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. 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.

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..




Sunday, July 31, 2016

A New Beginning - Because Nobody Died....

Today is the first day of the rest of our lives!

For me, it is the start of a new chapter for lack of a better analogy.

Last week I left my corporate job. I have been doing that routine for over 20 years, and I was with this company for the last 9.5 years. It was even longer than I thought!

It wasn't that it was bad. On the contrary. It was an interesting global company with a lot of internal opportunity. I had a child while I worked there and found some kind of work-life balance - even with diabetes in our lives, and my colleagues were great too. Perhaps I could have worked there the rest of my work life.

But I couldn't.

Something had been gnawing at me for almost two years or so. I wanted to do more. I was already doing a lot, but I wanted to do more to help diabetics somehow. I have over 15 years of experience in healthcare management and another five in corporate education and development. I am already active in some advocacy and share my experiences in a few presentations every year, but I need to do more.

It was not an easy decision, but it was. Yes, leaving the comfort of a regular salary and job behind is frightening, but I could not ignore my conscious any longer.

On my last day my boss gave a really nice overview of the work I had done over the last four years in my current position. One of the things that was highlighted was how even at the most stressful times when I would have every right to be going nuts, I was calm. She put it much more eloquently than that, but kept referring to my ability to smile and stay calm. I didn't expect that to be such a highlight. I mean, I can manage stress, but I didn't think I had this office zen vibe she was describing.

In the past, a few colleagues asked me how I was able to deal with certain situations or difficult people. My honest response: "Well, no one died." No one ever died from a lost deal, from an incorrect spreadsheet, reworking an agenda for the thousandth time, or redoing a powerpoint presentation until it saw a diminishing margin of return. I lived through some of those situations, and I lived to tell about it.

As I listened to my boss say these things, I kept thinking the same thing. I was calm because no one was dying as we were in the office at 10pm or as I was waiting for emails at 1am to finalize a big presentation. Furthermore, those times were temporary.

I used to work in clinics and hospitals. Medical mistakes have huge implications compared to a small mistake in a presentation. And there are so many risks that can contribute that must be considered. This is why waiting for an email until the wee hours of the morning, while not ideal, did not bother me too much.

Now I do not believe that anyone outside of healthcare should approach their jobs with a "no one died" attitude. Nor do not say this to belittle the work. This is not the case at all.

I believe we should all give 110% and work hard. Work as if you live for it when you are there. If you start thinking well, no one will die if I don't finish this report, you won't finish it. It becomes an excuse, and not a good one as that is not what you are paid for. The more you give, the more you will get. You must always deliver.

My moment of zen is that when someone gets really upset about something small, and I know I gave 110% or more, I try reframe it.

While no one was dying at my great corporate job, the sad reality that pushed me to make this move is that people do die.

As the caretaker of a diabetic, I am very well aware of the fact that adults and children die from diabetes. This was my challenge. This is what was running around in my conscious for more than a couple of years.

It is always heartbreaking to read about a diabetes related death that could have been avoided - whether that be a misdiagnosis or a mistreatment. It shouldn't happen.

Many more diabetics develop complications over time. Many people struggle with their disease. Diabetics are sometimes misinformed. The public is misinformed. Some may be ashamed of their diabetes. This bothers me.

So now armed with my healthcare management and education background, and the knowledge I have from managing diabetes for a child, I moved into the next phase. There is so much to do, and I am excited and overwhelmed at the same time.

I woke up today, and immediately got to work.

Thursday, June 23, 2016

... And Speaking of Courage

My Type 1 son has a lot of it.

A few months ago he came to me and said he felt tired of always having to explain what his pump was and what diabetes is. He read a book and had a kind of Q&A session for his class at the beginning of the year, but two bullying situations later, he wanted to do something more.

So with the help of his school counselor. He came up with the idea to make a video to help other kids understand more. I was shocked when he presented his plan to me. Honestly, I was worried it might put him out there for even more ridicule or labeling. But I kept an open mind.

Several months later, the video was complete and played in every second grade class during a snack break. I unfortunately could not pick him up that day due to a meeting, but when I called him to ask how it went, he was in tears.

He said that kids did not watch it and were running around the room. I later learned that his teacher had to leave the room during the break, and the kids were left with the assistant. I am not sure how things played out, but he was heart broken, and for what ever reason felt like he was not heard. I suppose I would be too if I had spent several days after school working on a project that was so important to me.

The video was edited by a high school student who was diagnosed with Type 1 about a year ago. She did a good job, but perhaps it was not flashy enough to keep the attention of 8 year olds in this day and age. Diabetes is not an easy subject to sell.

Of course mom mode kicked in, and I wanted to help him feel he was heard. I immediately shared the video with family and a few close friends. And of course the feedback was so supportive.

And now we are in the US where we will attend two different events for children and families with Type 1. I really hope this helps him feel heard.

I don't mean heard in the sense that people will watch his video. I mean heard in the sense that he will realize he is not alone. He is not the only child out there dealing with this. Hopefully he will make some new friends, have fun and maybe gain a little more independence in this process.

... And perhaps, with any luck, he will come to realize he is the most courageous boy I know.

Friday, June 17, 2016

Creativity Takes Courage




"Creativity Takes Courage"

I have a notebook with this quote from Henri Matisse, a French artist, on the cover. He is best known for his colorful paintings in the early 1900s.

I see this cover a lot of think of this quote in the context of many things - often diabetes. I assume medicine is not often thought of in this context, but I think it is applicable.

If we look at the bigger picture and all the research happening - creativity definitely applies. And you have to sometimes be really courageous to think out of the box.

On a day to day basis, diabetics have to be creative to manage this thing. Yes, there are certain rules to follow, but I strongly believe that understanding how much to insulin dose based on carbs, activity, the time of day and many other factors is definitely an art. Armed with facts, a constant artistic balancing act is required to avoid bad outcomes. Matisse's elaboration on this quote describes it well.

"It is not enough to place colors, however beautiful, one beside the other; colors must also react on one another. Otherwise, you have cacophony."

Cacophony. A reference to sound. The colors can be organized so badly that you can hear them scream! This is what diabetics and their caretakers are trying to avoid every day.

It is not just enough to administer insulin or count carbs. You have to "place" it as Matisse did with his colors. The cacophony of diabetes. The shrill is so high that it can make one want to plug their ears.

Being creative is scary. Despite the risk of cacophony, you have to be bold. You put yourself out there, and risk being judged by others.

If you feel you have not managed your blood sugar well or made a mistake, you judge yourself. You might feel judged by healthcare providers or others that believe you are not managing yourself or your child well. That can feel very defeating.

So how does one overcome that? It is different for everyone. To be courageous, you have to know that you have tried your best. Never give up, or give in. Even on the bad days. Keep trying.

As Matisse would say,  "Derive happiness in oneself from a good day's work from illuminating the fog that surrounds us."

Monday, May 30, 2016

My Peak Into Hypoglycemia

So tonight I had a very mild, small peak into what a low blood sugar feels like.

I went to the gym, and toward the end of the class I was taking, I suddenly felt incredibly hungry. I have not eaten beef for over 20 years now, and could almost be classified as a vegetarian, but the only thing I could think about through the last few minutes of trying to strategically balance myself on an exercise ball was barbecue brisket!

I was sweating from the workout, but I had that feeling of a cold sweat coming on. Could this be what my son feels when he is having a low, I wondered? Was I really low? Was I just hungry? Exercise usually does not have me running out the door in a manic quest for Texas barbecue!

Fortunately, I was in my complex, so in a matter of seconds, I returned home eager to ask my son to check my blood sugar because I felt low. I told him "I feel low", which is what he often says to me when he has a low.

I thought he was eagerly running off to get the glucometer, but instead he was eager to share with me what he was writing while I was away. It was incredibly awesome, but before I grabbed a juice, I really wanted him to check me to see if I was in fact low. I thought that reversing the roles somehow might make him feel better about diabetes, or not so alone.

I then followed him to his room thinking the glucometer was there. I still wanted a side of beef. Meanwhile, my husband is trying to tell me something, and my son is playing with some tape he wants to put over his mouth. Did I mention I needed a double brisket meal with potato salad and jalapeƱo corn bread?!

Where is the damn glucometer?!!!

Finally, it arrives. I asked my son to check my finger, but he was busy with his tape project. So I change the lancet and checked my own finger. The reading was 69. Wow! I suspected I would be a bit low as I did not really snack throughout the day as I usually do, and I had a small lunch, but wow. I really was experiencing a low.

Juice, I need juice. Off my son went running through the house trying to communicate with his mouth taped shut that I was low and I needed juice. Not sure how that was going to work as no one would expect me to be the one with the low. I reinforced the mumbled message by requesting a low carb juice from the opposite end of the kitchen.

My son brought me the juice and ran off just as I realized the straw was not in the hole. What? No straw? I was shaking a bit, and it was one of those juice bags, not a box, so I was skeptical that I could do this gracefully. I took the straw... no, I ripped the straw off the juice bag and tried to put it into the ready made hole. I missed!

After a few more attempts, I stabbed it so well that I also punctured the back of the juice bag. The straw never went in! And now I had a juice fountain in my hallway. I started sucking the juice out of the back hole of the bag, but it was still leaking out of the front! I was mostly sucking air from the back of the bag! Clean up on aisle six!

Finally, enough juice spilled onto the floor to allow me to insert the straw into the bag and finish what was left. Enter mop.

The juice seemed to helped a bit. That, or I felt so accomplished that I stabbed a juice bag with a straw, I went to shower - after which I sat down to eat immediately. I still felt like I was starving, but I must have been on my way to a normal blood sugar range as I no longer wanted to devour an entire animal. Crisis adverted.

I do not know what this all means, and I am not alarmed by a lower than normal blood sugar. It could be a fluke, or not. I'll do some checks and watch it. I'm putting it down to doing intense exercise on a day when the timing of my meals did not serve what I needed my body to do.

I am pleased that I had this mild low and I got to experience something that my son deals with every day. It was incredibly annoying and challenging. First because I could not finish my workout as I would have liked to, and I can see how as one goes lower, it can get frightening, quickly. The frustration and isolation of people ignoring you or not understanding the severity of your needs must be overwhelming at times.

I have no real message here. Just a random experience. I wish it were me instead. I am not sure I could handle it as gracefully as he does. And I am pretty sure that I have the potential to physically harm someone in a quest for good Texas barbecue. This could go horribly wrong considering there isn't really any here.

Friday, May 20, 2016

Tips & Tricks

Diabetic Blog week is coming to a close, but that does not mean the writing will likely stop for any of those who participate. One thing we do a lot of through our blogs or groups is share our tips and tricks. New "diabetes hacks" are discovered all the time.. I hate that term, "life hack", but really if there is something I can do to make diabetes management easier, I am on board!

There are probably many things I should site here, but I will focus on two. My first, many may know, but I think it is worth mentioning again. In the iPhone, there is a Health App. It has a section for medical information and emergency contacts. While it is my son with Type 1, I complete this information for both of us. I am not sure if all medical personnel are trained about this, but it could come in handy. To learn how to set this up, visit this link.

My other "hack", that I still haven't perfected is travel. We love to travel and do it a few times a year. But traveling with diabetes is a whole different game. I always over pack in the anticipation of several scenarios.

In this older blog post, What's In My Bag, I share some of my travel prep. It is still relatively the same. This summer I will travel to the US, so I am now looking into TSA Pre Registration. I have not done this before, but I have read others' experience on social media and everything was very positive. I have already purchased our domestic tickets, so fingers crossed we will qualify!