Welcome?

If you have found this blog, saying Welcome does not really seem appropriate. I know you wish you weren't surfing the internet for diabetes. I felt the same.

A big part of me wishes I were not writing about diabetes, nor did I anticipate to become so opinionated or informed on the subject, but it happened. In 2010, my son was diagnosed with Type 1 Diabetes.

It wasn't really part of the plan… Correction - it was not part of the plan, but it happened. It is not always easy, but I think we are all doing okay, and I hope we continue to do so.

Why the Middle East? I happen to live in Dubai. I don't think that living in the Middle East makes mine or my son's diabetic experience any more unique or challenging than it does elsewhere in the developed world.

I hope you stick around, or read something you like. Feel free to comment and join the conversation, subscribe or follow this blog by liking the Facebook page Diapoint.

Please note: This blog does not give medical advice. I am opinionated, and I share my experiences, but the first rule of diabetes is to follow up with your doctor and/or nurse educator about your care, diagnosis or medication. If you do not have a medical practitioner that is helping you find your way through this crazy world, then do not give up until you find the right one.

Thursday, December 22, 2016

Man In The Mirror

As 2016 ends, I struggle to find something significant to write or say that reflects on this year. I have nothing of diabetic significance to say that hasn't already been said. Maybe I will over the next week, but as I think of my sign off blog post for 2016, I am at a loss.

The world seems to be a mess for many reasons.. racism, war, terror and other atrocities we read about daily. At least my son is still young enough to live in a bubble. Although that bubble is slowly getting poked at.

Just last week he was curious about 9/11 after a discussion in school about Phillippe Pettit who walked across a tight rope between the two towers in 1974. Some children were aware that those towers no longer exist, but were not completely sure as to why. Of course I "mommed up" and told him the full story.

Today I took the day off and we went to visit the Legoland that recently opened in Dubai. On the drive home, I put on my favorite playlist in Spotify that I fondly call "Peanut Butter & the JAM". Full of songs I love, it is definitely my most played - and keeps growing.

Michael Jackson's "Man In the Mirror" came on. My son asked if we could listen to it again. He is very much my child - listening to a song again and again until he understands all the lyrics.

I asked him if he understood the message in the song. He did.

He replied, "If you want to make the world a better place, you should change yourself".

After a few seconds of contemplation - as he often does - he says, "You know mom, sometimes you can just change the world with your smile. Your smile can change people."

And you know what. He is right.

Everyone wants a change. Sometimes it is hard to decide what to change, or where that change should start. Sometimes it feels bigger than us. And while sometimes it is bigger than us, and we can't move a mountain right away, maybe a smile is a start.

In many cases, a little kindness can go a long way.

In the context of diabetes.. I can't add much today.. Maybe it is a cure you want, or people to better understand your challenges, or you just want to understand why your blood sugars act up... whatever the case may be.. maybe he is right. Start with a smile. Whether that is to others, or showing yourself some compassion, a little can go a long way.

Monday, December 5, 2016

News or False

I subscribe to various news alerts for diabetes. There is so much happening in the world of medical research and technology that it would be impossible to keep up with it all from one source.

How else could I have learned this week about the potential of the malaria vaccine to help Type1s produce insulin, or a new joint venture that will bring an implantable Continuous Glucose Monitor (CGM) to market. Many exciting things are happening every day.

While I cannot read every single newsflash, for the articles I can read, I have a mental categorization: News, Not Quite Newsworthy, and False.

This week an article from a newspaper in a not so far away continent came buried in my string of news emails.  The title started “How I Naturally Cured Diabetes….”

I have written before that the natural cure promise is not always possible, and in some cases it is impossible. I am a strong advocate of complimentary medicine - complimentary in the sense it should compliment what has been prescribed by your endocrinologist or someone else on your medically certified diabetic team.

I typically ignore these types of claims now as there are too many to count. But this one I have to highlight because I do believe the confident tone of articles like these misleads a lot of people, and could result in the harm of unsuspecting diabetics, or those new to this crazy world of managing diabetes.

This article addressed the “most frequently asked questions”. Question number 2 was “There can’t be a cure for Type 1 when your pancreas is damaged, how are you going to make a new pancreas?” Which is a legitimate question to someone that offers you a miracle cure.

The answer. “Its only an organ and every organ of the body has the capability of regeneration”

ONLY an organ? ONLY? There is so much wrong with this statement. But I think my son has lived with diabetes long enough and I have worked around physicians long enough that I can openly say, your organs and body parts are NOT JUST ORGANS. They are incredible parts of you that give you life, breath, energy, vision and all of those amazing things that allow us to live the lives we do. Forget the very important overlooked detail that beta cells kill any regeneration of cells in the pancreas of a Type 1, and will continue to do so until a medical cure for this autoimmune issue is found.

The next question goes on to ask, “Then why do doctors not tell their patients?”

The answer “Its because they will lose their license if they do not promote harmful and toxic drugs from large pharma companies”

While it is true doctors would fear to loose their licenses if they told their patients to stop their medication because a regimen of only cinnamon and ginseng would cure them, it is not for the reason cited here. The "cure" promised here is false.

I will keep this short and brief, but please be aware. No matter what part of the world you are in, there is no cure for diabetes. Type1s are insulin dependent. They cannot live without insulin.

Type2s may need insulin, but they can often manage blood sugars with diet and exercise as prescribed by a doctor or nutritionist.

Please do not take my word for it. Ask your medical doctor first.

If there were a natural way to cure this thing, be sure, the more than half a million children counted by the IDF with Type 1 diabetes would have been cured by now.

Cinnamon and ginseng over insulin.... file under FALSE




Wednesday, November 30, 2016

Diabetes - More Than Just a Month of Blue Circles

As today is the last day of November, Diabetes Awareness Month, I had a different message prepared today. 

All month I have attended events, posted a fact a day and bombarded my social media with other things to raise awareness about diabetes. 

I wanted to highlight that many may be tired of my daily posts about diabetes. 

I wanted to highlight that this is okay because it is small in comparison to how often a diabetic has to consider the information I have shared over the last month.

I wanted to highlight that diabetes is more than a post, or internet meme you can scroll through and pick up a quick soundbite. 

It is more than walks and fundraisers. 

It is more than the smiling faces of the children you see representing research efforts. 

While many diabetics manage and live with diabetes every day, all day, to the fullest, they are too often reminded of how horrific this disease can be. 

This morning, I was sadly reminded once again. A beautiful young woman lost her life to diabetes last night. I do not know her personally, but I do know her face and her smile. I do know the disease that took her life too soon.  I am not sure of the circumstances of her case, but I do know that she was in DKA because of Type 1.

Please know the signs, symptoms and what to do in the event of a diabetic emergency. 

If you are diabetic, please consider all the risks and what you need to do to manage those.  

Please be more than aware.. 

Please know there are people out there fighting the other 335 days a year..






Monday, November 28, 2016

Finding Gratitude In The Diabetic World

Last weekend we celebrated American Thanksgiving. Every year the same 25 or so children and adults come to our home for a traditional Thanksgiving dinner. Although I am the only one that grew up in America among the group, we are all always very thankful for this gathering and the special things in our life. 

And while I am not thankful for diabetes, I am thankful for many things it has given me - appreciation for health, the amazing people I have met as a result of this journey, those who are working diligently to find a cure, and I am thankful that we have access to the current technology to manage it.

When my son was first diagnosed with Type 1 diabetes, I was overwhelmed. I worried that he would miss out on a typical childhood experiences - having fun, playing with his friends and doing all the other things kids do that we often take for granted. I think every parent of a newly diagnosed Type 1 questions if their child will have a “normal” childhood.

As I learned more about diabetes and became less anxious with the daily routine of care, I realized that it is a manageable condition. Life saving insulin coupled with available technology allows my son to have a normal childhood.

So while I am very thankful for insulin, I am also incredibly thankful for that technology and the flexibility his insulin pump has given us. I am also thankful for how far the insulin pump has come.

This invention is a little older than I am, and has drastically improved over time. The first one was was the size of a very large backpack. Today’s insulin pumps are about the size of a pager (Anyone remember those?) and they have made diabetes management easier for many people.  

Pumps have many advantages including the elimination of several insulin injections a day and the delivery of insulin more accurately. There are also some models that when coupled with a Continuous Glucose Monitor (CGM), suspend insulin delivery to avoid life threatening low blood sugar. 

However, many people think an insulin pump is a cure. It is not. 

It still requires several blood glucose checks per day, changing of the insertion sites every 2-3 days, plus the need to accurately count carbohydrates and determine appropriate insulin coverage.  The diabetic, or caretaker of the diabetic still has to be supportive and vigilant.

Recently in the U.S., a new pump was approved that the media labeled as an "artificial pancreas". While it was a significant advancement to help patients maintain normal glucose levels, intervention and diligence will still be required.  While it is not a cure, it is a significant innovation that will make life easier for diabetics to manage.

I am thankful that the future is bright for diabetics.  Diabetes will continue to present its daily challenges, but at the present moment, insulin pumps and other technology have provided my child a flexibility not seen by previous generations of diabetics. 

I am thankful we are living in this time of research and scientific development that have allowed my son and others like him to be kids. I am thankful that in their lifetime they will (hopefully) continue to see much more advancement.

The First Insulin Pump - Invented in the 1960s



Saturday, November 19, 2016

Sick Days And The Signs

More from the photography series "Diabetes Every Day". 

The pancreas can sometimes tell a Type 1 if they are sick long before other symptoms show up. Blood sugars increase for what often seems like no good reason only to find out a few days later a flu hits, or there is something going around the school that the body needs to fight. 

This picture was taken when my son was sent home from school with a very low grade fever. Because of a high blood sugar, the school nurse checked his temperature, and even though it was only one decimal point above the allowed limit with no other symptoms, he was sent home for the day. 

As a parent, you want your child healthy. As the parent of a diabetic, you want it even more as true sick days are very severe and can result in DKA (Diabetic Ketoacidosis). But if they are not ill, you want nothing more than for them to be normal, in school learning with their friends. Some diabetics already miss more school because it takes them longer to recover than the average non-diabetic child. 

I won't lie that these situations where he is sent home healthy frustrate me and make me wonder how many low grade fevers and other flu-like symptoms are lurking in the school hallways unnoticed or unreported. Sometimes it feels like my child gets the short end of the deal because no one runs around the halls with a thermometer checking anyone else that is symptomatic for flu. 

Sent home from school with a fever one decimal above the school limit - only
discovered as a result of high blood sugar.
....And there are real sick days. The next image was less than 24 hours after blood sugars that were on the higher side did not go down right away. Meaning, there was not enough insulin in the body - which makes a person feel sick. They feel very sick. 

There are times that a blood sugar will not go down right away... could be a pump site that needs changing, could be a bad vial of insulin..could be many other things.. But the point is, it does not take long for high blood sugars to cause a Type 1 to not feel well. 

Nausea sets in pretty quickly.. a doctor will most often assume this is flu in a child that has not been diagnosed for Type 1 diabetes. Once we found the root cause of the insulin not getting to his system, and corrected that, in a very short time he was up and running again. 

My point in sharing this image - I want to further drive home the point that Type 1 can be, and sadly is often mistaken for flu. Please know the signs. This image looks exactly like flu.

A diabetic sick day. It looks like the flu. Please know
the signs! It could save a life.
As a parent, I debated to share these images. However, as I once again read of another life lost to undiagnosed Type 1 my heart breaks.

Common Signs of Diabetes Include: Frequent urination, Excessive thirst, Increased hunger, Weight loss, Tiredness, Lack of interest and concentration, A tingling sensation or numbness in the hands or feet, Blurred vision, Frequent infections, Slow-healing wounds, Vomiting and stomach pain (often mistaken as the flu). All of these signs need not be present - it may just be one or two. 

If you have any of these signs consult with your doctor immediately

Monday, November 14, 2016

Happy World Diabetes Day

Happy World Diabetes Day!

What's to be happy about a chronic disease you may ask? As difficult as diabetes is, we have a lot to be happy about on this day that brings the world together to raise awareness in fighting this beast of a disease.

Every year on November 14th, the world marks this day with events, campaigns, activities and other things to help those with diabetes and raise awareness about its diagnosis, treatment and management.

This all started in the early 1990s by the World Health Organization and International Diabetes Foundation. The day got the extra nudge when the United Nations adopted it as an official day of observance.

Why the 14th? This is the day that Dr. Frederick Banting was born. Dr. Banting and Charles Best discovered insulin in 1921. This forever changed the lives of many people living at that time, and continues to impact those who are diagnosed with Type1 and insulin dependent in Type 2. That in itself is a celebration of life - many lives that would not be here without their discovery.

So how am I marking this day? I am celebrating the entire month with a social media campaign that focuses on a diabetic fact a day. I am also visiting several hospitals and clinics to share my mission while participating in diabetic events in the UAE.  It has also been an honor to be invited to speak to companies, universities and other organizations about diabetes this month.

While I am pretty busy, I still find this very small in the grand scheme of things. There is much to be done to support the estimated 415million diabetics in the world. This number continues to grow. And at the rate it is growing, it will likely have an impact on all of us, if it has not touched your family and friends already. We all can do something.

As I told the employees at Eli Lilly yesterday where I shared our story, everything counts - no matter how small. If you are part of an organization that is making life saving supplies - in their case insulin - your contribution in your job is important. As they were about to go on about their work day focussing on various projects and initiatives, I closed by asking them to consider the drop of insulin in the image below. This tiny drop of insulin has such a huge impact for so many. Yes, something that small makes a huge difference.

Of course every diabetic wants nothing more than a cure. But thankfully, we have insulin until that time. Without it, my son and so many others would not be here. It is huge. These small tiny drops keep him alive.  It looks small, but its impact is so big.

So what can you do? A lot. Even sharing any of the factual internet memes that you see about the signs of diabetes could save a life.

If you are diabetic or a caretaker of one, and have ever thought about sharing your story, I encourage you to share it. It will definitely have an impact and help someone! If you don't have an outlet to share it, I welcome you to write a guest blog here!

Another great way to get involved is to participate in your local diabetes activities. Not only should it highlight the facts about diabetes, but it is a great way to raise awareness and get active in the process.

In the region, there were some great events held last weekend that you probably attended such as those in Abu DhabiDohaBahrainJordan and Lebanon and Turkey. If you could not attend these, bookmark their sites and reach out to them for more information about future activities. In Saudi, reach out to the Saudi Diabetes & Endocrine Association to learn about upcoming events.

If you are in Dubai and Kuwait, there are events coming up this weekend:

It doesn't take much to make a difference in your life, or in someone else's life. Please never think that it is not worth it, or that it does not matter

Sometimes, the smallest effort can have a very big impact.

Happy World Diabetes Day.


Sunday, November 13, 2016

Diabetes - Its A Family Affair

"Your child has Type1 Diabetes" was not an easy thing to hear. Those first days and months were a real struggle as we adjusted to the realities of this condition, how it would affect my son throughout his life and how to manage it on a daily basis.

The learning curve in the first year is steep and it impacts the whole family. Life changes for the entire family - everything from routines to personal or career priorities changes. Siblings are also affected as they can feel neglected or have difficulty adjusting to the new routine of living with a brother or sister with diabetes. While a diagnosis of diabetes often puts stress and pressure on the family unit, in time, it can bring families closer together.

To overcome the challenges that Type 1 Diabetes brings, it is important to have every family member educated and involved in diabetes management early on. In fact, research has shown that the way children manage their diabetes later in life is positivity influenced when their family is supportive and involved.

There are many ways to support a diagnosis of diabetes in the family. Some things to consider include:

Open Discussion.  Successful diabetes management requires constant review and control.  Getting used to the "new normal" is not easy and it is difficult for the child with the diagnosis. Discuss the kind of support with your child that they feel they need. Even if they are in need of more support than they express, or do not know, just having the ability to feel heard and understood is critical. Sometimes these will need to be one to one discussions, but it will also be helpful for the diabetic to share these feelings with the immediate family.

Educate yourself and all family members.  Learn and share as much as you can about the disease. For younger children, this is critical, as they need constant support to manage their diabetes. If possible, invite family to attend diabetes education classes with you.

Adopt mindful eating habits for the whole family. Type 1 is the dance of balancing activity with insulin and carbohydrates. Diabetes provides a great opportunity for the entire family to get involved in learning about nutrition. Understanding how food fuels the body with carbohydrates, fats and protein is good for everyone. Preparing meals together is a good family activity and can teach younger members the importance of balance and moderation.

Practice Get the family involved in carb counting, checking blood sugar and administering insulin. Put that new found information into action. Also practice what to do in the event of a diabetic emergency.

Managing diabetes is not easy. It may not seem possible to help as it is only happening to one person, but family members can be involved with many of the tasks. While we will never truly understand what it is like to be diabetic, we can – and should - support them in their journey.

This in turn will help them develop coping skills, build confidence and encourage personal responsibility as they learn self-care.   Family Matters!

Saturday, November 5, 2016

The Supply Closet

Here is another image from the series Diabetes Every Day.

This is The Supply Closet. I would say these are just 50% of the supplies we use. 

In a closet that used to be covered with pre-school art before we passed that age, hidden behind one of those doors is a mini pharmacy. We have other supplies in the bathroom, a slew of fast acting sugar in the kitchen and traces of diabetes in almost every room of our home. And don't forget our life line, insulin, in the refrigerator. 

This does not include the emergency bags in cars and the backpack we never leave home without. There is also a larger emergency backpack behind the door if we ever needed to evacuate. 

Overkill?  I don't think so.

With the exception of our big survival backpack we use every single supply we have and have to restock often.... This is Type 1.

The Type 1 Diabetic Supply Closet

Tuesday, November 1, 2016

November!

The year is wrapping up so quickly. We are already into November! Today is November 1st. Wow.

November is not just important because it is the month before December and for many the last mad dash to finalize things before the year end.

It is an incredibly important month that is relevant to many people throughout the world. It is an important time to share information, be active and learn more about the issues.

This is the very important month that the world comes together to raise awareness about diabetes.

The first ever World Diabetes Month was recognized back in 2007. World Diabetes Day is November 14th. This is the day that Dr. Fredrick Banting was born. His birth is significant because he discovered insulin in 1922.

Despite the many global and local campaigns and initiatives, there are still so many misconceptions about diabetes! Too many!

At Diapoint, I am participating in several local activities this month. I will also be sharing diabetic facts and busting some diabetic myths across my social media.

I will also share a photography series with you that I have been working on called "Diabetes Every Day".  In this documentary, I will highlight the way that diabetes is always with us. Sometimes in our faces, other times in the background. Below is an image from that series.

If you want to stay up to date with my activities, daily facts, images and my other random diabetic thoughts and experiences, you can follow at any of the links on the right side of this page - Facebook, Twitter and Instagram. Hope to see you there!

Have a happy, healthy November!

A routine blood sugar check before dinner. This 8 year old diabetic has to check his blood sugar by pricking his finger at least 5 times a day. It is usually more than that. He sometimes uses a CGM (Continuous Glucose Monitor) which requires fewer finger checks as it transmits the blood sugar numbers to his pump.  Not every diabetic is so fortunate. In some countries, glucose test trips are so expensive, or not available, that children cannot check their blood sugar so frequently - maybe once a day or even less.

Wednesday, October 26, 2016

Today Is The Only Day I Will Ever Give You Medical Advice.....

... and that advice is to GET PROPER MEDICAL ADVICE!

A couple of days ago a dear friend informed me that one of her closest friends suffered a brain hemorrhage. It appears to be the result of high blood sugar untreated. As I understand the story, her friend was insisting to treat her diabetes with only homeopathy, and it failed.

Now, I have a very strong belief in complementary medicine. I have used it myself on several occasions and I do believe there is a lot to be said for the benefits. However, the key word here is "complementary". Whether it be homeopathy, ayurvedic, Chinese medicine or whatever other form it is, it may not always be the 100% full proof cure for the condition or disease that you have.  Complementary medicine should be used together with, or integrated with traditional medicine.

I am a huge fan of all of these and others, and integrate them into my lifestyle whenever possible if there is no medical harm in doing so. I like homeopathy, and I get acupuncture often. (Yes, kind of ironic considering I hate that my diabetic son has a life sentence of several needles daily.)

It is difficult to accept that we might need medical intervention. Perhaps even more so if you were healthy most of your life, always abided by healthy lifestyle guidelines and beyond, and never needed any medical support before your world was rocked by something unexpected.

I am living proof that no amount of organic, healthy eating, exercising, breast feeding, making baby food with organic ingredients most of the time, and all that other positive stuff could protect my son from getting Type 1. I did it all right and then some. I was close to the walking poster child for "that kind of mom". However, I am now on a new poster and it might say "Stuff Happens".

But back to my point. Complementary medicine is exactly that. Complementary. While traditional medicine cannot always guarantee you a cure, complementary medicine is not an alternative treatment that will cure everything either. And in some cases it cannot help you treat the condition and may make it worse.

Since I started DiapointME and hash tagging images and entries with diabetes, I get at least one "miracle cure" follower every day and several more likes. On average, most promise to cure diabetes in three weeks.

I started getting so many miracle cure comments in this blog I recently started moderating comments. I welcome comments, but I am also very cautious that I do not want followers to misunderstand the severity of diabetes and what Diapoint is about.

Well intentioned friends send me all kinds of links and concoctions with the miracle cure. I politely respond back. There is some research that suggests that some natural remedies may help regulate blood sugars (and mostly in Type 2) but there is no miracle cure.  To that I often receive the response "What are you afraid of?" or "Well, you never know."

Sadly, I do know. I do know that if I took my son off insulin and administered anyone of those concoctions or miracle cures that he would die without insulin. If I took him off insulin and tried one of those "completely cure your diabetes in three weeks" solutions, be sure he likely would die before the three week period was up.

It is awful to say. It is so painful to see those words in print. However, I do not know how else to explain the severity of diabetes. It is deadly, and not easily fixed with the latest pop culture miracle diet. Diabetics need medical oversight, medical education about managing their disease, sometimes medication (in the case of Type 1, insulin) and regular medical check ups.

So please today I ask that you take the only medical advice I will ever give, and seek out medical advice for your diabetes. If you are thinking to try something alternative or a miracle diet or cure for your diabetes, please consult with your doctor. And not just any doctor - please go see a medical doctor that is educated and experienced in managing diabetes. And I bet they will be open to discussing complementary things that you are interested in to help you on your journey of managing this condition and living life to the fullest as a healthy diabetic.

Image: TempAlertID


Sunday, October 23, 2016

Love, Diabetes & Instagram

One of the things I am dedicated to doing at Diapoint is working to raise awareness about diabetes. It is something that I feel is so important, and I am so passionate about, that I left my full time corporate job to do it.

It is a complicated disease and there are several differences between the different types. There are also HUGE misconceptions about them.

As many of you probably know, November is Diabetes Awareness Month and November 14th is World Diabetes Day.

Among my many activities planned, in honor of this month, I will be sharing important diabetic facts and busting a few myths as well.

I will also share some images from a photography series I have been working on about diabetes. When I am not working on a diabetic initiative, I am a passionate travel and documentary photographer. At the advice of another photographer, I am finally putting some of those skills to use to bring light to some of the daily challenges diabetics face.

So if you are on Instagram and are not following me yet, you can find my Diapoint account here.

Hope to see you there!



Sunday, October 16, 2016

Type 1 Diabetes & The School Nurse

Managing Type 1 Diabetes at School - it is a subject I have written a lot about. It is always a learning experience every week, if not every day for those involved! I know I learn a lot as schedules and activities change. There are so many things to consider to keep a diabetic child safe at school it can sometimes feel overwhelming.

I think it can be just as difficult for the school nurse to take in. After all, they have hundreds of children to worry about and take care of. Understanding their challenges and the sometimes lack of awareness of diabetes, I wanted to do something to support them for some time.

The idea to do this started last spring before school finished. Once again, I was honored to work with Lilly Diabetes as we both felt it was such an important subject. After months of networking and collaborating I am grateful for their sponsorship of an education session last Friday just for school nurses.

It was a full house, and we even had some nurses come in from Al Ain, which is quite a drive for them. During this session, they listened to expert physicians discuss the medical details of Type 1 and how it differs from Type2 and how to manage it at school.

I was honored to be part of the agenda and shared my experiences as a parent highlighting some of my son's challenges at school as a Type 1 Diabetic and challenges that other diabetics may face.

There is a lot to think about. Having a clear Diabetes Medical Management Plan (DMMP) in place is key. Not only does it include the medical orders about how to treat a particular child, it is also a document that fosters communication between parent and school nurse about how a child should be cared for. I say particular child because each diabetic is different and each diabetic should have an individual DMMP.  While there are some general guidelines to follow, DMMPs are not a one size fits all.

While I shared many stories, still, one of my most important points was a statement from the US National Association of School Nurses.

Managing diabetes at school is most effective when there is a partnership among students, parents, school nurses, health care providers, teachers, counselors, coaches, transportation, food service employees and administrators.

It is the school nurse that provides the health expertise and coordination needed to ensure cooperation from all partners in assisting the student toward self - management of diabetes.

If you are a school nurse, your role is critical in supporting our children. If something is wrong at school related to our child and their diabetes, you will likely be the first to know before anyone.

Sometimes there are not enough nurses to support a diabetic child at school, or they may be hesitant to do so as they have never dealt with a Type 1 child before. What should you do?

I never assume the school will have all the answers, so typically my son's school nurses and I partner to coordinate my son's care. Sometimes I take the lead and reach out to the teacher, or who ever needs to be reached, other times it is the nurse.

Like the DMMP, there is not exactly a one size fits all template as to how to do this. It is not easy. Ever.

Even with the best nurses it will still require work. But it is one relationship that is well worth the time and effort that you will never regret investing in.

Thursday, September 22, 2016

....and What About Type 2 At School?

My son is Type 1.

However, there are an overwhelming amount of Type 2s all over the world, and the Middle East is not immune to that trend. Type 2 and "pre-diabetes" are also seen in teens and young adults here.

So while we always see images of senior citizens in Type 2 diabetes ads, this is not always the case. Some populations are genetically prone to develop it at younger ages.

What is the difference between Type 1 and Type 2?

Type 1 is when the body stops producing insulin altogether. This is typically autoimmune related. It was not caused by food, but food has a lot to do with how it is managed. Type 1s need insulin to survive.

In Type 2, the pancreas can make insulin, but not enough of it. Or, that insulin is not able to get where it needs to in order to create energy in the body. Sometimes Type 2 patients take insulin, sometimes not. There is no cure for diabetes, but leading institutions share the belief that you can often manage your Type 2 to decrease the amount of medication you require, or delay the requirement of medication.

So if you are Type 2 and in school, or have a Type 2 going to school what should you do?

  • Tell those who need to know. Of course you can advocate and share information about Type 2 with others, but at minimum, those closest to you or your child need to know. This includes the school nurse, teachers, coaches, bus drivers and any other personnel on the bus and close friends.
  • Make sure you have your medical supplies with you at school, or kept in a safe place where you can easily access them when you need them. This includes your glucometer, medicine if prescribed, treatment for low blood sugars, etc.
  • Speak to your doctor or nutritionist about how to handle school parties and food. 
  • Focus on healthy eating and learn about what food best fuels you or your child's body to help manage diabetes.
  • School can be stressful, especially during exam time. It may effect blood sugars as do the hormones in our bodies that change as we grow. Ask your doctor how to manage blood sugar fluctuations that result from these. Also, do not under estimate the value of activity. Playing sports, or even going for a walk will help manage stress and blood sugars.
Meet with your teacher and school nurse to discuss the above and make a plan. Managing Type 2 is not always easy, and having support at school will make it easier.

And whatever you do, do not be ashamed of your condition. You did not choose diabetes. It chose you. There is continued compelling research out there that indicates Type 2 diabetes is the result of genetic factors.

Do not let diabetes stop you or your child from achieving your goals!

Tuesday, August 30, 2016

Back to School with Diabetes - Directives & Supplies


When I meet with the nurses and home room teacher the week before school, I also make sure I take the first draft of my son's medical directives as well as emergency snack boxes. 

The medical directives are what the nurses will follow in regards to my child's care - daily insulin doses, what to do in extreme high and low blood sugar situations and other emergencies. At our school, only nurses are allowed to administer medications. I am fine with this. Just note that not all schools always have a school nurse available, so it is important to educate everyone that will be helping your child manage their diabetes.

I strongly suggest you have a written document with the exact protocol you want them to follow. Every diabetic is different, and every day each of those diabetics blood sugar will be different. No way is a general understanding of diabetes enough. This is not a one size fits all disease. 

You should complete this document with your child's physician. Or, if you have been around the diabetes block a few times, complete as much of it as you can and then review it with the physician to make any updates or suggestions before you take it to school.

I call it a working draft. It should be as complete as possible by the first day of school, but also know that you may find that due to your child's body's response to the schedule some things may need to be tweaked. And be sure, your child is going to grow throughout the year. So just as they will need new shoes soon, you may find one day they wake up and suddenly need more insulin.  

For the last several years, I have used the American Diabetes Association (ADA) Diabetic Medical Management Plan as a template for my child's details. It is nine pages long, but do not let the length scare you. The first time I used this five years ago, it really got me thinking about our diabetes management and things I did not consider when he was in nursery. I have actually added more information to this document  since then as I have suggestions for various blood sugar levels and activities now that I know my son's response to certain things. I am sure there are also other similar documents from other countries available on the internet. So if you find something that works for you and your child, use it!

And make sure that after you review every page of this with your child's caretakers at school that all of you sign it. Yes, this is formal, but it seals your mutual agreement about how your child will be cared for. 

Now on to emergency snack boxes. These are not the "Hey, I think I'm hungry" kind of snack boxes. I take one box of several juices and snacks to keep in each classroom where my son will be. This includes his home room and everything from the music room to PE class. In addition to these, he also has a large box of snacks and a comprehensive box of medical supplies in the nurses office. For medical supplies think daily care, and also emergencies. 

God forbid, if there were ever a lock down at his school, hopefully this would be enough. Each teacher who has one of these boxes in their classroom is trained about when to use them and how. I put a short summary on the lid of the box, and the nurses include a huge insert with their emergency phone number. 

In the US, where lock downs are more probable, many Type 1 children carry a bag of supplies with them everywhere they go. Always. Including the bathroom. But why? If there were an emergency and a Type 1 child was pulled into a random classroom, they may end up in a situation with no access to any supplies. This is a huge risk for a Type 1. If a Type 1 was running low and could not get to a fast acting sugar for several minutes, a half hour, an hour??? 

That is a scary thought as a parent. Because of what I see happening in my country, I am honestly considering that my son carry glucose tabs in his pocket always. Our children here are so innocent to the subject of such violence at school, that I cringe at the thought. But lock downs can also occur for things like routine fire drills.

Too an American an approach? Perhaps. Too much? Maybe. Unnecessary? I hope it would be unnecessary always, and if my time is ever wasted on something in my life, then let it be this.  I used to work in a hospital and dealt with risk management. There is a reason for risk management. Accidents and events do happen. Many are often out of our control, and the only thing you can do is try to prepare. In previous school years, the nurses are grateful for these boxes because it saves time. They can treat a low blood sugar on the spot, and not have to run back to the health office to get a fast acting sugar. If the supplies get low, just refill.

Below is our image of this year's boxes. My son shot this with my camera. There you see juice for severe lows, chocolate milk for mild lows, snack bars, raisins, fruit and vegetable purees among other things that will not go bad. You definitely want fast acting sugar in your boxes to treat lows. It does not have to be in the form of juice. Use what you would customarily use at home. 

With the exception of a quick fix for a mild low during a class, hopefully all these boxes return back full at the end of the year.

Have a safe, healthy year!


Tuesday, August 23, 2016

Back to School with Diabetes - The Before School Meeting



School starts next week!

All teachers and nurses are back to my son's school today. That does not give me much time to connect with them and my son's newly assigned teacher to give them the Type 1 highlights before school starts.

Anticipating this, I sent an email to the nurses last week requesting a meeting with them and my son's home room teacher. In some cases you may have to be persistent and follow up. It is not that they do not want to meet with you, but they have many meetings in those days and are quite busy. Never be afraid to follow up or call to set a time.

I use this meeting to start the year off with open communication. It is informative, but it is equally important to enforce the message that I want to work with them and make their life easy so they can focus on the job of teaching.

For the nurses, we review all medication doses, snack timings, blood sugar checks and emergency protocols among other things. It is also important to note that my son is in the 3rd grade. If you have a high school student, the student will play a bigger role in their care. However, it is still good to request a meeting before school starts - particularly if diagnosis is new, or you are at a new school.

When meeting with the teacher, I suggest that a school nurse also join. At that time I review the basics of what Type 1 is, and how we treat it. Having the nurse there also helps open the dialogue for how they may manage certain situations with the teacher. Based on your experience, you may have ideas or suggestions for them, so do not be afraid to share your thoughts.

I typically use a template for this discussion. For example, this Guideline for Schools, I found from Australia is a good place to start. I do suggest to read everything word for word. I use various guidelines as an outline and I take the best of their information that is relevant for me here and include things specific to my son and his care.

Other guidelines to consider can be found at Diabetes UK or at this American site, The National Institute of Diabetes and Digestive and Kidney Diseases.

There is a lot of information out there, and it can be overwhelming - for both you and the school staff. I use this information as a foundation and edit it when it comes to specifics for my son and his treatment. Every diabetic is different. For example, the way one child reacts to, or feels a low blood sugar is not the same as another. Be sure to highlight information specific to your diabetic.

It is also important to note that Type 1 school guidelines often include legal information specific to a country. It may not always be relevant for you, so update it to be in alignment with your location.

I typically focus on the following topics with the teacher and nurse:
  • What is Diabetes, and the difference between Type 1 and Type 2
  • Hypo and Hyper Glycemia. What is the difference, signs and why are they important?
  • DKA (Ketoacidosis). It is likely that a DKA would be managed at home on a sick day, but I still explain what this means as it is critical, and could happen at school.
  • How the teacher can help. (This is essentially, the expectations and support your child needs to function as a normal child in the classroom)
  • Diabetic Emergencies
  • Other topics. For example, depending on the age of the child, you may want to discuss discipline, what to do during tests, field trips or other things.
  • Thank them. Thank them all for their time and encourage them to reach out to me if they have any questions.
  • Note any action items. Do they need any more information or supplies from you? Do you need more information from them?
So far this has kicked off every year to a good start. Things are never 100% sorted after this meeting.  And let's face it, if you are a caretaker you know these are just the highlights when it comes to diabetes management. But it is a start!

Have a great school year everyone!

Stay tuned. Up Next on the Blog: Directives for medical management at school and "lock down" boxes.

Wednesday, August 17, 2016

Back to School With Type 1

School starts in just less than two weeks!

After a busy summer full of travel and learning more about our diabetes it is time to get ready for school. Of course that includes buying the next size in the school uniform we outgrew, shoes that fit, pencils, paper and all that good stuff.

For a child with Type 1, back to school means so much more. 

It is full of a myriad of medical supplies and snacks that must be strategically placed throughout the school, educating the school health staff and teachers on what it means to be a Type 1 Diabetic, how and when to use those supplies, and how they can help ensure your child's safety at school, advocating for your child to administration if there is no support available, new carb:insulin ratios, basal rates if you are pumping, and insulin doses if you are injecting to match the new school schedule, after school activities and all of those things I just mentioned must be considered in the context of the activity and with their coaches, if your child rides the bus what to you do, how do you manage school parties and those dreaded carb loads, depending on their age how do you get them to become more independent in managing their diabetes at school, if they are not independent yet how do you manage play dates and activities, this and more.. plus any anxiety or stress your child might have, and probably more for the caretaker that goes with all of that.... 

Read the above run-on paragraph three times out loud without taking a breath and you get a small idea of the heavy weight carried when sending a Type 1 back to school, or off to school for the first time. And those are just the highlights!

It is stressful, but with a lot of planning, work and advocating it can go well. Sometimes really well.

Over the next several days as I prepare to send my Type 1 back to school I will share the tools, links and other things I do to try to manage all of those things and more.

Even though I have done it a few times, I am still not mentally ready to tackle it just yet. But it has to be done. 

So as you recover from reading that paragraph three times without taking a breath, take a deep breath now and let's recall the beautiful days of summer just one more time before we begin..