Late

I know this entry is late. I was enjoying my family too much this weekend and this post slipped my mind.

I am training to do a leg of a relay team in the bike race, LotoJa. My leg/legs will be between 36-60 miles long. This is difficult for me and will probably be the first and last bike race I participate in. I have discovered that I am not a competitive person and like to ride just for the sake of riding and the joy it brings me, not to see how fast I can go or if I can beat a time. 

I was already riding about 17 miles 3-4 times a week but I knew that I needed to kick it up and start doing a long ride, 35-50 miles, once a week. Not to be competitive, just so I don’t die during the race. I did my first long ride (35 miles until I had a run-in with a hedge at mile 30 which put an end to my ride for the day) on Saturday. It was hard. But it was not as hard as I thought it would be and even when I got tired, I kept pedaling.

Someone has written the “purpose” on the trail I like to ride. It is my new theme word. Do things with purpose. If we could ask ourselves that question, “Am I doing what I’m doing with purpose? What is that purpose?” how much more fulfilling would our lives be?

Then I applied these experiences to this class, and to patients with diabetes in general. How can we educate with purpose? How can we get our patients to see that everything they do, as hard as it might seem, is done with purpose? The exercise, the carb counting, the glucose checks, the medication. It’s hard, but if we can get them to see purpose in what they do, discover their own purpose, I believe that compliance will be greater and their health will be better.

Sleep is good.

I have worked at Timpanogos Regional Hospital for twelve years. All of those years were worked on the grave yard shift. I just switched to day shift about one month ago. I could not remember feeling “normal”, sleeping “normal”, eating “normal”, until I switched. I think there should be a larger differential for night shift workers because of the havoc it wreaks on your body and mind. 

I’ve read many articles on the shortened lifespan for night shift workers, increased risk of heart disease, etc. This week I read an article on a Korean study that stated those who slept at least 8 hours each night had a 23% increased chance of getting type 2 DM. Those who slept 6 hours had a 44% chance of progressing to type 2 DM and those who slept 5 hours or less had a whopping 68% increased risk of progressing to type 2 DM.

As a night shift worker, you are ALWAYS operating on a sleep deficit. It would be interesting to do a study on these night shift employees to see if working night shift and living on sleep deficits increased your risk even more.  Just another reason night shift workers deserve props and more differential. So glad I feel like a normal human being again. I will never go back again. 

The Future

One of the posts from my group this week was on the tremendous cost of diabetes in this country. Then I read a diabetes brief that listed the current diabetes statistics. Currently in the U.S. there are 30.1 million people with diabetes with 85.6 million with prediabetes. It also stated that 25% of those who are 65 or older have diabetes compared with 4% of people ages 18-44 who have diabetes. 

These statistics are scary to me. The amount of resources devoted to this disease and the complications from it are astounding. With 2.5 times more people than already have diabetes waiting in the wings with prediabetes, the cost seems like something we would put near the top of the list for prevention education. And all studies I have read on projections only predict this number to increase greatly in the future. We have to do something in the healthcare industry hand in hand with government leaders and legislatures to curb this trend. Specifically with obesity and lifestyle changes. 

I don’t know what the answers are, maybe very early education on healthy eating and lifestyles, but this just seems like a ticking time bomb. 

Holistic Nursing

A friend of mine is finishing her BSN as well. She is going through a different school and is taking a class entitled Holistic Nursing. At first we both scoffed at the idea of this required class. She knows I am taking this class on Diabetes Management and was reading me some information from her book this morning.

It was about dietary supplements that have been studied in diabetes type 2. Supplements such as chromium which has been shown to help insulin take glucose into cells. Vitamin C can help reduce HgbA1C. Vitamin E protects cell membranes and may help prevent neuropathy in diabetic patients. B vitamins niacin and B6 help blood glucose control and preventing neuropathy. Magnesium deficiency may worsen diabetic retinopathy and taking the supplement may help to improve or prevent this. Zinc is protective in against beta cell destruction. Manganese can also help in BG control and thyroid function.

Anyway, I wonder if many PCPs or endocrinologists utilize holistic medicine? Of course, the patient would need to remain on his diabetic medications like metformin or insulin but are we missing ways to help these patients in a whole way? If we can help prevent the progression of this disease or some of the horrible side effects, wouldn’t it be worth doing more studies and maybe incorporating some of these supplements into the diabetic regimen? 

So many options

As I reviewed the many options for insulin for diabetic patients, I was overwhelmed with the many choices and treatment plans for these patients. It would be so overwhelming to navigate this on your own. I understand how important it is for each of these patients to have an endocrinologist or a person who specializes in DM education and treatment to help them find the right treatment and change treatment according to life changes.

There are new insulins and treatments being developed all the time as well as a plethora of information coming out all the time as is evidenced by the numerous studies each week just in the Diabetes Newsletters we read weekly.

I feel for patients who must deal with this in third world countries or in poverty. How do they manage it? And many probably die younger from the complications of poorly managed diabetes. We are so lucky to live in a country where so many modern medical treatments and medications are available to so many, even those who cannot afford treatment.

Love it!

There are 5 people on our team and we were to come up with 6 points. I took the last point and second point for me. I was concerned about the content of this point. I was to cover basically everything that we should have been covering in each individual point- Diet and Diabetes. I felt so incompetent with this subject and so afraid to even start it. I have to say though, that I am so glad that I took this subject on. I have learned so much researching the point. I feel so happy to finally understand several aspects of carb counting and pre-meal BG checks and how to figure an insulin dose with the correction and coverage dose. I’m so glad that I took this class and was forced to learn this stuff that has been so elus

Frustrations

I’ve felt a little frustrated this week. I would like to start the teaching plan over again now that I understand how it is all supposed to work and pull together. I would change the subject of the points and rewrite the points to focus on our subject-Diet. It’s all clear in my head now, but it’s too late with a group to say, “Hey, I don’t like the way we did this so let’s start all over again”. 

I have learned that I need to ask questions earlier and make sure I understand the big picture. I have also learned that, although this group has been amazing to work with (everyone has worked equally hard and been very responsive to texts and discussions), I much prefer to work on my own. Then I am the only one responsible for the outcome of the project. I know this is not a productive or professional attitude, but I am by nature a loner when it comes to work. 

So this is what education does, it stretches me and makes me do things I am uncomfortable with. 

Ideas

As we discussed and I thought about how expensive the disease of Diabetes is for the patient and especially the uninsured and lower socioeconomic patient, I tried to think of ways that could cover more patients at a less expensive rate.

Utah County has several great resources for uninsured, low income, and homeless patients. I also know that the Mountainlands Clinic is overwhelmed with the ratio of health care worker (NP, MD, PA) to client. Then I thought about how we use telemedicine in the ER a lot. All of our pysch consults are through the tele and a patient being interviewed and assessed via a TV screen. Not only does this allow the counselor to have more time to see more patients (less travel time, etc), but it saves money (travel costs, etc). We use it for neurology consults as well as the neurologist can visually assess and using the nurse at bedside perform a stroke scale right through the screen. 

Why can’t we use something like this for low income, uninsured patients? There would be more time, less cost, more patients able to be seen and assessed. Anyway, just a thought.

A Hard Life

As I thought about the case study this week, I thought about hard life can be for some people. Some times we make things harder for ourselves than they have to be, but then some people are just dealt a difficult hand in life. People with diabetes are in this group. I complain about counting calories because I don’t want to gain a few pounds or I want to lose a few. But people with diabetes, and add to that all the health problems that can accompany diabetes, have to be accountable for everything they put in their bodies. If insulin dependant, they must monitor their blood glucose frequently every day and then inject insulin several times each day. 

I know the person in the case study is make believe but I also know that these are real problems that real people have. It made me feel so badly for this woman, who already has the difficulty of managing her diabetes, dealing with her nephropathy and retinopathy, but now must deal with being a single mom and staying healthy for herself and her child.

I had a patient yesterday who is a type 1 diabetic. He can not work and could not get his Medicaid approved to get insurance for his medications. He had horrible diabetic ulcers on his legs and hip which were exacerbated by his scratching of the sores. What a difficult life this young man has. 

This is a horrible disease. For those who are vigilant about controlling their sugars and keeping their A1c levels low, life may not be as hard and they might expect a good quality of life. For those who are lukewarm in their glucose monitoring, it will only be a matter of time before they start suffering from the ravages of high blood sugar. 

Point 2

In our group, I was responsible for writing point #2 in our weekly project discussion/case study. I wrote about nutritional building blocks. It was fairly simple teaching but a good reminder to myself of how important a balanced diet is, not only for someone with diabetes but for myself as well. I have started gaining the weight that I have kept off for the last two years and it is very disconcerting to me. I don’t feel as healthy, I don’t have the energy that I had, I don’t feel as good about myself and I just feel uncomfortable all of the time.

As I thought about my regression and how difficult it is for me to get back into a healthy and lean lifestyle, I thought how difficult it must be for someone with diabetes. It’s not just about how they feel about themselves, it is matter of life or death for them. The future will look very bleak to the poorly controlled diabetic and yet I can understand how they would rebel and just say, “I’m tired of restricting myself. I want to eat what I want to eat”. 

How do you teach someone or inspire someone to have that desire to live healthy? To be disciplined in what they eat, what they do and how they monitor their glucose. Well, I know that I must set an example myself and try to be more disciplined in my diet and exercise and care for my health.