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Diabetes Developments - A blog on latest developments in diabetes by David Mendosa

Entries Tagged as 'Psychosocial'

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A Good Day to Die

January 14th, 2011 · No Comments

My brother-in-law, George Klotz, died today after a long illness. He and my little sister, Liz, had been married for 55 years.

George died from prostate cancer, and he had been legally blind for years. Liz had to take ever greater responsibility for him. Until today, when everything changed for her.

George fought hard for his life. But on adequate pain medication he died peacefully today. George lived in Chino, California, and as a veteran will be buried in Riverside National Cemetery. I will fly there for the funeral.

The family knew this was coming. And so, all day today I have been thinking about that famous statement, “This is a good day to die.”

Used in numerous books, movies, albums, and song tracks, this statement still raised questions in my mind. Who said it and why? What does it mean?

[Read more →]

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Posted in: Psychosocial

Adversity Makes Us Stronger

December 6th, 2010 · 1 Comment

A couple of years ago I made a strenuous hike in southern Colorado that I wrote about on my “Fitness and Photography for Fun” blog. While that hike didn’t kill me, it came too close for comfort.

I reflected at that time on the aphorism by the German philosoper Friedrich Nietzsche. In 1888 he wrote what we usually translate as, “Whatever does not kill me makes me stronger.”

My own anecdotal evidence has led me to accept this as wisdom. I know that I need to challenge myself, both physically and mentally. I have to push my limits. I have to keep pushing the envelope.

When I don’t keep trying harder, my mental and physical muscles atrophy. And my life gets boring.

Now, we have gone beyond the age of aphorisms and anectodal evidence. Now, a psychology professor at the University of Bullafo and three colleagues have studied
people who reported their lifetime history of adverse experiences and several measures of current mental health and well being. Their analysis of this study of a national survey panel of 2,398 subjects assessed repeatedly from 2001 to 2004 found those exposed to some adverse events reported better mental health and well-being outcomes than people with a high history of adversity or those with no history of adversity.

“Our findings revealed,” says lead author Mark Seery, PhD, “that a history of some lifetime adversity — relative to both no adversity or high adversity — predicted lower global distress, lower functional impairment, lower PTS symptoms, and higher life satisfaction.” They also found that people with a history of some lifetime adversity appeared less negatively affected by recent adverse events than other individuals. Although these data cannot establish causation, Dr. Seery says the evidence is consistent with the proposition that in moderation, experiencing lifetime adversity can contribute to the development of resilience. You can find the abstract of their study online.

What does this have to do with diabetes? A lot. No question that have diabetes is more than a bit of adversity. But anyone to is controlling his or her diabetes will tell you that having it will make us healthier and happier. And stronger too.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

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Posted in: Psychosocial

Diabetes Support in Korea

November 30th, 2010 · 3 Comments

When Jeongkwan (Brian) Lee of the i-SENS planning division introduced me to Cheol Jean, Brian called him “the Korean David Mendosa.” Brian was being too generous to me.

Both of us have written about diabetes for years and have organized diabetes support groups. But Cheol Jean, whose business cards reads as Charlie Jean to make it easier for Westerners, has written four books about diabetes — twice as many as I have — and founded and leads a much larger diabetes support group.

Charlie Jean and I Meet

Brian and I arrived in Busan, Korea, on Sunday evening on the bullet train from Seoul. We are here to participate in the Eighth International Congress of the International Diabetes Federation’s Western Pacific Region at the Busan Exhibition and Convention Center (BEXCO).

I will be covering the IDF meeting for HealthCentral from Monday through Wednesday. About 3,000 people are here for the meeting in Busan, mainly from Korea, Japan, Canada, and Australia.

I am old enough to have remembered this now vibrant city from the Battle of the Pusan Perimeter. In August and September 1950 North Korean forces drove back the UN Command, which included thousands of American troops, and South Korean forces — together with millions of refugees — to the extreme southeast corner of the country around the port of Pusan. [Read more →]

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Posted in: Psychosocial

Social Media Summit

August 9th, 2010 · No Comments

Getting together with 35 other people who have diabetes and write about it online is one of the best things about my work. I just returned home from a full day at the second annual Social Media Summit sponsored by Roche Diabetes Care. I still find myself invigorated by having spent hours in the company of so many passionate people.

Four of the 36 bloggers at the summit came from one organization — HealthCentral. Gretchen Becker posts here, Ginger Vieira posts here, Kerri Sparling posts here, and I post here.

Gretchen, Ginger, Kerri, and David

The combined passion for better diabetes care surfaced most intensely when our eight hosts from Roche brought in representatives from the American Diabetes Association and the American Association of Diabetes Educators to tell us what they were doing. If they had any idea of the number, range, and intensity of the comments that were going hit them, I wouldn’t have been surprised if they had declined to com.

On the other hand, we responded positively to our hosts, led by Lisa N. Huse, the director of strategic initiatives for Roche Diabetes Care. This company offers blood glucose meters, including the Accu-Chek Aviva, which I reviewed for Diabetes Health magazine, as well as insulin pumps. After welcoming us and giving each of us the chance to introduce ourselves Twitter-style in 140 words or fewer, Lisa briefly reviewed her company’s progress in the year since its first annual Social Media Summit, which I also took part in and reviewed here.

Last year Roche began in earnest to reach out to the diabetes community with that first meeting with those of us who write about diabetes. That effort was a good start, although of the 29 of us, only two of us represented the overwhelming number of people with diabetes who have type 2. I couldn’t count how many type 2s took part in this year’s event, although the number increased to include at least five or us. I was also pleased to note a much more representative number of people of color.

In the intervening year Roche started at least two major initiatives, which Lisa mentioned in her introductory remarks. The first is the Diabetes Care Project, which is a coalition of like-minded organizations focusing on improving the care of people with diabetes. Founded by the National Minority Quality Forum and Roche in partnership with the American Association of Diabetes Educators and Healthways Inc., the group’s website is the Diabetes Care Project.

The second big outreach to people with diabetes that Roche made between the two summits is the Genentech/Roche Diabetes Patient Member Research Community. This is a group of 300 people with type 2 diabetes is a private, by-invitation-only group representing Roche’s customer base. They provide the company with feedback about their concerns and what they want. By working with these people, Roche is able to learn about their customers’ lifestyles, mindsets, attitudes, fears, and passions.

In several ways the best part of this year’s event was Roche’s emphasis on the accuracy of blood glucose meters. The low standards of accuracy we have has long been my biggest concern with testing our blood glucose levels, one that I have written about many times. Recently, the U.S. Food and Drug Administration has also become concerned, as I wrote here a year ago.

The “Accuracy Activity” led by leading blogger Amy Tenderich, who writes at Diabetes Mine, and Todd Siesky, the new public relations chief for Roche Diabetes Care, was both fun and informative. We broke up into small groups where we debated what standards of accuracy we wanted at the two given levels — below and above 75 mg/dl. The activity forcefully brought home to me that we had to work with trade-offs and that we couldn’t hope for perfect accuracy.

Last year we met at Roche’s American headquarters in Indianapolis, Indiana. This year we travelled to Orlando, where we met at the Orlando World Center Marriott in a tropical resort setting. Of course, summer weather in Central Florida is hot and humid, but we never had to leave the hotel except to take the limos that Roche laid on for us to and from the Orlando Airport, which must be one of the most beautiful in the world.

We met just after the American Diabetes Association’s annual meeting, also in Orlando, which I had decided to skip this year, mostly because I didn’t want to subject myself to Florida’s summer weather. But I couldn’t resist Roche’s invitation to its second annual Social Media Summit at the same place. Roche brought off the event without a hitch. Of course, I hope they choose a cooler location next year.

The Whole Group of Us Had Fun

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

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Posted in: Psychosocial

True Immortals

August 9th, 2010 · No Comments

A few days ago I received a rather unusual compliment, sent in an unusual way. True Immortals has got to be science fiction, but presents itself as being real. At least I think that it has to be science fiction.

The apparent narrator, supposedly named Glenn, admitted on a post earlier this month that he has diabetes. “That means it’s hard to keep my blood sugar under control, even with nine kinds of medication,” Glenn says. “I’ve had it since I was little, and it’s taken its toll. At the bottom of my mind there’s a hope that if we make contact with immortals we’ll discover some way not to die.”

Meanwhile, Glenn is doing everything he can to manage his diabetes. “I work with an endocrinologist, a cardiologist and a renal specialist, and I also see a holistic doctor and use supplements.” And he exercises.

But it was Glenn’s next sentence that really grabbed my attention. “I read mendosa.com like it was the Bible.”

“Because I do all this, I’ve held up longer than my specialists expected.” Now Glenn is worried that he won’t life long enough until “we learn how to overcome disease and death and stay healthy forever.”

A big part of me wonders if Glenn and the other people who believe that we can live forever are overly optimist. The other part of me believes that we can never be too optimistic. Better to think positive thoughts like those people who believe in immortality on earth than to wallow in negativity.

Maybe those who believe in true immortality are irrational. But my guess is that they will live longer than the naysayers among us, all the while taking better care of their bodies and having a happier life, no matter how short or long it is.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

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Posted in: Psychosocial

Natural Vitality

July 13th, 2010 · No Comments

“Often when we feel depleted, we reach for a cup of coffee,” says Dr. Richard Ryan, a professor of psychology at the University of Rochester, “but research suggests a better way to get energized is to connect with nature.”

He is the lead author of a series of studies that the Journal of Environmental Psychology just published in this June 2010 issue. I asked him to send me a PDF of the full-text of his research report, “Vitalizing effects of being outdoors and in nature,” and he did. You can find the abstract online.

Instead of coffee, I restore my energy by going out for a hike. In fact, one of the most popular parts of my website is my blog of photo essays, “Fitness and Photography for Fun.”

Certainly, physical activity makes us feel better. Staying fit is indeed one of the four legs that those of us with diabetes have to keep our blood glucose levels down in the normal range (the other three legs are diet, reducing stress and inflammation, and usually taking oral medication or insulin).

Over the years I have written many articles extolling the benefits of exercise. Some of those articles say how much better I feel after going out for a hike.


Nature This Morning

That’s all true. But these new studies for the first time have teased out the effects of being out in nature alone from the feel-good effects that we get from physical activity and from the socializing that we often get at the same time.

Dr. Ryan and his co-authors were able to separate out the effects of nature alone. To do so they conducted five separate experiments with 537 of the usual suspects — college students.

What they found was so clear, Dr. Ryan says, that “being outside in nature for just 20 minutes in a day was enough to significantly boost vitality levels.” The Journal of Environmental Psychology article defines vitality as having physical and mental energy giving us a sense of enthusiasm, aliveness, and energy.

When we have a greater sense of vitality we not only have more energy to do the things that we want to do but were are also more resilient to physical illnesses. “One of the pathways to health may be to spend more time in natural settings,” he says.

I’m not knocking physical activity. Most of us who have diabetes need to get up and out a lot more. If you aren’t getting out yet, this beautiful late spring weather is a great time to start. I’m saying that getting our physical activity outdoors in nature gives us two for the price of one.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

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Posted in: Psychosocial

Life Isn’t Fair

July 9th, 2010 · No Comments

All of us feel sorry for ourselves once in a while. That goes double for those of us who have diabetes.

We do have a serious disease that can be awfully hard on us. The complications of this disease are almost too much to even think about.

But we aren’t alone. If you are as inquisitive as I am, you talk to lots of people who have diabetes. And you will find some who have even worse conditions, believe it or not.

For example, last summer I hiked 132 miles in two weeks on a Sierra Club outing. Four other people made the same High Sierra trek with me, and I assumed that none of them had any physical limitations. Was I ever surprised to learn that every one of them had serious physical conditions — some worse and much more painful than my diabetes!

And this isn’t the half of it. I seriously encourage everyone to watch a bit of Nick Vujicic’s story. Nick is an Australian of Serbian descent.

“He was bitter until age 12, when his mother showed him a newspaper article about a man dealing with a severe disability,” according to an article about him. “It would change his outlook on life. Suddenly, he wasn’t the world’s only struggling person.”

I won’t say any more. Just watch a YouTube clip about him at www.youtube.com/watch?v=Gc4HGQHgeFE

Life wasn’t fair to Nick, but he is far from bitter about it, which would be about the only thing that could be worse. Life is Beautiful.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

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Posted in: Psychosocial

Who the Empowered Health Seekers Are

June 2nd, 2010 · No Comments

The odds are that you haven’t yet fully empowered your search for good health. I know this about you because a couple of months ago HealthCentral surveyed 2,888 of its registered members who have one of eight chronic conditions, including diabetes, and who completed the study. And in this respect at least people with diabetes are just like the people with the other seven chronic conditions.

HealthCentral CEO Christopher M. Schroeder and James E. Burroughs, associate professor of commerce at the University of Virginia, presented their findings at the DTC National Conference in Washington, D.C. earlier this month and shared them with me. After asking the people in the survey all sorts of standard psychological assessments, they found that about 30 percent of us take an active role in our health care plan. If you are in this group, one of your characteristics is that you are energized and engaged when you need to learn new tasks or master new subjects — you are what the survey calls a person with a need for cognition. If you are an empowered health seeker, the other characteristic you have is self-confidence — you have, in the formal terminology of the survey, high self-efficacy.

You can click to view the study, “Understanding What Motivates the Empowered Patient,” here. Mr. Schroeder and Professor Burroughs prepared it in association with Ted Smith, Ph.D., HealthCentral’s executive vice president for research.

My posts here at HealthCentral and your many comments are just one small corner of this huge health resource. HealthCentral is a collection of condition and wellness websites providing clinical information, tools, and mobile applications. Its sites provide a platform for more than 3,000 bloggers, 200 expert patients, and more than 12 million monthly visitors sharing real-life experiences about specific conditions. [Read more →]

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Diabetes Disaster Plan

May 28th, 2010 · No Comments

One little problem with disasters is that when they strike it’s too late to start preparing for them. You never know when or where they will hit.

Those of us who have diabetes are particularly vulnerable, because we have so many things that we have to consider. That’s why the American Association of Clinical Endocrinologists working with Eli Lilly and Company created the “Power of Prevention: Diabetes Disaster Plan.”

Todd Frieze, M.D., who practices diabetes, endocrinology, and metabolism in Biloxi, Mississippi, spoke on the organization’s disaster plan for those of us with diabetes this morning at a media briefing during the last full day of the AACE’s annual meeting in Boston. He said that they developed this checklist of items that we need to plan for after thousands of people were caught unprepared as a result of Hurricane Katrina in 2005.

Dr. Frieze Plans

In such an emergency we may well be totally on our own. “When something does happen, access to medical care may be curtailed or absent completely,” Dr. Frieze said. He noted that in 2005 his patients were out of touch with him for seven weeks.

Here is the checklist. As the Boy Scouts say, “Be Prepared:”

Prepare a portable diabetes disaster kit that is both insulated and waterproof containing the following items:

  • List of all medical conditions and prior surgeries.
  • Information about your diabetes, including past and present medications, any adverse reactions to medications, and past and present complications.
  • List of all your health care professionals with their contact information.
  • Letter from your diabetes health care professionals detailing most recent diabetes medication regimen (especially for insulin) and containing most recent laboratory results.
  • List of all medications, which should also include pharmacies and active prescription information and eligible refills.
  • A 30-day supply of medications for diabetes and all other medical conditions. This should include insulin, oral anti-diabetic agents and severe hypoglycemia emergency kit (if prescribed by your physician).
  • Blood glucose testing supplies including lancets, test strips and preferably at least two glucose meters with extra batteries.
  • A cooler and at least four refreezable gel packs for storing insulin (do not use dry ice when storing your medication).
  • Empty plastic bottles and/or sharps container for syringes, needles, and/or lancets.
  • Source of carbohydrate to treat hypoglycemic reactions (e.g. glucose tablets). Ideally should also have one or two day’s supply of food that does not require refrigeration (e.g. non-perishable).
  • At least a three-day supply of bottled water.
  • Pen and/or pencil and notepad to record blood glucoses and any other test results and any new signs/symptoms suggesting medical problems.
  • Additional medical/first aid supplies like bandages, cotton swabs, dressings, and topical medications (antibiotic ointments or creams) to treat cuts or abrasions.

Other recommendations:

  • Wear shoes at all times and examine your feet often for infection.
  • Make sure that all immunizations including tetanus are updated.
  • Pack extra comfortable clothing including undergarments.
  • Take a cellular phone with extra batteries for you and family members.
  • Consider choosing a designated meeting place in case you are separated from your family and unable to reach them by phone.

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

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The Complexity of Health Care

May 28th, 2010 · 1 Comment

If you never heard about Atul Gawande, M.D., you don’t know the best medical writer in the world. As a medical writer myself, I consider my naming him that to be about the highest praise I can offer.

When the people at the American Association of Clinical Endocrinologists told me that Dr. Gawande would be the keynote speaker at this year’s meeting in Boston, I didn’t think twice about accepting their invitation. Listening to his address this morning, I was as impressed by his talk as I was earlier by reading his three books and his many articles in the New Yorker magazine.

But if Dr. Gawande were just a writer, this organization of practicing endocrinologists wouldn’t have made him their keynote speaker today. This incredibly talented young man, born in 1965, also happens to be associate professor of surgery at Harvard Medical School and a general and endocrine surgeon at Brigham and Woman’s Hospital in Boston — two list just two of his many positions.

At least he didn’t have to travel far in order to speak to speak to about 1,000 of us today. I made sure to get to the auditorium early so I could sit in the front row to photograph him.

Dr. Atul Gawande Speaking This Morning to Endocrinologists

I also wanted to take a close look at Dr. Gawande to see if he looked frazzled from all his work. As you can see from my photo, somehow he looks quite relaxed.

Earlier in one of my articles here I named Dr. Gawande as as inspiration for my writing style. He even takes time to answer my emails when I write him. No wonder that the John D. and Catherine T. MacArthur Foundation a few years ago named him a MacArthur Fellow, which well deserves its nickname, “the genius award.”

President Obama cited Dr. Gawande’s article last year in the New Yorker, “The Cost Conundrum,” which used as an example the town of McAllen, Texas, to argue that unnecessary medical tests and procedures were a primary factor in driving up the cost of health care in this country. That article affected the President’s thinking dramatically, according to Senator Ron Wyden, and soon after its publication, he showed the article to a group of senators including Wyden and said, “This is what we’ve got to fix.”

Today, Dr. Gawande spoke on “Beyond Reform: Facing the Complexity of Health Care.” The key word is complexity.

He mentioned diabetes a couple of times in his talk. But for now please think of diabetes as subsumed within our country’s much broader health care problems. Here are some of the passages of Dr. Gawande’s talk that immediately caught my attention as I recorded them.

“The deepest struggle of health care is its complexity,” he said. “This is the reason why health care often doesn’t work. Just half a century ago medicine wasn’t either expensive nor effective.

“We have identified now more than 13,600 diagnoses. And for each of them we have identified steps in their care that can reduce people’s suffering, if not actually cure their disease. But that arsenal has now accumulated to become more than 6,000 drugs currently that you and I can prescribe and more than 4,000 medical and surgical procedures that we can provide.

“It’s incredibly hard. There is no industry in the world that has to provide 13,600 different service lines to every community in the country, let alone the world, and customize it to every customer. It is man’s most ambitious endeavor.

“The value it’s producing, though, is already excellent. Life expectancy has increased five years since 1960 and nearly all of it has accumulated after the age of 65. It’s brought longer lives and later disability, and that has produced its own problems, because during that same time period we have reduced the average retirement age from 67 to 61. Somewhere this is not going to add up (he smiles).

“We are at the point where the volume and complexity of the discoveries we have had in the last century has now exceeded our ability as individuals to delivery optimal care reliably and safely. I think we were fooled by penicillin. It was miraculous for a couple of reasons: number one was the idea that you could treat this incredible range of infectious disease that could never be reliably treated before, and the second thing was that this took only an injection.

“It was that simply. And it led us to imagine that the future of medicine would look like that. There would be an injection for cancer. There would be an injection for heart disease. But it hasn’t turned out to be anything like that at all.

“We were fooled into imagining that discovery was the only hard part and that execution would be easy. And that couldn’t be further from the truth.

“What’s missing is innovations for great care. It’s innovations not as we are used to thinking, where we think of drugs and devices as the sole carrier of innovation; it’s about systems innovation in health care.

“Making food of higher quality at lower cost was the fundamental question of the 20th century. Now, we are coming to a basic understanding of how we will make better care at lower cost. This is the fundamental issue of the 21th century.”

This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.

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Posted in: Psychosocial