Diabetes Self-Management Blog

When I was diagnosed with Type 2 diabetes 27 years and 27 days ago (but who’s counting?), my “education” consisted of being handed a sheet of paper with a diet on it and told: “Here. Follow this. Don’t eat any sugar.” Not even sweet pickles! What was I supposed to eat on my cheese sandwiches? Just mayo isn’t enough!

At least I had it better than my husband, who was told a couple of decades later: “Oh, look. Your fasting is 140 (mg/dl). We’ll have to keep an eye on that.”

Of course, diabetes is classified as a fasting number of at least 126 mg/dl or 200 mg/dl random. It was too late to “keep an eye on it:” He already had full-fledged diabetes.

Sadly, even with all we know today, that’s still the state of diabetes self-management “education” in many cases. Deterrents to education include living in a rural area where the resources may not be available, doctors failing to refer people to education and — maddening to educators everywhere — failure of people who have been referred to show up.

I know some people — a bank CEO, a former college president, a professor — who have diabetes, but have not had education. Is it because their doctors didn’t refer them or because they didn’t go? I interviewed one after he’d had a heart attack and, in an article I wrote about diabetes complications, he kept saying “he knows he needs to” blah, blah, blah. How did he know? Because I told him! During the interview! Dang, he was surprised at some of the things he learned!

I could have used some education, and there was an educator here. Sadly, I found out years later, people with Type 2 diabetes were only referred to her when they went on insulin and all she did was teach them how to draw it up and give injections.

Nine years after diagnosis, when I finally got to a place that sent me for education, my HbA1c was 17.4%. Luckily, I chose my ancestors well. After unknown years of having Type 2 diabetes before diagnosis and nine years of knowing nothing about diabetes, about all I have is a small spot of background retinopathy in each eye and can pass the filament test on my foot with nine out of 10 points being felt.

Being handed a piece of paper with a diet on it wasn’t at all helpful. Having a registered dietitian/CDE say to me “all carbohydrates convert to sugar” turned the light bulb on over my head. So THAT’S why I was supposed to eat one exchange of this, two exchanges of that, etc. It was to regulate my carbohydrate intake!

The cost of education is priceless. Not knowing about diabetes and how to control it (as best as you can) can cost you an arm and a leg. Literally. Not to mention your vision, kidney function, and much more.

I know a woman whose stomach doesn’t work. It’s caused by nerve damage and called gastroparesis. She gets her nourishment through a tube that goes into her jejunum, which is the middle portion of the small intestine. Every bite she eats comes right back up, and she’s so thin her cheeks are sunken in. Sounds real nice, doesn’t it?

Do you think that, under Obamacare, education will be made available? I mean, really good education; not the stuff where they give you a piece of paper to read and turn you loose. Back in 2002, a study was published using people with prediabetes saying Type 2 diabetes could be eliminated or delayed. But the group that had the highest percentage of people who avoided getting diabetes…for a little while…had some highly intensive education and help.

Will the government shell out the money to help people delay, or stave off, joining the Type 2 diabetes epidemic? Do they know that Type 1 diabetes is growing fast, too?

Will they acknowledge that diabetes self-management education can prevent complications? Or will they continue to put education on the back burner? And that goes for medical centers, too.

Those are some of the things I wonder about. And I don’t have any answers. All I can do is continue to learn, to monitor myself, to make sure I’m doing the right things to prevent or delay complications (such as keeping my blood pressure and lipids in normal ranges), to keep my glucose under control as best I can, and to live as healthy a life as I can. I’m not perfect. There are things I need to do, such as get more exercise, but I’m doing the best I can. I’ve started by cleaning my desk and finding that chair-dancing DVD I bought a while back.

Maybe doing the best we can is the best we can do.

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Comments
  1. Jan’s column brings up old memories of what I was handed - prescription for pills, Don’t eat sugars and if one is interested you can use a glucose - meter - One touch - optical device.

    Guides, suggestions, learning tools - whats that. Here 30 years later I have finally learned the proper skills, the nisance liver defects in my body, eating better - low carbs and energy management and oh my god - sufficient exercise.

    On top of that I was one who had platform access - (Internet in those days - defense department).

    Yet worse it has taken 30 years, a stroke in 2007 and finally deciding I did not want to leave in a mess early, to get serious and walk thru the whole mess with my Doctor and make real needed changes. All that said, there seems to me too much bunkum, dogma and misleading information out there that also can lead one astray.

    That said; I am one who is most impressed of the work and bloggers like youself working these issues day after day.

    Posted by jim snell |
  2. I’m a 42 year old with Type 1 Diabetes. I learned, growing up, all there was to know about diabetes. But that was sooooo long ago, I’ve forgotten a lot of the important stuff! So going back and getting a RE-education sounds prime to me! If you find a place that takes Medicaid and does education, please let me know!
    Thank You
    Kelly

    Posted by Kelly |
  3. Great article. There are rural areas that have excellent diabetes educators, but you may have to look around for them. And sadly, sometimes the little hospital out patient departments they work for accept a limited number of insurances or your insurance doesn’t even cover one visit, much less enough to have several sessions. No one can take in all they need to know at one session! It always amazed me to find that one BCBS policy covered all visits, another only allowed 3 in a lifetime and another would not cover any. It depends sometimes on which state has the home office of the patient’s employer. I too hope the ACA brings some sense to this. From a retired CDE who still enjoys reading what is going on in this field and who did diabetes education in a community with population less than 1500!

    Posted by bk cde |

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Diabetes Basics
Bang for Your Self-Management Buck (07/30/14)
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Five Environmental Causes of Diabetes (03/19/14)

 

 

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