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.

Saturday, September 23, 2017

The Blog Is Moving!

Dear Followers of Diabetic In The Middle East,

I am happy to share the exciting news with you that this blog is moving to  http://diapointme.com/blog/.

When I started this blog over three and a half years ago, I was not planning to do much other than share my experience in the hopes it might help someone else in a similar situation.

Well, after several years, many presentations, much advocacy and the burning desire to do more than just share my story to help people, I created DiapointME.

I actually created DiapointME a few years ago, but it was only just over a year ago that I left my corporate life to devote my full attention to it.

DiapointME is a place for those who are touched by diabetes - whether that be someone with diabetes, or someone who loves someone with diabetes.

I hope you will visit the new site and have a look around. There is much more to come than just the blog. There will be a shop, recipes and more...

I look forward to seeing you there!

- Pam

Friday, May 19, 2017

More Than Diabetes

This is the last post in Diabetes Blog Week 2018. It has certainly flown by, and I am still reading posts and will continue to read the many posts from this week.  Today's post prompt:

More Than Diabetes - Friday 5/19 Lets wrap up the week by sharing a little more about ourselves, beyond the chronic illness we or our loved ones live with.  Share an interest, hobby, passion, something that is YOU.  If you want to explore how it relates to or helps with diabetes you can.   Or let it be a part of you that is completely separate from diabetes, because there is more to life than just diabetes!  (This topic is a suggestion from the 2016 #DBlogWeek survey.)

We are all so much more than diabetes...sometimes it may not feel that way because we always have to be mindful about it.

As for my son, he plays the piano, basketball, tennis and has been experimenting with parkour lately. He is artistic and athletic at the same time. He is an avid reader who wants to grow up and be an inventor among other things.

For myself, I try to stay fit and healthy and all that good stuff, but my great escape is photography. My favorite genre is travel and documentary because well, I love to travel. I love learning about different cultures and people. And this has actually taught us a lot about our diabetes too - preparing for the unexpected, dealing with the unexpected and just figuring out how to be a bit more flexible and accepting.

In addition to travel and documentary, I also enjoy night photography. It is quite meditative. There is something about the darkness and waiting for that long shutter speed. It makes time go slower and it is much easier to really get caught up in the moment you are shooting.

If you would like to have a look, you can find my work at pameladurantphotography.comI also try to include my own images into blog posts whenever possible. I keep a blog on my photography site which I should give more love to. Before I got really serious about leaving my corporate job to focus on helping diabetics, I blogged a lot more about life and photography at another site called Life In the Middle East.

Thank you again Karen for another great Blog Week. I look forward to the next one!

If you are just discovering blog week, you can find the links for all the posts at Karen's blog, Bitter Sweet.

Thursday, May 18, 2017

What Brings Me Down?

Throwback Thursday: What Brings Me Down - Thursday 5/18
Today prompt revisits a subject we wrote about in 2014. May is Mental Health Month (in the US) so now seems like a great time to explore the emotional side of living with, or caring for someone with, diabetes. What things can make dealing with diabetes an emotional issue for you and / or your loved one, and how do you cope?

I participated in Blog Week when we first discussed this two years ago so I went and had a look at what I wrote. I would say that pretty much exactly the same thing that got me down then can get me down now. Here it is....

Fortunately, not too much.  Yes, we have a lot of up's and downs - pun and no pun intended.  I am not going to say it is easy.  It is not.

My son was diagnosed at 20 months old, so he does not know a life before diabetes.  In some ways, I feel this is advantageous.  There is no longing for the days of yore when there were no finger checks or sick days.  I recall those first carefree 20 months of his life, but do not dwell on it.  I can't.  I have to keep looking forward.  Or at least live in the moment for my son's sake.

It is my job as a parent to teach him to grow up with this disease and manage it.  It is important for him to know that there are no limitations on what he can or cannot do.  If I get depressed about this, it will not help him.

I would say my most challenging times are when we've had too many consecutive highs and we can't always immediately resolve it.  Getting sick, bent cannula, or something else.  I try to learn and move on. (And ironically, that happened last night after pizza for dinner! Thankfully I am not a V-Blogger so you miss the dark circles under my eyes :-) )

There are also times when he is really sick, and I cannot make it go away.  I wish it were me instead of him. However, again, we cannot dwell on these.  If you do, it will get you down.

This disease is a lifetime.  What gets us down this year will be different next year, and again different in five years.  It will change with different phases of life. Although over the last two years, not much has changed in regards to how I feel about this.

We are challenged by diabetes almost daily, but I try to not let it get me down.  I know my son will face many emotional challenges with it as he grows up, but as his caretaker I feel it is important to stay positive.

The only thing we can do is to try and control it the best we can and not let it control us.  We are so blessed that a diabetic can do everything that a non-diabetic can.

I closed this two years ago by saying that when I have those moments when I think I want to slip into down mode, I always think there could be worse things to deal with.  Just read the news.  It's more than enough.  

Some of the headlines I cited that day were different - #Bringbackourgirls was one of them. I was so happy to read that some girls were released earlier this month - after two years. Those two years must have felt like a lifetime. There was a mine explosion in Turkey at that time. Today in the headlines we see Venezuela, North Korea, chaos in the US, Syria is still in the news and there are even more refugees than before. 

From time to time I meet people from these countries. I met a woman from Venezuela last week. I told her I was sorry to read about what is happening in her country. Her eyes began to fill with tears. Thinking of the challenges that many have faced, and continue to face...That's what gets me down.

Wednesday, May 17, 2017

The Blame Game

The Blame Game Having diabetes often makes a visit to the doctor a dreaded experience, as there is invariably bad news of one kind or another.  And sometimes the way the doctor talks to you can leave you feeling like you’re at fault.  Or maybe you have a fantastic healthcare team, but have experienced blame and judgement from someone else in your life – friend, loved one, complete stranger.  Think about a particularly bad instance, how that person talked to you, the words they used and the conversation you had.  Now, the game part.  Let’s turn this around.  If you could turn that person into a puppet, what would you have them say that would leave you feeling empowered and good about yourself?   

Just over two years ago, I wrote a post called Advocacy and Doctors where I discussed the need to advocate for your Type 1 child while in the hospital, or at a doctor visit. 

Within that post is a story about a lecture I received from a pediatrician because my son's last A1C was 7.1.

While I always strive for something below 7.0, I know I am below the global recommended standard. No matter how much our endocrinologist would sing our praises for this number, I always want a better result.

Yes, I know that as a diabetic my son risks heart disease, loosing eyesight, neuropathy, loosing a foot, shorter life span and all other kinds of complications if this is not managed. Exaggerated? Maybe yes, maybe no. Believe me, I know that this is the reality if I do not manage his blood sugar well.

As today's Blog Week topic description suggests, we should turn that around. What would I have them say that would have left me feeling empowered and good? 

Difficult question. I think a good doctor knows that diabetes is not just a one way conversation. I don't think this doctor is necessarily a bad doctor, but I think he just got caught up in his doctorness. After all, people go to the doctor to get prescribed treatment by an expert. In this case, we were actually there for that reason for suspected strep throat.

In chronic disease, this conversation changes. A patient (or caretaker) that has been dealing with diabetes for several years becomes an expert on their own care. We never wanted to, but we have to be the expert. Perhaps the best way to turn that discussion around is to have an open dialogue and work with a patient instead of telling them what to do, or reprimanding them.

As a wellness coach, I empower people by allowing them to set their own goals around their own wellness vision. Throughout this process, I spend more time listening than talking. Perhaps a coaching approach to work with a patient to understand what actions will get them closer to a more desirable A1C would help. 

Our very first endocrinologist would always ask me "Well, what do you think?", long before I really had any opinions or knowledge about diabetes care. At the time I thought it was crazy, but now I realize why he did that. I am a much better caretaker for his coaching approach.

Since that was not happening at this doctor visit, and the previous visits had a similar tone, I worried that my son would pick up on it. Continuously feeling scolded or ridiculed for medical results would probably make him feel bad about his diabetes. This thing is challenging enough without that. I want him to embrace it as much he can - that is age appropriate of course - and feel he is supported so that someday he will confidently take the reigns. 

But that day, I didn't waste any more time thinking about the doctor's tone. I didn't get defensive because this was not the first time. Rather than wishing the discussion were different on that day, I empowered myself. 

In life, we have choices. There is nothing more empowering in life than knowing that we can choose. 

That day that I decided to change doctors. My son's new pediatrician gives us advice, but it is delivered in a much more holistic way rather than just a one way negative message.

Disease doesn't give a lot of choices. No one ever chooses to be diabetic, but we can empower ourselves in other ways. That day I felt so much lighter knowing that I made the healthy choice that will ultimately empower my son.

Tuesday, May 16, 2017

The Cost Of A Chronic Illness

Day 2 of Diabetes Blog Week: The Cost of a Chronic Illness: 

Insulin and other diabetes medications and supplies can be costly.  Here in the US, insurance status and age (as in Medicare eligibility) can impact both the cost and coverage.  So today, let’s discuss how cost impacts our diabetes care.  Do you have advice to share?  For those outside the US, is cost a concern?  Are there other factors such as accessibility or education that cause barriers to your diabetes care?

Is diabetes expensive? 

You bet it is. Give Google a go at the "Cost of Diabetes" and there are numerous studies and infographics that confirm what those of us dealing with this disease already know. If you have a child with Type 1, you can take the search further and find even more alarming figures.

I live in the UAE. It is mandatory in most of the Emirates that everyone here have some kind of healthcare insurance. It is not socialized with everything covered, but most everyone has some kind of coverage depending on where they live and work, and what your plan pays for. We are fortunate that pharmaceutical prices are controlled by the government. Therefore, we do not see the overnight skyrocket increase in insulin that the US is experiencing right now.

As I mentioned, coverage can vary. We recently had to search for new healthcare coverage. I left my job last year to start a company to help diabetics and their families, so I no longer had the insurance of the corporate I used to work for. Shortly after my career change, my husband changed his job. 

We did a lot of consideration before making these changes, and insurance coverage was discussed. Diabetes is a deal breaker for us. To find a company that would cover a reasonable amount of his expenses, or offer a fair quote for my son was difficult. Why? Well due to the pre-existing condition, of course. 

The responses we received from some of the companies hurt and felt discriminatory.  One company got back to our insurance broker within minutes after receiving our applications with a $40,000 USD premium to cover my son for just one year. That was just for him only.

I do not know what an average premium is for Type 1(I searched quite a bit after that quote) but $40,000 seemed inflated. I am not even sure my son’s basic healthcare and supplies are that much in one year! It would have been much easier had they said, “Sorry, we do not wish to cover a Type1 diabetic”, but I guess that would be illegal. We eventually found something realistic, but we still pay for many supplies out of pocket. 

It is unfortunate that some insurance companies do not understand what Type 1 really is, or how it is managed. It is obvious by the tests they request and the discussions I have had with them on the phone. For example, one previous company asked for an eye exam to consider coverage of an insulin pump for my son when they had on record he just had an eye exam about five months before their request. It is redundant and not necessary.

This is the extreme. Not all insurance companies are like this, and awareness is changing. This only highlights the need of what we all know - education, education, education. 

Diabetes is not a small issue in this region. The Middle East has some of the highest incidents in the world, and this does not seem like it will change soon. 

Fortunately, there are a growing number of insurers and providers that now understand diabetes and how to treat it. When we started this journey, it took some time to find then. 

My advice for dealing with it all. Constant education and advocacy. If the first person you speak with does not understand diabetes, or if it is clear that they are requesting something medically unnecessary, speak to someone else until you find someone that is willing to listen and learn.

Monday, May 15, 2017

Diabetes & The Unexpected

Today’s topic – Diabetes And The Unexpected…. Is that not like every day?

The amount of unexpected that could happen seems endless if you really think about it.  It is difficult to risk manage your way out of all of it. 

There are many routine things in diabetic care. For example, changing insertion sites and filling reservoirs (if you have a pump), injecting your long lasting insulin at the same time every day, regular doctor check ups, counting carbs and weighing your food when you cook - just to name a few. However, on most days, I would say that we face something unexpected.

It can be a small unexpected nuisance like waking up before school with a random high blood sugar because a pump insertion site was kinked over night.

Large scale might include loosing or misplacing a critical supply or medication, or fighting an insurance company for something critical to your health.

But note: Never underestimate the small scale of unexpected incidents. They can easily become large scale problems if not addressed quickly enough.

We have dealt with all of the above at one time or another. So how can I define THE mother of unexpected diabetic situations?  Maybe it is best told through a story....

Once upon a time in a village not so far away....

One summer, when my son was much younger, a girl of his age pushed him off a pier into water while he had his pump on. Don't worry, the water was not too deep nor was it too shallow. He could swim. There were no sharks, jellyfish or anything dangerous in there. 

But I bet if you have anything to do with diabetes, those potential issues did not even cross your mind. This was back in the day before pumps were waterproof like so many of them are now.

This is a pier where children played and swam daily. So pushing someone into the water might seem like a fun thing to do for another child. Unfortunately, my son was not dressed or ready for swimming at all. He was incredibly upset because even though he was only about five, he knew his pump shouldn’t get wet. After he was in the water, humiliation did not set in. He was more concerned for his health. "My pump! My pump!" he cried.

To magnify the unexpectedness of it all, this incident happened in a seaside village in Turkey where my mother-in-law typically spends her summers. The closest qualified hospitals, doctors and pump companies were all in Istanbul approximately a four hour drive away. 

As we live in Dubai, we did not have a real relationship with any endocrinologists there so its not like I could just call up the local Medtronic rep and ask for a new one… Although now that I know better, I realize I probably could have done that.

We were pumping insulin, so we had no long lasting insulin with us. We had not used long lasting insulin since the first few months after diagnosis. Pumping so there is no need for long lasting insulin, right?! Maybe wrong. 

Perhaps I would have found long lasting insulin at the pharmacy in town, but I had no idea what we would need. Fearful that a local pharmacist there would not understand Type 1, or suggest the wrong kind of insulin, I stuck with what we knew.

Dealing with the unexpected when you have a life threatening disease makes you really entrepreneurial in how you address the unexpected. We were scheduled to leave about two days after this unexpected glitch, so we managed the rest of that time using only short acting insulin injections. 

Was this ideal? Absolutely not. But it worked.  I was always waking up for night checks with my son anyway, so what's a couple of more? Who said vacation should be relaxing anyway?

The difficult part was that he was still very much afraid of injections at that time. There was a lot of negotiation involved, but he understood why we had to do it.

As for the pump, I immediately took the battery out and used the hair dryer to dry it. It was the most advanced technology I had access to after our pump, a refrigerator and an old television. After running the self test function numerous times and testing several boluses over the bathroom sink, much to my surprise the pump seemed to work . However, I did not dare attach it to my son again because like I said, back then, these devices were not water proof. I heard tales of them going into washing machines by accident and surviving, but I was not going to test that. What if it malfunctioned?

And you might be wondering, what about the girl that pushed him into the water? 

I think she learned her lesson. When she pushed my son in, she also pushed in one of the more elder, respected men of the village who was standing there with him, so it really magnified the situation. Everyone was pretty angry with her for pushing him off the pier too, so she and her mother heard a lot of complaints that day. 

I never said anything to the girl or her mother. I was beyond furious. I also knew that this girl was five years old, and really had no idea that my son was wearing a pump.

The mother later came to apologize to me. What could I say. She didn’t understand Type 1 and how much a new insulin pump cost. Forget the cost, she did not know that a Type 1 would go into DKA very quickly without insulin, and what that really means.

Her daughter learned a lesson through her humiliation. It was done. There was nothing I could do at that point. More importantly, I was too angry, way too emotional and too inexperienced in dealing with the unexpected at the time to make it an "educational moment" about diabetes.

So the unexpected… It happens. It can happen at any time, on any given day. It is usually when it is most inconvenient. You learn from it. You learn to deal with it. The bigger the unexpected incident, the more you learn.  

I am convinced that there is a Murphy's Rule Diabetes Special Edition out there somewhere...If you get ahold of it, could you please send me a copy? Until I get my hands on that book, I always try to be prepared, and deal with the unexpected in that moment when it occurs. 

I guess this is why I often refers to diabetes as the "zen disease". It keeps you in the moment with it. Just because one blood sugar was great, doesn't mean the next one will be. You never know what it, the environment, or another person will throw you - or if another person will throw you.

Its diabetes. It demands our attention when we really don’t want to give it our attention.

So how does the story end? We returned back home to Dubai and got a replacement pump. It seems so long ago. That was our first really big lesson in the unexpected after diagnosis… but it was only the beginning. 

Within that Murphy's Rule book of diabetes, there is likely a whole chapter on diabetic events in remote villages. The following year when we were back in the village, we ended up with a stomach virus. This was before I learned about Zofran for nausea...

I am happy to say we continuously learn from these experiences...

The images in this blog are some that I have shot over the years from that lovely village. The pier is the actual pier where our unexpected occurred. But when I look at it, I do not see the unexpected. 

Children swim and play there every day. The village handy man fishes at the end of the pier every evening under the moonlight. We see the good stuff.

I only recall those unexpected memories just enough to come prepared in case the unexpected might happen again. 

And a camera. I always bring a camera to not forget the beautiful things in the world.

This was my first post for the annual Diabetes Blog Week. I am very happy to be able to participate once again.  This initiative was started and is managed by Karen over at the Bitter Sweet blog. This sharing circle of so much diabetic knowledge, goodness and positive energy continues to grow every year!

Today's topic:

Diabetes can sometimes seem to play by a rulebook that makes no sense, tossing out unexpected challenges at random.  What are your best tips for being prepared when the unexpected happens?  Or, take this topic another way and tell us about some good things diabetes has brought into your, or your loved one’s, life that you never could have expected? 

Thursday, May 11, 2017

Diabetes Blog Week 2017

For the last eight years, every May, Karen over at BitterSweet has hosted what is fondly known in the Diabetic Online Community as Diabetes Blog Week. And I am excited to see it is happening again in 2017.

I found Diabetes Blog Week completely by accident the first year I participated. It was at that time that I learned there were hundreds of people with diabetes just like my son, and caretakers like me, keeping blogs. It was refreshing to learn from others who face similar challenges.  

Every year I meet some of the most inspiring people through this process. I also learn a lot.

I will be taking part so keep an eye out for my upcoming posts. These are the topics Karen has chosen for the eighth annual Diabetes Blog Week:

  1. Diabetes and The Unexpected - Monday 5/15
  2. The Cost of a Chronic Illness - Tuesday 5/16
  3. The Blame Game - Wednesday 5/17
  4. Throwback Thursday: What Brings Me Down - Thursday 5/18
  5. More Than Diabetes - Friday 5/19
  6. Bonus: Diabetes Bloopers - Wildcard (Love this one!)

If you have a diabetic blog, or have been thinking to start one, why not participate? It is a very welcome forum, and Karen openly invites everyone – Type1, Type 2, LADA, Gestational – all diabetics. Here is the sign-up page.

Here is a list of all participating blogs and you can follow the Diabetes Blog Week Facebook page.

If you're taking part, leave a comment for me below with a link to your blog. I'd love to follow your journey throughout Diabetes Blog Week.

Thank you Karen for hosting Diabetes Blog Week again this year! I am always appreciative of your efforts in this and everything you do. This week and the other many things you do are making a difference for so many.

Wednesday, May 10, 2017

Diabetes & Ramadan

This year, the holy month of Ramadan is expected to begin on May 26th. That is just over two weeks away.  The majority of the 1.57million Muslims of the world fast that month from sunrise to sunset.

According to Dr. Osama Hamdy, assistant professor at Harvard Medical School and senior adult endocrinologist at Joslin Diabetes Center, “94% of the 150 million Muslim patients with diabetes choose to fast for at least 15 days of that month” or longer.

If you are a diabetic, and plan to fast for Ramadan, please visit your endocrinologist before Ramadan begins to discuss how to manage your blood sugars during this time – especially if you are new to diabetes.

If you are a doctor, and are looking for guidelines, there is now an official Diabetes and Ramadan International Alliance of doctors and imams that created guidelines for fasting. Start here. The medical advice and medical evidence is derived from doctors and studies in Muslim countries.

Please consider these guidelines and an open dialogue with your patients. I have met diabetics who immediately disregarded anything their doctor said immediately after the phrase “you cannot fast”.

While it may be deemed clinically risky for them to fast, it is important to have an open discussion about the risks involved, and what, if anything, they can do to fulfill this religious obligation that is very important for them.

In an article with Endocrine Today, Dr. Hamdy is quoted as saying that “Physicians should face the reality and not assume that their patients will not fast and try to adapt as much as they can to this scenario.”

For patients, please speak with your qualified doctor who understands diabetes. Fasting can be dangerous for your body if you are diabetic. According to Dr. Hamdy, fasting is not advised if you suffer from severe hypoglycemia, are unaware of hypoglycemia or have severe hyperglycemia within the 3 months leading up to Ramadan. If you are pregnant or have gestational diabetes, have Type 1, or have a chronic kidney disease.

At Diapoint, we know that every diabetic is different. What works for one diabetic will not work for everyone. What we do endorse is that you make an appointment with your doctor before Ramadan begins to plan how to best manage your diabetes during this time.

Ramadan Kareem!

For more information about the interview with Dr. Osama Hamdy, please visit this article