Do you T2's ever just 'need a break' from this disease?

[phoenix]

Diabetes' burnout' is well know in both T2 and T1. Dr W Polonsky has done a lot of work on the emotional side of diabetes, its's just as important to get that right and realise when things are getting too much.
One of the leaflets on his site has some good tips, including taking a 'safe' vacation every now . I think it is surely better to have a controlled ' break', than become overwhelmed and spiral downwards, perhaps losing control completely.
I think that a break from reading about diabetes on forums and the internet is probably an important part of any such break!
http://behavioraldiabetesinstitute.org/ ... tions.html

 

[pianoman]

While the word diet is often taken to mean a "short term measure -- to lose weight, for example", it can also simply mean "what we eat".

http://en.wikipedia.org/wiki/Diet_(nutrition)

In nutrition, diet is the sum of food consumed by a person or other organism. Dietary habits are the habitual decisions an individual or culture makes when choosing what foods to eat. With the word diet, it is often implied the use of specific intake of nutrition for health or weight-management reasons (with the two often being related). Although humans are omnivores, each culture and each person holds some food preferences or some food taboos, due to personal tastes or ethical reasons. Individual dietary choices may be more or less healthful. Proper nutrition requires the proper ingestion and, equally important, the absorption of vitamins, minerals, and food energy in the form of carbohydrates, proteins, and fats. Dietary habits and choices play a significant role in health and mortality, and can also define cultures and play a role in religion.

http://www.merriam-webster.com/dictionary/diet

a : food and drink regularly provided or consumed
b : habitual nourishment
c : the kind and amount of food prescribed for a person or animal for a special reason
d : a regimen of eating and drinking sparingly so as to reduce one's weight <going on a diet>

 

[ClaireG 06]

Can we please keep personal comments out of this, thank you.

 

[jopar]

Actually, part of my motivation in doing better is to prove my Doctor wrong on the whole low-carb thing

Good luck with that; I'm sure an non-blinded non-randomised study with sample size n=1 will really impress your consultant.
Besides, you'll need much, much more for that - remember insulin pumps? They improve HbA1C as well. However, they also increase mortality massively (odds ratio 7.2 compared to NPH - cf NICE TA 53)

I think you've actually got your information wrong and/or making assumptions..

TA 53 is basically an out dated Guide line superceeded by Type 2 (partially updated CG 87) CG 66 issued in 2008(tA 53 was issued in 2002) And this is purely based on long acting analogue insulin

Insulin pump therapy NICE guidelines TA 57 (2003) was replaced/revised y TA 151 in 2008

And insulin pump therapy only uses Quick Acting insulin... Totally different

So you've got this wrong.. But it seems you are using these to make assumptions over all..

I think it was the ACCORD study that suggested that driving the HbA1c of T2 diabetic to below somethting like 7.5% increased mortality, I do know that one of the American studies was pulled early because of this reason..

None of the study group would have been on insulin pump therapy, purely because there isn't a Guideline for T2 diabetics and insulin pumps...

In fact there is no edvidence for the T1 diabetic that insulin pump therapy increases the mortaility rate of this group...

So you are making assumptions of this alongside using incorrect information to make these assumptions with..

But back to the main questions.. I'm not T2 so can't answer from that prospective..

But I personally feel most diabetics if not all will at times go through a 'burn out' feeling of wanting to throw everything on the back buner..

But how often and to what degree this happens personally again it will be based on the type of regime the individual is following... If you are following a regime that involves a lot of restrictions and/or avoidence then it is more likely to happen and probably with greater impact on the individual.

When I was on MDI therapy, to maintain a reasonable level of control that maintain safe HbA1c levels meant a very intense regiem of monitoring and injecting (5-10 times a day) purely based on the lack of the humble insulin pen to deliver the correct dose required and the limitations of injecting background insulin that can not produce a flat even background profile to work your calculation from easily.. And yes there were times that you just didn't want it, you wanted a break from the intensity of it all...

But since starting insulin pump therapy 4 years ago, the intensity has been taking out of my managment, I no longer have to shift my butt out of bed every morning to catch the DP's before it had a chance to start impacting on my BG, nor a massive calculation of carbs/insulin, what time it was where I was to on my back ground profile, was I at the bottom of the trough or at the peak, or mid way and what direction was I heading...

Now the regime is so much easier, with I can sleep in to mid day if I wish, or even go to bed early I don't have to inject background insulin at 11pm anymore.. I don't get the 'Burn out' feeling with control..

But as phoenix mentioned, I put a lot into forums but every now and again I will disappear for a while as there is only so much you can take on that score..

 

[borofergie]

Actually, part of my motivation in doing better is to prove my Doctor wrong on the whole low-carb thing

Good luck with that; I'm sure an non-blinded non-randomised study with sample size n=1 will really impress your consultant.

Actually mate, he's a GP (not a consultant) his job is to dish out antibiotics, he probably doesn't even know what a non-blinded non-randomised study is. But anyway, as I said, it doesn't matter whether he cares or not, it's a motivation for me.

Besides, you'll need much, much more for that - remember insulin pumps? They improve HbA1C as well. However, they also increase mortality massively (odds ratio 7.2 compared to NPH - cf NICE TA 53)

:?: I'm not on any meds, what has insulin pumps got to do with a T2 diabetic on diet only? Are you sure you've taken your meds today?

 

[AMBrennan]

Your right, I did get the reference wrong but I'm very sure about having read it in some NICE publication, which looked in passing at early models of insulin pumps - thus the high mortality.
However, my point still stands - HbA1C is an imperfect indicator of "health"; improving your HbA1C may decease the risk of diabetic complication but increase the risk of complications from other conditions unrelated to diabetes.
Sorry, but I simply have a problem with the attitude that it's safe - and advisable - to completely disregard medical advice as long as a single measurement is within range.

 

[jopar]

Your right, I did get the reference wrong but I'm very sure about having read it in some NICE publication, which looked in passing at early models of insulin pumps - thus the high mortality.
However, my point still stands - HbA1C is an imperfect indicator of "health"; improving your HbA1C may decease the risk of diabetic complication but increase the risk of complications from other conditions unrelated to diabetes.
Sorry, but I simply have a problem with the attitude that it's safe - and advisable - to completely disregard medical advice as long as a single measurement is within range.

I would agree with you that HbA1c isn't always the best indicator to how well somebody is doing more so for those who use insulin, as it's about the quaility of day to day control...

I think that I can enlighten you a bit on your confusion on the insulin pumps...

Early pumps were very problematic and very different todays pumps.. They were very basic with a basal you adjust the flow with a screwdriver and then this just determind the rate over a 24 hour period, and the bolus was a one shot affair similar to an injection..

One of the downsides to using a pump, is that it only uses quick acting insulin, which can put the diabetic at an higher risk of DKA, due to you've only got 2 hours of background insulin in your body for 2 hours at a time, any pump failure that isn't noticed can quickly turn into DKA..

Pumps today have a self checking system, which checks the pump some in the region of 9 million times a day, they can pick up an occuslon (failure to deliver insulin) within missing 3 units, for most this is fine (for me it could be upto 6 hour before the alarm kicks in) all warning alarms are both audiable and/or vibration based you chose which you want or both..

Insulin pump therapy in it's infancy was problemtic, partly due to the basic limitations, lack of alarms of the pump itself, but also other factors such as at first they didn't realise that frquent changes of the cannular was necessary to avoid, infections blockages or damage to the underlying tissues..

The mortailty rate was based on problems with the limitions of the pump and lack of understanding of insulin pump therapy, not based on the improvements of HbA1c's... 20 years down the line pumps are very much different full of alarms etc and better understanding that avoids the problems of the early days..

 

[Grazer]

Not sure what any of this has to do with "needing a break"!

 

[borofergie]

However, my point still stands - HbA1C is an imperfect indicator of "health"; improving your HbA1C may decease the risk of diabetic complication but increase the risk of complications from other conditions unrelated to diabetes

It might not be perfect, but it is as good a measure of control as we've got. Do you have a suggestion of a better one AMBrennan?

Do you have any evidence that reducing HbA1c increases the risk of complications unrelated to T2 diabetes (paticularly for those of us not on insulin?). If not, then I prefer to reduce the risk of DIABETIC complications rather than worry about SPECULATIVE complications.

Sorry, but I simply have a problem with the attitude that it's safe - and advisable - to completely disregard medical advice as long as a single measurement is within range.

What are you talking about? Who is disregarding medical advice? We are discussing "taking a break from T2 diabetes", not giving up control altogether (or T1 or insulin pumps).

(Can we please get this back on topic now?).

 

[Sanober]

I'm taking a break, I think

My issue is compounded by not knowing what Diabetic type I am either and other health issues under investigation. I've tried so many things to influence my Hba1c and it's not shifting it!

I'm now 9stone 1, my height is 5ft 4(or 126 pounds) I've lost 18 pounds, thinking on my initial diagnosis of Type 2 I could lose 10% of my weight to see if it made a difference. It hasn't.

Self testing wise, I don't do it as much now - In the past three weeks of self testing, I've just been doing one fasting morning one and maybe a second one later in the day. This week, I've had two reads at 18.8 and 20.2 but never ever any Ketones. If I keep seeing those numbers I'll call the D nurse.

I tried reducing my carb to 25-50g/day, it didn't shift my readings much, also it just contributes to more weight loss, which for me isn't relevant. So back up to my normal 100-150g ish. Still very low pasta, rice portions, potatoes and no lunch sandwiches, all home cooked organic veg e.g chickpeas, lentils, chicken etc. My daily calories intake is about 1,300-1500 these days (Used to be 900 on some days), I exercise every two/three days including running.

So, where else can I go with this? One route - medication! My pancreas need some extra assistance.

My D nurse keeps telling me to stop doing anything drastic as I'm just trying to manipulate the Hba1c reading and it will not help the Diabetologist to understand what's going on with me.

She's right.

So I'm taking a break and my next Diabetologist appointment and Hba1c is on 30th Nov. I had crisps for the first time in a year last week. Last night I had a heroic amount of red wine (and some more crisps), incidently my morning reading today was 10.4 the lowest I've seen in nearly three weeks....it wasn't a deliberate manipulation tactic that :lol: