that person the notion that they really don't have diabetes itself and won't suffer the complications inherent in the disease.

Baloney!!!!! Controlled by diet still means you are diabetic and should be watching for the complications and taking care that you don't harm yourself further. It's nice to think that a person can control this by diet alone forever but it rarely happens. Sure a person can do that for a time but the lifestyle habits or the genetic disposition begins to impinge on things and eventually the blood sugars aren't controlled by diet alone and the slow work up to insulin begins. First one pill is used. Then two pills together. Then high blood pressure pills have to be added and finally a person is put on insulin.

Doctors get frustrated by non-compliance -- in other words, patients aren't doing well and they suspect (and in many cases truthfully) that the patient just isn't doing what the doctor has told them to do - or taken the meds properly.

People have strange ideas about diabetes.  They associate it with fat people whom they consider to be gluttons.  They think of needles (oh horrors), blood testing (sticking something in them to get blood), amputation and worse.  They can't see how they could possibly get diabetes.  They assume that they will have to eat like a rabbit.

You can't imagine what it's like for someone to learn to test their blood not just once a day but 4 times a day.  They build themselves up so fear takes over.  They get a monitor but it stays in the box.  Maybe someone takes it out of the box but it sits there on the counter.  Every time the person goes past it, they remember that they will have to make themselves bleed in order to test their blood.  They think of that booklet that they have to write down their test results to show the doctor and it all seems to blame them for their lack of courage.  It builds up in the mind over time and sometimes a person will actually put it away in a cupboard so as to be out of sight.  Out of sight -- out of mind is the theory.  Eventually they do have to bring it out of the box and deal with it.  But it's hard to do. 

The longer it takes, the harder it is to overcome that basic fear of hurting themselves.  They blame the disease for making them do this horrific thing.  It takes longer and longer for them to take the first say 15 or 20 times to get over the fear to some degree.

Now don't get me wrong, folks.  Some people have little or no problems with the idea of poking a finger, or an arm to get a drop of blood.  However, there are more out there than you think.  They are not cowards.  They simply have a problem dealing with this.  Unfortunately poking a finger to get blood for testing is a basic fact of life for a diabetic.

A lot of people coming to my chat room had this problem.  As a support group, we tried to help them with this, everyone cheering them on as they had the monitor out and dealt with it. 

There are a few tricks of the trade that do make things easier.  First of all - never do the prick on the tip of the finger as this is the part of your finger that is the most sensitive and definitely hurts the worst.  I personally use the fleshy part of the finger just below the tip and some people use the side of the finger.  These parts are much less sensitive and don't hurt as much.  Another thing is, that when a new diabetic gets a kit, which includes the lancet (the thing you use to poke the finger with) and there is a dial on it.  A new diabetic should move the dial to the lower numbers.  This means that the lancet doesn't go into the finger quite so far and it also doesn't need to click with a harder pressure.  The new diabetic's skin has no calluses (unless they are a person whose work develops calluses) and it doesn't need a lot of pressure to poke with and doesn't need to go further into the finger to get blood.  I also find that the fleshy part or the side part will get blood easier than on the tip. 

Nurses are taught to use the tip of the finger and the higher number on the dial so I never let a nurse prick my finger but rather do it myself.  If they insist, then so do I.

Doctors also can contribute to this menace to pricking your finger.  They think they are doing a person a favor by saying after a time of regular blood testing, that you can spread out your testing, even maybe doing it just once a week.

I ask you -- how can you remember if you've tested your blood on a particular day at a particular time.  What are you supposed to do, make sticky pad notes all over the house saying "Wednesday at 2:30 stick it to me!"  I can just see a visitor in the bathroom seeing such a message.  The mind boggles at their reaction particularly if they don't know you're a diabetic.

There is another thing to this.  The finger gets a chance to heal up in between times and cannot build up the calluses which actually help a person feel the pain less.  It means that you hurt yourself each time instead of being able to feel it less and less as time passes.  It's oh so easy to forget to test, yellow, pink or chartruse sticky pad notes notwithstanding.  People will get out of the habit and sometimes months will pass between tests.  The longer time passes the easier it is to rationalize  your way out of testing altogether.  After all, you went all those years before not having to poke yourself. 

The doctor (if he/she is any kind of a good doctor, will be doing that 3 month test of your blood, so that should be good enough, shouldn't it?

I can see the reasoning behind it.  But testing has a purpose beyond that of simply showing the doctor that you are within the normal range (or not)  Testing teaches you about your own particular version of diabetes.  Yes, folks, we all, every one of us, has a different kind of diabetes.

No way -- you say.  Yes way.

We all react to different foods with a different result on the blood glucose levels.  For example.  I have a friend who cannot touch ice cream because her levels go so high after having even one small scoop that she figures it's not worth it to have any ice cream at all.  I, on the other hand, can have one scoop twice a week complete with caramel sauce on it (my brand is chocolate ice cream) and my blood sugars show virtually no change either up or down.  I feel quite free to eat my twice weekly ice cream.  Actually I used to have ice cream nearly every evening for dessert but I cut down trying to lose weight, not because my bg's (blood glucose levels) were out of whack.

Someone else could eat pie without it affecting them but my bg's go way up if I try to eat pie.  This isn't to say that I don't, from time to time, indulge in a nice piece of pie but I sneakily raise my insulin levels for that meal to compensate.

The thing is, you can't possibly know what affects you personally if you don't test on a regular basis.  Sure the doctor is trying to let you off the hook from pricking your finger so often but it's making it harder, not easier.

Getting into the habit of doing the testing before every meal and again at bedtime means three things. 
    1)    You won't forget to test because it's a habit
    2)   Your finger won't hurt as badly because you have calluses
    3)   You will learn what affects you and what doesn't

So my advice to you is to test on a regular basis.  The benefits far outweigh the ouchiness of testing.


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Posted: Tuesday January 10, 2006, 5:58 pm
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Flo Taylor
female, age 67, married, 5 children
Grande Cache, Alberta, Canada
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