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[IP] Thoughts for the Health Care Professional

I wrote this in my journal a few months ago, after getting on the pump, but
learning that this therapy was being withheld from me due to the perceptions
of the team that I was "not ready".  I'm glad to say my persistance paid
off, but I truely believe that they interpreted the effects of depression as
a lack of interest in maintaining good control.  I submit this for your
consideration, but primarily for me......

A hypothetical conversation with a health care professional regarding the
difficulty in dealing with hypoglycemia:

 "I tell you this for three reasons; first and foremost I do so for myself.
Around every injection, around every finger prick, around every hypoglycemic
event there lurks a small piece of cloth, a piece so small that in and of
itself is insignificant, but as these pieces accumulate they begin to form a
quilt, a blanket that sneaks up and starts to smell of depression, that
somewhat smothering feeling that creeps over you ever so slowly.  Before you
know what is happening the depression arouses those corrosive feelings of
apathy, indifference, frustration and helplessness.  The mere act of
expressing and articulating, no matter how ineffective, is an essential
"venting" event.  The weight of carrying this quiet killer can be lessened
substantially merely by having the opportunity to share it with another
human being.  So remember when I try to express these feelings I am reaching
out for your ears to help myself cope and deal with one of the least talked
about complications of diabetes, depression.

"Secondly, I tell you these things for your benefit.  As a health care
professional, you need to crawl inside the head of a diabetic, you need to
hone your skills of perception, because you are dealing and treating a
patient, a person, not a disease.  It is incumbent on you to learn that you
not only have the opportunity to treat this unspoken complication, but you
have the responsibility to do so.

"Thirdly, and perhaps more altruistically, I tell you these things to
benefit the next patient you will be treating today.

"Prior to going on the pump, an attack of low blood sugar, was always
complicated by trying to understand exactly where I was in all the time
release curves of insulin absorption, knowing when I ate last, what I ate,
as well anticipating when I will be eating again, and so forth.  My reaction
to all this chaos was to merely over ingest carbohydrates, and consequently
overshoot by several hundred mg/dL.

"The logic of the pump simplifies greatly the task of dealing with
hypoglycemia.  Knowing and understanding that the pump, when all things are
settled out will maintain a fairly constant blood sugar level, and merely
consuming 15 g of carbohydrates will raise this sustained level to a better
level.  So the reaction now, to hypoglycemia is merely drink 6 oz of OJ, or
something equivalent in carbohydrates.  This may sound somewhat obvious or
even trivial, but remember the first reason why I am telling you this.
However, I need to mention that although the obvious physiological benefits
of not overshooting can easily be understood, they dwarf in comparison to
the psychological and even spiritual benefits.  The piece of cloth
associated with these hypoglycemic events has now been reduced to just a

"To further elaborate on the difference in dealing with these hypoglycemic
events allow me to use an analogy.  It is like being on an elevator and
realizing you are on the wrong floor.  You can merely push the button to go
up a floor.  This same experience prior to being on the pump was like
suddenly realizing that you are in the middle of your first bungee jumping
experience and you are not sure how long the bungee cord is or where the
ground is...

JD Manning - 11/11/2000

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