Why are you NOT taking care of yourself?

Treatment
1

Since I started working on the Log for Life diabetic logging project I have been doing a lot of research into the tie between preventative maintenance of diabetes and longer live spans. Here is a very interesting study I came across that I wanted to share and have a discussion on.

A study titled The Diabetes Control and Complications Trial (DCCT) was conducted from 1983 to 1993. The study showed that keeping blood glucose levels as close to normal as possible slows the onset and progression of the eye, kidney, and nerve damage caused by diabetes. This study was done on type 1 patients. Type 2 have it even easier. You may not even have to inject yourself, instead you may just need to change your diet and exercise routine and/or take some oral medications.

Normal range is considered an A1C of 6 percent or less.

“Intensive” blood glucose control is defined as:

  1. Testing blood glucose levels four or more times a day
  2. Injecting insulin at least three times daily or using an insulin pump
  3. Adjusting insulin doses according to food intake and exercise
  4. Following a diet and exercise plan

By doing what the trial considers intensive control of your blood glucose numbers you will reduce the risk of:

Eye disease by 76%
Kidney disease by 50%
Nerve disease by 60%
Any cardiovascular disease event by 42%
Nonfatal heart attack, stroke, or death from cardiovascular causes by 57%

Doing these 4 things will equate to you living a longer and healthier life?

What more needs to be said other than, why would you not do this? Do you want to have complications? Do you want to die before your time?

I want to know why if you are a diabetic you would not do these things that enable you to live longer…

2

I posted this for discussion and I will have the first post as well. I have type 1.5 and ever since my diagnosis I have been working on getting in the best shape of my life, eating well, and logging my numbers to learn what not to eat or do. My A1C is 5.9 and I am shooting for 5.5 because my heart doctor wants to make the chance of me having an event as close to zero as possible. (I have a family history of heart disease) WHY are people not treating themselves??? I am pulling my hair out on this because it is stupid not to, or to believe you are exempt from the rules. I keep reading about how only 17% of type 2 diabetics even treat themselves and this is a group of diabetics that are increasing at a rate of 400% a year… I seriously can not think about it without getting angry at people. Is it that they do not care at all? Please help me understand this because I am fed up in all this research I am reading that makes it sound like America is going to eat it’s self into type 2 diabetes then on to the grave and not do a damn thing about it.

3

Do you understand the psychological mechanism between attaining knowledge and applying it, or the countless mediating factors that affect that mechanism? If you do, you should contact the leading diabetes behavioral researchers, Richard Rubin, William Polonsky, Ann E. Goebel-Fabbri, and many others, because they’ve been working on it for years, and still don’t have a clear understanding.

4

It’s not “stupid”, but it is incredibly insulting and presumptuous to call a phenomenon that you don’t understand and have never experienced stupid.

5

i think that part of the answer is the fact that most doctors aren’t having people test as often. I’ve often seen them thing that they just need to be below 8 with their A1c. Cost is another big issue, the cost of strips/insulin/medications. and the biggest is MISINFORMATION! education is key!

6

How is not living longer and not taking care of yourself smart? Here is one of numerous studies that have clearly said, take care of yourself = longer and healthy life…

Lee Ann, 2+2=4 in my book…

7

Again, you are being judgemental of a behavioral phenomenon that your don’t understand, and clearly haven’t researched. There’s plenty of research about it out there, so if you look for it, you’ll find it.

8

And what will the research tell me that is different then what I have stated… take care of yourself and you will live longer? What research will I find that says never check your blood glucose, have a high A1C and drink as much beer as you can and you will live to be 105…? Let me lead a guess to say none.

I think it comes down to education like Landileigh pointed out. Education and getting people to understand that small changes in there life can have HUGE impacts… how difficult is that to understand.

9

Hey Joe…you sound a lot like my mom when I was first diagnosed.

I really am glad that you are taking good care of yourself and that you have got it all figured out and that your A1c is under 6%. I try every day to get to where you’re at.

Bravo.

Now I’d like you to stop shaking your angry finger and calling people stupid and and judging other people with this horrible disease. With all due respect, you’ve had diabetes for about a year (honeymooner), and you were diagnosed as a grown adult.

Some of us were not so lucky. Some of us went through our teenage years pretending like diabetes didn’t exist just to fit in. Some of us diabetic adults still practice these bad habits and struggle every day to balance life and diabetes.

What can I say Joe?..Does it make sense for a diabetic to NOT take care of themselves…of course not. But diabetics are just people. Not lab rats…not robots…not perfect. We have emotions, money problems, relationship problems, work problems, family problems, and insurance problems just like everyone else.

The only difference is that on top of all that we have to take shots, eat clean and exercise daily or else we go blind, lose our legs, and die. Sweet.

Hey…I’m not making excuses, and as diabetics I think we all know that we can improve our control. But I don’t think your angry scare tactics are going to inspire anyone because we’ve heard it all before. Try a little understanding because the judging gets pretty old pretty fast.

10

I agree with Lee Ann, you are being judgemental.

Some people don’t take the care that you may be taking because they are not well informed. I have been diabetic for 17yrs, I don’t know it all. After joining Tu Diabetes I learned a lot more, and I’m sure I will learn more. Also, speaking from experience some people just fall off the band wagon. There comes a time when you are just sick and tired of counting all your carbs, eating lunch at 12pm, or testing yourself in the middle of a party.

Maybe if our doctors were better educated, their patients would reap the rewards. Like I always say we have to be our own doctors and do our own research. I commend you of taking charge of your health, but you shouldn’t come down on those that haven’t yet.

11

Just like a day at work, you have good days and bad days. Stress can elevate you BG a lot, you may then check your blood so now what-you bolus and correct it, but because your stressed a normal bolus might not do it or maybe you over do it and you become hypoglycemic. Same thing goes for getting sick and exercising, it is all trial and error. If it were easy people would never have complications and diabetes would be no big deal.

You also do not have a full understanding of the disease yet because you have not experienced it yet. If you are still in the 1.5 stage it is very easy to manage your BG compared to being a full type 1. I know this because I experienced it in my early thirties. Your BG will be subject to swings and craziness that will not always be understood, you do the best you can.

I totally agree with you on the part about taking care of yourself and I want to live as long as possible without problems but it’s not worth the effort to get stressed out over others inability to take care of themselves. I worry about me because in the end that is all that will matter. If you start pumping this business of logging all your info becomes second nature and computerized!!

Good Luck!

12

Hey there is nothing wrong with having a couple of beers!!

13

Ladies and gentlemen… please, I meant do disrespect at all and I did not mean to offend anyone. I just wanted to try and understand a little more about the why’s behind some of this research. Again, please understand I am just looking for answers like all of us. Please accept my apology.

14

(apologies for one of my usual long rants)

On one hand, the questions make perfect sense-- why don’t we take care of ourselves?

On the OTHER hand, as many of you already pointed out, we are human and we all face different struggles. When I say that we face different struggles, I literally mean that we are all different:

  • we have different personalities (levels of discipline, I wish I was a more disciplined person)
  • we all have different families, social backgrounds, different genes…
  • we have different forms of diabetes!! And I don’t just mean type 1 or type 2, LADA, MODY or OTHER… diabetes is a unbelievably complex condition… there are some people that can drop from 500 to 40 in an hour. Other people who will never go below 80. Simply put, we face different struggles and we have different tools to face them.

If I could not afford to test my blood sugar 10 times a day, my control would be nowhere close to what it is. If… If… If…

Joe-- I think it is great that you have embraced your diabetes and I sincerely hope that you continue to maintain such great control.

When I was first diagnosed with diabetes, I was honeymooning and a BIG mistake would cause my blood sugar to go up to 150mg/dl and I would FREAK out. Then the honeymoon ended and I woke up above 400 one day and realized that I was facing a whole new struggle. I realized that things that seemed easy before were no longer easy. I think that this is a good theory to apply when dealing with OTHER PEOPLE with diabetes too. We don’t know their struggles (physical, emotional, financial, other…). So the best that we can do is help and inspire people to achieve better control. I think that TuDiabetes is an amazing place for this!!

15

I didn’t say medical research about how diabetes management affects health outcomes. I said behavioral health research about how human behavior affects diabetes management, research that has been taking place for many years and continues to take place because researchers don’t have a good understanding of human behavior.

Anderson, B. J., Miller, J. P., Auslander, W. F., & Santiago, J. V. (1981). Family Characteristics of Diabetic Adolescents: Relationship to Metabolic Control. Diabetes Care, 4(6), 586-594.

Cerreto, M. C., & Travis, L. B. (1984). Implications of Psychological and Family Factors in the Treatment of Diabetes. Pediatric Clinics of North America. 31(3), 689-710.

Colton, P. A., Rodin, G. M., Olmstead, M. P., & Daneman, D. (1999). Eating Disturbances in Young Women with Type 1 Diabetes Mellitus: Mechanisms and Consequences. Psychiatric Annals, 29(4), 213-218.

Delamater, A. M., Jacobson, A. M., Anderson, B., Cox, D., Fisher, L., Lustman, P., Rubin, R., & Wysocki, T. (2001). Psychosocial Therapies in Diabetes: Report of the Psychosocial Therapies Working Group. Diabetes Care, 24(7), 1286-1293.

Jacobson, A. M. (1996). The Psychological Care of Patients with Insulin Dependent Diabetes Mellitus. The New England Journal of Medicine, 334(19), 1249-1253.

Kovacs, M., Obrosky, D. S., Goldston, D., & Drash, A. (1997). Major Depressive Disorder in Youths with IDDM. Diabetes Care, 20(1), 45-51.

Miller-Johnson, S., Emory, R. E., Marvin, R. S., Clarke, W., Lovinger, R., & Martin, M. (1994). Parent-Child Relationships and the Management of Insulin Dependent Diabetes Mellitus. Journal of Consulting and Clincal Psychology, 62(3), 603-610.

Rubin, R. R. (2000). Psychotherapy and Counseling in Diabetes Mellitus. In F. J. Snoek & T. C. Skinner (Eds.), Psychology in Diabetes Care (pp. 25-59). New York: John Wiley & Sons, Ltd.

Schwartz, S. A., Weissberg-Benchell, J., & Perlmuter, L. C. (2002). Personal Control and Disordered Eating in Female Adolescents with Type 1 Diabetes. Diabetes Care, 25: 1987-1991.

Sternberg, E. M., & Gold, P. W. (1997). The Mind-Body Interaction in Disease. Scientific American, 7(1), 8-15.

I’m tired of typing these, but if you get through these, and still don’t understand my point, let me know because I can direct you towards plenty of other sources in addition to these.

16

Another thought:

Do you ask the same questions when…
… you see someone smoking?
… someone is overweight?
… someone does not exercise?
… someone does not eat enough vitamins?

Would we judge someone who can only afford bread and butter for not eating a well balanced meal? I think that everyone should have the chance to manage their diabetes well… but it isn’t quite that simple.

I am going to pull an all-nighter tonight to finish a research paper. I had fast food for lunch cause there was no time to shop or cook. Frozen pizza for dinner. I will probably eat fast food or popcorn (mmm…) for breakfast. I am a big advocate of tight control, but sometimes I also need to live my “non-diabetic” life when I’m just a normal PhD student. I will do my best, but still living my life… with diabetes! And next week will be a better week…

17

The diagnosis of a chronic disease is hard for some people to grasp. Plus not everyone can afford good medical care or even doctor’s in there area that even remotely understand diabetes. In the town I live in you have to travel minimum 45 min for an endocronologist. Plus being diagnosed as diabetic when your an adult means totally changing your lifestyle. Some people are set in their ways and don’t want to change even if it means having a longer life. And as for type 2 diabetics no they don’t have it any easier. Yes they can make lifestyle changes but the key there is lifestyle changes, you have to totally change your life when you have been living it that way for years. And sometimes type 2’s get misdiagnosed and are actually type 1.5 and are on the wrong medications for years and even them sometimes it never gets diagnosed properly or the proper treatment for it. And not all type 2’s can handle the oral medications as they do make you sick. And as a diabetic you should also know that some days there is no reason for high or low blood sugars at all. Insulin is a hormone and as with all hormones, it flucatuates from day to day and you never know how your body is going to react to it.

18

Cheers!!

19

Sorry, Joe. I know you didn’t mean to offend, but I’m with the veterans on this one. First of all, I wouldn’t be here if it was easy to achieve control. If those “4 things” were as simple as they seem on paper. Or if the “4 things” worked.

I would wager that there is a not a single one of the 4,000 of us here who doesn’t know the results of the DCCT. Some of us waited on pins and needles for its results to force insurance companies to begin coverage for pumps (called SCII in the study - subcutaneous continuous insulin infusion) and for some, simple coverage for meters and strips! But most of us who have known diabetes our whole lives know that doing everything right and seeing results doesn’t always correlate. Why can a smoker at age 90 die peacefully in his sleep and a healthy athlete die at 30? When I woke this morning in the 200s and took a bolus, I was trying to be good. Two hours later, when I dropped like a rock while I was teaching and I ate my glucose tabs to correct it, was I not attempting to be good? Did I expect to be 287 less than an hour later? The daily living, breathing animal that is diabetes doesn’t always care that you’re trying. Yes, I understand the importance of good control. If someone can tell me HOW to achieve it everyday, that’d be awesome.

I always feel secretly sad when I read blogs in our community where the writer says they finally have it down because they had their first day of “all good sugars.” Maybe I’m just a cynic. Maybe I’m resentful. Maybe I have just been at it too long. Who am I to tell them that tomorrow brings a whole new day? I’ve had this a long time. I can recall in my life the few-and-far-between “all good sugar days.” I’m sure I circled them on a calendar and possibly threw a party (which probably included a spoonful of ice cream and then there goes tomorrow)!

I love what Kristin said about overweight people, etc. How supportive would a Weight Watchers meeting be if someone who was losing a few pounds a week waltzed in and asked why the rest weren’t trying harder and don’t we know that those extra ten pounds will kill us? You know you’re supposed to drink 8 8 oz. glasses of water a day. Why don’t you? You know that carbon monoxide is bad for the ozone. Why do you drive a car? It’s not so easy to practice a perfect regimen - especially when in practice, it does not even promise perfect results.

That being said, you guys take care of yourselves, d**n it. This community means to much to me. :slight_smile:

20

What I have always found interesting about this study are the percentages. For instance, by “intensively” controlling one’s blood sugar, you reduce risk of kidney disease by half. So no matter how perfectly you are under control, you still have these awesome complications to face. It is so disheartening.

I think it is great that you want people to take better care of themselves. Yes, it can be done. It is challenging, but it can be done. Proclaiming that it is “stupid not to” may not be the best tagline for your campaign though.

You have made yourself sound like an insensitive jerk. I thank Lee Ann for the huge list of books which proves how complicated dealing with diabetes can be.