Diabetes Diary, Part 6

“No More Rationalizations”

For some reason, I get nervous during doctor’s visits. Typically, right before my blood pressure is taken, my heart starts racing. I don’t know why this happens, but usually the nurse asks me if I’m nervous; I say, yes; and he or she re-takes my blood pressure. The second blood-pressure check is usually much better than the first, and there’s no more discussion about it. But that wasn’t the case when I recently visited my endocrinologist.

During the visit, he pronounced that I have high blood pressure. “No, I’m borderline,” I protested—due, of course, to the nervousness I experience during exams.

He looked at me expressionlessly and said (while writing me a prescription for irbesartan-hydrochlorothiazed): “Borderline is high blood pressure for a diabetic.”

The fact that I “officially” have high blood pressure still hasn’t sunk in—even though I’ve been taking a daily dose of the 150-mg, peach-colored pill for nearly two weeks. I rationalized that were I not a diabetic, I wouldn’t be considered hypertensive. (Isn’t the mind a funny thing?)

But here’s the reality, per HealthSquare.com: My new combination medication treats high blood pressure. One of its components prevents angiotensin II, a hormone, from constricting the blood vessels. The other component, a diuretic, removes excess fluid from the body, and thereby, lowers blood pressure.

Pretty serious, I thought. My pharmacist confirmed that it is, in fact, serious, when she attached an “urgent” note to the prescription bottle—which she’s never done—stressing the dire consequences of noncompliance. This—in addition to the baby-blue warning-stickers on the bottle—got my attention. Now that I’m among the 60 percent of diabetics with high blood pressure, I plan on being the perfect pill-popper—lest my pharmacist’s dire consequences get me. In other words, I plan on taking this new med every day as directed to avoid heart disease, stroke, hardened arteries or heart failure.

Then, I ran across this tidbit from WebMD’s “Diabetes: High Blood Pressure” article, and I ceased musing about having “borderline” hypertension: “Even high yet normal blood pressure or pre-hypertension (defined as 120-139/ 80-89) impacts your health. Studies show that people with normal yet high range blood pressure readings, over a 10 year period of follow up time, had a two to three fold increased risk of heart disease.”

Enough said.

Until next time,
Nicole Crawford-Tichawonna
Contributing Editor

Diabetes Diary, Part 5

Although I’ve been using my current blood glucose meter since last September, I hadn’t bothered to check out its Web site until last week. To my delight, I found a great resource for managing my diabetes. Accessing the site was simple. I had to join its online community by registering the serial number on my blood glucose meter—plus the membership was free.

The first tool I plan to use is the site’s Testing Log. I currently track my glucose levels throughout the day the old fashioned way: with pen and paper. I fold an 8x11” photocopied daily log grid in half three times, in order for it to fit inside my meter’s carrying case. As you can imagine, by the time the sheet is filled up, it’s pretty dog-eared.

By using the online log, I can forgo the tedium of folding and refolding my log sheet. My meter keeps about 100 test results in its memory. So I can retrieve the day’s results before I go to bed and--with a few points and clicks--enter them all at once. The online log also allows me to create line graphs or pie charts by day, week, month or year. This will not only give me a visual image of how I’m doing, but it may also help me figure out what I need to tweak in my diet and exercise regimen and when.

Other features on the Web site help you set and complete exercise goals; cook tasty-sounding, carb- and calorie-specific recipes; understand diabetes terms and stay abreast of the latest diabetes research. The Web sites for your meter and meds may offer similar online resources. Check them out, and let me know if you find anything useful.


Until next time,
Contributing Editor
Nicole Crawford-Tichawonna

Diabetes Diary, Part 4

I’m sick of waking up each morning and pricking my palm or forearm to do the first of four blood-glucose tests a day. I’m tired of injecting myself with short-acting insulin before breakfast, lunch and dinner—and of having to wait 15 to 20 minutes before I can eat. And I’m so over having to end my days with yet another shot of insulin—the long-acting kind that’s supposed to sustain me for the next 24 hours. I’ve got the blues…the diabetes blues.

In my first blog, I briefly mentioned the diabetes blues, or burnout, as it’s more commonly known. I surmised that my late aunt had suffered from this affliction and been unable to shake it. I also vowed to develop strategies to beat back burnout when it comes my way. But lately, the stresses of being a mother, wife and first-year grad student—and of being severely sleep deprived—have made it hard for me to stay positive about my self-care. In fact, I’ve begun to resent my chronic condition; I even made an emotional outburst about it to my husband the other night: “I H-A-T-E having to do this,” I said. Half asleep, he muttered, “I know.”

Realizing that being mad about having diabetes is no way to beat my blues, I decided to be proactive. Yesterday, I checked the Web for ideas for coping with burnout. Here’s a sampling of what I found:

BOOKS
• Diabetes Burnout: What to Do When You Can’t Take It Anymore, by William H. Polonsky.

• 50 Secrets of the Longest Living People with Diabetes, by Sheri R. Colberg.

• Cheating Destiny: Living with Diabetes, by James S. Hirsch.

WEB SITE ARTICLES
• “Diabetes Burnout: How to Stop the Daily Grind from Bringing You Down,” by Linda Beeney, PhD.
http://www.diabetesaustralia.com.au/conquest/0101-burnout.htm

• “Diabetes Burnout: When to Leave ‘Good Enough’ Alone,” by Linda von Wartburg.
http://www.diabeteshealth.com/read/2007/04/13/5116.html

• “Avoid Diabetes Burnout,” by Joslin Diabetes Center.
http://www.joslin.org/managing_your_diabetes_596.asp

Until next time,
Nicole Crawford-Tichawonna
Contributing Editor

Diabetes Diary, Part 3

For as long as I can remember, my smile has been my vanity. But despite a lifetime of twice daily brushing and flossing, my dentist recently confirmed that I have periodontal, or gum, disease: Plaque has begun to destroy the gums and bone around my teeth.

While anyone can develop periodontal disease, people with diabetes are more susceptible to it—probably because we’re more prone to infections. The American Academy of Periodontology, in fact, calls gum disease “the sixth complication of diabetes.” The good news for me is that my condition is “moderate.” (I won’t lose any teeth!) My mouth will be restored to relative good health after just a few dental visits.

Once diagnosed, I wasted no time starting treatment. At my first visit, my dentist probed my teeth to measure the space, or pockets, between them and the surrounding gums. During my second visit, the dental hygienist performed scaling and root-planing on the right side of my mouth--a procedure that removes plaque and tarter from below the gumline. On my next visit, this Thursday, the hygienist will scale and root-plane the left half of my mouth. After that, my dentist wants me to increase my dental visits from two to three times a year.

But periodontal disease is also linked to diabetes control. People with uncontrolled blood glucose levels may develop gum disease more often and more severely--and may loose more teeth—than those with good control, according to the American Diabetes Association. This is yet another reason for me to improve my diabetes self-care.

In addition, people with or who are at risk for diabetes may not know or experience all of the warning signs of gum disease. To learn more about tooth and gum problems caused by diabetes, check out the following Web sites, and see the list below:

• National Diabetes Information Clearing House (NIDDK): To download brochure.
http://diabetes.niddk.nih.gov/dm/pubs/complications_teeth/

• American Academy of Periodontology: To view free brochure, click second bullet under “Find Out More” section.
http://www.perio.org/consumer/mbc.diabetes.htm

• American Diabetes Association: “Oral Health Topics A-Z.”
http://www.ada.org/public/tipics/diabetes_faq.asp


Signs of Gum Disease
--Red, sore swollen gums
--Bleeding gums
--Gums pulling away from your teeth so your teeth look long
--Loose or sensitive teeth
--Bad breath
--A bite that feels different
--Dentures that do not fit well

Until next time,
Nicole Crawford-Tichawonna
Contributing Editor

Diabetes Diary, Part 2

I periodically get newsletters from hospitals in my area. Typically, I toss them out, barely having read the cover. But recently I received one that caught my eye. I was flipping through its pages when an article jumped out at me: “Diabetes Treatment Center Makes Debut.”

The article seemed serendipitous. I’ve been without a primary care physician (PCP) for more than a year. Dr. L, my former PCP, had handled my diabetes management since 2001. But in December 2006, she announced that she was changing the nature of her practice, making it unfeasible for me to continue to see her.

Finding a replacement hasn’t been easy—and not just because I felt a bond with Dr. L. One internist I visited flunked her tryout after prescribing the wrong version of my insulin. Another highly recommended PCP informed me that she wasn’t taking new patients. And several doctors referred by friends don’t take my insurance. Meanwhile, too much time was passing since my ABCs—A1C, blood pressure and cholesterol (LDL, HDL and triglycerides)—had been checked.

Then, as if on cue, the newsletter arrives in the mail. It boasts that the new diabetes center is state-of-the-art and has a multidisciplinary approach to patient care. A one-stop shop, it offers endocrine consultation, diabetes education, nutrition counseling, podiatry, retinopathy screening and self-management training.

Not being one to look a gift horse in the mouth, I called and made an appointment. It’s in April, and I can’t wait. I just hope that the center lives up to its hype. I’ll keep you posted.

Until next time,
Nicole Crawford-Tichawonna
Contributing Editor

Diabetes Diary

April 2008 will mark the eighth year of my diabetes diagnosis. My struggle with this disease began during my sixth week of pregnancy. I was at my second OB visit when my doctor informed me that I was to be hospitalized… immediately. Being a gestational diabetic is no cakewalk, but I managed my disease with near-perfect compliance. I was fanatical about portion control during meals and learned not to wince while giving myself four insulin shots a day. I tested my blood glucose levels—requiring four more sticks a day—exactly two hours after every meal. I did this day in and day out, without fail. And it was worth it: I gave birth by C-section to a beautiful and healthy baby boy at 38 weeks.

For many women, gestational diabetes goes away once the baby is born. This was not to be my fate. Despite my fervent prayers and wishes, I knew—even during my pregnancy—that living with diabetes would be my lifelong challenge. After all, the disease was rife on the maternal side of my family: my grandmother, two aunts and at least one uncle had the disease.

Although I was disappointed that I had graduated from being a gestational to a type 2 diabetic, I knew I could handle it. My grandmother had been an excellent role model for controlling the disease. When she died at age 84, it was from cancer, not diabetes complications. Her youngest child, on the other hand, was the poster child, for what not to do. My aunt’s unmanaged diabetes eventually led to her having several strokes in her 50s and dying way too soon at 61.

I spent a lot of time being silently angry with my aunt. She decided that she could no longer give herself her insulin injections, which, to me, was preposterous. First, as a single woman who lived alone in a city away from family, she needed to depend on herself. She chose instead to rely on the goodwill of church members with nursing skills to stop by her house at injection time. (I don’t know the details of this arrangement, but it must have been messy.) Second, she had injected herself for years, why had she suddenly become too squeamish to do it? Now that I have some years as a diabetic under my belt, I think I have some insight. My aunt probably developed burnout and languished there.

Diabetes books, magazines and Web sites are filled with information on how to avoid or cope with burnout—a clear indication that many of us living with this disease will experience it at some point. My turn came about two years ago. A life challenge had me in its crosshairs and I slowly and steadily began to let my regimen lapse. For example, I’d leave the house without my blood glucose monitor--an essential tool for diabetics--or I’d forget to eat on time. Fortunately, I never completely abandoned my self-care regimen. In fact, I’m ready to get back on track. Starting this blog is part of my new wellness plan. I’ll be chronicling my life with diabetes, my successes, setbacks and everything in-between.

I also want to hear from you. Whether you’re a new diabetic, a veteran like me, or a concerned friend or loved one, let’s support each other. Diabetes is plaguing the black community. This disease cuts short too many of our lives, especially black women’s. But I ain’t going out like that. Together, we can learn to gain control and thrive. That’s my intention.

Until next time,

Nicole Crawford
Contributing Editor

New Mommy Files, Part 23

Can you tell that the holiday season had me in its cheery grip? Last we blogged I was about to get Raine ready for an early morning of shopping. Well, it didn’t happen. I got her up. Did my motherly duties of feeding and cleaning her and thought that we would be on our way to mall bliss. Well Raine had other plans. One, she had a diaper blow out. I washed and changed her again. Second, I guess she felt like a nice nap. So she napped as I watched the hours tick away. Under normal circumstances, a lengthy nap is a welcome occurrence. But not that day! Not my only day to hit the streets! But the alternative was to have a grumpy, tired baby on my hands in the middle of mall mania. No way. Not this elf. Needless to say, momma never made it out and what followed were crazy dashes here and there to the stores after work. But it all got done—by Christmas Eve.

This Christmas was different than most. Of course, it was Raine’s first Christmas, but it was also my first Christmas away from the family. It really hit me that I was a grown up with my own family to worry about. We did the Christmas thing with Raine’s two half brothers. They were determined to spend the holidays with their baby sister, and I’m glad we made it happen. So for a week I was responsible for 3 tykes. I must admit it was mostly Daddy-o who did the caretaking. I didn’t take time off for the holidays (it really wasn’t planned that way-I swear), so I worked while he watched the kids. He did a great job. I just had to go on duty as soon as I entered the door in the evening. I felt this overwhelming urge to educate them. I figured I had to read to them. Keep them from playing games 24-7. I can at least say that they didn’t lose any brain cells while they were here! But having kids around helped to shake off the holiday hum drums—all of the hustle and bustle and money! But the sheer joy in the kids’ faces when they turned the corner and saw the tree was truly priceless.

And drum roll please…Raine can now walk! At 10 months (nearly 11) she was moved to take a few steps over the holidays. I think we better hold on because Bam Bam (as we lovingly call her) gets into enough as it is. Now that she’s getting this walking thing down, she will only find more goodies to destroy.

And another drum roll please…I’ve been feeling mighty old lately and feeling like I had "middle-aged mother" stamped on my head. Not that I’m looking, but an occasional inappropriate “Hey shorty” is welcome from time to time just for self-esteem reasons. So, I just went downstairs to grab something to eat and a youngin’ (we’re talking early 20s) followed me into the food joint to ask if we could “talk” for a minute. I declined the invitation, of course, but could momma be getting her mojo back for the ’08?

Marcia Caster
Senior Editor, Beauty and Fashion
mcaster@heartandsoul.com