[Marylou1102]

Making changes in your life is a very difficult thing to do. It is easier if you take one step at a time. Don't try to change everything at once, that's a sure fire recipe for failure. With your physical disabilities try one of those armchair exercises. Just do what you are able to do. If you can, do it two or three times a day. Eventually you will build up stamina. Where diet is concerned, does your husband truly understand the long and short term consequences of noncompliance? Maybe you can get him to make just one change at a time to help both of you adjust before you make another one.
I hope these suggestions help. I am a fairly new diabetic myself and I too find it hard to change my life habits. We all need all the support we can get. Good luck Grannynurse and let us know how things are going with you.

[strong_willed]

I was diagnosed type 2 in 1998, when I weighed 98 lbs (at 5'4''), so it's just not about obesity....I am now 190 lbs-quit smoking 6 yrs ago-work 6p-6a (trying to get on 6a-6p) 4 or 5 nights a week due to low staffing, go to school 2 nights a week, and try to fit in a walk with dogs if I get that extra day off a week-they love it, so do I!-I wonder if anyone has advice-other than stop sleeping-on how I can start getting the weight back off. I don't ever want to be 98 lbs again, but a nice comfortable 120-135 lbs would be great, plus I want to lose it the right way, not some fly by night crash diet or unhealthy regimen..... BTW, I am a nutrition buff, nearly a vegetarian (only eat meat/fish 1 or 2 days a week, and try to avoid red meat like it's the devil!), and lactose intolerant to boot.....Any ideas. I'm sure I'm not the only one like me out here

[mandana]

My schedule is very busy too, and my dietary preferences sounds fairly similar to yours. I'm not a vegetarian, but I rarely eat red meat. I keep frozen salmon filets in the freezer - I buy these at Sam's - they defrost quickly and I can cook several and take them to work/school with me the next day. Also, once a week, I clean and cut up veggies for salads. I keep lettuce in a big container, and the other stuff that I like in little bags. When I'm hungry, it's VERY easy to make a salad when it's all ready. It's even easier than making a sandwich, so that helps. I'm a coffee and chocolate addict, so I'm a fan of "Skinny Cow" desserts, and I just switched to Splenda which I don't love, but I am learning to tolerate for my coffee. I also made the big leap to non-fat milk. I dislike milk intensely, but I'm also sort of the poster-child for osteoporosis, so I'm forcing myself to drink it. I'm also skipping salt, which I love. That's the worst for me.

I also love Morningstar Farms veggie burger and I eat a lot of things most people wouldn't consider "dinner". But, I'll eat asparagus, broccoli or brussels sprouts and call it dinner. So, I am very well behaved for a couple of weeks, then I go out and splurge on something I've been craving. It's not the most fun way of eating, I'll admit. Plus, I'm a foodie and I love to cook, so it's extra boring for me, but it's what I have to do right now. Once I reach my ideal weight maintaining it won't be nearly as hard.

As far as exercise, take stairs at work when you can instead of the elevator. If someone needs something from another area and you have a minute, volunteer to be the runner. Every little bit helps.

Weight was never an issue for me, but after my second baby, it's been really tough to lose the extra. I'm getting there slowly but surely, and it's very, very hard work.

[grannynurse FNP student]

Originally Posted by gsnitch2001

Ditto to everything said in the post below.

I have diabetes myself (Type 1, 15 years come March '06), and I think I'm coming from a slightly different point of view than others here, as I'm 20 y/o, but any way you look at it, a lot of the factors are the same. I ultimately agree, it does come down to personal responsibility in the end. I was really lucky, and I KNOW I was lucky - I was diagnosed at 5 years old, so I had people helping me out from the beginning, not to mention that the two diabetes teams I went to are definitely one of the best ones in the state (Atlanta, GA) - and it scares the heck out of me that some PCPs only spend 10 minutes w/their patients - shows what I could be taking for granted when I get a minimum of 50 minutes with a CDE.

Also said in the quote - the whole "excuses" thing - agreed, granted, there are some that are easier to fix than others. Everybody's going to mess up with the food every now and again, I'd be lying if I said I hadn't, lol! The thing with the food/weight/etc. is that an endo/PCP can tell you all of this, but you just have to do it - in my case, it was checking blood sugars more than 4x/day (I'm on an insulin pump - my baby ), and I've had my bad points (not testing for 1.5 months, gotta love that denial), but I finally listened, so I'm ok there, but I have my bad days, and that's ok - I move on and say I'll do better tomorrow.

On the other hand, the supplies...again, got lucky - basic supplies are expensive enough, insulin pump supplies in themselves are incredibly expensive, and they also double what you need in basic supplies. Example: if I didn't have insurance, an insulin pump w/3 months of supplies for me would be roughly $9,000, and roughly $2,000 every three months after initial purchase...so basically, it's an expensive disease, and this is one of the main reasons people can't take care of themselves, b/c they can't afford the treatment, let alone top of the line treatment, and yes, that's upsetting to me. And like someone mentioned before, there's no way there is this much money in a cure.

Exercise-wise, can't say too much on this - I do have bad knees, and I eventually found swimming/water aerobics to be my forte, amazingly, as I was always a not-so-good swimmer, but I was forced to learn by the PE requirement at school, and was stunned at the results, so it stuck - it's anti-gravity, so to speak, so the knees don't mind it - that's my on that. And I definitely understand the medicine/blood sugar thing, granted I have the opposite problem - winter for me is always a rollercoaster of sorts b/c Sudafed is equivalent to insulin to my system - can be sitting on the sofa doing absolutely nothing, glucose 360, 2 hours after taking a Sudafed, 50 mg/dl - guess that's diabetic life for us!

So, yeah, personal responsibility is what I think it ultimately comes down to, and from personal experience, it's not easy, quite frankly, it's far from! And even if you have the best of the best of diabetes educators, the only person that can put what they are saying into effect is the patient. (One of my pet peeves, diabetes educators that think they are GOD and can change everything about you...won't happen, only person that can change a person is themselves, hence why we diabetics can tune the ultra-forceful CDE out!) But you don't have to be Superman/Wonderwoman while doing it - baby steps are the key, just start little, they can and will get you somewhere, trust me, I've been there!

~Adria (Hopefully RN in 2008, CDE in 2010)

Thank you for your imput and sharing of your life and experiences. I would like to point out a few things. Type I's are generally diagnosed as toddlers or youngesters. Unlike Type II, they are not faced with a life time of wrongly learned foods and behaviors. And your life literally depends on control of your intake and blood sugars. I would suggest your speaking with several Type I's of my generation but that is impossible. Most Type I's, from my generation, are no longer alive. Most long ago die from complications from their disease. When I first started out in nursing, strict dietary control was mandated. We hate Halloween, Christmas and Easter for the obvious reasons. Type I's are, if you will pradon my assumption, having an easier time of it. In my day, you wouldn't have even been considered for nursing school.

I and others realize the importance of self control and self regulation and personal responsibility. Unfortunately, we generally don't have the access to the team you did. And many of us are fighting a lifetime or atleast a generation or two of learned behaviors. And most of our peers seem to believe these are and can be easily changed.

Thanks for the swiming suggestion. I will see how much the Y will charge me for a pool membership.

Grannynurse

[grannynurse FNP student]

I am truly encouraged and happy by the posts I've read this morning. And by the number of private messages I've received. It is nice to know I am not out here along; not the only one fighting the battle; not the only one struggling against a life time of learned behaviors.

By the way, I would like to share a story. A patient came into an ER, high blood sugar, poor control. And to top it off, she was fighting her nurses, try to strack and bite her care givers. I forgot to mention, she is a 15 year old cat. Guess even animal diabetic have problems

Grannynurse

[mandana]

Originally Posted by grannynurse FNP student

I and others realize the importance of self control and self regulation and personal responsibility. Unfortunately, we generally don't have the access to the team you did. And many of us are fighting a lifetime or atleast a generation or two of learned behaviors. And most of our peers seem to believe these are and can be easily changed.

Just for the record, I don't think making changes, especially when it comes to a lifetime of lifestyle preferences, is easy. It's not easy at all, and I completely realize that.

Amanda

[grannynurse FNP student]

Originally Posted by mandana

Just for the record, I don't think making changes, especially when it comes to a lifetime of lifestyle preferences, is easy. It's not easy at all, and I completely realize that.

Amanda

I realize that you do Amanda. It is my other peers that seemed to think control is just a matter of taking personal responsibility. I have found that things are not as simple as the appear. I don't know how many times, during my active career and since, that I have attempted to educate my peers and physicians into the realization that non-compliance, in the course of any type of treatment, is much more then a patient failing to take personal responsibility. And I have stopped counting the number of times that I have been told I am wrong, I am just making excuses.

A patient comes into an ER, for the forth time, with an extremely high blood sugar. The staff lectures him on his diet, testing his blood, controlling his blood sugar. Then, after getting his blood sugar under control, discharges him. No one has asked him about his health care coverage; his type of work' even if he does work; who does his shopping and cooking; asked him to explain just what he knows about his diet, to name a few reasons for his non-compliance. One nurse has related about her dh who is a truck driver and his difficulty with his diabetes. If it were a matter of self responsibility, he should be able to control his disease, shouldn't"t he? Let me tell you, things are not what they appear. Ever stop and read the menu at a truck stop eatery? I have, not actually heart or diabetic friendly. And what about those long hours on the road, not much time for exercise. And even if he only hauls within the state, he spends time living alone and is not really up on cooking. And it is easier to eat out. I'm not making excuses for him but I am asking others to take a deeper look into their patients non-compliance, even when it takes numerous looks.

Grannynurse

[suzyderkins]

Couple quick notes:

First, I HIGHLY recommend this series in the nytimes. You do need to register to read, but it is free (at least most of the site including this series). The articles are a great combo of factual info and anectdotal stories.

Second, I read the series with great concern about the lack of resources being devoted and even more worry over stats that say 1 in 3 children born 5 years ago with get diabetes in their lifetime and 1 in 2 of Latino/Hispanic background. But, I also thought, I don't think I could ever be a home nurse or outreach worker with this population because the frustration level would be so high. Personally, I don't know that I could adapt to the lifestyle changes necessary, but it would still be challenging to keep trying to get people to change. Especially those who are most resistant. That fact of preventive treatment is important because we need to find ways to provide incentives for working with at risk population and the financial resources to fund it.

Third, the stats in the articles that most hit me:

1 in 8 NY-ers has diabetes with rates as high as 1 in 3 in some neighborhoods.

In NYC the public health department devotes $27 million to TB which affected 1,000 people last year and only $950,000 to diabetes affecting over 800,000 people.

One doctor said looking at rates of diabetes, it is effective to think of the number of cases in a 24 hour period.

4,100 people are diagnosed
230 amputations occur
120 enter end stage kidney disease
55 go blind

The arguments on the nytimes website feedback are all about "shoulds". What people should do, personal responsibility etc... But, I see no way "shoulds" will resolve the problem. Some type of action needs to be taken. The ultimate costs to society in every way are so high. Now figuring out what to actually do, that is a whole other debate.

[grannynurse FNP student]

Originally Posted by suzyderkins

Couple quick notes:

First, I HIGHLY recommend this series in the nytimes. You do need to register to read, but it is free (at least most of the site including this series). The articles are a great combo of factual info and anectdotal stories.

Second, I read the series with great concern about the lack of resources being devoted and even more worry over stats that say 1 in 3 children born 5 years ago with get diabetes in their lifetime and 1 in 2 of Latino/Hispanic background. But, I also thought, I don't think I could ever be a home nurse or outreach worker with this population because the frustration level would be so high. Personally, I don't know that I could adapt to the lifestyle changes necessary, but it would still be challenging to keep trying to get people to change. Especially those who are most resistant. That fact of preventive treatment is important because we need to find ways to provide incentives for working with at risk population and the financial resources to fund it.

Third, the stats in the articles that most hit me:

1 in 8 NY-ers has diabetes with rates as high as 1 in 3 in some neighborhoods.

In NYC the public health department devotes $27 million to TB which affected 1,000 people last year and only $950,000 to diabetes affecting over 800,000 people.

One doctor said looking at rates of diabetes, it is effective to think of the number of cases in a 24 hour period.

4,100 people are diagnosed
230 amputations occur
120 enter end stage kidney disease
55 go blind

The arguments on the nytimes website feedback are all about "shoulds". What people should do, personal responsibility etc... But, I see no way "shoulds" will resolve the problem. Some type of action needs to be taken. The ultimate costs to society in every way are so high. Now figuring out what to actually do, that is a whole other debate.

I couldn't agree with you more. Just think, take the statistics of NYC and transfer them around the country, into our public schools, into our public parks, into our retirement communities and states with a high retirement population. I can think of four, all located here in the deep South, that have large older, retired populations and have the smallest public funding of diabetic education and health care. And my state, Florida has one of the poorest PE requirements I have ever seen. My two youngest grandkids are in grade school. They receive one hour of PT a week and it is nothing like what I was use to. Their sister is in middle school and there, they receive 18 weeks of P.E. If they 'forget' their PE clothes, they can walk or do 'laps' around a field. Organized sports-if you consider kickball an organized sport, I guess it is all right. Why do I bring it up, you should see the number of over weight students in both schools. And my grandson is one of them. And I worry about him developing Type II.

What is scary about NYC, is that it could be any major city or community, in this country. And the apathy of the medical community and public officials is terrible. And the lack of understanding and work on the part of the medical community, including nurses, is equally terrible. And the lack of attempts to get their disease under control, by some diabetics, is terrible. Management of this disease is not entirely on the shoulders of the diabetics. It is a public health, facilities, health care communities-including physicians and nurses-management issue and problem. And it is a problem for the tax payers and insurance companies and their poor funding of preventive care.

Grannynurse

[Indy]

I don't know where I stand on the issue of personal responsibility with diabetes. I think it depends on the person. Last week I saw (briefly, she wasn't my patient) a diabetic in her twenties with end stage renal disease. She was begging for a chocolate chip cookie.

Most of the family members that I suspect had diabetes, are deceased and it isn't talked about in my family. It's not considered polite. I did feel free to chime in a bit on the effects of diet on the feet, kidneys and heart when my MIL asked me to look at my FIL's feet. His feet aren't bad but I see varicose veins there and to me that's a red flag. Result? My MIL felt good to have someone agree with her and I think my poor father in law felt a bit nagged.

My patients who are elderly, set in their ways and have all the complications to deal with now, I don't really think much about their responsibility unless they are morbidly obese. Then I feel bad for wanting to be snarky with my obese patients. I don't think I actually get snarky, but I think about it. My mother made me really angry the time she was telling me that she couldn't sit for over 30 minutes at a time without cutting the circulation off to her legs with her nice rotund belly. I wanted to just yell, "ok so get up and get moving!"

I do think that if my husband ever develops these problems there may be no end to the nagging that would ensue. In my ex, I took a lack of taking care of himself as a lack of self respect, and translated that as not caring about the people in his life who might care whether he lives or dies. This wasn't something he wanted to hear. He would not listen to word one of medical advice and would say things like, "salt does not cause hypertension, smoking is okay because I can still run if my life is in danger and my blood pressure is good so I can drink, smoke and eat all I want." Uh huh. He has GERD, is morbidly obese, god knows what his liver and lungs are going through, and that "good" blood pressure won't always be that way. I look at the support that I did offer when we were married- home cooked low fat, moderate calorie meals and offers to exercise together. The result? He spent his nights at the waffle house and refused to exercise, stopped eating what I cooked and I quit cooking. No fun if people don't eat it.

So I don't get too huffy with other people about their responsibility but if it's a family member I care about, I tend to take it personally if they don't have any desire to take care of themselves.

We did have one patient post heart cath, big ole feller, with family members in the room who were more rotund than they were tall almost, talking about his niece who had heart surgery at the age of twelve. I asked if it was a congenital heart condition, he said no. That does tend to make me less sympathetic towards his entire family for subjecting a child to a lifestyle that's directly life threatening.