Diabetes Art Day 2012...

Portion

Control

'You are special'... Not Really.

To see this year's other entries to Diabetes Art Day for 2012 click here.

Hanging out with insulin pumper extraordinaire, Dr. John Walsh...

(And by 'hanging out with' I mean 'in the audience of a presentation by'.)

So, yay! John Walsh was in Toronto last week doing a few presentations. I packed my bags and travelled for a whole hour out to a convention centre around Pearson Airport for his last session... at 9am on a Saturday morning. Despite the early rise, however, the room was pretty packed and I had trouble finding a spot to sit.

The early presentation began in pretty much the same fashion that every person with diabetes starts their day: numbers. The first topic for discussion was the Actual Pump Practices study, whereby the data of 396 pumps with meter results input were analyzed. The data was divided into three categories depending on the average blood meter glucose results: 

• Low Third- 144 mg/dl (8.0 mmol/L), 
• Mid Third - 181 mg/dl (10.0 mmol/L),
• High Third- 227 mg/dl (12.5 mmol/L.

The results were kind of interesting (even without caffeine), because in terms of behaviour all three groups were similar. 92.7% used the bolus calculator to cover meals and 96.5% were using the calculator to correct high readings. People in the lowest blood glucose group were testing their blood an average of 4.73 times per day; while, similarly, those in the high group were testing 4.01. The only noteworthy differences between the lowest and highest groups were that the latter tended to be using greater amounts of insulin, and infusion set failures/occlusion errors appeared to significantly raise blood glucose averages. From this there was a conclusion that high blood glucose results were not necessarily a matter of people not trying to manage, but rather those people needing more insulin, or losing insulin from set malfunctions.

The next topic my new BFF Dr. John Walsh discussed was how to go about fine tuning your pump settings in order to gain the best control you can of your diabetes. On paper, this looks like:

1. Stop lows first
2. Find an iTDD (improved total daily dose- using chart from the new Pumping Insulin)
3. Set and test basals
4. Set and test Carb Factors
5. Lower post-meal blood glucose
6. Set and test Correction Factors

However, in real life my new BFF Dr. Walsh likened all the data needed to analyze and manage diabetes to a Jackson Pollack painting. It was funny...

The rest of the presentation was essentially about steps 1-6... But here are the points that struck me the most:

• small carb factor changes make a big difference- ex., a person 73kg (160 lbs) has a TDD of 40 U (<--- I don't actually know what weight has to do with anything, but I wrote it down, so I feel like it was important somewhere?) Said person changes from 1U per 10g CHO to 1U per 9g CHO. On avergage people from the APP study ate 190 grams of carbohydrate a day. Assuming this average, changing that carb factor puts another 21 units 2 units (forgot subtraction!) on the person's TDD.
• try not to eat if your blood glucose is over 8 mmol/L (144 mg/dl)
• half of the protein you eat turns into carbohydrates
• some fats seem to provoke insulin resistance (I heard something about cheeses and then I tuned out, because I can't eat dairy. Sorry)
• setting the duration of insulin action on your pump is important, because setting too short a time is a recipe for later lows 

And this one made the whole room gasp: A woman asked how she could avoid so many bad infusion sites. New BFF Dr. Walsh asked if she used a set with an auto-inserter. She said yes. He said stop using those... because they way that they are cocked means that they are difficult to get to go in straight and without kinking. (And from my experience those suckers tend to bleed into the canula more times than not.)

With respect to infusion sites, there were also these recommendations:

• Sure-T/Contact Detach, Sof-Set, and Silhouette are more reliable infusion sets
• always anchor the line with 1 inch tape to reduce irritation and tugging that can cause insulin small leaks at the site
• suggested tapes were: durapore, transpore, hypafix
• when you have a site failure and your blood glucose shoots up (to the sky) don't forget that you were not getting basal along with whatever you carbs you might have bolused for... you, therefore, will likely need more insulin to get your blood glucose down to target.

So, that was that. In a nutshell (<--- no carbs!) My favourite part was during break when a woman went up to ask about her up-and-down blood glucose readings that she'd been trying to get under control with the help of her CDE. He asked her a few questions and then asked if he could look at her pump settings. Occassionally he would look up and say, "Do you have x, y, z happen?" and she would respond, "Yes, that's exactly what happens." And he'd change a setting and explain. I like to think her blood glucose is a constant 5.5 mmol/L now and forever. She should probably never wash her pump again.

They gave away a few copies of the new 5th edition of Pumping Insulin at the end of the morning. I didn't get one. I kind of imagined that after the draw someone would stand up and pull an Oprah, yelling for everyone to look under their chair to find a copy of the book... "AND YOU GET A BOOK! AND YOU GET A BOOK! AND YOU GET A BOOK!" And we'd all lose our shit, just like on the show... But that didn't happen either. 

In the end, though, I was just really happy I got to hear from what could maybe be define as the rock star of pumping insulin (too much?) He was pretty engaging and generous with his knowledge. Even during break he didn't stop to get anything to eat or drink, but instead made sure he got to everyone's questions. I hadn't realized that he also has diabetes and has been on what seems like every pump imaginable over the years. Because of that he would make the occassional reference to diabetese, like the Pollack-type BG graph joke or talking about type 3's (aka 5.5ers or support people without diabetes.) So, despite the early start time and the rather obscure location and the no free book under my chair issue, I found it was really good times and learning.

"Ha! Made you gush," said the Insulin Pump.

I keep getting nasty gushers. Like non-stop bleeding everywhere gushers. Half the time I put in a new infusion set and blood draws up through the canula right away. So, all this in mind, of course when I woke up at 4am the first thing thought in my brain was, "Oh, I forgot to take out my old site. I should rip that out RIGHT NOW." Smartness. I really wanted to have to get up to change clothes and bedding at that hour.

That's really just a sample size. It went EVERYWHERE. Maybe I should start pulling them out while standing over a basin or something?

Diabetes Art Day 2011

It's been hectic this summer, so I don't have much this year, but I like this day... and I wanted to contribute something... so, I give you this:

and, look, you can meme that:

You can read more about Diabetes Art Day at Lee Ann's blog or the official site.

This is important: Professor Jean Claude Mbanya, president of the IDF speaks about diabetes around the globe

Listen to internet radio with DiabetesSocMed on Blog Talk Radio

July 27th, 1921 insulin was discovered by Banting & Best and their dog friends. I think about them sometimes. Sometimes I wonder what I would said if I got to somehow skip back in time a bit and have a chat with them. I know when they realized that what they had and what it meant for people with diabetes, the group decided to sell the patent for $1. This allowed the drug speedier production. I wonder, considering this good will, what they would think of some of the situations described by Professor Mbanya, president of the International Diabetes Federation, where parents are faced with the grim reality that treating their one child with diabetes could mean devastating hardship or even death for the rest of the family? I would surely feel embarassed to tell them that at this point in time there are still people who die from diabetes, because they simply don't have access to the insulin they need. 

Back-up Packrat

I've developed this odd quirk whereby I have back-ups of EVERYTHING: back-up shampoo, back-up conditioner, back-up toothpaste, back-up granola bars, back-up laundry detergent, back-up coats, back-up bags, back-up etc... And I get REALLY anxious if I don't have my back-ups.

It finally dawned on me it stems from a bonafide anxiety around always requiring: back-up food, back-up glucose tabs, back-up insulin, back-up infusion sites, back-up cartridges, back-up needles, back-up medical things etc...

The bad news is I got a lot of clutter. The good news is I'm ready for the zombie apocalypse.

Curiously, most of these symptoms are similar
to those of a low blood glucose... though with respect
to the last point: I'm not so picky about what I
eat when low.

Awesome Things

Today's post for Diabetes Blog Week is about Awesome Things:

In February the #dsma blog carnival challenged us to write about the most awesome thing we’d done DESPITE diabetes.  Today let’s put a twist on that topic and focus on the good things diabetes has brought us.  What awesome thing have you (or your child) done BECAUSE of diabetes?  After all, like my blog header says, life with diabetes isn’t all bad!

So, last summer I discovered a site for the group called Connected in Motion. They provide different outdoor events for people with type 1 diabetes, in the belief that we all have a lot of valuable lived-knowledge about diabetes that we to share with and learn from one another. I saw that they had a weekend canoe trip planned for the end of August...

FLASH BACK TO SEVERAL YEARS EARLIER: I remember friends had asked me to go camping with them. I remember noting that we would need to brainstorm about food, because at the time I was on shots and very sensitive to insulin... which meant that any exercise (like carrying a bag of groceries!) meant dealing with lows. I remember them saying there wasn't a lot of exercise involved, so I should be fine. "But, isn't there hiking/portaging and canoeing?" I asked. "Yes," they replied, "but it's really not that much exercise." To which my brain thought: These are my friends and I love them, but there is no way in hell I'm going out into the woods with them. So, I had always wondered what I was missing out on in these trips... So, figuring that everyone on the trip would be kind of in the same boat (no pun intended... ha!) I signed up for the canoe/camping trip with Connected in Motion.

Now, here's how I remember the conversation with my parents after I signed up for this trip:

Parents: So, do you know anyone else going on the trip?

Me: No.

Parents: Do you know people that have done the trips before, then?

Me: Nope.

Parents: Well, how did you find out about it?

Me: I found it on the internet.

Parents: (Silence)

Me: It's going to be fiiiiine. I think maybe I do know someone who knows something about them... ?

That trip was the first time ever that I got to hang out with people that had type 1 diabetes. I kind of underestimated how great that would be. I didn't have to explain diabetes or glucometers or lows or highs to anyone. I didn't have to ask people if they minded stopping so I could test my blood; I just said I needed to or did it and people understood. (Which made me realize I should never really ask. I should just tell people it's going to happen, stop and do it.) It also felt pretty great to be able to do something that I felt like I would never get to do. After that trip, if anyone had asked if I wanted to go camping/canoeing I felt like I had the tools and knowledge to be able to do so. 

Anyway, I thought this was a good story for this post because it's not just something I did despite diabetes, but also because of diabetes... And not just my diabetes, but everyone's on the trip: without their support and knowledge I wouldn't have been able to achieve what I had that weekend.

About six months later I went to another event hosted by Connected in Motion. At one point we all gathered and figured out how long each of us had had diabetes... then we added up all those years to see how much live experience was sitting in the room:

Ten things I dislike about diabetes...

Today's Diabetes Blog Week post is about 10 Things I Hate about Having Diabetes:

Having a positive attitude is important . . . but let’s face it, diabetes isn’t all sunshine and roses (or glitter and unicorns, for that matter).  So today let’s vent by listing ten things about diabetes that we hate.  Make them funny, make them sarcastic, make them serious, make them anything you want them to be!!

I don't know if this makes me weird, but I had a hard time coming up with a list of ten. (Serious???) Seriously. (WTF?!?) I know...

I didn't think it would be that hard, but I could think of things that I find annoying or that I maybe even severely dislike... I couldn't think of things that I HATE. I feel like diabetes is so a part of me at this point that it feels like saying I hate myself... and I think if I felt like that I would just stop dealing with all of it, so I kind of don't really want to ever feel like that about it... 

In light of this strange conundrum, I made this about things that I dislike about having diabetes. Hope that's okay.

Here are my top ten dislikes:

1. Going low
2. Going low and not realizing it until it's really, really low... and inadvertently eating the top of the glucose tab tube, because it's the same width and height
3. Eating extra food when you go low and you've already eaten... Teletubbies tummy (See image below.)
4. Eating after you throw-up, so you don't go low
5. How much more complicated it makes having other illnesses, even just a cold
6. That doctor's blame all other physical symptoms as complications of diabetes, even when they have nothing to do with diabetes... and they're not even recognized as complications of diabetes
7. Writing papers (the stress and sitting around make my blood sugars go high)
8. The sawdust-mouth feel that goes along with a high
9. All the extra medical gear I have to lug around  (when I travel it's half my luggage!)
10. The sense of isolation when you don't have people around that understand/have diabetes

I can say out of all of those, the one thing I really do hate is going low. I'm so sensitive to insulin it really doesn't take much for me to take a nose dive, though it has been better on the pump and when I stay away from certain foods. Sitting at a 1 mmol/L is a pretty disgusting and frightening experience.

Dramatization of #3

Letter Writing Day

Today's topic for Diabetes Blog Week is Letter Writing Day:

You can write a letter to diabetes if you’d like, but we can also take it one step further.  How about writing a letter to a fictional (or not so fictional) endocrinologist telling the doctor what you love (or not) about them.  How about a letter to a pretend (or again, not so pretend) meter or pump company telling them of the device of your dreams?  Maybe you’d like to write a letter to your child with diabetes.  Or a letter from your adult self to the d-child you were.  Whomever you choose as a recipient, today is the day to tell them what you are feeling.

Dear 15-year-old Self,

If this time-machine thing works out as planned, it's January of 1994 and you're sitting in the car on the way to the hospital. Yes, you have diabetes. No, no matter how much you bargain with the ether, it isn't going to go away. You are about to enter a medical system that does not do well with informing young people of what is going on. So, let me give you the heads up on some of the things that are going to happen over the next eight days:

1. When your parents bring you toileteries from home MAKE SURE THEY BRING YOU SOME DECENT/NORMAL SMELLING SOAP. The Bacto-Stat soap they give you to use in the hospital smells like disease. So discomforting.
2. They are going to TAKE YOUR BLOOD EVERY FOUR HOURS, EVEN IN THE MIDDLE OF THE NIGHT. It will freak you right out the first night, because nobody told you it was coming. 
3. They are going to WAKE YOU UP AT 6 AM THE FIRST DAY YOU ARE THERE. Since you are still practically in a coma you will do something (that maybe only you ever find) incredibly funny. Enjoy it. 
4. That first morning they wake you up at 6 am THEY WILL BRING AN ENTIRE NURSING CLASS TO OBSERVE YOU. No one will ask if it's okay. They will just barge right in like it is their right to do so. If you don't want them there, tell them to leave... but not until after you do the incredibly funny thing.
5. There will be a nurse that comes in to your room. She will not even greet you. Whatever you do, DO NOT LET THIS NURSE GRAB YOUR ARM! She will take something called a Heparin Lock (or Hep-Lock). It will look like a long large gauge needle and she will just shove it in your arm. They will tell you it is so they can take blood from this IV instead of always taking it from your arm, where it will hurt and bruise. BEWARE: This is a lie! There will be only one nurse with the Heparin and she will generally not be available. Then, they will just take the blood from your arm anyways!!! So, for the love of God, I repeat: DO NOT LET THIS NURSE GRAM YOUR ARM.

In general, diabetes will be a lonely disease for a very long time. People will help out (and that will be awesome), but no matter how many are in the waiting room you still have to learn to go into those doctor encounters alone. Growing up people will feel badly for you, they may call you 'brave' or 'courageous'... even though you don't feel sad for yourself, nor brave about any of it. Don't let people treat you like your porcelain or fragile (I know that you won't!) Don't strive to be normal-- it's a bullshit social construct. Do visit the Banting House in London, ON sooner; it will give you a greater appreciation for wonderful it is that you get to finish high school, go to university (ugh, THREE degress... I know), make great friends and love a lot. Most of all feel proud of yourself, because you will handle a complex chronic illness (in combination with the lot of crappy life circumstances you already know about) with grace and determination... and that's all anybody can ask.

Sincerely and with love,

Your 33-year-old self.

Admiring Our Differences

This week is Diabetes Blog Week and the first topic is 'Admiring Our Differences':

We are all diabetes bloggers, but we come from many different perspectives. Last year, Diabetes Blog Week opened my eyes to all of the different kinds of blogs (and bloggers) out there – Type 1s, Type 2s, LADAs, parents of kids with diabetes, spouses of adults with diabetes and so on. Today let’s talk about how great it is to learn from the perspectives of those unlike us! Have you learned new things from your T2 friends? Are D-Parents your heroes? Do LADA blogs give you insight to another diagnosis story? Do T1s who’ve lived well with diabetes since childhood give you hope? Pick a type of blogger who is different from you and tell us why they inspire you - why you admire them - why it’s great that we are all the same but different!!

I have a confession: I always thought that LADA or latent autoimmune diabetes in adults was just like Type 1, except in adults... BUT...

Not too long ago I was writing a definition about diabetes mellitus for a paper. I had a lot of resources about Type 1 and Type 2 diabetes, but nothing about that type somewhere in-between: Type 1.5. I found a snippet here and there in different books or articles, but couldn't find all that much. I thought maybe it would be best to ask a real expert about LADA and sent a tweet to @Diabetic_Iz_Me, a.k.a. Cherise, who has had LADA since 2004. Cherise referred me to one of her favourite sites: the Islets of Hope page. From there I was able to find a lot of references and information... and learn lots about how my assumptions of this Type 1.5 were WRONG.

From what I read (and please correct me if I am wrong) LADA starts off looking a lot like Type 2, except unlike Type 2 there are certain autoantibodies present that are linked with the destruction of beta cells. In Type 1 there are way more autoantibodies and the beta cells die off much more quickly, but in LADA there is only one or two of these autoimmune proteins and the pancreas cells are destroyed much more slowly. Every person's diabetes is unique and requires individual plans of care, but the average time it takes a person with LADA to require insulin injections is around 4 years. So, kind of similar, but still different. I was glad to have the opportunity to challenge my assumptions and learn something new. I was also glad to have someone open to questions and willing to inform (Thanks Cherise!).

Diabetes Social Media Advocacy Blog Guest Post

I know this is a bit late, but I was a little out of it when this first posted over at the Diabetes Social Media Advocacy blog: http://diabetessocmed.com/2010/guest-post-by-virtue-b/

I'd like to say thanks to Cherise and everyone over at DSMA for allowing me the space to write. All the posts for Diabetes Awareness Month were great to read.

Thanks again,
V.

Diabetes Art Day

For more information on Diabetes Art Day, please see Lee Ann's blog post here: http://www.thebuttercompartment.com/?p=5441

Show-and-tell...

I have rectified the aforementioned problem by introducing my pump to the entire office at this morning's all-staff meeting. I just said that I know people have had questions and, so, rather than repeat myself to each concern (which was getting quite stressful) I thought it best to just present it to the group.

I introduced several issues I knew to be of concern: I went through how the pump works, the various types of diabetes, the misconception that people have, like: somehow people with diabetes cause their own illness and that treatment starts with diet, then if it's really bad you go on needles and then if it's really really bad you end up on a pump. I relayed that the truth is there are various regimes for various types of diabetes and that everyone is different. I told them that I do not manage by diet, but rather I have an insulin to carb ration that tells me for every gram of carbohydrate I eat I know I take X amount of insulin to keep my blood sugar under control. I said that managing this way meant I could eat whatever I wanted, included candy and treats.

Finally, I told people I realized that their concerns come from a good place and I wasn't blaming people, because I realize there is a big public information gap regarding diabetes. I finished by letting people know it was okay to ask questions if they wanted...

I'm pretty sure, though, that I covered most of what people were curious about or had misunderstood, but we will see...

Tired of people "catching" me "sneak" sugar/candy at the office...

(I don't need a f---ing lecture- it actually makes this all much harder to bear.)

The price of licorice...

I was eating licorice and then someone said, "Hey, you're not supposed to be eating that." Someone else said, "Oh, no, are you diabetic." My brain said, "FUUUUUUUUUUUUCK." But my mouth said, "Yes, but I can have this." "Oh, you're a bad diabetic." "No," I pointed to my pump, "I just take more medication." (Probably not the best explaination at that point, but I was already flustered.) "Well, prevention is better than..." And I don't know what else they said, because then I felt really sad and embarrassed and just starting shutting people out. I felt like I should have been better prepared for this moment. It's not like I haven't had to deal with misperceptions of the 'betes before. But it was so innocent- a piece of licorice. I've eaten the candy put out before. So, it was completely unexpected.

I didn't know what else to do, so I put it out to friends on IM and Twitter: I just got called a bad diabetic :(

@JamieH responded: do you want us to send the D-mafia after them ?! ;-) ugh

@ElizabethArnold: By who???? (And did you kick them? Because if not, I will kick them for you. @JaimieH would too, I bet...)

AND

Hmmm...They should know better.Reminds me of 2nd grade when kids told me I shouldn't be eating Lifesavers. (I was LOW at the time.)

AND

All DOC tweeps shd take pics of ourselves eating candy for you to show 'em. Here's me, with liquorice! :P http://twitpic.com/273k5v

While, @scottkjohnson wrote: yeah, then start chasing them around with needles. :-) Or maybe @ninjabetic & I need to pay them a visit? We're pretty scary...

Moral of the story?

1. "Bad diabetic" is a pejorative term. It hurts. Don't use it... ever. If you want to ask questions (honestly, it gets old and kind of annoying for me, but...) it's better than judging.

2. Don't piss off the DOC.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Thanks for the support everyone, otherwise I would have hid in my office for the rest of the day and thought about all the things I should have said or done... even though it's not really my side of the encounter that should have to review anything said or done.

The kind of sad part is that I don't think I want to be going anywhere near the candy jar anymore, or at least for the next little while. I don't want to deal with that spectacle again. I feel kind of whimpish for admitting that, but it's true.

Death of a pancreas... Again!

I got water in my pump. Actually, that makes it sound like it was my fault- they told me it was waterproof and though it has been for the past two years, it was not this weekend: I was swimming and when I got out there was water behind the screen. The pump worked find, but I thought I should call tech support and let them know. They told me they would send me a new one to be safe... And I had to send pump-kin back to the Animas :(

This is the hearse they sent for pump-kin:
Bye, bye pump-kin :_( Thanks for the past two years. You made my life much easier and I'm glad that you at least got to stick around for the canoe (bestest ever) trip on the week (<--- more about that later, btw!) For reals, though, it felt kind of sad... and I, ahem, did kiss the pump goodbye. It was weird to see it in the 'mail out' box at work, knowing no one else knew the history and significance of the device sitting inside the package. Next glucose tabs I (figuratively) inhale in a fit of low blood sugars, I will ingest for you...
Oh! Why hello birth of pump-kin jr! And, so, we start again...

("It's ALIVE!!!" ~Frankenstein)

(PS- pump-kin jr has much more sealant around the screen. I thought maybe that was the problem, because I couldn't see where else the water could have come from and I could shake the water out... probably the latter point was most indicative!)

MacGyver Moment: Portable Strip Disposal

I got fed up with finding test strips EVERYWHERE! So I went to the drug store and started searching for some sort of cylinder/pill-box on a keychain (<--- apparently it's called a "pill fob")... VOILA! MacGyverism! Attached to the zipper of my glucometer is my new used test strip garbage bin.

Would it really be so difficult to include this in the first place, glucometer manufacturers?!?

Dear Feet,

I am sorry that I have neglected you. I did not know what could happen. I mean, I knew in theory, but reading through a book for school on diabetes I came across some truely painful photos of gangrene and infection. These pictures showed a much sadder picture than what I'd understood the issue to be.

Now, I can't promise any outcomes (as I am sure you are aware, sometimes these things are about chance), but I can promise to be more aware of how I treat you. I have bought you some nice foot cream and will be checking in on you every night from now until forever.

Be well, and thanks for hauling my ass around every day...

Love,
V.

PS- I am also sorry that in a fit of irony I accidentally dropped the rather heavy bottle of foot cream I bought for you on you and bruised you.

To Whom It May Concern:

I am writing you today to ask that a new feature be allowed for glucometers. More specifically, I would like there to be the option to replace the "HI" and "LO" warnings with "FML (HI)" and "FML (LO)", respectively.

K, thanks so much... Bye.
V.

Today is National Aboriginal Day

So, since here in Canada today is National Aboriginal Day I thought I would speak a bit about diabetes in Canada's Indigenous communities. First, there are three different groups understood as 'Aboriginal' in Canada: First Nations, Inuit and Métis. I know of a lot of documents relating to statistics and understandings of wellbeing from First Nations perspectives, but there seems to be much less information regarding Inuit and Métis peoples. Contrary to the many myths purported by Hollywood and pop culture there are many different communities of First Peoples in North America. However, there are some general similarities between various First Nations perpectives of health. The most glaring difference is that while mainstream medicine sees only the physical; while First Nations understand that wellbeing includes the physical, mental, emotional and the spiritual. That's is just the surface of differences, but I think it is enough that you can see the two views, although both concerned with wellbeing, come to this understanding with very different concepts of what is worthy of focus. (If you wish to read more, I think that the First Nations Regional Longitudinal Health Survey: The People's Report has a nicely illustrated outline that goes through the differences and similarities of First Nations and Western understandings of health.)

As you can imagine, study after study illustrates that misunderstandings and racism are commonplace in Aboriginal peoples encounters with mainstream health services. I don't think it takes a genious to see that if Western medicine only considers the disease, than it is ill equipped to understand the various cultural and racial issues at play in these encounters. Take for example Catherine T. Elliott's narrative:

When I was a medical student, one of my teachers warned me to be wary of misunderstandings that could cloud my judgment. He described a case in which the powerful negative image of “drunken Indian” impaired a physician’s ability to assess and treat a man with diabetic ketoacidosis. The aboriginal patient waited in a wheelchair in the waiting room for several hours until the next physician came on shift and discovered the error.

While, she goes on to note:

In medical school, one of the first “facts” learned about Canada’s aboriginal peoples is that they have poor health status and experience substandard social and economic conditions. Many of us do not come to understand the historical and social contexts of these facts. This can lead to a sense that “being aboriginal” means having poor health and social conditions. This belief might leave us vulnerable to adopting common social stereotypes.

The practice of conflating health outcomes with cultural norms, when they are better explained by social, political, and economic factors, has a long history in Canada. It can occur when members of one group become marginalized and impoverished, and their behaviour in response to the marginalization is deemed “part of their culture.” For example, in the early 1900s when First Nations in British Columbia were separated from their land and resources, their ways of life changed from migratory to sedentary. Previously healthy living conditions became unsanitary, and high mortality rates from infectious disease ensued. The historical record suggests that First Nations themselves were blamed for their poor health, without an appreciation of the social effects of this dramatic change in way of life. Poor health was deemed “an inherent part of indigenous lifestyles.”

These last points, I think, are especially pertinent to diabetes. With colonization came the stress of displacement, genocide and residential schools (also see: Where are the children?) and a shift from traditional diets to Western foods- processed, rich in carbohydrates and fats. Diabetes, in this case, is not just an illness of the body, but also one of colonization... but is also now one of epidemic proportions in Native communities.

Consider these research findings:

"Diabetes among the non-reserve Aboriginal population was most prevalent in the North American Indian population, where 8.3% of the population age 15 and over was diagnosed with diabetes, as opposed to 6% of the Métis population and 2.3% of the Inuit population.

Rates of diabetes have risen for North American Indian adults not living on reserve since 1991 when the rate was 5.3%. Rates for the Métis and Inuit changed only slightly: 5.5% for Métis and 1.9% for Inuit adults in 1991.

According to Health Canada, there is evidence that the prevalence of diabetes is higher among the Aboriginal population living on-reserve. (Health Canada 2000) If this group were included, it is likely that the rate of diabetes for the total Aboriginal population (both those living in reserve and non-reserve areas combined) would be higher than 7%." (StatsCan)

More recent statistics note the prevalence of diabetes in First Nations adults is closer to 14.5%. While "among First Nations adults with diabetes, 78.2% have Type 2 diabetes, 9.9% have Type 1 diabetes and 9.8% are in the pre-diabetic stage." (RHS: The People's Report)

The average age of First Nations youth diagnosed with Type 2 diabetes is now 11 years. (RHS: The People's Report)

In research conducted between 1980-2005: "The prevalence of diabetes increased over the study period from 9.5% to 20.3% among First Nations women and from 4.9% to 16.0% among First Nations men. Among non-First Nations people, the prevalence increased from 2.0% to 5.5% among women and from 2.0% to 6.2% among men. By 2005, almost 50% of First Nations women and more than 40% of First Nations men aged 60 or older had diabetes, compared with less than 25% of non-First Nations men and less than 20% of non-First Nations women aged 80 or older." (Dyck, Osgood, Lin, Gao, & Stang in Canadian Medical Association Journal)

"In addition to high rates, according to Health Canada, diabetes is a significant concern for the Aboriginal population because of 'early onset, greater severity at diagnosis, high rates of complications, lack of accessible services, increasing trends, and increasing prevalence of risk factors for a population already at risk.' (Health Canada 2000)." (StatsCan)

Below, I have embedded a National Film Board of Canada short-film by Brion Whitford, an Ojibway man living with Type 2 diabetes. The piece follows Brion as he learns to deal with his diabetes by learning about his heritage. For various reasons, the film is sometimes hard to watch, but I think the lessons described and put forth are quite honest and touching.

(PLEASE NOTE: some of the scenes can be difficult to watch, especially if you or a loved one has diabetes and/or experienced colonial traumas. The film starts with Brion losing kidney function and having problems with circulation, in addition to struggling to find balance and health with diabetes. Also, there is one discussion where a man talks about losing his mother to diabetes and it is somewhat graphic... Just thought I should mention...)

Finally, I realize that in discussing illness there is a tendency to focus on deficit. I think it is important to remind people that (like all groups) while there are negatives there co-exists many positive facets to Native American communities. To this end, I would like finish here by sharing this most recent post by Adrienne over at (one of my favourite blogs!) Native Appropriations: Between Pageantry and Poverty: Representing Ourselves