Diabetes Management: What’s Your Category?

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Dad had surgery last Friday to have a stent placed to keep the excess fluid in his brain at a normal level. He has a condition called normal pressure hydrocephalus, which is when the cerebrospinal fluid that keeps the brain nourished and cushioned doesn’t drain fast enough. That causes pressure to build up and affect the areas of the brain that control urinary continence, the ability to walk properly, and memory.

He’s doing well, and we talked Sunday. Before the surgery, he was in the equivalent of the third stage of Alzheimer. A couple of days after surgery, he knew my name, that I was his daughter, and that I had sent him balloons. But I had to keep myself from laughing when he asked, “When are you going to come over to (pause) wherever I am.” Which was in his bedroom at home.

Bless his heart, as they say in the South. And the story was apropos of nothing, except that it gave me a chuckle and I hope it gave you one, too — and because I believe people should know about normal pressure hydrocephalus. Because it usually occurs in older individuals, most think “it’s nursing home time” when people begin to wet themselves, stumble around, and fall and become forgetful, when, in fact, it’s a treatable condition. If one of your loved ones begins displaying those symptoms, you might want to ask about having that person tested for the condition.

OK. On to something else.

While working on a project, I discovered I’d forgotten to include a link to a medical journal article in an e-mail I’d copied into a document and saved in a folder. So I went looking through my old e-mails to see if I’d saved the original. (I had. Whew!)

In the same general vicinity was a comment I’d saved from a blog entry called “Type 1s vs. Type 2s?” written by David Spero.

Here’s most of the comment:

Yes, I’ll admit to being one of those who gets a bit peeved when people don’t understand the difference between a type 1 and a type [II]. I have pretty much gotten used to the ignorance of many doctors and try to ignore the uneducated general public. But my experience has shown me that much of the irritation type 1’s have with type II’s is a result of the attitude of so many type II’s. First of all, as a group they obviously do not have a good understanding of their own disease, let alone what type I is. (just read some of the comments above)

I have heard many T II’s say “I really don’t even know I have the disease”, and find many do not even know what their AIc levels are.

How many times have I witnessed type II’s gobble down large amounts of potatoes and dessert at a meal? Often!

I have no animosity toward the type II’s as a group…but admittedly resent being lumped together with them. I do believe that about 50% of them could be diabetes free with a lifestyle and diet change and that about that same % often give all diabetics a bad name. I believe one of the regular writers for the Diabetes Self Management blog is sometimes guilty of this.

See that last sentence? Gee, I wonder who he was talking about.

(By the way, one of my pet peeves is the use of “Type II” more than a decade after it was changed to Type 2 so it wouldn’t be mistaken for “Type eleven.”)

I think that people with Type 2 diabetes fall into three basic categories: those who either don’t take care of themselves at all or try it for a while and then give up; those who are obsessive about managing their Type 2 diabetes; and those who educate themselves enough to be able — for the most part — to maintain the lifestyle they prefer.

I am, or have been, in all three categories.

Have all of you out there had diabetes self-management education? I didn’t until nine years after diagnosis. Well, I guess I had some. It consisted of my doctor handing me a piece of paper with the American Diabetes Association’s (ADA) exchange diet on it and telling me: “Here. Follow this. Don’t eat any sugar.” And to come back in three months for an HbA1c test “so I can tell if you’ve eaten any pizza. Har har.”

I followed it for about two weeks. It didn’t fit the way I ate, and it didn’t include many of the foods I eat. “Matzo? Falafel? Kugel? What are those?” that piece of paper seemed to say. I was miserable. So I gave up. After all, all I knew about diabetes was that you had to follow that diet, you couldn’t eat sugar, and you had to take insulin. I didn’t have to take insulin, so my diabetes must not have been the “bad” kind.

A friend’s son went to his doctor five or so years ago and his education was: “you have diabetes. Watch what you eat.”

My husband’s (former) doctor told him: “Gee. Your fasting level is 160. We’ll have to keep an eye on that.” That was something like three years ago. So it’s still going on.

How many people get diagnosed with Type 2 diabetes and aren’t told anything or sent for education?

Nine years after diagnosis, I went to an educator for the first time. It was shortly after I learned there were such things as CDEs. Nine years it took me. As it turns out, I learned later, the doctor who diagnosed me didn’t believe in preventive care. And he later became medical director of the clinic — the largest group of doctors in town.

At any rate, I learned about diabetes and became obsessive about taking care of my Type 2 diabetes. I ate precisely the amount of carbohydrates I was allowed at precise times every day. The first time I “allowed” myself to eat something I’d been wanting for a long time, I dissolved into tears when my husband said, “Jan, your diab…” We were at a restaurant. I’d already taken my insulin. (This was pre-rapid-acting insulin). Appetite now gone, I had to eat anyway.

During this period, I lectured other people. That’s the way it was supposed to be done and that’s the way they should be doing it. I was a pain in the patootie! I was also stressed and depressed. I’m more of a loosey-goosey free spirit.

Today, when I run into people in the obsessive category, I wonder if that’s their personality type or if they’re like I was for a while and are miserable while they’re trying to do “the right thing.”

Next week, I’ll address the final category. And probably add some other related stuff. This blog entry is now approaching the tome category!

In the meantime, what were you told at diagnosis? Were you sent for education? (Did you go? Many people who are referred don’t show up, I’m told.) Are you an obsessive type — or a recovering one?

And in the “for what it’s worth” department, it doesn’t matter to me what method you use to control your diabetes — as long as it’s something that works for you.

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