Think Like a Pancreas
Page 24
Call your doctor immediately if you have ketones in your blood or urine, or if you are experiencing these types of symptoms. Although fluids and insulin are the preferred form of treatment, DKA is not something that you can treat on your own. The severe dehydration that accompanies DKA usually keeps insulin from absorbing properly from below the skin. Nausea and vomiting may also limit the amount of water you can consume. Treatment of DKA almost always requires a visit to an emergency room for intravenous administration of insulin, water, and electrolytes. The acidity of your blood will have to be monitored very carefully at the hospital to prevent coma or death. The length of your hospital stay will vary depending on the severity of the DKA, but expect to be there for at least a day or two.
There are a few things that you can do on your own prior to hospitalization. Try to eat light, easy-to-digest carbohydrates and drink at least eight ounces of liquid per hour. Diluted orange juice is a good choice because it replaces fluids as well as potassium that is lost with excess urination. Check your blood sugar and ketones every couple hours, and report the information to your doctor.
Remember: They don’t call it “insulin-dependent” diabetes for nothing. We depend on insulin to stay alive. DKA causes more than 80 percent of hospital admissions for people with insulin-dependent diabetes. Practice the preventive measures described above, and stay in close contact with your health care team at the first signs of trouble. Diabetes management is truly a team effort!
Chapter Highlights___________________________________________
Hypoglycemia is a major limiting factor in intensive diabetes control.
•Mild and moderate lows should be self-treatable. Severe hypoglycemia requires glucagon or intravenous dextrose.
•Loss of hypoglycemia symptoms (hypoglycemia unawareness) can be reversed by preventing lows for several weeks.
•Implement strategies to prevent hypoglycemia if you are experiencing more than a few lows per week.
•Taking bolus insulin earlier and/or applying strategies to slow the digestion of your meals can help you minimize after-meal blood sugar spikes.
•A complete lack of insulin in the body can lead to diabetic ketoacidosis (DKA).
•Checking for ketones at the first sign of an unexplained high and administering insulin and fluids if ketones are present can help prevent DKA.
CHAPTER
10
Resources for Everything and Anything Diabetes
Giving Support, Getting Support
Feeling the ups and downs of blood sugar swings, handling the incessant responsibilities of managing a chronic disease, trying to make sense out of a highly imperfect science, and facing the grim reality that, despite all your best efforts, serious health problems may be in your future—living with diabetes can be a frustrating and sometimes frightening experience. At times it can also make you feel very much alone.
If you have ever felt the need to reach out to someone who understands how you feel—someone who has been there—support networks may be just the answer. Even if you don’t feel the need to receive support yourself, the act of giving support to others is worth its weight in gold. Nothing will make you feel better and enrich your life more than helping others.
Opportunities for giving and getting support are widespread—both in-person and on the Internet. And the beauty of it is that you can find groups that are general and diverse or highly specialized.
For an in-person type of support group, your local hospital or diabetes treatment center is a good place to start. If there is a diabetes association office near you, they probably have a listing of support groups in your area. If nothing exists near you or if what exists fails to meet your needs, consider starting a group of your own. Post fliers at doctors’ offices and let your local diabetes association chapters know so that they can share the information with their members. Have the meeting at your home or at a centrally located restaurant. You could also ask a social worker at a nearby hospital if there is a room you can use. Each meeting should include plenty of networking/socializing time, but also try to have at least one pertinent topic to address. Have a sign-in sheet so that you can compile a mail and e-mail list for future meetings.
Do not go overboard in terms of expenses for the meetings. Remember: The people in attendance are the highlight. Light snacks and beverages are more than enough. As the group grows you might consider bringing in guest speakers from various hospitals or pharmaceutical companies and ask them to sponsor the meeting by covering your out-of-pocket costs.
If face-to-face groups are not feasible because of space, distance, or your desire for confidentiality, consider participating in or starting a chat room or group on the Internet. Although information derived from online groups may not always be 100 percent accurate, you can still gain an emotional lift from conversing with other people facing similar challenges.
Resources are not limited to mutual support–type programs. There is also an assortment of clinical support, associations, media/publications, government entities, books, product manufacturers, and mail-order suppliers ready to serve you. Below is a list of some of the resources we’ve found to be highly useful.
Integrated Diabetes Services
Here’s my chance to “toot my own horn.” My practice, Integrated Diabetes Services, is a worldwide leader in one-on-one consulting for people who use insulin. Diabetes coaching services for both children and adults are available in-person and remotely via phone and the Internet. Our team of highly committed Certified Diabetes Educators (most of whom have diabetes themselves) focuses on improving blood sugar control, teaching advanced self-management skills, and working with you to reach your individual goals. If you’re ready to take your diabetes management to the next level, we provide the care, attention, and expertise you’ve been looking for. Call 877-735-3648, or visit www.integrateddiabetes.com.
Type 1 University
T1U (www.type1university.com) features advanced online courses for insulin users and parents/caregivers of insulin users. Each forty- to sixty-minute class is available live (via webex) or in prerecorded format, accessible on any computer or mobile device with Internet access, so you can participate from the comfort and convenience of your home or office. Enroll in an individual class or a group of courses. Class topics include:
•mastering pump therapy
•advanced carb counting
•blood glucose control during sports and exercise
•weight loss for insulin users
•getting the most from your continuous glucose monitor
•after-meal glucose control
•hypoglycemia prevention and treatment
•fine-tuning basal insulin
•managing pregnancy with type 1 diabetes
•optimizing Symlin therapy
Other Sources of Diabetes Management Consulting
The International Diabetes Center (Minneapolis, MN) www.idcdiabetes.org; 888-825-6315; international:
1-952-993-3393
Joslin Diabetes Center (Boston, MA) www.joslin.org; 800-567-5461; 617-309-2400
Barbara Davis Center for Childhood Diabetes (Aurora, CO) www.barbaradaviscenter.org; 303-724-2323
Dietitian Locator: Contact the American Dietetic Association at 800-877-1600, or visit www.eatright.org/public (click on the “find a nutrition professional” icon).
Diabetes Educator Locator: Visit the American Association of Diabetes Educators at http://www.diabeteseducator.org/DiabetesEducation/Find.html.
Associations/Organizations
American Association of Diabetes Educators (AADE)
800-338-3633
www.aadenet.org
American Association of Kidney Patients
800-749-2257
www.aakp.org
American Chronic Pain Association
800-533-3231
www.theacpa.org
American Diabetes Association (ADA)
800-232-3472
www.diabetes.org
&nb
sp; American Dietetic Association (also ADA)
800-877-1600
www.eatright.org
American Foundation for the Blind
800-232-5463
www.afb.org
American Heart Association
800-242-8721
www.amhrt.org
Amputee Coalition of America
888-267-5669
www.amputee-coalition.org
Celiac Society
www.celiacsociety.com
Celiac Sprue Association/USA 402-558-0600
www.csaceliacs.org
Diabetes Camping Association (DCA)
256-883-2556
www.diabetescamps.org
Diabetes Exercise and Sports Association (DESA)
800-898-4322
www.diabetes-exercise.org
Friends with Diabetes (Jewish)
845-352-7532
www.friendswithdiabetes.org
Gluten Intolerance Group of North America
206-246-6652
www.gluten.net
International Association for Medical Assistance to Travelers (IAMAT)
716-754-4883
www.iamat.org
Jewish Diabetes Association (JDA)
718-787-4532
www.jewishdiabetes.org
Juvenile Diabetes Research Foundation (JDRF)
800-533-2873
www.jdrf.org
National Center on Physical Activity and Disability
www.ncpad.org
National Diabetes Education Program
800-GET-LEVEL
www.niddk.nih.gov/health/diabetes/ndep/ndep.htm
National Diabetes Information Clearinghouse
800-860-8747
www.niddk.nih.gov/health/diabetes/ndc.htmm
National Federation of the Blind Materials Resource Center
410-659-9314
www.nfb.org
National Kidney Foundation
800-622-9010
www.kidney.org
National Institute of Dental and Craniofacial Research
301-402-7364
www.nidcr.nih.gov
National Institute of Diabetes and Digestive and Kidney Diseases
301-496-3583
www.niddk.nih.gov
National Institutes of Health
301-496-4261
www.nih.gov
National Library Service for the Blind and Physically Handicapped
800-424-8567
www.lcweb.loc.gov/nls
Neuropathy Association
800-247-6968
www.neuropathy.org
Taking Control of Your Diabetes (TCOYD)
www.tcoyd.org;
TrialNet
www.diabetestrialnet.org
e-mail: trialnetinfo@epi.usf.edu
Financial Resources
There are many programs available to help offset the cost of diabetes care.
Medicare is a government-sponsored program for people over age sixty-five as well as younger people with serious health problems such as kidney failure. Medicare covers blood glucose monitors, test strips,lancets, insulin pumps/supplies, therapeutic shoes, glaucoma screenings, flu and pneumonia vaccines, and limited counseling by some registered dietitians and Certified Diabetes Educators. Medicare Part D provides prescription drug benefits for items such as insulin and oral diabetes medications. For eligibility information, call the Centers for Medicare and Medicaid Services at 1-800-633-4227, or visit www.medicare.gov.
Medicare also offers a database of public and private prescription drug assistance programs at www.medicare.gov/Prescription/Home.asp. The Cost Containment Research Institute (202-318-0770; www.institute-dc.org) provides a similar list. Another website, www.needymeds.com, provides up-to-date information on nearly two hundred patient assistance programs run by drug manufacturers.
Medicaid is a health assistance program sponsored by each individual state. Eligibility is based on your income level. Medicaid recipients may qualify for full or partial coverage for select types of diabetes medications and blood glucose monitors/strips. For information, contact the Department of Human Services in the government pages of your phone book.
CHIP is the Children’s Health Insurance Program provided by each state. It is for children whose families earn too much to qualify for Medicaid but too little to afford private health insurance. For information, call 877-543-7669, or visit www.insurekidsnow.gov.
PCIP is the preexisting condition insurance plan, established by the Affordable Care Act and administered by the U.S. Department of Health and Human Services. It provides a health coverage option for children and adults who have been locked out of the insurance market because of a preexisting health condition. For information or to apply, find your state at www.pcip.gov, or call 866-717-5826.
The Bureau of Primary Health Care (also called the Hill-Burton Program) offers professional medical care regardless of insurance status or ability to pay. For a directory of local primary health care centers, call 800-400-2742, or visit www.bphc.hrsa.gov.
The VA (Department of Veteran Affairs) runs hospitals and clinics for veterans who need treatment for service-related ailments and/or financial aid. To find out more about VA health benefits, call 800-827-1000, or visit www.va.gov.
WIC (Women, Infants and Children) is founded on the premise that healthy eating is an essential component of diabetes self-care. With this in mind, women with preexisting diabetes who become pregnant as well as those who develop gestational diabetes may be eligible for assistance with grocery costs if certain criteria are met. For more information call WIC Headquarters at 703-305-2746, or visit www.fns.usda.gov/wic.
Together Rx is a program in which people who have no prescription coverage and are not eligible for Medicare may be able to obtain a free Together Rx Access Card. Using the card can save you 25 to 40 percent on a select list of brand-name and generic drugs/supplies (including insulin, oral diabetes medications, meters, and test strips). For qualification information and a list of covered drugs, call 800-444-4106, or visit www.togetherrxaccess.com.
Lilly Cares is a patient assistance program for users of Eli Lilly insulin and other medications. Free insulin is provided by way of coupons supplied to your physician. Lilly Cares is open to legal U.S. residents who cannot qualify for government-sponsored programs, do not have private insurance, and fall below a certain income level. For more information, call 800-545-6962, or visit www.lillycares.com.
Novo Nordisk offers a Patient Assistance Program that provides free insulin, pen needles, and glucagon kits for those who cannot qualify for government-sponsored programs, do not have private insurance, and fall below a certain income level. For more information, call 866-310-7549.
Aventis Pharmaceuticals also offers a Patient Assistance Program that provides free insulin to those who cannot qualify for government-sponsored programs, do not have private insurance, and fall below a certain income level. For more information, call 800-221-4025.
Medtronic, makers of insulin pumps and pump supplies, offers financial assistance for those who use or are looking to use insulin pumps. Contact the Charles Ray III Diabetes Foundation at 919-303-6949, or e-mail chuck@charlesray.g12.com.
Glucose Test Strip manufacturers often provide copay cards for users of their blood glucose meters. The copay cards either reduce or eliminate copays associated with test strip purchases. There are usually no income or insurance eligibility limits. For details, call the toll-free number on the back of your glucose meter.
In the United States, each state has its own Attorney General’s Office whose job is to enforce laws and regulations of that particular state. Since most healthcare standards are enacted and governed by each state, the Attorney General’s Office can come to your aid if you feel that you are being dealt with unfairly by your health insurance, healthcare providers, pharmaceutical company, or a medical device manufacturer. Check in the white pages of your phone book, or search online for the attorney general office for your partic
ular state for contact information.
Media and Publications
Countdown (published by the Juvenile Diabetes Research Foundation)
800-533-2873
www.jdrf.org
Diabetes Forecast (published by the American Diabetes Association)
800-806-7801
www.diabetes.org/diabetesforecast/
Diabetes Health
415-883-1990
www.diabeteshealth.com
Diabetes Living Today (radio)
http://www.diabeteslivingtoday.com
Diabetes Monitor
www.diabetesmonitor.com
Diabetes Self-Management (published by Rapaport Publishing)
800-234-0923
www.diabetesselfmanagement.com
Diabetic Cooking (published by Publications International)
800-777-5582
www.fbnr.com
dLife (TV, web portal, and mobile)
203-454-6985
www.dLife.com; email: info@dlife.com
TCOYD (TV) with Steven Edelman, MD
http://tcoyd.org/series-television/tcoyd-tv.html
Fab Websites
www.1happydiabetic.com/
Just the right formula for a positive attitude
www.bd.com/us/diabetes/page.aspx?cat=7001
BD (Becton-Dickinson)’s Diabetes Learning Center
www.childrenwithdiabetes.com
Unlimited resources for kids and parents
www.closeconcerns.com
A consultancy devoted to the business of diabetes
www.deo.ucsf.edu
University of California Online Diabetes Teaching Center
www.diabetesdaily.com
Diabetes news, tools, community, and blogs
www.diabetesincontrol.com
Free weekly news and information for diabetes health professionals