Guest blog…Diabetes Impact on the Mental Wellness of the Elderly

I was recently contacted by Jenna Walters, an English major with a passion for diabetes. We know that there is a strong connection between diabetes and depression.  Jenna speaks to the issue of the impact on the mental wellness of the elderly.
Thanks Jenna!
Once diabetes develops in a person, it becomes a life-long medical condition that requires an effective management plan. Most people are familiar with the negative health implications associated with diabetes, which include an increased risk of stroke, heart attack and kidney disease. However, few people realize that diabetes can contribute to various mental conditions, especially in seniors. Regular health screening for diabetes increases the chances of early diagnosis and reduces its impact on mental wellness.

Mental Illnesses Linked to Elderly Diabetics

Depression is a common mental condition that occurs synonymously with diabetes. In some patients, the diagnosis of diabetes contributes to overwhelming emotions and stress leading to a depressed mental state. Depression in diabetics may also be linked to some medications used for diabetes treatment, metabolic processes or the sudden realization of a life-altering medical condition.

Results of a scientific study published in the September 20, 2011 issue of Neurology, an American Academy of Neurology publication, indicate an increased risk of Alzheimer’s disease and other dementia conditions in diabetics. Type 2 diabetes and its connection to the development of Alzheimer’s disease is not entirely understood. It is believed that uncontrolled blood glucose levels in elderly diabetics causes a condition known as vascular dementia, caused by blood vessel damage in the brain. This damage to the brain’s blood vessels contributes to mild cognitive impairment, MCI, a phase of mental and cognitive changes that occur between normal aging and more serious conditions such as dementia.

Improving Mental Wellness in Elderly Diabetics

An active lifestyle has been found to improve overall mental wellness of cancer sufferers, such as peritoneal mesothelioma, as well as in elderly diabetics. Studies indicate diabetics who participate in 30 to 60 minutes of aerobic or a mix of strength training and aerobic exercises, three to five times per week, decrease their risk of mental disease and complications from diabetes. Regular exercise increases mental alertness and improves judgment and thinking skills as a person ages.

Maintain a healthy diet and reduce blood sugar spikes and fallouts. Drastic swings in blood glucose levels have a direct impact on a person’s mood. Extremely high or low readings lead to irritability, loss of concentration and decreased mental sharpness. Use a balanced diet of lean proteins, fiber-rich foods, vegetables, whole-grains and complex carbohydrates to combat food’s affect on glucose levels and mood.

Follow a doctor’s treatment plan for diabetes and mental illness. Discuss symptoms of depression or other mental changes with a healthcare provider. Identifying the source of the symptoms helps treat the underlying cause and improves the chances of successful treatment. Diabetics in a successful treatment regimen tend to manage their diabetes better than those with uncontrolled mental diseases. Good mental health improves a diabetic’s ability to focus on managing the disease through diet, medications and exercise.

Who knew? I Should have.

I mentioned on Monday that I was writing a letter to our provincial government in an attempt to expand our insulin pump program.  I had created a group on Facebook as a way to unite people to get this done.  I knew from past experience that the more people involved, the more letters that were written, the greater our chances of seeing change in the 2012 spring budget.

I invited a few friends to this group.  I asked them to invite a few friends.  We were a small group.  With the exception of me posting encouragement, I did not see a lot of activity.  Was anyone paying attention? Had everyone given up before we started?

As I worked on a draft letter, a few people began to comment.  There were thanks for getting this together. There was an interest in seeing change.  Despite this I still was wary.  Could we create change? Could we at least mount a real campaign in support of this?

I continued to work on my letter. I read studies.  I researched dollar amounts.  I took notes and prayed that I could fit everything into some sort of order that would get the facts out there and would keep the reader’s interest.

I sent a copy of the letter to the budget committee. I posted what I was doing here and on other sites and groups that I belonged to.  I emailed some people and hoped that they too would help.  I continued to rally my Facebook friends and family members to get involved. 

I didn’t expect a lot. 

In the first day, a person that I had contacted said that five letters had been forwarded through themselves and friends.  Other people began to say that they too had forwarded the letter on.  Soon we had at least 20 copies of the letter sent out and it had only been day one. People were getting out seven and eight copies in a  day thanks to family, friends and their own dedication.  They were spreading the word. 

Yesterday the work week ended. I have no idea as to how many letters were sent out.  I had emails from people in other provinces who wanted to use my letter to help out in their area.  I had people without diabetes who have followed my ramblings who wanted to obtain a copy of the letter and show their support. I was truly touched.

I often worry that I am not doing enough. I fear that my time as past.  I think that perhaps I  need to just give it all up.  What difference does it really make? I am starting to see the difference. 

I can’t say for certain that we will see a change in this budget.  I can say that we have created a very strong case. We have brought a large number of people together on this issue and we are not done! Letters and emails have until February 13th to be in.  We will see many more submissions made by that time.  Our voice is strong. I am truly amazed and privileged to have been able to be apart of such a wonderful group.

Let is Snow

We have established that my son’s body has an aversion to snow.  He loves snow. He loves to snowmobile and enjoy the cold crisp air. Diabetes on the other hand does not like snow…or perhaps its just allergic to the physical work that snow brings.

For years, whenever it has been snowing and I made my son go outside to shovel he would be low.  No, not after the activity but long before it has started!  Before he can put on his boots, he will feel shaky, test and be low!  It has always drove me insane.

This winter, the snow was piling up.  Larry was outside clearing the driveway.  I could hear my son head into the kitchen, open and close the fridge door, and then head back to his room.  Five minutes later Larry came in and asked him to go outside and clear the steps.  He couldn’t.  He was low–in the two’s (low 40s).  He did come back up, had a cereal bar for good measure and got the job done but Diabetes made sure he was low first.

A few days later, he was again asked to go outside.  Yep, he was low before he put on his mitts!

“Why does your body hate snow?”

“I think it just feels that I really shouldn’t be doing this kind of work. It thinks that snow should be reserved for skidooing and not manual labor.”

Funny boy! Diabetes or not, he does his share of work around the house and that includes shoveling snow when needed.  Diabetes will just have to get used to it!

My Purse

Since its “wordless Wednesday” I figured that a picture of just some of the contents of my purse would speak volumes for me.

Strength in numbers

Its that time of the year again…pre-budget time in Newfoundland and Labrador.  This means that its our opportunity to try and convince the current provincial government that money spent on insulin pump therapy now will save them money in both the short and long term.

Newfoundland and Labrador is one of the better places to live in if you have diabetes. They cover insulin pumps for those people with Type 1 diabetes who are under the age of 25. This is better than those people living in Alberta who have no provincial coverage but is not as good as those living in Ontario. 

Each year, I have worked to see this change. First to see pumps covered at all, then accepting the increase to 25 and now…well I am done with crumbs and I want the entire cookie for people with diabetes in this province!

I have spent the past few weeks researching and reading.  I took that information and spelled out exactly why we need the insulin pump program expanded to include all people with diabetes and continuous glucose monitors. 

Sadly the government only cares so much about the quality of life issues.  They only care so much about how much easier it will make your life.  Their main concern is how much it will cost them. They want bottom line so this year I gave it to them.

With the help of some great studies, I was able to show the cost of less than optimal control on the health care system. I was able to show them the dollar value of a person working versus someone who has had to leave the workforce because of diabetes related complications. I showed how money was saved and funds could be re-routed by adopting a more expansive program.

I am only one person though. I have shared the document with a group of people who want to see change. I have shared it with other people that I felt would be interested in seeing this happen. I have asked these people to share with their families and friends.  Every person who shares this plea with the provincial government brings us that much closer to seeing real change. Never doubt the value of public pressure…even when the government is crying broke.

If you live in Newfoundland and Labrador, or know someone who does, please send your own letter or email me for a copy of the letter that I have sent. There truly is strength in numbers.  Together we can make a difference! but hurry! The submission deadline is February 13th.  

“Good” is not a number

Does this happen in your house?

“What was your reading?”

“Good”

“No, what was your reading?”

“I don’t know but it was good.”

Arggghhhh!! “Good is not a number. Good is a four letter word.  Yes, “four” is a number but good does not necessarily mean “four”. “

At this point, my son usually looks at me like I am completely insane.  If I am lucky he has figured out that I would like to hear a real blood glucose reading and not his generalization of his take on his reading. 

“10.0” (180)

“That is not good.  That is actually a bit high since you just woke up and should technically be under 7.” 

“I like it. Its good for me. I think 10 is a good number.”

“And that is why good is not a number. What you define as good and what I define as good are not the same.”

The teen years can be trying enough, but a teen with diabetes? Well he may well tip my sanity scale! Time to buy some more hair dye to cope with the dozen new grey hairs he just caused me.  

Update after…Hating Five

I was driving in the car with my youngest son. He yawned and I asked if he was tired. 

“Why?”

“Well, I thought you might be tired since I was up all night wondering when you were going to go low.  You hovered between 4 and 5 all night. I wasn’t sure what to do and didn’t want to send you high so I ended up awake for most of the night. You finally did go low, I gave you a juice and things eventually worked out.”

“Next time give me a sandwich.”

“What???”

“Next time I’m low.  Don’t worry about the juice, I would rather have a sandwich.”

Oh my! Teen boys and food! Its not like I haven’t fed him a sandwich while he slept before but that was back in the days of injections and NPH. Nowadays its juice, gel or tablets and some sleep. 

After this nightmare night, as I mentioned, I had to decide if I should decrease the basal rate or give it one more shot.  We had a huge dumping of snow that day and my son had been out shoveling for a few hours. When the evening came, I had to decide what to do. I went with the wait and see approach. In hindsight, it wasn’t my most brilliant decision but this time he was over 7 (130ish) before going to bed so I thought I had a lot more wiggle room.

Wrong! Two o’clock in the morning saw him dropping again. There was no sandwich.  I found some regular pop and decreased his basal rate.  I also changed the previous rate back down to where it was to begin with. I was not taking any more chances!

Why I hate Five

Its been three Thursdays and we are still doing the “Reading Review Thursdays“! Yesterday was actually a bit of a fluke.  My son had been having high reading overnight for the past three days. I knew that it was time to make a change. I decided that it was easiest to look at the rest of his readings then as well.  As I was writing down dates, I realized that it was Thursday! I was right on schedule. Yeah me!

Yes, I need a life and am a little sleep deprived.  You see, despite being high for three nights (and I mean close to 20 or 360 for my American pals) my son was perfect to on the low side all night long last night. 

After our pump tweaking, we sat at the kitchen table and chatted while he drank a Tim Horton’s smoothie.  He was 4.5(81) before he started.  He then ate two Eggo’s as well.  I felt that he would soon be running a lot higher and my basal changes came just in time!

Erring on the side of caution however, about 20 minutes after he went to bed I had him test again. He was 4.2 (75)! Crap! I sent him to the kitchen to chug a glass of juice. 

“Should I stay up and retest because I am low?”
“Well, you aren’t technically low. You are just in a range that I really don’t like you to go to sleep at.  The juice should cover it. You have school tomorrow, get some rest and I will check later.”

I checked him a few hours later and he was right around 5 (90).  Was he going to go up or drop? I was not going to get any sleep.  I hate these nights–no clear low but clearly not safe yet either.  I didn’t want to add glucose and send him too high but was it safe to leave him? Would he stay around 5? Could I be that lucky? My mind would continue to race like this all night long.

I slept for another hour but I had to get up and check again. He was dropping.  At 4.2(75) I gave him juice, grabbed my book and waited.  By 4am, he was back up to 5.6 (101) and I could sleep for another couple of hours.  By 6am I was up again but he was finally up over my favorite number 6 and had climbed to 8.6(155).  A bit of peace at last!!

Today I have to decide if I keep the basal rates at their new higher level and risk a repeat performance (although with a little knowledge, a temporary basal would be added to the mix if things began to tank) or if I go back to the old settings and assume that the highs were site related. Decisions, decisions. Just another night on the Diabetes Roller coaster.

Two..its not so terrible anymore

For years I couldn’t look at two year olds for more than a few minutes. My heart would break when I realized how truly small they were. I would look at the tiny fingers with no marks on them and want to cry. 

I have had to get over this. Yes, my son was that small once. Yes, what he had to endure was not what a two year old should experience but he is alive and healthy today.  He still goes through things that a teen shouldn’t have to think about either but that is our life and we have to live it. 

I have a precious little two year old girl in my life.  I am able to look at her tiny fingers and simply see the amazing things that she creates with them and how she uses them to pull her mother’s face close as she kisses her.  Every once in a while, I still slip back. 

Yesterday she came for a visit.  We nursed her dolls back to health, caught up on Dora, played with play dough and colored a few pictures.  All of that work required a snack! She sat down to the table and chose what she wanted to eat.  She ate the amount that she wanted and was blissfully happy.

For just a moment, I looked at her cute little face and realized that she was the exact same age now as my son was when he was diagnosed with type 1 diabetes. I didn’t have to count her crackers. I didn’t have to measure out her milk.  She would not be forced to eat when she wasn’t hungry.  She would not have to learn about “cow-bo-hi-dwates” until she was an adult and only then if she chose.

The thoughts of diabetes faded quickly however as she showed me her mouth filled with food and laughed at my feigned disgust.  Its a game we have been playing for months–I “see” the food all mushed in her mouth, she swallows and then tells me that she sent it to her tummy and shows me that.

Diabetes no longer robs me of these moments but it still lurks in the background taking me back and making me grateful for healthy pancreases in those I love and more.

How much is it?

Friday night I had to run out and on my way home I stopped into Dairy Queen.  We don’t often have ice-cream in the house and despite living near many fast food places, don’t often frequent them. Friday night we deserved a treat! 

I ordered three blizzards and headed home. I knew that I would be met by two happy young men.  I was right. I had chose the right flavors for each child.  The next thing was to figure out the carbs for my son. 

I asked him “How much do you think that is?” 

His friend instantly replied, “They cost a lot!”

I laughed to myself.  We were looking at the carb count and that was the furthest thing from this boy’s young mind. That was great!  

I smiled at my son and pulled out my phone to search for the carbs.  We established it was around 64 grams.  The other boy had now realized what we were talking about and was shocked to know that his ice-cream was so high in energy.  I know it didn’t diminish the flavor for any of us!

We all enjoyed our treat and it was refreshing to see a “diabetes free” perspective on a question my son and I ask each other numerous times each day.