Movies, Type 1 diabetes and Real Life don’t often match up

There are a lot of challenges we face living with Type 1 diabetes in a world addicted to simple answers and sensationalism. Living with the condition is mostly manageable, if challenging. Living with the image of the condition as portrayed in movies, books and T.V. adds to our daily challenges, as this is where the misleading, erroneous and dangerous public perceptions of us are formed and  disseminated.

Steel Magnolias, which was a popular movie and play in the late 1980s depicting relationships amongst a group of women in a small Louisiana town, contains a portrayal of a woman living with T1D that made a big contribution to the stigmatization and exclusion of people living with this medical condition, particularly women of childbearing age, on the basis that they could not possibly live normal lives and that it was reckless and irresponsible to try.

The screenplay was written by the brother of a woman who had died from complications of diabetes. Nonetheless, it is riddled with inaccuracies and misinformation and perpetuates the myth that people with diabetes are weak, irresponsible and doomed to an early death if they try to do ‘normal’ things like having children. Quite simply, T1D is used in the story for its dramatic effect and it is exaggerated and vilified to increase the emotional impact of the narrative, in typical Hollywood style. This aspect of the narrative is milked for all its potential tear-jerking effect.

In 1989, when the movie came out, I was working as a Bay St. lawyer and trying to get pregnant with my first child. I had been living with T1D for 16 years at that point, and had not let it stand in the way of moving away from my small hometown, getting an education and launching a successful legal career. I had been married for 3 years, and we decided to try for a baby. Knowing that at the ripe old age of 29, I was already considered higher risk for a pregnancy, and after 16 years of T1D, that risk was increased, I was still keen on taking a careful and well-planned approach to reproducing. I was enthusiastically supported in this endeavour by my medical team, including my endocrinologist, my family doctor and my ob/gyn, all of whom had a significant amount of experience with women with T1D having successful pregnancies.

This movie did not help my situation at work or in society when I disclosed to people that I was pregnant and living with T1D. In fact, it made it very difficult, because it added an additional source of external stress at a time when I least needed it. It made my friends, colleagues and family fear for me at an unwarranted level, and some to consider me irresponsible for trying to have a child.

In fact, the pernicious effects of this misleading image of living with T1D drove me further into the closet than I had ever been and kept me there for many years.

I realize that the story of the T1D woman in Steel Magnolias is a narrative device used to showcase and emphasize the strength and endurance of the relationships of the other women in the play, but I and many other women with T1D were stigmatized by the portrayal of that character. The story should come with a warning or a disclaimer at both the beginning and end of it. Something to the effect of:

“Although this story is based on actual events, the accuracy of the information and portrayal concerning women with T1D has been subject to considerable poetic license and dramatization and does not in any way represent a true picture of most such women, who are, in fact, quite capable of living normal and productive lives which often include successful pregnancies and challenging careers.”

(Photo and  text © Lynda Covello, 2015. All rights reserved. )

World Diabetes Day 2013: Crisis Managed

Posted on my FB Profile on WDD 2013:

Today is World Diabetes Day. Since most of what you will read will either conflate Type 1 and Type 2, or just focus on Type 2, which is 90% of cases, here are a few quick facts about Type 1:

-78,000 children a year are diagnosed with T1D

– 85% of people living with T1D are adults– so do the math…

-More than 300,000 Canadians and over 3,000,000 Americans have T1D.

-the prevalence of T1D has doubled in the last 25 years and is projected to double again in the next 15-20.

– it is an autoimmune disease and we don’t know what causes it. For some reason, your immune system attacks and kills the cells that produce insulin.

-insulin converts sugar into energy for your cells.

-people with T1D don’t make insulin.

-without insulin you die, so you need to inject it or pump it on a daily basis.

-there is no cure, and no matter how much you exercise or how little you eat, you will still need to inject or pump insulin every day.

-“Both children and adults like me who live with type 1 diabetes need to be mathematicians, physicians, personal trainers, and dietitians all rolled into one. We need to be constantly factoring and adjusting, making frequent finger sticks to check blood sugars, and giving ourselves multiple daily insulin injections just to stay alive.”— JDRF International Chairman, Mary Tyler Moore

-managing T1D over a lifetime makes you smarter, more self disciplined and actually healthier than most people your age who don’t have to pay the same amount of attention to their diet, exercise and overall health. It also reminds you on a daily basis that we all live on the edge of death, all the time. That can get heavy.

-T1D patients are routinely discriminated against in employment, healthcare and insurance — people underestimate our abilities and capabilities and make wrong assumptions about us all the time.

– People living with T1D can achieve anything that they wish, they just have to work hard to manage their condition so that it doesn’t interfere.

WEAR BLUE TODAY TO SUPPORT PEOPLE LIVING WITH DIABETES, AND IN PARTICULAR TYPE 1, THE ORPHAN CHILD OF THE DIABETES WORLD.

Thanks for reading all the way to the bottom of this. For more information on T1D, go to www.jdrf.org.

XXXOOO
Lynda

So I start off World Diabetes Day 2013 with a 3:45 am ‘Replace Battery’ Alarm on my insulin pump, bleeping me into foggy consciousness and telling me I’m not getting any insulin until I put in a new battery. Wait a minute, I just replaced the battery yesterday! And the day before! What’s going on?

I get up and put in yet another new battery (the expensive, lithium kind that is supposed to last for months and has a 15-year shelf life) and go back to bed. 7:45 am the ‘Replace Battery’ alarm goes off again! WTF???!!!

I get out my emergency replacement pump and try the last two batteries in it — no go. Okay, the batteries really are duds. But that was my last one, from the new pack that I just bought a few weeks ago (I always keep at least 2 new ones in reserve). So I’m not doing anything today until the pharmacy opens at 8:00 am so I can get some new batteries. Thank God I live in a big city, where the love of my life (Jim) can zip down to the corner pharmacy for opening time and grab me some fresh batteries and make it back before I finish my first coffee.

Two things:

1. Always have about 4x the amount of diabetes management supplies you think you need, and
2. A supportive life-partner can literally save your life. Treasure him!

Okay, now, and off to walk, run and hike with the Russian for our usual hour in the morning. Dressed all in Blue to show support for World Diabetes Day….

MY WDD FB POST ATTRACTED A LOT OF SUPPORT AND INTEREST FROM MY NON-T1D FRIENDS. UPDATED ON MY FB PROFILE THE NEXT DAY….
Okay, so MB (not a T1Der, but someone I grew up with), you were right! It was the pump. So here’s what happened and why I love Animas Canada, my insulin pump company. After all of yesterday’s shenanigans with batteries, I noticed this morning that the battery indicator was showing about half-charged, which shouldn’t be for a brand new battery (these things usually last 2 or 3 months).

I checked the History DB in the pump and saw that I had changed the battery 5x in 4 days. I called the 24/7 Technical assistance number on the back of my pump and spoke with Sue, RN, CDE. She asked me to pull some info off the pump and decided that we should replace the pump right away, and that I should switch to my back-up pump to ensure insulin delivery was not impacted. She said that Animas Canada would be calling me shortly to arrange delivery of my replacement pump.

She wasn’t kidding. Within about 15 minutes, I was speaking with Marynim of Animas Canada and she arranged to have a new pump couriered to me at my location within 1.5 hours. It arrived as promised, I transferred all the info from the old one to the new one, paired it with my OneTouch Glucometer, loaded it up with insulin and presto! Good to go.

The reason I love this company so much is that they provide such amazing service. I only spoke with 2 people, each of whom did exactly what I needed them to do. I was never placed on hold. I never had to repeat my story. They quickly addressed and resolved the problem to my complete satisfaction, always making my needs paramount. I was treated with respect, trust and compassion throughout what could have been a very stressful and dangerous experience.

Thank you Animas Canada! You are a trusted member of my diabetes management team!

XO
Lynda

(Photo and  text © Lynda Covello, 2015. All rights reserved. )

Captain of My Team

It is a cultural artifact that we regard medical professionals as authority figures. We expect them to command us and we are expected to obey. Hence the phrase: “doctor’s orders’. This relationship does not work for Type 1 Diabetes. It infantilizes the patient, which is the worst possible outcome. A person living with Type 1 needs a team of professional health care providers — endocrinologists, opthamologists, general practitioners, nurses, dietitions, psychologists, social workers, diabetes educators —  to help with management of the condition. But the patient needs to be the Captain of that team. Healthcare providers should be trusted advisors, not authority figures.

Healthcare providers may have relevant and necessary training and expertise in the science of the condition. I say ‘may have’ because in my experience not every healthcare provider who purports to understand T1D actually does. And a little knowledge, as they say…

Many conflate it with Type 2, and seem to think that all diabetes — and all diabetics — are the same. This is one of the things that irritates me the most. As far as I am concerned, Type 2 is a whole different medical condition that is not relevant to my life or my chronic medical condition. The two diseases share a name. They should not. This has created dangerous confusion in both the public and certain healthcare providers, who insist on speaking to and treating individuals with Type 1 the same as those with Type 2.

My body does not make insulin. No matter what I do, that is not going to change. I can diet and exercise till the cows come home, but I will still need insulin. We all need to deal with that. Putting me in a room with a bunch of Type 2 patients does not help me. All of the programing, public information and educational initiatives that are concerned with ‘Diabetes’ are, in my experience, primarily focused on Type 2 and we are just an afterthought. There may be some focus in the paediatric system on Type 1, but once we turn 18, we are abandoned.

Some of us are trying to change that.

Anyway, back to being the Captain of my healthcare team. A Type 1 patient needs to be in charge of her own healthcare management, because it requires effort and attention 24 hours a day, 7 days a week, and my healthcare providers are not available to me on that basis. Notice that I did not conflate that into 24/7. That’s because I want to convey to you just how specific, comprehensive and overwhelming that effort is. It is a tremendous amount of work. I am thinking about my condition all the time, every waking moment, no matter what else I am doing. I’m balancing my blood sugar against my food intake and my exercise level, plus the effects of my stress level, climate, altitude, etc. , all of which have an impact on blood sugar.

When I’m walking my dog, I’m managing my diabetes, calculating whether exploring that new path in the park is going to require a lower basal rate or some carbs to keep me balanced, wondering whether my perspiration is caused by exertion or low blood sugar.

When I’m in a business meeting, I’m managing my diabetes, calculating how much time I have before I need to make some adjustment in order to maintain my cognitive acuity. Stress makes my blood sugar rise, so does prolonged inactivity. Did I adjust my insulin dosages appropriately and is it still working properly?

When I wake up in the middle of the night, I have to manage my diabetes, directing my foggy night-time brain to get up and test my blood sugar to figure out if I woke up because it’s too high and I need insulin or if it’s too low and I need sugar. Then I need to be mentally clear enough to take the right corrective action, if indeed one is required. An error in either direction can have nasty consequences. Ignoring it and going back to sleep is just not an option.

When I’m performing on stage with my band, I’m listening not just to my voice and the music, but also to my body, looking for signs of low or high blood sugar. For a whole 45 or 60 minute set, I’m stuck there, not able to test my blood or bolus insulin – and people are watching me. At least I hope they are.

The point is I am managing my condition constantly. It’s not like I just give my medication and then forget it and get on with my day. So a Type 1 patient soon gains more intimate and comprehensive experience of her condition than any medical professional can match.

You need both in order to succeed: the medical expertise and the experience of the condition. You need a collaboration between trained medical experts who are current with all the latest scientific data and studies, treatments, therapies and theories and the you need the expertise of the individual who is living with the condition in his or her own particular body and managing it 24/7.

Healthcare practitioners seldom treat just one type of patient. Typically, they see a range of medical conditions, even if they specialize. T1D is only one of the medical areas an endocrinologist or a nurse or a dietitian will need to stay current with. T1D is extremely complex and not entirely understood. There is no cure, and we still are not sure why some people acquire T1D and others don’t. Also, each case is unique and what works for one individual doesn’t necessarily work for another. And in case that isn’t complicated enough, the condition in a state of almost constant flux. What worked for me a year ago (or a month or even a day ago) doesn’t necessarily work today. I can do exactly the same things two days in a row and get wildly different results. It’s like having a tiger by the tail.

The T1D individual, on the other hand, lives and breathes T1D, but in the context of their whole life. It is not the only thing I’m doing. So I need you, healthcare providers, to help me understand the big picture – the broader implications of the studies of hundreds, perhaps thousands of individuals over time and in varying circumstances. I need you to help me understand the possible implications of the things that are happening to me, as well as the things I do or don’t do to manage my condition. I need you to present me with alternatives and possibilities. But in the end, I need to be the one ultimately responsible for managing it. I need to make the decisions, after appropriate input from the experts on my team. Because I am the Captain. I need to be the Captain, because ultimately I am the one living with the consequences of the decisions made in the management of my condition.

So I don’t accept ‘doctor’s orders’. I expect consultation, communication and collaboration. I think we all want the same thing: better health outcomes, fewer hospitalizations, and lower long term costs — physical, psychological and financial —  of managing chronic illness. I believe – no, I know — that this is the only way to get there. We all need to be team players, and I need to be Captain of my T1D management team. Go Team!

(Photo and text © Lynda Covello, 2015. All rights reserved. )

 

Does the world really need another blog?

(Photo ©  Peggy Lampotang,  text © Lynda Covello, 2015. All rights reserved. )

Probably not. Yet here I go. I’ve decided to write this blog to collect my thoughts on life and living and to consolidate some of the other writing I’m doing as I navigate the transition from keeping my thoughts to myself or only writing privately, to sharing them and being in conversation with others. I know that I have enjoyed reading other people’s blogs, have learned from them or reflected upon them, and I’m hoping that you enjoy mine. But if you don’t, that’s okay. Just stop reading.

Still here? Okay. A lot of what I have been writing in the past year or so has been inspired by my experiences as a patient ‘voice’ in the Type 1 diabetes community. I’ve been living with T1D for a long time – 41 years now – and there is a very good chance it will be with me until I die. Although it influences me and has shaped my life in important ways, it does not define me. This blog will not shy away from talking about T1D and how it impacts my life, but neither will it be only, or even primarily, about that. There is so much more to me and my life than just how I manage my chronic medical condition. If anything, I have a greater appreciation for the things life can bring me, a hunger for living and experiencing as much as I can in the best way that I can, than I did prior to my diagnosis. So there’s gonna be a lot of talk about life, art, music, family, animals, nature, literature, and so on and so on. This will not be a how-to-live-better advice column, or a whipping post for the difficulties of living with an incurable medical condition. All you will get are my musings and thoughts about my experiences and the things going on around me.

So, to begin.

I started writing non-fiction again in the summer of 2013, after a transformative experience with the T1 Diabetes Think Tank Network, a group of people using the arts in innovative ways to improve communication between Type 1 patients and their healthcare providers. After many years of keeping my medical condition mostly under wraps, and not speaking publicly about it, I found this community of people made me feel that it was safe and not just selfish, but actually helpful to others, to talk about it. So I wrote a couple of short pieces that first appeared on their website: www.t1thinktank.com. I reproduce them here just to give some context about how this started