There are times that I am dismayed at what I read on Facebook about people navigating diabetes care for themselves or their child. Today, I was asked for my comment on a situation where a child with type 1 was being threatened with the removal of her pump because her HbA1c was higher than target.

This really gets my blood boiling for a number of reasons. Let me count the ways!

  • A pump is not a luxury. It is a way of delivering insulin. Let’s be clear about that. It is a tool that we use in the management of our diabetes.
  • The only person who has the right to determine how their diabetes will be managed is the person with the faulty pancreas (or their parents in the case of young children).
  • HCPs are there to work with us and be guided by what we need and what we are asking for. Equally, we look to them for support, education, advice and information about our diabetes management. We do not look to them to be told off or judged.
  • Punishing a PWD by removing a management tool is just plain stupid. Like it or not, I need to give myself insulin and I choose to use a pump to do that. If I’m feeling a little unmotivated and don’t have the capacity to be checking my BGLs, taking away my pump is not suddenly going to give me an injection (bad, bad pun) of motivation.
  • Scare tactics DO NOT WORK. I’m going to say that again. Scare tactics DO NOT WORK. Also, scare tactics DO NOT WORK.
  • The person in charge at all times is the person with diabetes. Let’s be clear about that too. The PWD is up front, directing traffic. HCPs, diabetes organisations, friends and family are there to support the person in charge.
  • This is going to sound crass, and I don’t mean it to, but HCPs need to remember that they are being paid to do our bidding. They are providing us with a service. And that means, if we don’t like the service, they get sacked and we find someone who will give us the service we need.
  • Threatening to remove a pump is bullying behaviour and it absolves the HCP of any responsibility in the management of their patient. I will never blame my HCP if my A1c is out of range or I am not checking my BGL. I would ask that they don’t blame me and threaten me.
  • Deciding to take away a pump because HbA1c is too high is placing far too much importance on the value of the HbA1c! It’s just a number that gives an average. But not much more.
  • Also, by using results of an HbA1c check as a reason to threaten to remove someone’s pump is forgetting about the considerable emotional impact of diabetes. Just as an out of target A1c is not a reason to rap someone over he knuckles, an in-target A1c is not necessarily an indication that everything is A-okay.

I know that it is not always easy to be your own advocate, but it’s times like this that you really need to be able to stand up for yourself (or your child), or bring along someone who can. Being clear about what you want and need is important – and that includes being clear about what you won’t accept.

I attended the ADS/ADEA conference last week in Sydney just for one day to present at a technology and healthcare symposium (more on that soon).

It was one of those crazy days that started long before the sun rose. I can’t be chipper at 6.30am as my travel companion realised as he greeted me in a very cheery manner only to be met with a steely gaze and pronouncement of ‘I’m yet to have coffee’. It sounded like a threat!

After my presentation, I made the most of a couple of hours at the conference and caught up with as many people as possible. I’d arranged about eight ‘we’ll chat at the conference’ meetings and ended up seeing four people.

I only made it to one session apart from my Symposium and it was a debate.

I love a bit of debating. Those who know me won’t be surprised to know that I was in the debating team when I was at school (Renza nerd fact #3569). But the topic at the conference made me a little uncomfortable and that was before anyone even opened their mouths!

‘It’s our fault if our patients’ HbA1cs are too high’

I don’t like the word ‘fault’. Blaming people for being outside their diabetes targets rarely does anyone any good. As the people living with diabetes, we don’t like to be blamed or told off if we’re not meeting targets, so blaming our HCPs doesn’t make much sense to me either.

Nonetheless, I went along to see what was said.

First up for the affirmative – Cheryl Steele. Now, as far as I’m concerned, Cheryl Steele is wonderful. She was one of the first people I saw present about diabetes when I was first diagnosed with diabetes and she has inspired me ever since. She is a favourite speaker of the T1 Team at DA-Vic, not only because she does a brilliant presentation EVERY SINGLE TIME, but also because of her tell-it-like-it-is manner. And the fact that she is living with type 1 makes her even more awesome!  She changed hats a few times yesterday whilst giving her presentation –sometimes speaking as a CDNE and other times as a PWD. And the confusion about anagrams was one of her points.

The affirmative team’s argument was that until HCPs stopped moving the goal posts, provided better tools for management and stopped disagreeing on what they were telling people with diabetes, then yes, they had to consider taking the blame for their patients higher than target BGLs.

The negative said there was no way that HCPs could be blamed – and were at great pains to point out that they weren’t blaming the PWD. Except there were times that they came pretty damn close – as evidenced by this tweet:

tweet1

 

I felt a little uncomfortable at times during the debate. Although it was very tongue in cheek and there was great spirit throughout the session, there were moments that I wondered just how much truth was in the silliness.  It is a little like the ‘oh-we’re-just-joking’ comments about patients lying about filling in BGL record books.

I know that by and large the HCPs in the room are there for the PWD (I was sitting next to my endo and I know that’s definitely the case with her), but I do get a little concerned at the lack of understanding about what life with diabetes is all about when the negative team thought that dealing with a life-long chronic health condition is kinda like taking a course of antibiotics.

tweet2

Was I being a little too sensitive? Possibly. Am I expecting HCPs to get it wrong? Again, possibly. But as a consumer advocate, I am on heightened alert to make sure that there is compassion, understanding and respect being directed towards PWD at all times. I’m not sure that was necessarily the case throughout the debate last week.

Next time, I’d love to see a debate between HCPs and PWD. Now THAT would be worth paying money to see!

TV’s Dr Gregory House repeatedly says ‘Everybody lies’. He believes that doctors can’t and shouldn’t believe what their patients are telling them because they will omit key points about their health – intentionally or not. Diabetes makes us liars. Not big liars, but it’s easy to tell a white lie here and there.

‘I have NO idea why my BGL is 32.5’ (conveniently forgetting two serves of cheesecake)

‘My last A1c was 7.3%’ (actually, it was 8.3%, but what’s one percentage point between friends?)

‘Of course I bolused for lunch!’

….. etc etc etc

These are small lies and in the scheme of things, really don’t matter. But we do need to ask ourselves, who are we really lying to and why do we feel the need to bend the truth?

I have been seeing the same endo for almost 12 years. After three and a half years of endo-hopping and endo-shopping, I finally found ‘the one’. I admit – the not-so-great relationships with the previous endos where partly my fault. I found them judgemental and I dealt with that by not being completely honest. I didn’t want the admonishing looks or the exasperated sighs from them when they saw my above target numbers.

So, I made things up.

This did me no favours and did nothing to foster a relationship based on trust with them. The relationships were doomed from the start when I think about it. I’m sure they knew that I was lying (they were pretty stupid if they didn’t!) and it was pretty disrespectful of me to think that they were dumb enough to believe what I was saying.

When I started seeing my current endo I made a promise to myself: I would tell her the truth. Now, the fact that she isn’t at all judgemental, is kind and caring and has the best communication skills of any health professional I’ve ever met certainly has helped me keep that promise. Her response to me saying ‘I’m over this and really don’t care about diabetes anymore’ is not head shaking, tut-tutting and telling me off. She wants to know why, how she can help and to know what I believe I can manage to do that will make ME happy. She makes me want to be honest and tell it like it is.

And I hope that because it’s always been that way that she doesn’t doubt what I am saying. I hope she knows that it’s the truth when I say things have been tough, or that I really don’t know why my sugars have been all over the place, or that I really have been checking my BGLs six times a day. I hope that because our relationship started with honesty she knows she can trust what I say as the truth and never doubts me.

A relationship with your health professional that is based on trust, honesty and just telling the bloody truth is rewarding. Starting off that way is critically important. I think that when you feel you can be that way – and it does open you up to feeling vulnerable – that you have found the right match.

But if you start with lies, there is probably no chance that either of you will be getting what you need from the relationship. If you feel you need to lie to them, ask yourself why. Equally, if they know that you are not being honest with them, they need to wonder why that’s the case. No one wins when we are dishonest about our diabetes.

Dr House may believe that everybody lies, but I believe we can start with honesty. My relationship with my endo is rewarding for me because that is how we started. I trust her implicitly and she has no reason to doubt me. It was a good starting point 12 years ago. And it’s still working today.

House

I’ll take any excuse to look at Hugh Laurie!

I’ve been baking up a storm lately. It’s what I do when it’s cold outside. I love sweets but figure if I’m going to set my pump into overdrive, then whatever I am eating had better be bolus worthy!

I don’t ever use sweetener – it’s the real deal all the way for me! I’ve worked out that in most cases, the quantity of sugar listed in the ingredients list can be halved and the end product will still taste great. This is one of the fun things about baking and cooking in general. As you get more confident and learn how things work together, you can play with the ingredients to get the taste just as you like it!

If you feel like joining in, here are a few of my recent sweet treats and links to the recipes.

 

Cake1

Does anything beat a homemade chocolate cake? This is one of the easiest, no-fail recipes you’ll find and it always results in a beautiful cake. Extra-special points for the fancy writing on top!

 

cake2

I always double the lemon quantity given in cake or slice recipes because I think it’s a crime if I don’t get a real hit of zesty-ness when I take that first bite! This recipe is brilliant and it’s no bake! The eight year-old kiddo made this pretty much on her own, so it’s a great one if you’re looking at getting kids cooking. I always feel like I’m getting my CWA on when I make this slice!

 

cake3

Bacon. Chocolate. Brownie. Were there ever three words that sounded better in a row? My baking hero, Nigella Lawson, came up with this recipe which includes a fudge-y brownie with salty, crispy bacon delights strewn throughout. The main problem with this recipe is stopping yourself from eating the candied bacon before you stir it through the brownie mix.

 

cake4

I have eaten more red velvet cupcakes than I care to admit. It’s my favourite cupcake flavour and I love tearing open the cake to reveal the seductive red colour. When we were in NYC over Winter, many afternoons were spent in Magnolia Bakery escaping the cold, enjoying a red velvet afternoon tea. Here’s their recipe. I’m warning you – they are addictive!

So, get baking! Then, put the kettle on and enjoy…Just don’t forget to bolus.

20130818-163351.jpg

Feeling calm after having my senses blasted! A Sunday afternoon spent with family at a beachside pub, eating good food, listening to good music followed by a windswept walk on the beach.

Calm and at peace. A perfect Sunday.

balthazar 2

The bar at Balthazar NYC

There is a restaurant in New York called Balthazar. It’s quite well-known and has been a favourite of ours when we’re in the Big Apple. Each trip has seen us eat a few meals there, pop by for a coffees and pastries, and visit with friends.  We love it because the food is great, the staff are attentive and, with its dark timber-panelled and mirrored walls, it makes us feel like we’re in an old Parisian brasserie. And because there are playing cards on the ceiling.

 

Scattered across the ornate plaster work, are a dozen or so cards. Some are face up, others face down. We noticed them on our first visit there and tried to work out how they got there.  The second time we ate there, we asked our waitress for the story behind the cards. ‘We had a party here quite a few years ago and a magician did a trick. And they stuck to the ceiling,’ she told us. Now we knew how they got there, but we weren’t too sure how they stayed there.  We knew the result, just not the secret to their sticking power.

There are days that diabetes just works. Numbers stay in target, boluses give exactly the right amount of insulin for consumed carbs and no alarms squeal warning of falling or rising BGLs.  Most times, I can’t work out why that happens; it just does. And I love it!

I’ve decided that on those days, I don’t try to analyse it. I sit back and watch the pretty flat line on my CGM and smile at yet another BGL check beginning with the number 6. I just accept the fact that I feel good and energetic and that coping with diabetes seems easy for a day or so.

The longer I’ve lived with diabetes the more I’ve come to realise that there are times that what we put in may not necessarily correlate with the results we’re getting. Sometimes, I need to throw my hands in the air and accept the day has gone to diabetes. Other days, I claim victory for doing nothing special. It’s the nature of the beast. Coming to accept that has been quite refreshing. Accept the result but know that sometimes I just can’t work out why.

This last weekend, the family went to a little French café in Fitzroy. We were enjoying our meals in the timber-lined room, with shelves filled with French wine and Champagne. All of a sudden, Aaron pointed to the ceiling. ‘Look!’ he said. There on the ceiling was a solitary playing card. We looked at each other in surprise and as soon as our waitress walked by asked her about it. ‘We had a party here a while ago’, she began. ‘And a magician did a trick. It’s been there for years.’ I knew that would be the answer she gave, but it still didn’t explain the magic. Sometimes, the method doesn’t matter. But the result is delightful.

 

 

Do you know the secret for getting playing cards to stick to the ceiling? I’m kinda torn between wanting to know and keeping the secret alive…..

Grief is an emotion that is, at times, quite toxic. It is all consuming and can be irrational. I’ve written before about grieving for my pre-diabetes life and how once given permission to do so, I was able to put in perspective where diabetes belongs in my make-up.

But the grief I have been experiencing for the last month has been like nothing I have ever known. It has moved in, made itself at home and is now ordering me around and making me angry.

It may come as a surprise, but I am actually quite pragmatic about the miscarriage. It happens. I knew the stats. At our first ‘Oh-my-god-we’re-pregnant’ appointment with the obstetrician, he calmly, but firmly, told us the stats. Thirty per cent chance of miscarriage at my age. I took it in, smiled weakly and added ‘plus, I’m not good at being pregnant….’ and let my voice trail off.

I refused to get too hopeful and every visit to the bathroom for the next few weeks, I expected to see the tell-tale signs of the pregnancy ending. Throughout our holiday, as I counted another week down, I got a bit more confident, a bit more hopeful. And even though I thought as I ticked of the 12 week and then 13 week mark that I was getting close to feeling sure the pregnancy had ‘stuck’ the stats were always in my mind.

When I miscarried, I was prepared for sadness, although not the all-encompassing grief that engulfed me and took over. But even that was understandable. I was grieving the loss of a baby and the addition to our family.

What I wasn’t prepared for was the anger. It started two days before we were due to get on a plane and head home. I woke up, and there in the pit of my stomach, I felt a heavy stillness that at times threatened to overtake me. At first, I was able to aim the anger at diabetes and to a degree, I still do. I cursed by body. MY stupid fucking diabetes made this happen. The rational side of my brain – which, in all honesty hasn’t had much of a look in lately – reminded me that an A1c sitting in the 6s would not have in any way contributed to the end of the pregnancy. The side that had been overtaken by anger simply disregards common sense. It does it well.

But diabetes – and me – were not the only targets for my anger. As is often the case, the people closest to me bore the brunt of my fury. Aaron was in the direct firing line and there was nothing he could do to avoid – or understand – where this was coming from.

As it became apparent that I’d need further treatment for the miscarriage – another D&C the week we returned home because the one in the US hadn’t been completely successful – I pulled away more. He was compassionate and concerned and I pushed him away. As we sat in the hospital waiting for my name to be called to go into surgery, he tried to hold my hand and I pulled it away.

I was short with my parents – especially my mother. I withdrew from them too and became silent and sullen. And angry.

I realise now though, that it wasn’t really anger towards them that I felt. It was just easier to yell or dish out the silent treatment or be nasty. Because the truth is that the anger was really directed at myself. I couldn’t tell my family that I felt that I’d failed them because I knew that they would tell me that it wasn’t the truth. I didn’t tell them that I was blaming myself for the miscarriage because they would try to make me see that it wasn’t my fault. I couldn’t tell them how much I was hurting or how sad I was because there were no words that expressed those emotions.

It’s been four weeks now. I still feel emotionally wrecked and my heart is heavy with sadness. There are moments when I feel my eyes fill with tears for no real reason – just because. But I can now look at myself in the mirror and not feel hopeless because my stomach has returned to its completely flat state.  I can look at photos from our trip and smile at the memories rather than just focus on the fact that I was pregnant then. And now, I’m not. I’m healing and I’m breathing again and that is a victory.

I know that this is a stage on my way to acceptance. I just wish that there were a way that I could take loved ones along for the ride rather than attack them and alienate them.

This is the last time I’ll be writing about my miscarriage here. Diabetogenic is about real life with diabetes and despite trying with all my might, I can’t blame the miscarriage on diabetes. Thank you to everyone who has read, commented and sent their love through this time. It’s greatly appreciated. 

Follow Diabetogenic on WordPress.com

Enter your email address to follow this blog and receive notifications of new posts by email.

Read about Renza

Archives