[Spidey's mom]

Originally Posted by SharonH, RN

Heh-heh, I'm in a cynical mood tonight. I was just coming back to raise a similar point. Prevention of diabetes and diabetes-related complications is boring and cheap. Diet and lifestyle changes are not high-tech enough for a lot of people and it certainly is harder than taking a pill. We as a society have become so accustomed to putting our faith in technology, that some believe that it must not be worth doing if it's within our reach. It's cheap because there are no fancy or expensive diagnostic procedures and no expensive surgeries to correct the condition. And for sure, the pharmaceutical companies are not interested in something that is going to reduce the billions they make yearly from diabetes and related conditions and complications.

I'm a little bit afraid of this scenario - people rely on the drugs instead of making lifestyle changes.

Even though, in at least pre-diabetes, you can roll back or at least stop the progression of the disease.

Fergus - you make great points. I too have trouble with my weight and so who am I to point the finger at my husband?

steph

[grannynurse FNP student]

Originally Posted by SharonH, RN

Heh-heh, I'm in a cynical mood tonight. I was just coming back to raise a similar point. Prevention of diabetes and diabetes-related complications is boring and cheap. Diet and lifestyle changes are not high-tech enough for a lot of people and it certainly is harder than taking a pill. We as a society have become so accustomed to putting our faith in technology, that some believe that it must not be worth doing if it's within our reach. It's cheap because there are no fancy or expensive diagnostic procedures and no expensive surgeries to correct the condition. And for sure, the pharmaceutical companies are not interested in something that is going to reduce the billions they make yearly from diabetes and related conditions and complications.

I have to disagree. I am not looking for a quick fix or a pill to suddenly help me lose the 40 pounds I've gained over the past four months from taking predinsone. And if I had the extra weight, I still would not be interested is gastric bypass. The prevention of complications is cheap, when it is compared to inpatient care of complications. But for a lot of us diabetics working out a diet plan, getting the rest of the family to follow it, when they have no problems and the expense of food is not that simple, cut and dry. And a number of us do not have the necessary will power to cut ourselves off, cold turkey, from the foods we like. And for some of us, the foods are a source of comfort. And while there are no expensive diagnostic procedures, try paying for the test strips, the medication, the insulin, the syringes on a fixed or moderate income. Do you have any idea how much 124 test strips cost a month, if that is all you have to use. And just how many Medicare and private insurance actually allow. People may think that it is an inexpensive disease to manage correctly. Sorry, for me it is not. Especially when coupled with payment for my other health problems and medications. Medicare D will cover less then four months of my medications, then I fall into the donut and that will take almost another four months of full payment on my part. Then finally I can get the 95% coverage. Then I and others start the year all over on January 1. Please do not belittle me or any other diabetic by telling us that we just need self responsibility. If it were that simple we wouldn't be sick with chronic diseases, none of us would. I am still waiting for some worthwhile suggestions on how to deal with my diabetes, weight, exercise.

Sorry I am tired.

Grannynurse

[SharonH, RN]

Originally Posted by grannynurse FNP student

I have to disagree. I am not looking for a quick fix or a pill to suddenly help me lose the 40 pounds I've gained over the past four months from taking predinsone. And if I had the extra weight, I still would not be interested is gastric bypass. The prevention of complications is cheap, when it is compared to inpatient care of complications. But for a lot of us diabetics working out a diet plan, getting the rest of the family to follow it, when they have no problems and the expense of food is not that simple, cut and dry. And a number of us do not have the necessary will power to cut ourselves off, cold turkey, from the foods we like. And for some of us, the foods are a source of comfort. And while there are no expensive diagnostic procedures, try paying for the test strips, the medication, the insulin, the syringes on a fixed or moderate income. Do you have any idea how much 124 test strips cost a month, if that is all you have to use. And just how many Medicare and private insurance actually allow. People may think that it is an inexpensive disease to manage correctly. Sorry, for me it is not. Especially when coupled with payment for my other health problems and medications. Medicare D will cover less then four months of my medications, then I fall into the donut and that will take almost another four months of full payment on my part. Then finally I can get the 95% coverage. Then I and others start the year all over on January 1. Please do not belittle me or any other diabetic by telling us that we just need self responsibility. If it were that simple we wouldn't be sick with chronic diseases, none of us would. I am still waiting for some worthwhile suggestions on how to deal with my diabetes, weight, exercise.

Sorry I am tired.

Grannynurse

Grannynurse, I have lost 3 aunts and an uncle to the complications of diabetes, I have another uncle who is in a nursing home after suffering a stroke with his diabetes and my mother is disabled due to compliations of her diabetes. Oh yeah and my mother is a nurse also. Trust me, I am very well acquainted with the costs financial, physical and emotional of that particular disease. And since I am at high risk to develop diabetes myself, I have an acute interest in it so I can assure you that there was nothing belittling in my point of view.


I did not mean that anyone is looking for a quick fix or a pill, only that as a society we tend to respect technology more than the natural option. And as far as patient education, from what I can see it is only in the past 5-10 years that we have learned so much about preventing both diabetes and its progression when in the past, it was all about deprivation.

The lessons we know about diabetes now are too late for my mother and her siblings so I certainly don't blame them for not having enough willpower. I don't blame anyone and I don't look at it as a matter of responsibility. If you look at my first response, I stated that there is not a sense of urgency about diabetes from the medical community and I believe the general public picks up on that. It is not an easy disease to deal with, which is why I am desperate to prevent it for myself.

[Spidey's mom]

I think diabetes has only recently been in the forefront of the public's eye, so to speak.

I was sure my husband was diabetic or at least pre-diabetic for months and it was only his DMV physical that found it. He gets them yearly, thank goodness or who knows how long he would have gone on with no medical intervention. The year before, there was no indication of diabetes, except his weight.

His aunt is diabetic (overweight and does not even take walks). His grandfather died of heart disease in his 60's (smoker) and his grandmother lived until she was 97 with no real health problems. Both his parents are alive and very healthy - dad is 83 and mom is 77.

I did have my husband read this thread. He feels that he alone is responsible for his decision-making and although group support may help some people, he probably would not attend a group session. He does realize that he needs to make some changes and is starting to do that.

This is an interesting thread . . .


steph

[Nella]

I have to hurry or I'll be late for work.

There's always some cost associated w/ diabetes. Diabetics have to use a glucometer, strips etc.

CMS has been doing demo projects in selected states and areas for management of diabetes for 2 years or so now. I beleive they have moved from demo projects to the next step: pilot programs. Education will play a large part of these programs. Dieticans will be a part of these programs. As well as podiatrists and pharmacists.

So hopefully, these programs will be picked up and be made available in all states.

[grannynurse FNP student]

Originally Posted by SharonH, RN

Grannynurse, I have lost 3 aunts and an uncle to the complications of diabetes, I have another uncle who is in a nursing home after suffering a stroke with his diabetes and my mother is disabled due to compliations of her diabetes. Oh yeah and my mother is a nurse also. Trust me, I am very well acquainted with the costs financial, physical and emotional of that particular disease. And since I am at high risk to develop diabetes myself, I have an acute interest in it so I can assure you that there was nothing belittling in my point of view.


I did not mean that anyone is looking for a quick fix or a pill, only that as a society we tend to respect technology more than the natural option. And as far as patient education, from what I can see it is only in the past 5-10 years that we have learned so much about preventing both diabetes and its progression when in the past, it was all about deprivation.

The lessons we know about diabetes now are too late for my mother and her siblings so I certainly don't blame them for not having enough willpower. I don't blame anyone and I don't look at it as a matter of responsibility. If you look at my first response, I stated that there is not a sense of urgency about diabetes from the medical community and I believe the general public picks up on that. It is not an easy disease to deal with, which is why I am desperate to prevent it for myself.

I am truly sorry for having offended some, especially my last response, last hight. Actually, down here in my neck of the woods, diabetic education is still left to one visit as an inpatient from the dietican for a ten minute or less learning session-yes I timed mine. Some times I am asked if I wish to give my own NPH but that is a rare occurance. And never my finger sticks. Nothing is ever mentioned about my eyes or feet. And never any education from the nursing staff or even an offer of education, that I could turn down if I wanted. And there is very little available in my community for new or long standing diabetics. And waiting in line, for my medications, you would be surprised at the number of Type II diabetics I meet. And their complaints or misinformation they have about their disease.

You are correct in your assessment that there is not a sense of urgency in the medical community or for that matter, the general community. It only hits when it is diagnosed. Unfortunately for the ten to twenty years a person has been developing and suffering from this very silent disease, it is also impacting on their body. And a lot of our medical and nursing community forgets this. And there are many of the suffers from Type II who are the first in their family with the diagnoses. They don't have a family knowledge to fall back on. I am the first one, on either side of my family, going back three generations.

This is truly a very silent disease, with limited resources currently available and not yet a top priority. Instead of criticizing us, please offer us more education, give us a chance to accept it or turn it down. Help us lobby our community facilities for more education and inexpensive group support. Teach us how to use the internet, to go on line to obtain more education and diet advice. You would be surprised at how many do not have a clue of how to go on line. Or that they can thru their public liabaries. Go over our diet, incorporating our food likes and dislikes, cost, giving us the opportunity to accept or turn down your help. And make the offer each time we are hospitalized.

Thanks.

Grannynurse:hatparty:

[grannynurse FNP student]

Originally Posted by Nella

I have to hurry or I'll be late for work.

There's always some cost associated w/ diabetes. Diabetics have to use a glucometer, strips etc.

CMS has been doing demo projects in selected states and areas for management of diabetes for 2 years or so now. I beleive they have moved from demo projects to the next step: pilot programs. Education will play a large part of these programs. Dieticans will be a part of these programs. As well as podiatrists and pharmacists.

So hopefully, these programs will be picked up and be made available in all states.

I believe this is the program I have been contacted about. I sure hope so.

Grannynurse:hatparty:

[fergus51]

Originally Posted by stevielynn

Retraining does not mean rearranging.

We acquire tastes for things. Salt for one. You can retrain yourself to lighten up on the salt by slowly reducing the amount you use.

Many cultures don't use sugar and salt like we do. Their tastebuds are the same as ours. They have just been "trained" to taste what they are used to.

If we are raised on non-fat milk and never tasted whole milk, we would never know the difference.

The aftertaste of diet soda is not noticed by me anymore - I do remember it initially. My husband still doesn't notice it unless he thinks about it.

We do actually get used to certain flavors - otherwise we would all still be eating as children - Kraft Macaroni and Cheese and hot dogs and hamburgers. I'd have never tried sauted mushrooms as a child but I tried them as a teenager and liked them right away. Other things took awhile - I used to hate onions but I love them now.

I think you can retrain your tastebuds - desensitize them to things.

Rearranging your taste buds on your tongue - no.

steph

I managed to do it. I was one of those "I would NEVER drink diet soda, they're disgusting!" people. I loved my regular sugar filled coke. Nothing better after a walk with the dog or on my break on a busy night.... I gave it up altogether for a while then just made myself drink the diet when I started having soda again and I don't miss it a bit. A lot of people were shocked because I always had a Coke in my hand My name's Tracy and I'm addicted to Coke...

[grannynurse FNP student]

Originally Posted by fergus51

I managed to do it. I was one of those "I would NEVER drink diet soda, they're disgusting!" people. I loved my regular sugar filled coke. Nothing better after a walk with the dog or on my break on a busy night.... I gave it up altogether for a while then just made myself drink the diet when I started having soda again and I don't miss it a bit. A lot of people were shocked because I always had a Coke in my hand My name's Tracy and I'm addicted to Coke...

And what about those of us, that for a variety of reasons, including our own innate weakness, are not able to ever adjust our taste buds? Are we just weak and totally lacking in self-restraint and responsibility? Are you not assuming that just because you are able to do so, everyone should be able to do so as well? I realize that I started this discussion as a means of learning what my peers thought of diabetics, their problems with their disease, of suggestions on how to deal with a variety of problems I and others face daily. What has transpired it not exactly what I expected. I expected some to hold all diabetic responsible for their own control of their disease and was not disappointed. I expected to read some worth while suggestions, something that I have generally been disappointed in. And some of my peers, who suffer the same challenges that I do and I thank them for their responses. One of my peers has taken the challenge of educating her own peers and patients. I applaud her and am encouraged and encourage her. How about instead of applauding yourselves on your backs, you offer us some realistic suggestions on how to deal with our diet and exercise problems. I posted that request last evening and am still waiting for a response.

Grannynurse

[Nurse Ratched]

Originally Posted by fergus51

I managed to do it. I was one of those "I would NEVER drink diet soda, they're disgusting!" people.

Ditto hubby. When we met, his college diet consisted of daily runs to either the Varsity or Juniors in downtown Atlanta for daily double cheeseburgers and fries. Early on in our marriage, a lentil nut loaf nearly ended it lol. Slowly, over time, he has altered his diet in ways I could never have hoped for. He went to skim milk, diet sodas, and is now trying to get off soda altogether. We are both mostly-vegetarians (we'll eat meat when there's no other choice if we're somewhere besides home.) The vast majority of my meals are some bean or whole grain derivative. It's cheap.

As to the original posts, we have FABULOUS diabetic educators here. There are a number of intractable misconceptions held by members of our population, however, regarding diabetes. I offer friendly assistance to an elderly gent whom I have mentioned here from time to time. He is diabetic and has been for a number of years, as was his mother. He refuses to use any area of his body for insulin injections except his abdomen. His logic: people who use the tops of their legs have to have their feet amputated. Circulation problems exist in the hands of people he knows that are diabetic and inject in the backs of their arms. His logic is that "they can't cut off my belly." He also complains about "the bumps" in his abdomen (from not rotating sites.) Have I tried to explain these fallacies? You bet 'til I'm blue in the face.

We have tried to explain the notion of carbohydrates - he figures if the word "sugar" isn't high on the list of ingredients, he's fine. White bread, fine, high fat, high calorie meals, fine, as long as there's no "sugar" in it. Takes his insulin 1-2 hours AFTER he eats and then takes his blood sugar and is irritated because it's high ("I don't think they make the insulin as strong as they used to.") Thinks he's on insulin because "the doctors hooked me on it - I used to use pills, and they started giving me insulin, now I have to use it.) This is not the only person I have heard these things from - just an example of what providers fight against. Yes - he has been educated. Repeatedly. He's not demented. He's stubborn and fixed in his ways and will not deviate.

C/o eye problems. Explained problems with diabetic neuropathy. Won't get a dilated eye exam (no charge to him) to determine if it's his known cataracts, or whether there's more significant underlying damage. Says the last time he had one done everything was fine (15 years ago...)

I guess my point of all this is, it's not necessarily always our failure to educate; sometimes it's the patients' refusal to hear it.