Tips That May Help You in Blogging

I know that I don't always follow my own advice, but if you find these useful, have at. First, I write about one topic – diabetes, specifically type 2 diabetes. Second, there are topics that relate to diabetes and sometimes the relationship is obtuse or difficult to recognize. However, I still try to stay on the topic of diabetes.

Second, I have researched blogging and there are many tips and discussions on what to do. Rather than list a large number of links, I suggest using the following search string in your search engine – 'tips for bloggers'. Please understand that many of the tips apply to many types of blogs and some are not for bloggers writing about diabetes or other chronic diseases. Some will still apply, but not all. I would suggest reading this discussion first Tips Beginner Bloggers.

One blog author does say that some rules and tips are meant to be broken from time to time. Two blog authors suggest limiting blogs to under 700 words and one author says if you can't say it in 600 words, it does not need saying. Now admittedly I have over 900 words more often than I should and I have too many two and three part blogs. Now I say that I detest overly long blogs, but there are times when I would rather read a long blog when the subject matter is interesting.

One tip I find useful is providing a email sign up for new posts. This is one way to make sure your readers are alerted when you post a new blog. Another way to inform your readers of a new blog is to have a RSS or other blanket feed for those that subscribe.

Third, I would like to cover a few minor issues that drive readers away. Some are not minor to some people and they will quite reading your blog.

1. People with color blindness – read about it and look at the color charts on . wikipedia.org Avoid using a lot of colored fonts in your blog.
2. Do not use acronyms without an explanation the first time. You may know the meaning of the acronym, but will your readers. Consider the acronym ADA. Yes, often it is easy to figure out in context, but I would not say this all the time. I recently had a blog here in which I could have used ADA for two of its many meanings – American Diabetes Association and Americans with Disabilities Act. I did only use it for the first one.
3. Always admit when you make a mistake – I do more often than I like.
4. Never apologize for expressing your opinion. Not everyone may agree with you, but that is expected. However, it is better to avoid controversial opinions.
5. One frustration I have is when reading a blog is not having a date for the blog to know whether it is the most recent or if there are more recent blogs.

When it comes to diabetes, some words do make readers angry. David Mendosa does explain them and I agree with him. I would urge my readers to take time and read his blog Incorrect Diabetes Terms. The only term that David describes that I have some disagreement with is the term “brittle diabetes.” It is often used incorrectly, but now has official recognition from the National Institutes of Health, which recently listed brittle type 1 diabetes as a rare disease, a distinct and separate form of type 1.

One word that does upset me is the word control. I sincerely wish we could control diabetes, but this is impossible under any circumstance. We are capable of managing diabetes to the best of our abilities and many people are able to manage diabetes with nutrition and exercise without medications. Others of us must use a medication, whether oral medication or insulin, to assist us in managing our diabetes. Some people chose not to manage their diabetes and they wonder why they must put up with the complications. If those of us with type 2 diabetes could actually control diabetes, we would not have diabetes.

The other word that offends those with any type of diabetes is the word “cure.” As of today, there is no cure for diabetes. There is some great research offering hope, but no cure, yet. Repeat, no cure! That is why we know that when someone advertises they have been cured and can provide that cure to us, we know that we are being conned and all they want is to separate us from our money. Those that use the word cure and the word remission, may not have had diabetes in the first place. We know they also wish to sell us something that will not cure us.

People with diabetes do like other words, but have a strong mistrust for today's media and their sensationalism of many topics. We know they want listeners and to sell papers, but they seldom report diabetes accurately. Most do not even understand diabetes.

Our Diabetes Support Group and Stress

Our February meeting was somewhat different. Tim had taken the topic and assigned different people parts of it to present. Since I was blogging about stress, Tim chose to leave me out since I had provided him with several links and a variety of stress topics. When the meeting started, he stated why some topics had been left out. He had purposely left out the positive stress topics I covered in my blog here. He said no one had asked to have them or felt the need for inclusion. He even stated that several of the other stress topics saying we don't have traffic jams and even when the river overflows, we still have routes to get to the stores for food and other supplies.

No one disagreed with him when he said that the extremely cold weather and frequent snow days were enough of a stress. He asked how many experienced bad batteries because of the cold. Six hands went up, and then he asked how many that worked were unable to get to work. Only one hand remained up. A.J. stated that all of his neighbors had left for work before he needed to leave and as such, he had no way to get to an auto supply to purchase a new battery. He said, he then called his work site and was told that they would be closed for the day.

With that pressure off, he raised the hood and recorded the information on the battery. Next, he called the auto supply store he did business with and asked if they would be making deliveries. They were and he ordered the battery. He paid for it when it arrived and then installed the new battery. The car started and he took the old battery to the auto supply store for credit since it was still under warranty.

Next, Tim put the topic of diabetes stress into discussion. No one disagreed that the daily management of diabetes was without some stress. Allen stated that he is happy with the success he is having with his diabetes management, but that he is worried about burnout. Allen turned to me and asked me how to overcome burnout. I said that a positive attitude is a key to help a person get through. Often people can have depression to go along with burnout. I brought up the book by Dr. William H. Polonsky and that it was a good resource - “Diabetes Burnout: What to Do When You Can't Take It Anymore”. Jason said that he had a copy that he referred to often, but he would loan it to Allen. Max said he had a Kindle version and reread it several times and he said it had helped him avoid burnout.

Brenda said she would be ordering it, now that her granddaughter had been diagnosed with type 1 diabetes. If she found that it would help her family, she would possibly order another copy. Sue then asked what burnout was. She could understand stress and depression, but could not make the link to burnout. Ben said he and Barry had been talking about burnout and was not sure he had the right answer, but they had agreed that burnout was when the repetition becomes frustrating, and the effort of the daily chores becomes overpowering. Stress may help cause burnout or be a contributing factor.

I agreed with Ben and added that even minor depression may be a factor to burnout. Jason agreed and said he believed burnout was all of these and people sometimes are at wit's end or mental resources to deal with diabetes. Rob said he would like to add that burnout can happen even when blood glucose management is going well and people just become tired of doing the same thing day after day. Tim asked Sue if she had a better understanding of burnout. Sue agreed that what we had said helped and her husband said he felt he had a handle on it and would talk about it at home.

Tim then brought up the article from Washington University in St. Louis and we covered what stress can do to the organs listed.

When we discussed what effect stress can have on the pancreas, John said that stress may have been part of the reason he developed diabetes because he was in an extremely stressful job at the time and dealing with his father nearing the end of his life. He admitted that he was not aware of anyone in his family having type 2 diabetes and had wondered why he had developed it. He stated that by leaving his job and having two sisters available to be caregivers to their father had been a big help, but he still did what he could to give the sisters some relief. The job he obtained after leaving the stressful job was actually fun to be at and not stressful.

We had some more discussion about the effects of stress and quickly covered the points in my blog here. When we discussed the use of counseling or psychotherapy, Jason said we could all think that it might not be for us, but stop and think about it. He continued that counseling had saved his marriage shortly after he was diagnosed with type 2 diabetes and now his wife and he are enjoying a stronger and closer marriage. He felt that his diabetes almost cost him his marriage because of the stress of diabetes.

Tim asked to end the meeting and interested people could continue discussions if desired. Discussion did continue for another half hour and then several decided to take the discussion to other places. All I can say is this was not the most intense meeting we have had, but it was not far from it.

Who Should Be in Charge of Medical Care?

This could be the $64 billion dollar question. I have been reading several blogs lately and each one seems to want to go in a different direction. Insurers are beginning to feel that they should have management control over health care. Doctors are beginning to push back demanding that they be in control. More patients are saying, “Now wait a minute, we would appreciate some voice in our treatment.” All of this may be out the window with government voicing more from the Centers for Medicare and Medicaid Services (CMS). They may drown out the other voices as they dictate more in what will be allowed and not allowed.

For many, having CMS wag the reimbursement tail and the insurance industry following lock-step will mean that neither doctors nor patients may have much hope of managing health care decisions. This may not be a good situation when insurers refuse to allow life saving procedures.

It was with some amusement that I read this by Dr. Pelzman in MedPage Today. Dr. Pelzman says, “A couple of years ago one of the major insurers got in touch with our practice and told us that they would like to come over to our office for a sit down, to talk about our patients and how we take care of them. When they arrived, the executive and his retinue of employees presented us with data that suggested that "we" were costing "them" a lot of money to take care of "their" patients. We went over the data they had, which showed it was costing them several million dollars more per year to take care of the panel of patients we shared than they collected in premiums from those patients.

Despite the fact that it appeared that much of the cost was due to several patients with acute leukemia who had massive unavoidable costs, they firmly came down with the recommendation that we find ways to take care of their patients with less cost.”

What follows is not a surprise as insurers want to make a profit and will take measures to ensure a profit. It is obvious that the practice Dr. Pelzman is part of felt they had to allow the insurer to install a care coordinator in their practice, even if this meant doing some practices that would literally exclude people based on their insurance status.

As patients, even we know the insurers have a purely financial interest in delivering care more efficiently and cheaply to patients. Then Dr. Pelzman goes where many doctors fear to go and says, “We should welcome the insurers to the table, as we continue building the patient-centered medical home, but it's time we as practitioners and providers of care seize the reins, take control, and start making some rules of our own. We are here to provide care for "their" patients, and ultimately we (hopefully) know best. We understand that they're worried about fraud, over-spending, over-testing, over-referring, but hopefully we can work together to build a more patient-centered way of taking care of these patients as our healthcare model changes in the 21st-century.”

Now if he had urged bringing the patients into the discussion and making them part of the decision process, then the doctors and patients would have had more bargaining clout for dealing with the insurers. Yet most doctors refuse to consider patients as having any advantage other than providing them income in the practice of medicine.  Too often, we are thought of as non-adherent and incapable of following their ill thought-out instructions.

Pharmacists Are Ready and Qualified

The biggest challenge pharmacist's face is obtaining provider status. As a profession, pharmacists are equipped with the knowledge needed to make the change, but other medical professionals are unwilling to let this happen. With the changing of law under Obamacare, the medical professions may have to allow pharmacists to be considered medical providers and capable of billing Medicaid, Medicare, and other insurance companies. Or, Congress may have to step up and mandate that pharmacists be given provider status.

With shortages already occurring in primary care and family medicine, the wait times for doctor appointments are increasing and many are reducing the number of times per year they are seeing patients. With the increasing number of people being diagnosed with diabetes, care for this chronic disease is being strained to the breaking point in some areas of the United States.

These same areas are short on doctors and other professionals capable of helping people with diabetes. This also applies to people capable of providing education for people with diabetes. A shortage of pharmacists does not seem to be happening on the same level. There may not be an abundance, but there is no extreme shortage of pharmacists. Yet the state medical boards stand in the way of pharmacists obtaining provider status.

“As the number of people with diabetes grows, so does the need for health care providers to give optimal care, and so does the amount of money it takes to do so. Diabetes is a complicated disease. It takes a lot of effort on both the patient and physicians part to maintain control. It's tough to see your doctor when you are sick, and it's even tougher to see them on a regular basis. Doctor visits every other month are not enough for most diabetic patients. Things fluctuate and need regular attention. Often, poor people, Medicaid patients, and people without their own transportation have the most trouble with getting care.”

Pharmacists can be more accessible and they can provide optimal care for patients between visits to the doctor. It is possible for pharmacists to monitor insulin pump data, check glucose readings, look over carbs/diets, and make recommendations for therapy adjustments. The benefits of this type of work can help improve care, optimize control, and save money in the end. Yet the state medical boards stand in the way of pharmacists obtaining provider status.

How many times will I have to say the last sentence? State and national medical groups apply pressure to state medical boards who then lobby state legislators to prevent pharmacists from obtaining provider status.

Diabetes and Your Rights on the Job – Part 2

Part 2 of 2 parts

#3. Do I Have a Right to Medical Leave to Take Care of My Diabetes?

The answer is a qualified 'Yes.' The Family and Medical Leave Act (FMLA) requires

most private employers with more than 50 employees and most government employers to provide up to 12 weeks of leave per year because of the worker's health needs, or an immediate family member's, serious health condition. This time does not need to be taken all at once, but can be taken in small blocks of time. This will allow for short-term problems caused by managing blood glucose levels or for doctor's appointments.

#4. Can My Employer Require Me to Undergo a Medical Examination Because of My Diabetes?

Yes, under certain situations, employers are permitted to inquire about an employee’s disability and can require that the worker undergo a medical examination. Generally, these situations are limited to employment physicals, requests for reasonable accommodation, and when a worker returns to work following an extended medical leave. This also applies when a worker has experienced a problem on the job, like severe hypoglycemia, that raises safety issues for the employer.

#5. Can I be Disciplined for Having Diabetes?

Yes, if your employer has workplace conduct rules that are applied uniformly to all employees, you can be disciplined if your conduct violates these rules. This applies even if that conduct was because of diabetes, for example, your behavior was caused by hypoglycemia. This is one reason secrecy of diabetes is not a good policy.

#6. Can I Be Fired Because My Employer Believes I am a Safety Risk?

This and the following are probably the most contentious problems for a person with diabetes. “A common problem in diabetes discrimination cases is that the employer claims that the person with diabetes creates a safety risk to other employees.

Sometimes this is due to the worker experiencing hypoglycemia on the job – but sometimes it is based in the employer’s ignorance about diabetes. You may need to dispel myths and stereotypes about diabetes and educate your employer or a court about your ability to be a safe and responsible worker.”

#7. What are My Rights if I am Terminated From My Job Because of my Diabetes?

“If you are fired from your job because of your diabetes, the first thing to do is to contact the American Diabetes Association so they can help you understand your rights and the legal processes available to you.

You have a right to file a charge of discrimination with the Equal Employment Opportunity Commission (EEOC) or your state fair employment agency.

You also may have other options available, depending on the situation, such as filing a union grievance or negotiating a return to work with your employer.”

Just because you manage your diabetes extremely well does not mean that you might not face the questions above. It can take only one case of hypoglycemia to cause an employer to take action against you. This is true especially for employers that do not understand diabetes. The more dangerous the job is that you have, the more important it is that you discuss diabetes with your employer. Some employers are often able to move you to jobs that are less dangerous. If you are a valued employee, the employer may want to keep you and be very willing to move you.

Just remember that not all employers are sympathetic and will look for any excuse to terminate an employee. This is when the American Diabetes Association may be a valued ally.

Diabetes and Your Rights on the Job – Part 1

Part 1 of 2 parts

If you have diabetes, do you consider yourself having a disability? Many people with diabetes do not and that is part of the reason for secrecy among many people with type 2 diabetes. Many are horrified when told they have a disability. Well, suck it up; the American Diabetes Association (ADA) says you have a disability.

As a person with diabetes, you are a person with a disability and as such, you are protected from discrimination. This means that your employer -

1. Cannot fail to hire or promote you because of your diabetes.
2. Cannot terminate you because of your diabetes – unless you post a direct threat to yourself or others – think hypoglycemia.
3. Must provide you with reasonable accommodations that help you perform the necessary functions of your job.
4. Must not discriminate in employer provided health insurance

For more information, read this PDFfile from the ADA. If is well written and a bit legalese, though understandable. This ADA article has many links to specific definitions and discussions affecting a person with diabetes. I may cover some of them. If you are a person that has repeat episodes of hypoglycemia, there are several concerns about employment – more on this below.

There are both federal and state laws that offer protection from workplace discrimination.

#1. The Americans with Disabilities Act applies to private employers, labor unions, and employment agencies with 15 or more employees, and to state and local government.

#2. The Rehabilitation Act of 1973 generally covers employees who work for the executive branch of the federal government, or for any employer that receives federal money.

#3. The Congressional Accountability Act covers employees of Congress and most legislative branch agencies.

#4. All states have their own anti-discrimination laws and agencies responsible for enforcing those laws. Some state anti-discrimination laws provide more comprehensive protection than do the federal laws.

The cause for concern by many people with diabetes is they don't want to be classified as a person with a disability. Secrecy then becomes a problem, as many do not want to inform their employer that they have diabetes. I would urge everyone that has diabetes to read the two links above

Then for those interested in reading the Americans with Disabilities Act (1990) click on the link above. I would strongly urge you to read the September 25, 2008 Americans with Disabilities Act Amendments Act (ADAAA) at this link. This is hyped by the American Diabetes Association, but helps explain the importance of the ADAAA. It has some important links to follow.

This is one of the disadvantages of having a few of the members of our diabetes support group visit while I am in the middle of a blog. They wanted to make this part of our next meeting and Tim and I had to say that stress was the topic for the meeting and by putting this out before our meeting was not a good idea. Posting this after our meeting and giving them the links will help people be prepared for the next meeting. After some grumbling, they agreed that stress was what everyone was aware of and that if this could be our topic for March.

Important points to remember -

#1. What is a 'Qualified Person with a Disability?'

Before the Amendments Act, the Supreme Court and most lower courts often disallowed people who managed their diabetes extremely well to claim discrimination under the Americans with Disabilities Act. The 2008 Amendments Act clarified this and some other problems needing clarification.

This discussion will be quoted.

“In order to be protected by federal anti-discrimination laws, a worker must show that he or she is a "qualified individual with a disability."

The first step is establishing that the worker has a disability, "a record of" a disability, or is "regarded as having" a disability.

A disability is defined in these laws as a mental or physical impairment that substantially limits one or more major life activities – such as eating, walking, seeing, or caring for oneself, or a major bodily function such as endocrine function.

In making this determination, you are viewed as you would be without the help of mitigating measures such as insulin.

In addition, you must establish that you are qualified for the job in question.

A qualified worker is one who satisfies the skill, experience, education, and other job-related requirements of the position held or desired, and who—if given reasonable accommodation—can perform the essential functions of that position.”

#2. What are 'Reasonable Accommodations?'

A reasonable person would think this would be easy, but this was part of the problems thwarted by the Supreme Court. Generally, accommodations for people with diabetes are easy and inexpensive; however, the courts until the Amendments Act have mostly ruled against people with diabetes.

Employers are required to make a reasonable accommodation if requested by an employee, unless the accommodation would cause an 'undue hardship' on the employer because of significant difficulty or expense.

Throughout the discussion the American Diabetes Association makes the following statement and I will just make it here - “Contact us to discuss a specific issue with a Legal Advocate.”

Continued in part 2 of 2 parts.

2014 Type 2 Blogger List

I have adapted the current list of type 2 bloggers to attempt to have more listed. Instead of getting permission for an expanded listing, I am starting with a URL listing. If you see your site listed and would appreciate an expanded listing like I have in my blog here, please contact me via my email on my profile page.

The only thing I am limiting is that the blogger must have type 2 diabetes or pre-diabetes. I will continue to search for other type 2 bloggers and add them to my listing. I am planning to start a new list each January. When I notice a blogger not blogging for over a year, the listing will be removed. I will also remove a listing when I see that a blogger has taken the site down.

Because of the number of people with type 2 diabetes, I will appreciate receiving information about a new site. We need more bloggers that are type 2 and you do not need to be afraid to write in a technical style or a personal style. There is so much bad information available on the internet, that there is room for more bloggers telling it like it is or covering news items.

In the 2014 type 2 blogger listing, there are many good bloggers and you should be able to discover those that you like to read. Some are very serious, a couple are mildly humorous, and a couple can make you roar with laughter.

Proper Disposal of Sharps

How do you dispose of your syringes, pen needles, and other sharps equipment? The time is coming when you may be forced to pay more for this disposal. Tom Erickson, CEO, UltiMed, a manufacturer of insulin syringes and pen needles for the Canadian and U.S. markets wrote an article laying out his observations about what is happening in both countries on regulations for sharps disposal. He thinks that pharmacists will be affected by the changes.

Surveys indicate that less than 5 percent of the more than 3 million sharps devices sold in the United States in a year are disposed in some type of closed container. The rest ends up unprotected in household trash. The influential group promoting sharps disposal regulations is the companies that handle household trash. Their workers are being accidentally stuck with the used needles and each needle stick creates more than $3,000 in testing and sick leave expenses for each employee and some cause serious illness.

Yes, and the frequency of needle-stick injuries is going up. As more waste disposal companies expand into sorting lines to recycle and reduce landfill loads, the injuries are going up. The workers are wearing protective gloves, but this doesn't prevent all needle-stick injuries. This is causing waste companies to lobby heavily to remove sharps devices from the household waste stream.

Pressure is now coming from another direction. The global environmental movement has been actively promoting the safe disposal of all hazardous products. An ever growing number of countries is enacting rules regulating the proper disposal of waste, including batteries, electronics, tires, paint, and pharmaceuticals. The safe disposal of medical sharps devices, such as syringes, and pen needles, is part of the objective of the movement.

Tom Erickson says, “There are two generally accepted ways to transport used needles to a collection point:

1. The user returns the needles in an approved sharps container to an authorized collection point (for example, a pharmacy or hospital).

2. The user mails the needles to the collection point, called "mail-back." Due to postal regulations and much higher expense, the mail-back option is rarely used.”

The United States currently has no national laws about the safe disposal of sharps waste. The Environmental Protection Agency (EPA) has published new guidelines for the disposal of home-generated sharps waste. To encourage sharps waste removal from normal household waste, the EPA recommends six disposal options, and the use of sharps containers is mandatory in all six.

Many states and cities are attempting to adapt to the EPA guidelines, but with little success. Some states now are requiring the storage and transport of used syringes and pen needles in sharps containers. California tried, but they omitted two critical components – free sharps containers and convenient authorized collection points. Two successful city programs are Sioux Falls, SD, and San Luis Obispo, CA. They included the two afore mentioned components.

In Canada, some pharmacies pay for disposal of home use sharps. When other pharmacies realized that they were losing their valued diabetic customers to this tactic, they countered with their own programs. Now some of the provinces in Canada are considering legislation to move the cost from pharmacies to sharps manufacturers.

Tom Erickson also says the next few years will be interesting. He says political pressure and EPA guidelines will cause nearly all 50 states to enact home-use sharps collection legislation. He comments that it is easy to predict the most controversial issue in this new legislation – who is going to pay the bill?

“There are three alternatives:

1. The Canadian model, where pharmacies pay the cost.
2. The Sioux Falls and San Luis Obispo models, where government pays.
3. The EPR model, where the sharps manufacturers pay for the safe disposal of their products.

It will be interesting to see which of the three options the 50 state legislatures take.”

This should mean that those of us with diabetes and using insulin will need to watch and take action to prevent all of the cost becoming an even bigger financial burden. In the town where I live, I have the entire financial burden for taking my sharps to the collection point and paying a fee to have them properly disposed of.