We thank you for your many queries related to life with diabetes! And many thanks to our host Wil Dubois — diabetes author, community educator and veteran type 1 himself — for diving deep into such a variety of D-related topics.
This week at Ask D’Mine he’s taking on some fundamentals: dealing with mega-unhelpful family members and mega-challenging workplace issues.
{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}
Renee from New Jersey, type 1, writes: When I went home to visit recently, my mom actually asked me to test and take my injections in the bathroom, in order “not to upset people” in my family. This made ME really upset! Why should I have to hide? How un-supportive can a family get?
Wil@Ask D’Mine answers: My wife and I have talked it over, and we’ve decided to adopt you. Of course, we’ll have to stand in line with the other 940,000 adult type 1s in the country who’ll also want to adopt you once they read this column.
So, your email made ME really upset, too! Well more than upset. Upset would be an understatement. It pissed me off, big time. I got mad. Really mad. This is one of the most degrading, detestable, despicable, contemptible, loathsome, reprehensible, vile, awful, revolting, foul, horrible, callous things I’ve ever heard of! And from your own mother, no less!
You should not have to hide.
At home or any frickin’ other place, for that matter.
Not then. Not now. Not ever.
You have the fundamental human right to be you, and to do what needs to be done to keep yourself healthy. You deserve the active understanding and support of your family; not to be treated as a metaphorical leper.
I believe your family has reached a new low in unsupportiveness. In fact, I think we 
should give them an award. You, know, in the spirit of the Razzies, the Ig® Nobel Prizes, or the Darwin Awards. Readers can help us choose the name for this award to recognize new lows in diabetes support.
But meanwhile, what to do about your mom? I don’t think you can just let sleeping dogs lie in this case. I think you need to call her on it, in some way. Diabetes is part of who you are. Your family, most especially your mother, needs to accept it as part-and-parcel of Renee.
Frankly, if I were in your shoes, I’d now go out of my way to test and shoot up in front of them. Wear them down from constant exposure and constant reminder. Refuse to retreat to the bathroom. I’d even go further than that, oh, here, will you hold this vial for me while I shoot my insulin?
I bet that’s what Gandhi would have done, if he’d been type 1, and his mom had treated him that way.
Randy from Rhode Island, type 1 writes: I have a high-stress job and work the night shift. I have other medical problems that I have been able to manage; but diabetes is a very complex disease where diet, rest, exercise and medications are a continuing balancing act. I’m not sure if there is anything I can do other than find a day job, but do you happen to have any ideas or information about diabetes management and working night shift?
Wil@Ask D’Mine answers: If you find a day job you’ll find that diabetes is still a very complex disease where diet, rest, exercise, and medications are a continuing balancing act. It really doesn’t matter if you are trying to do it by moonlight or sunlight.
Painting: JP Irizarry
One thing I don’t know is whether you’re using an insulin pump. If not, that’s the single best thing you could do to balance the demands of your life. Pumps allow for much, much, much, much, much, much more flexibility when dealing with a chaotic life. Take basal insulin, for instance. For our type 2s who take pills, let me briefly review this topic: All type 1s (and some folks who’ve had T2 for a while) need two kinds of insulin coverage, called basal and bolus. Bolus is a fast, strong insulin you take when you eat, or when you need to fix an oops! blood sugar. Basal on the other hand, is a slow, low-grade insulin that helps the body process the constant drip-drip-drip of sugar from the liver that keeps your cells fed between meals and while you sleep.
Basal insulin needs, for those of us pancreatically challenged, have traditionally been addressed by taking injections of a time-release insulin. This actually works fine for some people, but not so well for folks with highly variable stress. Pumps dispense with the need for this kind of basal insulin by dripping a constant supply of the fast-acting insulin into your body from the pump, to cover your body’s basal needs (of course the pump can also deliver a bolus for meals or corrections).
The advantage is that you can easily vary the supply as your needs change. First, you create a basal pattern where you and your medical team choose how much basal drip, called a rate, you’ll get at various times of the day, based on your patterns of eating, exercising, stress and blood sugars. But you can override these and deliver more insulin to counteract elevated blood sugar from increased stress; or less insulin to compensate for lower blood sugar from increased activity. The real beauty of this system is that, because it uses fasting-acting insulin, the changes you are making only effect a relatively short window of time.
By comparison, you can’t “take away” a time-release basal insulin shot after you’ve taken it. If you need less, your only solution is to eat extra carbs to soak it up, and that makes you fat! Also, if you need more basal insulin and you’re using an old-fashioned shot, you’re committing to more insulin for a full 24 hours, which often leads us back to the start of this paragraph.
So rather than get a day job, I’d get a pump. After all, your diabetes therapy should be made to fit your lifestyle; your lifestyle shouldn’t have to change to fit your diabetes therapy. That’s putting the cart before the horse.
But for what it’s worth, I also called around to some other night workers to see how they were handling their diabetes. Edward Cullen, Nick Knight, Barnabas Collins, and Lestat de Lioncourt all tell me they use insulin pumps to manage their diabetes, crazy night shifts, and stress.
What? You didn’t know that most vampires have type 1 diabetes?
Disclaimer: This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.
When I can, I inject in public. I get nary a look, thankfully.
Renee might also want to check out the “diabetes etiquette for people who don’t have diabetes” cards from the Behavioral Diabetes Institute (http://behavioraldiabetesinstitute.org/resources-diabetes-information-publications-etiquettecard.html). If it’s too tough to start a conversation with the unsupportive family/mother cold, the card could be a good conversation starter.
#5 is “Don’t look so horrified when I check my blood sugars or give myself an injection. It is not a lot of fun for me either. Checking blood sugars and taking medications are things I must do to manage diabetes well. If I have to hide while I do so, it makes it much harder for me.”
SERIOUSLY?
This make me sooo mad that a FAMILY member would ask you to do this. Hubs is diabitic as is my mother in law and insulin taking is something that’s just done. Hubs has ALWAYS in our own home taken insulin where he is and has felt awkward at times when we are out. Diabetes is awkward ENOUGH without having to worry about how people react to you taking your shot. That’s just wrog.
Yes, this behavior is hurtful, and especially painful coming from those we should be able to trust: our family, friends, and colleagues. If we all had a dime for every comment, diabetes research would be fully funded. But it stems from ignorance, and widespread and outdated misinformation. The solution is to be very visible in the ways we deal with diabetes and to explain again and again and again. After 7 years of LADA, my husband and daughter get it, 98% of the time. My family are getting better, but we get together infrequently and what they seem to learn is often forgotten by the next visit. My instinct is to hide even more, not to bother them, to protect myself; but because we are blood, they need to know. It’s the demon in the darkness that frightens us the most; turn on a light and the world is less scary.
My almost 3 years young granddaughter has been helping me with my injections ever since she could sit and put a little hand on the diapen (automatic gadget). And she insists on opa’s bare belly pulling the shirt out of my trousers when I attempt to shoot through the shirt with more company than just the family at the table. And sure she also helps me with my finger pricking. – I’ve heard of people like Renee’s mom, but so far they’ve all been lucky not to have met with me yet
Loved your response to the first question. I totally agree and feel for this person. I’d feel quite hurt if my family treated me this way
As for the pump, that may be true, but I do rather well with my very inconsistent schedule of activity, sleeping and eating (due to my twin 2 year olds that I stay home with all day) and shots and lower than average carb meals do the trick for me. So I’d say the pump thing is relative. But the best way to find out is to try the pump! Then you know for sure if you benefit well from it or not and if you do, you win!
I worked the nighshift for a few months last year. My biggest problem wasn’t so much the fact that it was the night shift, but that made it for little consistency. I have always found that consistent patterns throughout the week for eating, sleeping and exercising was very helpful in keeping my Diabetes regulated.
But I worked the nighshift week days and then in the weekend when I had to keep my social life alive, I had to swap out of the night shift regimen. And thats a bigger change then the normal workday and weekend switches. Keeping consistency in carb intake and exercise every day was a big help for me in managing the whole thing.
Instead of using normal clock hours to add consistency (breakfest at 07:00, lunch at 12:00, etc) I just swapped to an X hours from waking up schedual (breakfest 1 hour after waking up, etc). Sounds weird, but it worked very well for me. My a1c went up only 0,4 for those months to like 6,3. But in the end I was glad when it was over (and I knew beforehand it was a limited time). In hindsight being in a supportive relationship back then was also a major help to pulling it off.
Hi Renee… any chance you live within an hour or so of Princeton, NJ? I run a monthly support group for people with type 1 (there are also weekly groups for people with type 2 and weight issues)… called http://www.TheSuppersPrograms.org where we come together for the first hour and cook a low carb meal of healthy whole foods TOGETHER… so fun.. all t1s… we all test our blood sugar together, compare meters and pumps, CGMs and our trials and tribulations… as well as our successes. Then we sit down to share a meal for the the next hour. It is fantastic. Supportive, empowering… loving!
The support groups lead me to change my career… become a health and nutrition coach mainly for people with diabetes… I am so crazy passionate about supporting people like you… after my 15 years of living with t1… I just felt compelled to go back to school in nutrition and bring what I have learned to others.
Check out my site… http://www.RoseHealthCoaching.com... for more info on my approach.. I even have several docs (including my endo) sending patients to me!
Keep up these wonderful connections Will!!!
Karen Rose Tank… 15 years of t1, Certified Health Coach
This is about Renee’s mother’s request that she take care of her shots away from her family. I did not agree with Wil’s comments. Why does she have to get in everyones face with it? It has nothing to do with being supportive. People can show compassion but don’t need to witness blood testing, injections and viewing an aray of equiptment spread out on the dining table. It’s like “it takes a village” mentality. Actually the strength should come from within yourself. Make it no big deal – it’s a daily meds thing you do quietly – no need to sound so resentful – you’ll find that ultimately it’s your thing – not anybody elses. Wil’s comments were so childlish – getting so upset mom’s request. The most important thing is to keep her blood sugar normal and daily life normal and happy.
I worked the night shift for awhile. The thing that worked for me was to keep that same schedule on my days off. It’s tempting to switch to “normal” hours for socializing, but I found it hard to keep to a consistent schedule doing that.
The benefit of working the night shift was no tempting restaurant food. You’re pretty much required to bring in food, which makes it easier to carb count and eat healthy.
I think I would work on addressing your reaction to stress as well, since stress can mess with your blood sugars.
I agree with Meri about the request that testing and injections be done privately. It’s not an unreasonable request. Wil, I bet if you give it any thought you can think of some medical procedures you’d rather not see at the dinner table! Some people are really uncomfortable seeing injections – don’t make your problem their problem.