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A dose of diabetic reality

If you’ve missed my last few posts, I am currently in San Jose, California attending a diabetes conference at the Johnson & Johnson Diabetes Institute.

Today was jam-packed full of new diabetes knowledge encompassing everything from reimbursement guidelines to pharmaceuticals to motivational interviewing to GIVING MYSELF INJECTIONS!!


That’s right, I gave myself a saline injection just as a diabetic would do if requiring insulin. I know how to teach injections, but I’ve never given myself one before! RD’s traditionally hold a HANDS-OFF role in health care, but this is rapidly changing. The role of the dietitian is quickly broadening to include much more of what I consider to be the “fun stuff”! 😉

[Fact: Some RD’s in progressive teaching hospitals are inserting naso-gastric tubes in patients — a tube inserted up the nose and down through the esophagus and into the stomach for feeding. How cool!]

If you are an RD or RD-to-be, embrace this increasing span of care. These new responsibilities as medical providers ensure you are a top-notch provider and create more autonomy for your profession! Hello, job security and better reimbursement rates!

Anyways, I digress.

We learned a method of injection called the “Daniel Method”. Basically, you gently place the tip of the needle on the cleaned and sanitized entrance site. You take a deep breath and then look down. More times than not, the needle slides right in. If not, a very light pressure will insert the needle. I was telling my husband about this exercise and for those outside the medical world, it is a little bizzare to think about….30 some medical professionals of all shapes and sizes, lifting their shirts/dresses and injecting themselves with…nothing. It’s amazing to me how many nurses, Nurse Practitioners, and Physician Assistants had never injected themselves! I was not alone! Did it hurt? Not a bit! I didn’t even know the needle went in!

THEN we move on to insulin pumps. Insulin pumps are a great tool for insulin-dependent diabetics (type 1 or 2), most commonly seen in type 1 diabetics (usually appearing in young children when diagnosed). The pump entrance is injected and then adhered to the body with a strong tape. There is very small tubing that leads from the entrance site to a small pump that looks just like a beeper, worn traditionally on the waist band of pants and skirts.

I am the first to admit I know very little about insulin pumps as most of the diabetics I work with are 1) type 2 and avoiding insulin at all costs and 2) poor. Insulin pumps are SPENDY! The one you see in these pictures retails for over $6,000!!!

I thought inserting the insulin pump would be painful. Hello, another needle into my fluffy belly!! Again, wrong. Didn’t feel a thing. It’s hanging out down there and other than carrying the pump with me, I have no reminder of it being there. I worked out with the pump, showered with the pump (water-proof!), and slept with the pump. A change, for sure.

Here is my pale, fluffy tummy and my insulin pump insertion site

When I first inserted the pump, I was mad. Why and how will I be wearing this? Mind you, for the next 24 hours. Can you imagine having one inserted to be with you FOREVER?

Talk about empathy. Empathy I would’ve never felt had I not come to this conference and had this experience. In that moment, I truly understood denial of the disease. And as I type this with sore fingers from testing my blood glucose just 5 times yesterday, I empathize with my patients who test 7 times a day…every day. Because it’s what’s best for their disease management.

Wow, just wow. What an eye-opening, humbling dose of diabetic reality.

And I won’t forget the food… 🙂

The food is all prepared from a diabetic cookbook! Chicken, cucumber and strawberry salad with an orange and cilantro salsa (interesting!), mixed vegetables, and whole grain rice

We also went to a really nice seafood restaurant for dinner in downtown San Jose (Scott’s, for those in the area). The view of the city was BEAUTIFUL and so was the food! Too bad that in this fine establishment we tested our blood glucose at the table…all 30 of us, and then proceeded to carb-count our meals and enter it in to our pump. You know, so we were sure to get enough saline 😉

I need to head off to day #2…and tonight is dinner with Andrea!

Question: Knowing what I just shared, do you think you could give yourself an injection? Or have you given yourself an injection before?

Sugar love,

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  1. Rebecca
    April 20, 2010 / 4:25 am

    Really cool post today- I learned a lot! Thanks for sharing and enjoy your conference!!

  2. April 20, 2010 / 5:38 am

    I gave myself a flu shot last fall (under my physician father-in-law’s watchful supervision), but I can’t imagine having to do it several times a day, or to carry around an insulin pump forever, or prick my finger 5-7 times a day. I remember my mother having to test her blood glucose many times a day and she HATED it. This was with the old school needles, too. Do you know if insulin pumps are covered my insurance? They are are pricey (I had no idea)!

    This conference is such a great experience! I hope that I can participate someday. One of my professors told us about how, when she was an intern, she had someone insert an tube in her, so that she could see how it felt to have a tube feed (no formula, though). She said she learned more in that 10 minutes than throughout the rest of her internship.

    I’m glad you are having an enlightening time, Nicole!

  3. April 20, 2010 / 6:08 am

    I really like that at the conference they are trying to make you really feel what it is like to be diabetic. All doctors should go through something like this.

    I’ve never had to inject myself but I suspect I might someday…

    Can’t wait to hear about day number 2!

  4. April 20, 2010 / 6:35 am

    Wow! That’s so interesting. I can’t imagine having to do all that everyday!
    Thanks for sharing! Very informative!

  5. April 20, 2010 / 7:28 am

    I could inject myself if need be but honestly never want to. That’s one of the reasons I finally started doing something about my weight and what I eat.

  6. April 20, 2010 / 8:18 am

    Thanks for sharing this Nicole! I enjoyed reading this post. I think I would be able to give myself an injection, granted it may take time, but overall I think I could do it! From what you said, sounds like it is a piece of cake!

  7. April 20, 2010 / 8:28 am

    What a great and informative post! Needles do not tend to bother me all that much but it may be hard to do it to myself the first time if I did not know what to expect. When I was in treatment for my ED they checked our blood sugar multiple times a day for the first week to make sure our numbers were good. I remember my finger tips being so sore. I can not believe the pumps are so pricey. It is sad to think a little kid or adult for that matter may have a little easier time with a pump and not having to give themselves injections but they may not be able to afford it. I hope at least some insurances cover the pumps.

  8. April 20, 2010 / 9:21 am

    While I have given many an injection to an animal (because it was sick), I have never given myself one. I could do it if I had to, I think, because needles don’t bother me.

    I am really enjoying seeing the medical side of nutrition on your blog. Keep these kinds of posts coming!

  9. April 20, 2010 / 9:39 am

    Wow! What a conference. That’s such a cool concept, and it seems like it really affected you the way it was intended. So much respect for RD’s:)

  10. April 20, 2010 / 9:46 am

    Sounds like a really eye opening day Nicole! I am not a needle fan. Even just the thought of them makes me kinda woozy so giving myself injections is not something I’d look forward to everyday.

  11. April 20, 2010 / 10:34 am

    I always tell my pt’s I like to give the shots, but not receive them, ha ha. I have never given myself an injection. I guess you just do what you have to, especially if you have diabetes. I can’t tell you the amount of times I have had uncontrolled diabetic’s as pt’s. It’s really sad when they come in with huge sores on their feet.

  12. April 20, 2010 / 10:46 am

    I think I could give myself an injection…I say that…but you never know! haha!

  13. April 20, 2010 / 10:50 am

    Thank you so much for posting this — I learned a lot. I have never seen diabetic supplies up close and only about diabetes from a nutritional standpoint. Looks like you are learning a lot at your conference.

  14. April 20, 2010 / 10:51 am

    Wow – I am impressed! I *think* I could give myself an injection….I guess I’ve never thought about it! I have a pretty high tolerance for pain (I’m just thinking about all the jerks I’ve dated LOL) and needles don’t gross me out when I give blood. It’s good to hear you didn’t think it was that painful! I can’t imagine giving myself injections everyday….

  15. April 20, 2010 / 10:55 am

    I write for a diabetes magazine, and before I started I knew nothing of the disease. The thing that struck me is that, at least for type 1s, the question is never will you our wouldn’t you. You just do. And for most type 1s it’s something they don’t even think about. The food and dealing with that is much more annoying than injections. (Of course, for type 2s it’s a different story since there’s the myth that insulin means your diabetes is really bad, which is not the case.) I think what most shocked me, too, is how complex everything is. I mean, pumps are amazing technology and they make life with diabetes so much easier but at the same time they’re pretty complex. There’s so much math that goes into just eating a snack. How much insulin do you correct for? What if you had extra insulin on board? How much fat was in it? And so on. It’s mind-blowing that people can do that day in and day out. I give them a lot of credit because, unlike what many people think, it’s not just about avoiding sugar or carbs.

  16. April 20, 2010 / 11:00 am

    This just shows how committed you are to helping your clients/patients. You want to know what they are going through to support them and let them know you can relate. I bet that brings them immeasurable happiness to know how much you support them. Way to go!

    And I don’t know if I ever could give myself an injection. I hate needles, but mostly because I hate seeing things go in me.

  17. April 20, 2010 / 11:00 am

    When my asthma was really severe I had to learn to give myself shots, at this point EpiPens were not as common as pre filled doses of epinepherine, learning to give myself shots sucked, but was very handy for fertility treatments later in life, giving myself shots in my stomach, YUCK.
    Sounds like you are learning a ton and gaining some empathy, not that you weren’t before but I think wearing the pump etc give you new perspective, well done for doing it.

  18. April 20, 2010 / 11:26 am

    Have fun at dinner. I am so jealous that you are at the conference, but I am so glad you are learning all this great stuff to help you on your journey to being a kick ass CDE. I have friends that do NG placement and they have the fun machine that helps with the placement.

  19. April 20, 2010 / 12:27 pm

    I went to a diabetes camp for children. I thought it was a real eye opener. We did a lot of the similar things you did. It was interesting to talk to the kids about their thoughts on having diabetes. I learned so much as well!!

  20. April 20, 2010 / 12:33 pm

    You make diabetes look fun. Obviously, it’s not though.

    I love needles. I think it’s sweet to watch an injection. Is that Weird?

  21. April 20, 2010 / 1:18 pm

    I think it’s great they had all of you give yourself an injection. There’s no better way to teach others than from experience. I don’t think I’d necessarily enjoy giving myself one, but I would definitely do it so I could be able to understand my patients better.

  22. April 20, 2010 / 1:29 pm

    Oh my…loved learning about injections, insulin pumps and what not. It’s more than I’ve learned in the past week at my job 🙂 I’ve heard San Jose is beautiful! Hopefully you are able to enjoy it a bit!

  23. April 20, 2010 / 2:23 pm

    Very interesting post. I couldn’t imagine being hooked up to an insulin pump or having to give myself or my loved ones injections. Glad to hear you are learning so much at the conference. xo

  24. April 20, 2010 / 3:06 pm

    Wow, I can’t imagine having to do that every day. I’m sure I could do it if I have to but wow, would definitely not want to.

  25. April 20, 2010 / 3:16 pm

    I see this everyday living with Andrew, but I’m so used to it that I don’t even notice it anymore. I don’t even realize what a pain it must be for him b/c he has NEVER once complained. Ever. He gets little bitty bruises all over his belly from the injections and he has teeny scars all over his fingers from years of pricking them. I’ve used his BS meter to test myself and it does hurt!! I would not be ok having to do that multiple times in a day. I can’t even imagine having an insulin pump in me all day long. People with diabetes are pretty amazing and I think this conference is such a great idea!!

  26. April 20, 2010 / 3:17 pm

    Very cool post!! How neat that you actually experienced the pump by wearing it for 24 hours! Reading your post gives me added empathy for my diabetic patients… I also like your injection method – I’m going to teach this method to my patients from now on! Thank you!

    I have injected myself, drawn my own blood, started an IV on myself etc… I confess I actually prefer sticking myself instead of having someone else stick me – that way I know exactly what’s going on! :-p And I still can’t wax my own eyebrows. Go figure. 🙂

  27. April 20, 2010 / 7:34 pm

    Wow, this is such an eye-opening glimpse into the life of someone with diabetes. Thanks so much for sharing, Nicole! I’ve never given myself a shot — I think I’d be squeemish at first but if I had to, I think I could get used to it.

  28. April 20, 2010 / 9:29 pm

    Oh, jeez… I knew diabetes was bad but I didn’t really consider the day-to-day suffering. 🙁
    I think it’s awesome that you were willing to do that. Dedication, much? 🙂

    Could I give myself an injection? Uhm… maybe? I’m excellent at getting injections and getting blood drawn, but I’m not sure I could actually inject myself with something. =\

    Unrelated, but I just nominated you for an award on my blog. 🙂

    Oh, and your stomach is NOT fluffy!

  29. April 20, 2010 / 10:42 pm

    Sounds like an awesome conference! And the diabetic friendly looks delicious! Hope you and Andrea have a great dinner 🙂

  30. April 20, 2010 / 10:42 pm

    Omg. I would pass out.

    I can give my horses and dogs injections no problem, but I pass out cold anytime I get a shot.

    I’ve got the chills thinking about it…

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