That sucks! Must have been frightening at such a young age. Good to hear that you have your sight back. 
Just FYI, in the U.S., with some variation in licensing by state, a âtherapistâ is a fully trained clinical practitioner who works directly with clients. While a Psychologist may also do the same, they are frequently the ones who do testing or are program supervisors. So a therapist would definitely be qualified here to do CBT. As for the qualifications of the people who presented the course the OP discusses, that I couldnât tell you. I am often dismayed at the lack of qualifications of people who present workshops on Psychological topics. Donât even get me started on the topic of âlife coachesâ, who as far as I can ascertain are self-created self-help gurus with charisma but absolutely no professional credentials.
I will never forget what my doc said to me when I was dxâed: âYou are smart. Diabetes is not a bad disease for smart people.â. I have no idea why he thought that I was smart. Nevertheless, I have to agree with him. Diabetes is not a difficult disease. Food makes BG go up. Insulin makes BG go down. Itâs a game with an up button and a down button with the objective to keep BG level. There are obstacles, of course. I had a hard time controlling BG when all I had was urine test strips. BG test strips were a big improvement. But nothing compared to my Dexcom 7+. All I needed was a real-time BG readout. I learned more about food and how my body reacts to it in the last 2 years than I learned in the 36 years before. There is a lot of literature out there to help the blind (the ones without a CGM). Once I could see I was able to leap ahead of the blind pack. Nobody should kid themselves. Being able to see is a competitive advantage. I am not about competition at all. My only goal is to tilt the odds in my favor. Which means buying as few tickets in the complication lottery as I can.
Yes it is! It is a $%^$#@& pain in the â â â !! Who is your doctor so I can go beat him up?
My doctor was in his 60s at the time. Might be too late for a beating.
Hana, I have an older friend who is a T2 on MDI (Lantus and Novolog) and she has never once counted a carb in her entire career as a diabetic.
They have her on a so-called sliding scale (?) based solely on her BG reading before the meal. She could eat âone eggâ or âcereal plus milk plus toast plus juice plus fruitâ and her insulin dose (per her sliding scale) would be exactly the same. Plus the sliding scale tops out at 250 mg/dl â sheâd inject the exact same amount of insulin if she were at 250 mg/dl or 350 mg/dl.
WTW?!?
Sometimes I think there are crazy people infesting the so-called helping professions. I really do.
When I tried to talk to her about carbs and their impact on her BGâs she got very huffy with me and insisted that she was already keeping track of her calories and that was all she had to do. Of course, having her BGâs spike into the high 200âs should have been a clue that their approach wasnât working, but as far as I know, a year later, theyâre still taking this approach.
It makes me crazy when people are being given such inadequate to downright harmful âmedical adviceâ but they are faithfully following their doctorâs orders right over a cliff.
Iâm in the same HMO and they tried that crap with me â I insisted on them helping me figure out my I:C ratio, correction factor, basal, how to lower carb, etc. and they simply didnât have anyone on staff who could do it â so I came to TuD, got the books, asked a billion questions and Iâm doing it myself. Where do these people come from? Why are they âteachingâ a protocol that is twenty years out of date? How many diabetics in their âcareâ are getting complications needlessly? Why do their patients follow them faithfully with A1Câs of 10, 11, 13, etc?
Itâs a mystery.
One of my Tae Kwon Do instructors was 67. She, in turn, picked up sparring ideas from her cat.
My real point is: CBT shouldnât be used to overcome depression about diabetes. It would be valid to use it to help patients deal with the condition. thus hopefully eliminating most of the cases of depression.
I personally live a low-carb life, but I know there are people out there who prefer the high dose medication life. If they can CONTROL their condition that way and have made an informed decision, more power to them.
Hana
I canât disagree more strongly with your real point. One doesnât treat other possible complications of diabetes by simply working on BG control. One helps heal the foot wound, treats the heart disease, uses laser surgery to clear up the retinopathy. Why should someone suffering from depression not get useful and targeted treatment.
Maurie
Me too. CBT is the therapeutic treatment shown to be most effective in treating Depression, whatever its cause. The statement that âit would be valid to use it to help patients deal with the condition thus hopefully eliminating most of the cases of depressionâ doesnât even make sense if you know anything about CBT. You wouldnât use CBT to manage diabetes, that is do such things as teach carb counting, insulin dosing, dietary choices and blood sugar testing. What you would use it for would be to deal with the faulty and maladaptive assumptions a person might have that are getting in the way of them controlling their diabetes and causing them sigificant distressâŚof that is, the symptoms of their depression. That depression may or may not be entirely caused by diabetes, but once it becomes an ingrained pattern in the brain it is, as Maurie says, a disease in itself. People who have suffered from Depression know it is like living in a bottomless pit. It takes perseverance to test and treat day after day with mixed results. People suffering from Depression can barely get out of bed, let alone do the constant sometimes futile tasks we do every day.
You can no more cure Depression by eating less carbs or testing more often than you can cure it by saying in a loud voice, âcheer up!â And one of the most significant symptoms of Depression being lack of motivation you probably wonât get very far by yelling in the same loud voice, âTest your blood sugar, manage your diabetesâ. All you will accomplish is increasing shame and hopelessness.
On the contrary Maurie
One CONTROLs BG at NORMAL numbers [ie 5mmol/l or 90mg/dl ] or very close to and avoids the complications. There are plenty of people like me who have this tight control and are complication free after numbers of years.8 in my case. Laser treatment may curtail retinopathyâs progress, but it does irreparable damage. I am married to a long time T1, who has severe sight loss in one eye as a result of several doses of lasering and vitrectomy following a major retinal bleed.
In addition the repeated foot ulcers he suffered have disappeared since he decided that maybe my belief in NORMAL BG had something to recommend it. The Charcot feet will never be right though. Most of the complications of Diabetes[if not all of them!] are down to persistent high blood glucose. The numbers given as targets for control by the medical profession are MUCH TOO HIGH. Those targets were never set to protect the patient, but to protect the medical profession from lawsuits. As recently as a month ago, I was in a hospital meeting where self management of diabetes by inpatients was being discussed⌠The new protocols to be set up are to be designed to protect the nurses. When I asked one of them if a self managing patient had ever caused a problem to the nurses within that hospital, I was told that it had never happened. This same hospital had taken over my husbandâs diabetes control whilst he was in for a non-diabetes infection and had succeeded in raising his blood glucose to 22mmol or 396mg in the space of 2 days. They were so focussed on avoiding hypos, they kept giving him glucose in an IV[until I stopped them1]
Hana
I donât disagree with you but there are people who can keep high BGs for a long time and have no complications, e.g. look at SuFuâs post about his grandmother-in-law. On the other hand I know of one recently diagnosed T2 with great control (low 5% A1C) + pump + CGMS, who had a heart attack a few months ago. Both might be statistical outliers. But there are no guarantees in life. At my last annual review, the doctor looked at my A1C and said âthereâs absolutely no chance of you getting complications with that A1Câ but letâs be honest, the risk of complications never goes down to zero.
Hana,
A few points:
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Congratulations on the tight control and I hope you can keep it up. But 8 years isnât that long to be complication free. There was a study I read a while back that showed an elevated level of kidney disease for people who maintained A1cs under 6 as compared with the general population. They did better those those with higher A1cs and much better than those with high A1cs but still there wsa increased risk. We suffer from a serious hormone deficiency and that has consequences no matter how hard we work at it.
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The Joslinâs basic BG target for patients is 120 which is higher than my personal target but I donât think it is set that high simply to protect medical staff at the expense of the patient⌠Tools are getting better rapidly but not everyone has access to pumps, CGMs or even modern basal insulins. The DCCT demonstrated both that lower A1cs reduced the risk of complications AND that the curve started to flatten out around an A1c of 7 (avg bg 154). Given the tools available in the late eighties targets designed to help patients reach an A1c of 7 were appropriate. Even now only a minority of people with diabetes achieve that goal. An average blood sugar of 100 and a standard deviation of 25 means that a blood sugar of 50 is only two standard deviations below the mean. I donât think it is irrational for a patient to decide that they want to target a little higher so that the chance of going that low is reduced.
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My rhetorical question still remains. Why shouldnât those who suffer from complications including mental illness be treated for the complications especially when treatment is likely to allow them to take better care of themselves.
Maurie
Funny; I had a boyfriend who was a martial arts instructor and he used to watch my cat play and comment on her âmovesâ.
I do agree with a lot of what you are saying Hana, but I donât agree that the risk of complications goes to zero with super tight control. You are reducing your chances, but they wonât be totally gone.
Here is a link to an article about diabetic retinopathy. After studying the Joslin Medalists, they came to the conclusion that resistance to retinopathy had nothing to do with control. They stated that the degree of control did not predict which medalists would get retinopathy and that goes against every other study that they have seen. What they found was that people with high levels of a signaling molecule called SHP-1 are more likely to get retinopathy than those with low levels. Here is the link to the article.
http://www.medpagetoday.com/MeetingCoverage/AAO/22856
I agree with Maurie that 8 years isnât that long to be complication free. I went a lot longer than that before the complications set in. Although I agree with you the goals are set too high, like Maurie said, only a small percent of people even meet the goals that we think are too high. A year ago that number was 13% - that means only 13% of diabetics managed an A1c below 7. I donât know if that number has changed, but I doubt it changed too much. I do think education is some of the reason for that but I also think the âI donât careâ attitude is a large portion. I have family members and neighbors that fall in that category and all the education in the world wonât change them.
As for your husbandâs ulcers disappearing, an ulcer is a wound or break in the skin â that is not caused by high blood sugar. The high blood sugar will prevent minor problems from healing but they did not cause the cut. I had two ulcerâs last year â one was caused by moving furniture around and I donât know what caused the other. The one that I didnât know happened while I was low and I woke to EMTs over me. I went thru a 2 year battle to save my leg and I lost part of my heel during that battle. I see a doctor that specializes in wounds on a regular basis so I called him at the first sign of trouble last year. He told me that he never saw a diabetic foot heal like it was supposed to before. Good control made that possible, but it did not stop the ulcer in the first place!
I agree with you that high blood sugar will cause depression but that is not the only thing that causes depression in a diabetic. Although I agree with you that helping someone with high blood sugar is necessary, I also agree with the others that you still need to treat the depression. I have met people in good control that are depressed. I have met people that are very angry about being diabetic. They need help dealing with that anger. Fixing their blood sugar isnât going to help the anger that they feel about having to take shots and test their BS.
I donât think the medical profession knows what a NORMAL A1c is!! Itâs much lower than even most diabetics realise. I think Bernstein now believes it to be about 4.2% . Without large doses of something, I canât get below about 5.5%. Even that comes out of the hospital lab labelled âLOâ. Monitoring and blood testing is done by hospitals under the NHS
I serve on a voluntary panel at the hospital with the most senior nurse at the Diabetes clinic. She told me sheâs seeing A1cs in double figures mostly.
I donât attend the clinic. I get my monitoring through my GP and BUY my own test strips. The NHS wonât provide them for T2s with âgood controlâ and not using insulin
I too found that learning as much as I can is the best road. I know it works. I recently fell off my bicycle and banged up my knee pretty badly. For many diabetics, that would have led to infection and a period on antibiotics. I cleaned my scrapes, some of which were deep, with antiseptic,put on a simple antiseptic dressing untill my trousers were no longer in danger of blood stains and healed up completely in 3 - 4 weeks with no scarring.
Poor circulation can cause simple wounds to develop into ulcers. I recently met a fellow dog walker in the park with an ulcerated foot. she isnât diabetic, but does have circulation issues.
surely if CBT can combat depression, it can be used to help people come to terms with life âas isâ so they can betterr control their diabetes.
I am 8 years diagnosed T2, which probably means I developed it something like 15 years ago.
I meet many diabetics in the cours of my voluntary work and complications within 5 years are common. In my area the figure for hitting A1c 7% or under is almost 50%, however the hospital clinic sees mainly much higher with a significant number in double figures.
Hana
I find it difficult to understand why docs/insurance/NHS etc. canât make the connection between testing more frequently and an improvement in A1C for T2s. Granted there will be no improvement if the PWD does not act on the test results, but then theyâll probably also just stop testing as frequently. For me the feedback from frequent testing also keeps me motivated to keep up with my diet and exercise.
My cat (the one whose pic serves as my avatar) is very good at shadow boxing.
So good she once gave me a black eyeâŚ
Hana - I believe you are on Metformin? I think you can get a medical exemption certificate as long as you are diabetic and NOT on diet/exercise only.
From the NHS website:
http://www.nhsbsa.nhs.uk/1126.aspx
Medical Exemption
People with certain medical conditions can get free NHS prescriptions if:
- they have one of the conditions listed below; and
- they hold a valid Medical Exemption Certificate.
Medical Exemption Certificates are issued on application to people who have:
- Diabetes mellitus, except where treatment is by diet alone