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. When my son was 20 months old he 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. He is now six. 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.

If you stick around, or read something you like, great. Feel free to comment and join the conversation, subscribe or follow this blog by liking the Facebook page Diabetic in the Middle East.

The one thing I ask is that you do not take this as diabetic gospel, or consider it medical advice. I am opinionated, and I will 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.

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..