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The School of Hard Knox – Guest Post from The Poor Diabetic

Chris Stocker

Today’s post is a guest post from my good friend The Poor Diabetic
.  If you haven’t read The Poor Diabetic before, than you are missing out.  Ronnie’s posts are fun, educating, and just down right awesome.  I met Ronnie for the first time out in San Diego for the Roche Social Media Summit.  After speaking with him, I have been wanting a guest post from him since.  So here we go, on the subject of diabetes education.

I have been a diabetic for about 14 years and the real life experiences that come with that has to account for something when it comes to diabetes education doesn’t it?

Yet a newly diagnosed diabetic is more apt to listen to a first year medical student or a nurse practitioner than they would me right?

The reason is obvious, they purport themselves to be medical professionals and  I do not, In fact I like many other diabetic blogs you read go the further to proclaim this in bold print. The reasoning behind this is obvious as well, someone’s health is of primal importance and giving health advice should be left to said professionals. Woe unto you if you give  medical advice with adverse critical results, it is not just a moral issue but a criminal one as well.


But there is something to be said about life experiences when you are living with a chronic disease like diabetes.

It would be an understatement to portray the lack of diabetes education as a mere lacking.

Truth be told most if not many newly diagnosed patients have little if no knowledge of diabetes beyond the passing fancy and I would venture to say that this knowledge one has is fifty percent fact and fifty percent lies, myths, misconceptions, rumors, or any of the many unknowing words you might use to characterize it.

The learning curve after a diagnosis is steep at best and the learn on the job mentality if you may while it might be wrong is the accepted norm.

If I was to share a typical diagnosis it would be as though I was reading from a prepared script.

“ You have diabetes, you need to check your blood sugar using this machine, watch your carb intake, exercise and good luck to you” make an appointment with a nutritionist for your diet adjustments and a nurse will show you how to use your life saving gadgets other than that you are on your own and If you have any questions then I will be happy to answer them on your next visit six months from now. goodbye and good luck” This was my diagnosis story and am sure it was yours as well with a few minor variations.

I was left with very little in alternatives and back then the web was at its infancy, there was no diabetes websites or education resource or the DOC to say the least.

I learned diabetes management the hard way and even with all the online resources available today diabetes education still has a long way to go just to be proficient.

It would be naïve for me to say that a solution to this problem would be one broad stroke of the brush, the problem is a bit complicated than that. But I have one tangible and easily attainable solution.

The Medical profession is overworked  this we know to be a fact, it is for this reason and many others that most newly diagnosed are left to fed for themselves as it may.

These new diabetics are inevitably going to get online to find information on diabetes so why not steer them to the DOC and real diabetes information online.

The benefits for this process will go along way in laying the ground work for a  real diabetes education

Diabetes Police Run-Ins

Chris Stocker

Thanksgiving always gives me a great opportunity to run into the diabetes police.  It also gives me a great opportunity to explain diabetes to just a few more people.  There always seems to be somebody new at Thanksgiving dinner, or somebody at work may have questions when it comes to Thanksgiving and diabetes, and whoever it may be, there is just usually more diabetes police at that time.  This year was no different.

At work, when talking about Thanksgiving, people had questions, like what do I eat?  How much can I eat?  Can I eat pumpkin pie or apple pie?  I gave them all the correct answers, and without the smart-ass comment that I am usually known for.  Ok, so maybe I said, I will eat as much apple pie as you should eat also, but that’s the truth.  I have written before about the diabetes police and I don’t mind them, in fact I see it as an opportunity to educate somebody else about these bad diabetes misconceptions.

Do you also find that you have more run-ins with the diabetes police around Thanksgiving and Christmas times?

Driving with a Low Blood Sugar

Chris Stocker 1 Comment

Tonight when I was driving home from work, my blood sugar started to feel a little low.  I was on Interstate 95, so there was no way that I could just stop and test.  About 45 minutes before I left work, I tested and I was at 105.  First, you may be asking, why are you testing, don’t you have a Dexcom?  Yes, I do.  I finished my first Seven days with the Dexcom and it was starting to peel off because of a lot of exercising and moving around I was doing, so I didn’t extend it.  Anyway, back to the drive home.

Before I left work, I stopped at the soda machine and bought a pink lemonade that was high in sugar and took a swig of it.  I didn’t start to feel a little low until about halfway through the drive home.  I drank a little more of the lemonade and I felt fine.  But then I thought, what if I didn’t test right before I went home and didn’t buy the lemonade?  I didn’t have any candy with me like I usually do.

As soon as I came home tonight, I made sure to put more candy in my bag that is always with me.  It made me nervous thinking that I didn’t have any candy in there, and I don’t know when I actually ate the candy that was previously in the bag.  Do you keep sugar tablets or candy or something sugary in your car with you at all times?  I used to have sugar tablets, but the ants in south Florida are crazy good at sniffing out that sugar.

So, tell me about your scary driving experience with a low blood sugar.  I try to test before I drive home from work, but I don’t always test before every single time that I drive, even though that I know you should.

How are we fighting high cost of test strips

Chris Stocker 2 Comments

Since I have been diabetic, there is one thing that was constant and was very easy to understand, this disease is expensive.  One of the more expensive items is testing strips.  This is a question that we have all asked before, why do they cost so much damn money?  Well, why do they?  I know this is a business and they need to make money, I totally understand that.  I run a company myself, I understand the bottom line figure that is all so important to the CEO.  But, there has to be something that can be done to lower the costs of diabetes testing strips.

What are these things that we can do?

I don’t know or else I wouldn’t be asking.  I like to ask questions about things that I don’t know about.  I would also like to somehow help others save money on their strips, so how do we work with legislation to get this accomplished?

Thoughts, ideas, concerns, issues, or just general feedback?

First Day with Dexcom

Chris Stocker 1 Comment

Yesterday was the first day that I used my Dexcom.  I received the package on Friday afternoon, but had a softball game Friday night, and didn’t want to use it that night.  Saturday, I decided that I wanted to try and get as much feedback as possible from the DOC, which I did so thank you all very much.  Sunday was the big day, I was finally going to insert my first sensor.

I am a former Medtronic CGM user.  I didn’t use it for very long, but I did have the CGM system and was not a big fan of it, so I just stopped using it because it wasn’t worth the pain and uncomfortableness to me.  So, obviously my first reaction to the Dexcom insertion was, “Is this going to hurt really bad?”  I loved the fact that I couldn’t even see the needle, so I had no idea how big it was.  I also liked that I was able to make sure that the adhesive was stuck on the skin just the way that I wanted it before I had to insert the sensor.  That is one issue that I have with infusion sets is that sometimes they don’t stick properly and they get all bunched up.  I also liked that the sensor and the transmitter stick to my body and aren’t flopping around.  If you have used the Medtronic CGM, then you know what I’m talking about with that big thing.

My One Touch and the Dexcom are not matching up perfectly, but they are pretty close, at least to me.  Luckily, I have not hit a high or low alert yet, but I’m sure I will very soon.  Overall, this process was easy.  Everybody who left comments and tweeted back to me or e-mailed me, thank you.  It was these suggestions that made it easier for me to insert my first sensor.

More Dexcom posts to come in the near future.

Attention Dexcom Users I Need Your Help

Chris Stocker 1 Comment

For those of you that follow me on Twitter, you may have read yesterday that I finally received a Dexcom. I have been wanting one of these for several years now and just have not had a chance to get one because of insurance reasons. With my new insurance, new as in January 2011, I was approved. The process was so simple and easy too.

At my last endo appointment two weeks ago I told my endo I was interested in the Dexcom because I refused to go back on the Medtronic CGM because it was like stabbing myself with a dagger every time I wanted to insert a new sensor, which would fall off every 2-3 days. She gave me the paperwork that I filled out before I left the office. Before the end of the day, I received a phone call from Dexcom stating that my insurance coverage out of network. Here we go, I thought.

But, luckily she said that there is a supply company that they work with and I would be able to get the Dexcom through my insurance with them and that I would be receiving a call from them early the following week. I missed the call from this other company and when I got out of my meeting went to call them back and realized the rep had emailed me directly. One thing about me that you will learn quick, I hate the phone. Email me, and I can have a whole email or chat conversation with you, but don’t call me. That’s why I’m an online marketer, so ice communicate online.

Anyway, she explained that it was going to be covered, just needed some paperwork from the doctor’s office. She emailed me a few times a day to keep me up to date with where they were with everything. That’s awesome customer service. Finally, I got the email with a Fed Ex tracking number and when I went to my mailbox it was there, packaged all nicely.

Another side note about the trip to the post office. I have a goal in 2012 to read one diabetes related book a month. Whether it is some miracle diet book or an actual inspiring book, I want to have a better understanding of the material out there. I will review these books and give my honest opinions on them. With that being said ( I think I tweeter that awhile back) but I had 3 different books sitting at the post office waiting for me. I can’t wait to read them and share if worth it.

Back to the main reason of this post. For all Dexcom users, I need your advice. Please leave a comment or send me an email. What has worked best for you? Do you use any coverings over the site? Do you put something over it when you shower? How long on average does it last? Past the 7 days?

Anything else I should know?

Thanks.

Guest Post – Hope Warshaw Diabetes Education and Educators

Chris Stocker 2 Comments

Diabetes Education and Educators: Who, What, Where and How?

Brief intro: Hope Warshaw, MMSc, RD, CDE, has been a dietitian and diabetes educator for more than 30 years. She’s the author of several books about diabetes care and healthy eating published by American Diabetes Association. She’s currently on the national board of directors for the American Association of Diabetes Educators. She’s a member of Diabetes Advocates (www.diabetesadvocates.org) and is passionate about building bridges between diabetes educators and the diabetes online community (DOC). Check out her interview with DOC leaders filmed at AADE 2011 (http://presentdiabetes.com/etalk/Joy-Pape-Hope-Warshaw-Interview-t4441.html#-1). Connect with Hope at www.hopewarshaw.com.

 

Stats show only 30 to 40% of people with diabetes in the U.S. ever meet (that’s even once) with a diabetes educator or attend a diabetes education program. What’s up with this? Oh let me count the reasons!

Even though Medicare and many large or small employer-based and individual health plans cover the services of diabetes educators (at least a few hours a year), far too few primary care providers (the people caring for the vast majority of people with diabetes, especially type 2s) make this important referral. Plus too few people with diabetes know about diabetes educators/education. It’s likely you do, so we’re hoping YOU will help spread this important message.

It’s my goal here to make sure you know who diabetes educators are, where they typically practice, how to access us and how YOU can take action to increase PWDs access to diabetes educators throughout the U.S.

Who are diabetes educators?
Diabetes educators are credentialed health care professionals who are most often nurses (including nurse practitioners, clinical specialists), dietitians, or pharmacists. A scattering of diabetes educators are social workers, psychologists, exercise physiologists, physical therapists or physicians.

Many diabetes educators make the choice to obtain the additional credential as a Certified Diabetes Educator (CDE). Another credential is BC-ADM, Board Certified in Advanced Diabetes Management.

Unfortunately there are far too few U.S.-based diabetes educators (<30,000) for the growing population of people with diabetes (excess of 18 million diagnosed, 80 million with prediabetes).  AADE is the multidisciplinary professional organization of diabetes educators (http://www.diabeteseducator.org). Learn more about AADE and about the field of diabetes education. As you’d suspect, a goodly number of diabetes educators are PWDs.

How diabetes educators can offer an assist?
You know this first hand…taking care of diabetes is a relentless 24/7/365 job which requires you to be in the driver’s seat making hundreds of decisions about your care each day. Study after study shows that people with diabetes can stay healthier with frequent and continual education and SUPPORT.

Working with diabetes educators has the potential to:
– help you learn more about diabetes in general and your diabetes specifically
– assist you to analyze your BG/CGM records and think through options to improve control
– be a shoulder to cry on when you are burnt or bummed out
– serve as your advocate with other HCPs
– be one of your cheerleaders or coaches.
Plus, they can help keep you up to date on the latest research, medications, devices, technology and more.  (I’ll admit it, I’m a bit biased!)

Where are diabetes educators?
Diabetes educators most often work in diabetes education programs most typically found within the campus of a hospital/medical center out-patient clinic. You’ll often find a few diabetes educators working together in a program – most commonly a nurse and dietitian. These programs are often referred to as diabetes self-management education (or training) programs, abbreviated DSMT or DSME.

Due to the current evolution of how and where healthcare is/will be delivered, where diabetes educators practice is changing. More educators and programs are and will continue to be found in large primary care provider offices (duh? That’s where all the people with type 2 diabetes are), in pharmacies, supermarkets, and other convenient locales.

Eventually I believe there will be more online and telephonic education and support offered by educators. Mobile health (mhealth) will offer even more opportunities. AADE has just embarked on an exciting mhealth program with AT&T to deliver DSMT via AT&T mobile devices (http://www.diabeteseducator.org/About/Media/09.12.11_Release_-_mHealth_project).

Is diabetes education a covered/reimbursed Medicare or health plan benefit?
Medicare and many other health plans require a DSME programs to be “recognized” by a Medicare accredited organization to cover/reimburse the service. To date there are two major accrediting organizations for DSME, American Diabetes Association and American Association of Diabetes Educators.

Medicare and many other health plans cover/reimburse a limited amount of diabetes education. Medicare covers up to 10 hours of DSME within the first year of your diagnosis of diabetes and then an additional two hours in consecutive years (link to Medicare.gov).

You may be eligible for coverage of another service called medical nutrition therapy (aka nutrition counseling). Medicare beneficiaries who have diabetes are eligible and many health plans also cover this benefit.

Laws passed in most states across the country require private health plans mandated by state law to cover some diabetes education (http://www.diabetes.org/living-with-diabetes/treatment-and-care/health-insurance-options/health-insurance-in-your-state).

If you believe you should have access to diabetes educators/education and it is being denied, talk to your health plan or your worksite health benefits plan administrator. Today, most people with a health plan can have access to some diabetes education.

How to find diabetes educators/programs?
To find a “recognized” DSME program approved by American Diabetes Association in your area go to: http://professional.diabetes.org/erp_zip_search.aspx?utm_source=WWW&utm_medium=GSA&utm_content=keymatch-Diabetes-Education&utm_campaign=DP). You’ll come to a screen to search for programs in your area.

To find a “recognized” AADE program in your area, go to http://www.diabeteseducator.org/ProfessionalResources/accred/Programs.html. From here go to your state.

Want to Help More PWD Access Diabetes Educators Across the U.S.?
Here’s the current problem: Medicare regulations only allow reimbursement for diabetes education to Medicare beneficiaries within a DSMT in-person program and not directly to individual credentialed diabetes educators (those with the CDEs and BC-ADM). This restricts where and how diabetes educators can practice and restricts access for PWDs.

To fix this AADE is forging ahead to change the Medicare regulations (Title XVIII of the Social Security Act or Medicare). The goal is to authorize direct reimbursement to credentialed diabetes educators for DSMT provided in-person and via telehealth (a growing method of delivering healthcare to people in small and rural communities) under Medicare out-patient services (Part B). 

The legislation is the Medicare Diabetes Self-Management Training Act of 2011, (House Resolution 2787, Senate Bill 1468). I ask that you support AADE’s effort to widen PWDs access to diabetes education/educators. Learn more about HR 2787 and SB 1468 and contact your Representative in the House and your two Senators to request their support of this legislation via AADE: http://www.diabeteseducator.org/PolicyAdvocacy/Federal_x_State_Legislation.html. Take one more action (30 seconds) to show your support for this important legislation. Sign on to the petition: http://www.thepetitionsite.com/1/support-access-to-diabetes-self-management-training/

In conclusion, if you’re reading this blog you likely value the support you get from the diabetes online community (DOC). Perhaps you follow the diabetes news and connect with PWDs on twitter, Facebook and other social networking venues. Social networking has created an exciting and dynamic venue for PWDs to give and get support. In addition, consider connecting with a diabetes educator on an ongoing basis as another vehicle for supporting your efforts to take the best possible care of your diabetes and you through the years.

Diabetes Education in America

Chris Stocker 3 Comments

Today’s post is coming at you very late at night because of some hosting and WordPress issues that I was having, but it seems that everything has been settled, let’s hope.  My post for today is to speak about diabetes education in America.  The main part that I want to focus on is the lack of diabetes education that is out there.  I have written about diabetes education in the past and still feel strongly about the need for it.  Tomorrow, I have a special guest post from Hope Warshaw with more information about diabetes education.

Here is my thought on diabetes education.  How do we expect people with diabetes or who may be at risk for diabetes to change their lifestyles for a healthier life if they don’t know what they are to do?  When somebody is rushed to the ER when they are first diagnosed they get hit with so much information and then may have one or two follow up visits with a diabetes educator.  And then that’s it.  Maybe their insurance doesn’t pay for it, or they don’t have any insurance at all, or they can’t afford to go see a dietician or psychologist or any other form of diabetes educator.  How are they supposed to make the decisions that they need.

One simple way is by providing easier access to this diabetes education.  The hard part is, how do we do this?  How do we get insurance companies to cover the costs of dietician visits or diabetes educator visits.  But what if your insurance does cover a Certified Diabetes Educator, but you can’t get an appointment for 6 months because there is only one CDE in your area and they are booked.  Guess your health just has to go on a 6 month long vacation right?  Uhhh…I don’t think so.

Some of the best diabetes education I ever received in my life came from a non-CDE, just a diabetes educator in general.  Of course there needs to be guidelines, you can’t just have any Joe Schmoe off the street coming in and giving diabetes education, but there just has to be a way that somebody who can provided information about diabetes is allowed to.  How do we do this?  I don’t know exactly.

This is exactly why I am looking for help from people out here.  I am interested in forming some sort of diabetes education advocates group.  I tweeted tonight about what we can do more for advocacy and one idea that I mentioned was that, it’s great to have as many people advocating as possible, but I think that if there were certain groups of people with more of a passion about one aspect than the other, more can be accomplished this way.

If you are interested in joining some sort of weekly, bi-weekly, monthly chat, Skype call, anything, please let me know.

Remember, tomorrow Hope Warshaw.

Type 1 Diabetes Day – T1D

Chris Stocker 2 Comments

So today is November 1, 2011. It is a day of many special things. There are some birthday’s to be celebrated today, that is taking up some of my time in reading blogs and writing posts, today is the beginning of Diabetes Awareness month, and it is also the first Type 1 Day (T1D).

I received an e-mail from JDRF a few weeks ago talking about T1D, but I still was not exactly sure what it was going to be all about and what the campaign was going to be to help spread awareness. All I knew is that it was a day to spread the differences between Type 1 and Type 2. I think that it is great to have specific days dedicated to individual diabetes related “things” throughout the entire month. I like little themes to make up a larger one.

I received a little foam finger in the mail the other day from JDRF that explained it was to be used to “give diabetes the finger.” Genius, I love it. I love giving diabetes the finger. You can take that for whatever meaning you want, but they encouraged us to take pictures with the foam finger. So you will be seeing one photo a day either on the blog or on Twitter with the foam finger. It is almost like the concept of Flat Stanley where kids are to take pictures with him in different regions of the world and report on where he was and what he did there.

This T1D campaign may not be the best idea this year, but with it in it’s first year, I think there are always ways to improve going forward. I think the concept and idea is great. JDRF has been hearing from adult type 1’s for a long time that we are left out, they don’t do anything for us, etc. Well here is a perfect campaign and example on how they are gearing something towards adults. I love the fact that national is being receptive to our voices, even if it took a long time. If they could only get my local chapter to be more receptive.

They created a video to promote T1D, by introducing you to a girl named Meg. I think that the video uses an older, World War 2 style type of campaign. I like retro. Here is the video below:

To wrap up today’s post of many to come this month, I just want to say that I am honored to share my birthday with a new Type 1 day. I see big things for this day in the future.

Testing Out Other Insulin Pumps

Chris Stocker 1 Comment

When I was first diagnosed with diabetes back in April of 2004, I was on MDI using a Humalog insulin pen and syringes to take Lantus at night.  I was doing fine with this, and was actually eating healthy at that time and staying at a good weight, but I decided that I wanted to try out an insulin pump, it just sounded so much easier.  I am glad that I made that decision 5 years ago.  There are definitely things that I don’t like, especially the fact that I now eat anything I want, whenever I want because it is just a few pushes of buttons on the pump.  At the time, I wasn’t really given much of an option on a pump.  Also, at that time I didn’t know anything about diabetes.  I knew I had it and that was about it.  I had it less than a year before I went on the pump, I wasn’t blogging, and I wasn’t looking on the internet for information.  I was given a Medtronic 712 I believe they were called at that time, I can be mistaken.

I loved the pump.  I loved the way it worked and how it helped me manage my blood sugar levels a lot better.  Then I got into finding blogs online and just reading them and learning that there were other diabetes companies that existed other than Medtronic and One Touch.  I spent some time working for a diabetes supply company, so I had access to a lot of different products from different manufacturers and found out the benefits of all these different pumps.  I also learned more as I blogged longer and met more people using different kinds of pumps.  So, this finally leads me to the reason of today’s post.

I have been happy with Medtronic, but I’m not 100% loyal to Medtronic.  I would like to try other pumps.  I would love to try or test out the One Touch Ping and Omni Pod.  I have been given the trial pod for Omni Pod and I have worn it and I loved it.  The only issue is that I would be changing out the pod every 1.5 days based upon the amount of insulin that I use.  If I lose weight then the possibility of my insulin usage can go down and then I can use an Omni Pod.

Along with insulin pumps, I would love to try out the Dexcom CGM, but I just haven’t had a chance to do so.  I have used the Medtronic CGM in the past, but haven’t used it in nearly a year because I haven’t had any sensors and some issues with the insurance company.  Starting next year I will begin using a CGM again.  Whether it is Medtronic or Dexcom, it is one of my top goals for 2012.

For those that have used multiple pumps, not those that have only used one and will tell me how much you love it, but only those that have used different pumps, which have you liked better and why?

I appreciate any responses or feedback in advance.