T1D Real Talk: Confronting the Harder Truths of Living a Life with a Chronic Disease


type 1 diabetes real talk

“If there ever was a good time to have diabetes in history, now is that time,” said an optimistic, caring, and very knowledgeable endocrinologist at a quarterly appointment with a patient, “…plus, the cure is probably 5 years out, so there’s that.”

Oh, how I loathe that last sentence. It seems as though the cure is always 5 years out. It was 5 years out when I was diagnosed at 12 and thought we’d have a cure before I finished high school. It was 5 years out on my 21st birthday and I thought I would be cured before I walked down the aisle at my wedding. It was 5 years out when I first started seriously considering if I should ever really try to have kids with a chronic disease and experience a difficult, high-risk pregnancy. The magical “5 years out” is a myth, and hurtful to people, especially children, when they are first diagnosed.

I love all of the optimism and positive aspects of the diabetes online community (DOC) and the power behind people and our ability to connect across space and time (zones). When children are first diagnosed with type 1 diabetes (or type 2), there’s a lot more hope out there for people than there was even 10 or 20 years ago. But sometimes I think all of that optimism and hope sets kids up to think that diabetes isn’t difficult and that there won’t be struggles in their future at all and, when they face those struggles, they don’t have the coping mechanisms to deal with them.

According to the National Institutes of Health, the prevalence of major depression in patients with diabetes ranges from 8-18%, while milder types of depression are reported to be present in 15-35% of people with diabetes. That is huge. It’s important to look out for the symptoms of depression and to not misguide those that are newly diagnosed with the notion that everything will always be normal and easy.

Depression and type 2 diabetes

Here’s some T1D real talk. Diabetes is hard. Diabetes is chronic. There is no cure, and it’s invisible. That’s really, really tough. It’s tough when you’re 400 mg/dL on a Tuesday morning, but still have to make that 8:00 a.m. meeting, because no one can see how awful you really feel. It’s tough when you’re trying to hike with friends, but you’ve gone low 23 times on the trail and want to give up.

It’s tough when job applications ask, “do you have a disability?” and you know the answer is a resounding yes, but in the back of your mind, you’re worried that you’ll be discriminated against and not get the job. It’s tough when people say, “Well, at least it’s not cancer.”

It’s tough when you’re a struggling college student and it’s just not fair that you have to buy insulin, and syringes, and test strips, and glucose tabs, and pay for specialists and pump supplies and lancets on top of being a college student and it makes you want to scream. It’s tough when you cry. And you’ll cry.

It’s tough when you have to know the vernacular of insurance companies and can translate the EOB (explanation of benefits) on bill statements for all of your family and friends. It’s tough when you have to introduce not only yourself, but your diabetes to every single significant person in your life, for the rest of your life. It’s tough that diabetes always seems to tag along.

It’s tough. Diabetes is painful. People who say it isn’t are under an illusion. A person with diabetes often feels like a pin-cushion and skin isn’t infallible. The number of bumps and bruises that diabetes causes is infinite. People will question everything you eat; people will question everything you don’t eat.

People will stare. People will ask if you’re carrying a pager (Hello, it’s 2017!), and most people won’t really understand the physical and emotional toll that diabetes takes on the body. (No, I don’t really want to answer the “So is your diabetes under control yet?” question again.)

People will always relate your diabetes to that of their grandma. People will ask if you can eat salt. People will regale you with stories of their second cousin’s girlfriend’s mom who had to have her foot amputated from diabetes (thanks). People will be scared, but the ones who stick around are worth their weight in gold.

But people will try. People will prove to you that they care. You will make real, deep connections with people that just get it. When you fall, you’ll fall hard, but when you stand, you’ll be taller (even by an inch). You’ll triumph. When we talk with kiddos and people that are recently diagnosed, let’s keep in mind to keep it real for them, so they’re not whiplashed with the reality of a chronic disease in a cruel, unforgiving world, leaving them ill-prepared for success.

Yes, diabetes is hard. Diabetes is tough. But diabetes makes people more persevering, more disciplined, more determined, and some of the hardest working people in the world. They’re tougher than diabetes. And so are you.

Physicians call for drug abuse to be treated as ‘chronic disease’


With drug overdoses causing tens of thousands of deaths every year in the U.S., physicians are calling for the crisis to be treated like a medical emergency.

Today, the American College of Physicians (ACP) published a position paper arguing that action needs to be taken by the medical community and others to stem the crisis, especially in light of the massive growth of the opioid epidemic.

“Twenty-two million people need treatment and a large percentage of people aren’t getting treatment,” Dr. Nitin S. Damle, president of the American College of Physicians, told ABC News, citing national statistics compiled by the U.S. Centers for Disease Control (CDC). “We want to focus the spotlight on that.”

In the paper, the ACP is making a host of new recommendations on the basis that substance abuse should be considered a chronic disease that needs ongoing treatment, not a “moral disorder or character defect.”

Damle said compared to other chronic diseases such as high blood pressure or diabetes, where 75 percent of people get treatment, just 18 percent of people with substance abuse disorders get treatment, according to CDC statistics.

The ACP paper emphasizes shifting the focus to treatment, rather than punishment, for drug addiction, including opioids. They said they would like to see tighter controls for opioid prescriptions, more training in the medical community to deal with substance abuse and more options for patients to receive mental health treatment.

In addition, the ACP advocates for policies that give non-violent drug offenders the option to receive treatment and reduced prison sentences for possession.

 “We need to have more treatment programs and we need to have more funding in this area,” Damle explained. “It’s a heavy societal burden it really endangers families and not just individuals.”

Physicians can make a huge difference in combating the substance abuse epidemic by limiting the amount of opioids they prescribe, Damle added. Checking databases to ensure patients aren’t getting opioid drugs from other doctors and taking additional courses on substance abuse to better treat disorders can also help, he said.

Opioid abuse remains a deadly crisis in the U.S. An estimated 91 people fatally overdose on opioids every day, according to the CDC, and approximately 52,000 died from drug overdoses in 2015.

Dr. Caleb Alexander, Co-Director of the Johns Hopkins Center for Drug Safety and Effectiveness, said the paper is “welcome news” given how little help there is for people suffering from substance abuse disorders.

“There is a huge gap between the need for these services and their delivery,” Alexander said. “Millions of Americans need treatment for an illicit drug or alcohol use problem yet don’t receive.”

“This is all the more shocking because it’s a good investment,” he continued. “For every dollar invested in drug prevention and treatment, we save money as a society –- we can either pay for it now, or pay for it later.”

Alexander said the fact that the paper emphasizes treatment for substance addiction rather than incarceration is important.

“When it comes to opioids, we should be talking about addiction, not abuse,” he said. “Addiction is a disease, abuse is a behavior.”

Source:http://abcnews.go.com

5 Health Tips if You Sit at a Computer All Day


Excessive Sitting When Working

In recent centuries, advances in industry and technology have fundamentally changed the way many humans spend their waking hours. Where it was once commonplace to spend virtually all of those hours on your feet – walking, twisting, bending, and moving – it is now the norm to spend those hours sitting.

The modern-day office is built around sitting, such that you can conduct business – make phone calls, send e-mails and faxes, and even participate in video conferences – without ever leaving your chair.

But there’s an inherent problem with this lifestyle. Your body was designed for near perpetual movement. It thrives when given opportunity to move in its fully intended range of motion and, as we’re now increasingly seeing, struggleswhen forced to stay in one place for long periods.

What Happens When You Sit for Too Long?

Studies looking at life in natural agriculture environments show that people in agrarian villages sit for about three hours a day. The average American office worker can sit for 13 to 15 hours a day.

The difference between a “natural” amount of sitting and modern, inappropriate amounts of sitting is huge, and accounts for negative changes at the molecular level.

According to Dr. James Levine, co-director of the Mayo Clinic and the Arizona State University Obesity Initiative, there are at least 24 different chronic diseases and conditions associated with excessive sitting.

As he wrote in Scientific American:1

“Sitting for long periods is bad because the human body was not designed to be idle. I have worked in obesity research for several decades, and my laboratory has studied the effect of sedentary lifestyles at the molecular level all the way up to office design.

Lack of movement slows metabolism, reducing the amount of food that is converted to energy and thus promoting fat accumulation, obesity, and the litany of ills—heart disease, diabetes, arthritis, and more—that come with being overweight. Sitting is bad for lean people, too.

For instance, sitting in your chair after a meal leads to high blood sugar spikes, whereas getting up after you eat can cut those spikes in half.”

Not surprisingly, sitting for extended periods of time increases your risk forpremature death. This is especially concerning given the fact that you may be vulnerable to these risks even if you are a fit athlete who exercises regularly.

It takes a toll on your mental health, too. Women who sit more than seven hours per day were found to have a 47 percent higher risk of depression than women who sit four hours or less.2

There’s really no question anymore that if you want to lower your risk of chronic disease, you’ve got to get up out of your chair. This is at least as important as regular exercise… and quite possibly even more so.

Practically Speaking: 5 Tips for Better Health if You Work at a Computer

You might be thinking this sounds good in theory… but how do you translate your seated computer job into a standing one? It’s easier than you might think. For starters, check out these essential tips for computer workers:3

1. Stand Up

If you’re lucky, your office may be one that has already implemented sit-stand workstations or even treadmill desks. Those who used such workstations easily replaced 25 percent of their sitting time with standing and boosted their well-being (while decreasing fatigue and appetite).4

But if you don’t have a specially designed desk, don’t let that stop you. Prop your computer up on a stack of books, a printer, or even an overturned trash can and get on your feet.

When I travel in hotels, I frequently use the mini fridge or simply turn the wastebasket upside down and put it on top of the desk, and it works just fine.

2. Get Moving

Why simply stand up when you can move too? The treadmill desk, which was invented by Dr. Levine, is ideal for this, but again it’s not the only option. You can walk while you’re on the phone, walk to communicate with others in your office (instead of e-mailing), and even conduct walking meetings.

3. Monitor Your Screen Height

Whether you’re sitting or standing, the top of your computer screen should be level with your eyes, so you’re only looking down about 10 degrees to view the screen. If it’s lower, you’ll move your head downward, which can lead to back and neck pain. If it’s higher, it can cause dry eye syndrome.

4. Imagine Your Head as a Bowling Ball

Your head must be properly aligned to avoid undue stress on your neck and spine. Avoid craning your head forward, holding it upright instead. And while you’re at it, practice chin retractions, or making a double chin, to help line up your head, neck, and spine.

5. Try the “Pomodoro Technique”

You know those little tomato-shaped (pomodoro is Italian for tomato) timers? Wind one up to 25 minutes (or set an online calculator). During this time, focus on your work intensely. When it goes off, take 5 minutes to walk, do jumping jacks, or otherwise take a break from your work. This helps you to stay productive while avoiding burnout.

What’s It Really Like to Work While Standing?

If you’re curious… just try it. Reactions tend to be mixed, at least initially, but if you stick with it you will be virtually guaranteed to experience benefits. The Guardian, for instance, recently featured an article with a first-hand account of working while standing, and the author wasn’t impressed.

He said “standing up to work felt like a horrible punishment” and lead to aches and decreased productivity.5 I couldn’t disagree more, but I will say that standing all day takes some adjustment. However, many people feel better almost immediately. As one worker who uses an adjustable-height work desk told TIME:6

“I definitely feel healthier standing while working as it causes me to be more focused on my posture and ‘hold’ myself better in terms of my stomach and shoulders especially.”

Personally, standing more has worked wonders for me. I used to recommend intermittent movement, or standing up about once every 15 minutes, as a way to counteract the ill effects of sitting. Now, I’ve found an even better strategy, which is simply not sitting. I used to sit for 12 to 14 hours a day. Now, I strive to sit for less than one hour a day.

After I made this change, the back pain that I have struggled with for decades (and tried many different methods to relieve without lasting success) has disappeared. In addition to not sitting, I typically walk about 15,000 steps a day, in addition to, not in place of, my regular exercise program. I believe this combination of exercise, non-exercise activities like walking 10,000 steps a day, along with avoiding sitting whenever possible is the key to being really fit and enjoying a pain-free and joyful life.

You’re Not a Prisoner to Your Chair

If you’re still sitting down while reading this… now’s your chance – stand up! As Dr. Levine said: “We live amid a sea of killer chairs: adjustable, swivel, recliner, wing, club, chaise longue, sofa, arm, four-legged, three-legged, wood, leather, plastic, car, plane, train, dining and bar. That’s the bad news. The good news is that you do not have to use them.”

Many progressive workplaces are helping employees to stand and move more during the day. For instance, some corporations encourage “walk-and-talk” meetings and e-mail-free work zones, and offer standing workstations and treadmill desks. But if yours isn’t among them, take matters into your own hands. You may be used to sitting down when you get to work, but try, for a day, standing up instead.

One day can turn into the next and the next, but please be patient and stick with it. Research shows that it can take anywhere from 18 to 254 days to build a new habit and have it feel automatic.7 Once you get to this point, you’ll likely already be reaping the many rewards of not sitting, things like improved blood sugar and blood pressure levels, less body fat and a lower risk of chronic disease.

LIFE EXPECTANCY GAINS THREATENED AS MORE OLDER AMERICANS SUFFER FROM MULTIPLE MEDICAL CONDITIONS.


NEARLY EIGHTY PERCENT HAVE MORE THAN ONE SERIOUS AILMENT

With nearly four in five older Americans living with multiple chronic medical conditions, a new study by researchers at Johns Hopkins Bloomberg School of Public Health finds that the more ailments you have after retirement age, the shorter your life expectancy. The analysis, one of the first to examine the burden of multiple chronic conditions on life expectancy among the elderly, may help explain why increases in life expectancy among older Americans are slowing.

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A report on the findings, based on an analysis of 1.4 million Medicare enrollees, appears in the August issue of the journal Medical Care.

“Living with multiple chronic diseases such as diabetes, kidney disease and heart failure is now the norm and not the exception in the United States,” says Eva H. DuGoff, a recent PhD recipient at the Johns Hopkins Bloomberg School of Public Health and lead author of the report. “The medical advances that have allowed sick people to live longer may not be able to keep up with the growing burden of chronic disease. It is becoming very clear that preventing the development of additional chronic conditions in the elderly could be the only way to continue to improve life expectancy.”

For their analysis, researchers used the Medicare 5% sample, a nationally representative sample of Medicare beneficiaries, enrolled as of January 1, 2008, which included 21 defined chronic conditions and the records of nearly 1.4 million people 67 and older.

Life expectancy in the U.S. is rising more slowly than in other parts of the developed world and many blame the obesity epidemic and its related health conditions for the worsening health of the American population.

The analysis found that, on average, a 75-year-old American woman with no chronic conditions will live 17.3 additional years (that’s to more than 92 years old). But a 75-year-old woman with five chronic conditions will only live, on average, to the age of 87, and a 75-year-old woman with 10 or more chronic conditions will only live to the age of 80. Women continue to live longer than men, while white people live longer than black people.

It’s not just how many diseases you have, but also what disease that matters. At 67, an individual with heart disease is estimated to live an additional 21.2 years on average, while someone diagnosed with Alzheimer’s disease is only expected to live 12 additional years.

On average, life expectancy is reduced by 1.8 years with each additional chronic condition, the researchers found. But while the first disease shaves off just a fraction of a year off life expectancy for older people, the impact grows as the diseases add up.

“We tend to think about diseases in isolation. You have diabetes or you have heart failure. But many people have both, and then some,” says senior author Gerard F. Anderson, PhD, a professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health. “The balancing act needed to care for all of those conditions is complicated, more organ systems become involved as do more physicians prescribing more medications. Our system is not set up to care for people with so many different illnesses. Each one adds up and makes the burden of disease greater than the sum of its parts.”

The researchers say their findings could be useful to Social Security and Medicare planners as they make population and cost predictions for the future. Policymakers are facing a different landscape as so many more people are living with multiple chronic conditions than before: 60 percent of those 67 and older in the U.S. have three or more of these diseases, the researchers found. Eventually, there may be a tipping point, when the medical advances that have boosted life expectancy for so long can no longer keep pace with the many illnesses people are collecting as they age.

“We already knew that living with multiple chronic conditions affects an individual’squality of life, now we know the impact on quantity of life,” DuGoff says. “The growing burden of chronic disease could erase decades of progress. We don’t want to turn around and see that life expectancy gains have stopped or reversed.”