Sunday, May 20, 2007

Doing her job

8:28 a.m. A big, black paw hitting my shoulder awakes me. It hits me a few times. I reach out and pet the paw, and close my eyes--trying to get back in my dream.

The paw hits again, only this time on my face. I reach out and pet and attempt to coerce the dog to lie down and snuggle.

“Come on buddy. I’ll pet you. Lay down.”

Now the dog is standing over me, digging with her paws near my face.

8:32 am “FINE! I’M UP. O.K. I’ll TEST!”

Grab the testing kit next to my bed. The dog gives a heavy sigh and curls into a ball and rests on the bed. No more pawing me.

Fumble it open and slide a strip into the machine. Turn the light on so I can see where to put the blood.

Pick a finger to poke. Push the button. No blood.

“Dam, I need to put a new lancet in here.” It’s probably been a month since that lancet was changed.

After three pokes, I finally pierce a finger and squeeze blood on the strip.

The light goes out- sample was accepted.

Beep. 55.

Grab a juice box and slurp the whole thing down.

I reach over and pull the dog close to me. I kiss her head.

“Thanks. Good low. Good dog.”

The dog sighs and rolls over so that I can rub her belly.

We both fall back to sleep for 20 minutes.

She’s content.

I’m safe.

Sunday, May 6, 2007

New diagnosis

I don’t understand the treatment for Type 2. I don’t really know a lot about medications that are available. I read Diabetes Forecast and have stopped skipping through the Type 2 articles and actually reading them. I’ve tried to understand this “other diabetes” because many friends and acquaintances have that disease.

A woman that I work with at school was diagnosed with Type 2 about a month ago. Her doctor (at a major medical center in the twin cities) sent her home with a prescription for Metformin, directions for its use, and a scheduled appointment for diabetes education four weeks from that time. She filled the Metformin and started taking it. I asked if she was testing, and she said that the doctor said that she could wait until the education class.

The education class was last Thursday. This woman left work early to attend it.

She came back to work on Friday. I asked how the class was. She said that she couldn’t be in the class because she had to meet individually with her doctor. Apparently her blood sugar was high. They did a “1AC” (A1c) and it was 19.8. My jaw dropped.

19.8. OH… MY…GOSH! I didn’t know the test range went that high. Isn’t that a serious medical condition?!?!

I ask if they gave her any insulin. She said no, that the doctor had just told her to keep taking the Metformin, test her blood sugar twice a day, and come back for a follow up appointment in another month. What?!

I wish this were the only time that I had heard about that kind of plan for someone newly diagnosed with Type 2. But it wasn’t. I’ve heard stories like that more that once.

Why aren’t people with Type 2 treated aggressively? Why wouldn’t this woman be instructed to test more frequently, to figure out if the Metformin was enough? Where’s the meal planning information?

Diabetes is a challenging chronic illness. I am constantly out there researching what is new and possible for my management. I’m an informed member of my health care team.

I have friends that are not. They take the back seat in their diabetes management. When I suggest that they ask their doctor about new things, they are reluctant. Their control often reflects that.

Heck, I have a family practice doctor who is my "primary care physician." It's the rule to have a doctor to call that, and it can't be a specialist like my endocrinologist. I see her if I have an illness or injury. She has suggested, many times, that she just manage my diabetes. No way. Although I appreciate her willingness, I'm not settling for anyone but an endocrinologist who specializes in diabetes. I have friends that do see just a general practitioner for their Type 1. They are also often the ones who aren't aggressively managing their disease.

If health care providers aggressively helped manage people’s diabetes, would the rate of complications be so high? Is our health care team content with basic management?

It seems like people with Type 1 are diagnosed, and expected to make major life changes immediately. MDI, insulin pumps, carb counting, sick day management, ratios, etc are all started quickly. Why not with Type 2 diagnoses? Why is the management plan for Type 2 so gentle, so slow? First try and lose some weight, test a couple times a week, take a couple pills. Where’s the urgency?

Is it our society that has made Type 2 “not a big deal.”? Lose a little weight, exercise, and you will be healed. It seems so simple that I fear people don’t understand the seriousness and the complexity of diabetes. The woman I work with told her doctor that she “…didn’t want the needle.” I hope her doctor told her that diabetes isn’t really a disease where you can “choose” your treatment. Certainly your life choices will affect the level of intervention that is needed—whichever kind of diabetes you have.

I've certainly read other people's blogs who are living with Type 2, and they seem to be very educated about treatments, etc. Maybe I just know the people who aren't...

I hope that people with diabetes, despite which kind, get attentive medical care that gives them the chance at having a great quality of life.


Yesterday I got a hair cut. (as my students would say “you got lots of hairs cut.”) The woman called my name and walked me back to her station. She looked uncomfortable. She told me that she was afraid of dogs. I assured her that Dixie was well trained and had passed an exam that allowed her to be in public places without people having to worry about their safety. I don’t think that she bought it.

She was clearly nervous during the whole process. Dixie was perfect. She just lay on the floor with pieces of hair dropping on her. It’s awkward. It’s the first time anyone has ever said that to me.

It made for an uncomfortable 20 minutes.

(the photo of Dixie is from school. She had just alerted me - by jumping on the table and hitting me with her paws. It's her last behavior, when I've ignored all the other alerts.)