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Posts Tagged ‘disease management’

The Power of Paper

Thursday, October 30th, 2008

Don’t dismiss paper forms and lists as powerful tools in managing diabetes.

The simple act of writing something down raises the level of awareness of the action you have taken or are about to take. In turn, this means that you are more likely to do a little self-critique (even subconsciously) to assess how you are doing. Also, if you know what you should have done, this is particularly good feedback.

Since most of us tend not to live tethered to a computer, writing it down is a convenient way to remember the details, including any notes, that should be logged in your digital diary, like My Project Diabetes, later.

Personally, I think another good reason to write it down is the value of “touching” your numbers. When we write something down we have “touched” it and have a sense of how it feels. We can associate that feeling with our physical state at the moment and recall it later when we have a similar experience. For the person with diabetes, especially, knowing what low blood sugar feels like is very important.

So, even though we are big fans of online tracking diaries, we’re also big fans of writing it down. Do you know how your numbers feel?

Woody Runner is Founder and CEO of Three Questions, LLC which operates Project Diabetes as part of My Health Projects. Three Questions also operates Healthcare Fellowship Networks. Woody.Runner@ThreeQuestions.net

Diabetes by Design – Part 3

Tuesday, August 5th, 2008

In Diabetes by Design – Part 1 and Part 2, I raised a few questions about how we might think about designing a life with diabetes. I talked about the importance of a framework and an intentional approach to life with diabetes. I addressed the question of owning your diabetes versus being owned by it.

As I said in Part 2, I don’t pretend to have all of the answers or to have it figured out. I don’t. My purpose in this series is to encourage you to think about how you approach life with diabetes and come to terms with the disease. Figuring out life with diabetes is a process and always will be. And, the process will move at a different pace for everyone.

What does it look like?

Having thought about a framework and having made a decision to own or be owned, it seems sensible to me to visualize how a desirable life with diabetes might look. For me, this is how I manage my own expectations. For example, it would foolish for me to imagine a life with diabetes that was all fun and games, a carefree ride into the future. Rather, the visualization process allows me the chance to see different scenarios and wrap my head around one or more possible alternatives that are sensible to me.

One way I visualize my life with diabetes is that I simply have a pancreas that has been set to “manual” mode. I think of it kind of like a having a stick-shift in a car. It requires slightly more effort and much more attention than driving a car with an automatic transmission, but it’s still a very efficient way to get around. This visual model works for me since it is consistent with my stated intent to own the disease. As the owner, I control what gear I am in, so to speak, as well as how fast or slow the engine revs.

As I have said before, what is sensible to me may not be sensible to you. This is a highly individualized endeavor. The point here is to think about a mental model or visualization that fits your situation and is consistent with your framework.

How would it work?

The next aspect to consider is the practical application of a lifestyle framework. What is it going to take to make this work? What information and tools will I need? How do I find what I need? The real nuts and bolts of how you carry on day-to-day. Drawing from my own experience, here’s some of what was on the list of specific things I considered and why I thought they were important:

  • I knew there was going to be a lot of data. Since I knew there would be way more than I could keep track of on paper, it would be important to have a organized database on a computer that I could use to store and analyze big quantities of data.
  • I had a strong sense that the data, over some period of time, would tell a story and help me, my doctors and other caregivers understand something about how my body behaves in certain circumstances. This matters because today’s data will someday be useful in predicting the future. Without the history, however, I would not be able to see or remember the whole story. Beyond anecdotal evidence, I would never really know if I was doing better or worse – at least not until maybe it was too late. Think of it like tracking stock prices. Among other things, analysts look at history to help predict the future. The same principle applies here.
  • I had a pretty good idea that the length of time that it might take for the data to tell a coherent story was not known nor easily knowable, so it would be important to have a long-term solution. This mattered to me because of the very real possibility that technology and equipment would change over time and that the data management solution I picked would allow me the control my data over the long term. Several solutions I looked at didn’t fit since they were product or device-centric. So, for example if I wanted to consider changing to a different meter or pump in the future, there was a very real possibility that I might face the prospect of losing my historical data – at least in a workable format.

These and other considerations led me to design and build the solutions that worked for me and my particular framework. Those original tools are the basis for the design of the tracking diaries found in My Project Diabetes.

The point here is not a pitch for Project Diabetes, although we think they are pretty good tools. The point is that the tools and information you choose to use should be informed by the framework and expectations that you have built for your particular situation. Taking this approach should lead to a sustainable process for living life with diabetes on your terms, not its terms.

Woody Runner is Founder and CEO of Three Questions, LLC which operates Project Diabetes as part of My Health Projects. Three Questions also operates Healthcare Fellowship Networks. Woody.Runner@ThreeQuestions.net

Diabetes by Design – Part 2

Wednesday, July 30th, 2008

In Diabetes by Design – Part 1, I wondered aloud about what would happen if we thought about diabetes (and by extension other chronic conditions) as “everyday things” in the context of design after reading Donald A. Norman’s The Design of Everyday Things.

Specifically, I wondered – What do we make of the fact or reality of diabetes in our life? What if we think of and adopt lifestyles that allow us to own the disease, rather than being owned by the disease? What would that look like? How would it work? So, let’s consider some possible answers. By the way, I don’t mean to suggest here that I have it all figured out – I don’t. I invite you to wade in and comment with your thoughts.

What do we make of diabetes – building a lifestyle framework?

Diabetes, like any aspect of our lives, requires that we make choices. Choices about what to eat, how much to eat, whether to take medication (or even fill the prescription), test our blood sugar, follow up regularly with various specialists and so on. The framework for how we make those choices is very important, which means we ought to think about that framework (I use the term framework to mean the overall physical, emotional and practical environment in which we live our lives).

In his book To Follow Him, Dr. Mark Bailey observed that “You can choose your actions, or you can choose your consequences.  But you can’t choose both.”  This means that once we have made the choice of which one we want to control – or at least influence in an intentional way – the consequence or the action, the succeeding choices that we have to make become very clear.  This bit of wisdom is generally useful in life.  I think it is particularly meaningful when it comes to living with a chronic disease because the stakes are magnified with every choice we make.

For instance, after being diagnosed with diabetes, I decided that one of the important long-term consequences I wanted was to be healthy. That fundamental choice became the foundation of my personal framework for dealing with the disease and made it very easy to make subsequent choices. So, if I want to be healthy, I know clearly that I should choose to exercise daily as opposed to not, choose the chicken more often than not versus the burger, choose to test my blood sugar regularly, and so on. If I fail to make choices that are consistent with the consequences I have chosen, then it becomes unlikely that the consequences I desire will be realized.

To own or be owned?

Another choice that I made was to own the disease, not be owned by it. This meant that I had to embrace diabetes and accept it as part of my life, rather than become bitter or avoid the realities that come with it. In other words, I decided I would not dwell on “Why me?” type questions (they don’t have an answer anyway).

For me, adopting this ownership point of view is an important part of the framework. Everyone will have their own particular way of responding to this question, but for me being in the ownership role means that I can think clearly about how I want the disease to work for me. That may sound odd, but it goes back to the earlier reference to an opportunity being on the other side of any problem. In my case, I have used the disease (the problem) as a catalyst to adopt and maintain positive lifestyle habits that are in my long-term best interest. Who could argue that eating right and exercising regularly are not good for you? All my life I have known these things to be true. But, I was never able to follow through since I did not perceive the need as real. Diabetes made it real and I use the disease to help me do things that I should have done already.

There are as many versions of this as there are people, but the point of this discussion is to encourage an intentional approach to how we think about life with diabetes. I can only speak to my experience and I encourage you to share your thoughts.

In Diabetes by Design – Part 3, I will take on the questions, “What does it look like?” and “How would it work?” when it comes to designing a life with diabetes.

Woody Runner is Founder and CEO of Three Questions, LLC which operates Project Diabetes as part of My Health Projects. Three Questions also operates Healthcare Fellowship Networks. Woody.Runner@ThreeQuestions.net

CDEs – A Guiding Hand

Tuesday, July 29th, 2008

Hello Everyone! My name is Nancy Bristow and I am a Registered Nurse (RN) and Certified Diabetes Educator (CDE). I currently work in a private practice endocrinology clinic where I work with people with diabetes on a daily basis. I work with four wonderful Endocrinologists in our busy practice group and have been a CDE for 18 years and worked in the field of diabetes for over 25 years.

I have a family history of diabetes – I lost a grandfather with Type 2 diabetes and one of my children weighed almost 9 pounds at birth. I work closely with all types of patients with diabetes and enjoy working with adult patients.

The CDE’s role is an important part of a health care team. The CDE should be an active listener and coach, helping patients to achieve their goals in managing diabetes. When I work with patients, the common recurring theme seems to be that current management routines are far too complicated and overwhelming. So I make it a goal to simplify – If you can imagine a routine that is simplified, you can succeed and avoid getting discouraged. Project Diabetes is a passion of mine and I have hopes of helping many of you on your journey and hope my insight and experiences can be helpful to your personal situation!

Nancy Bristow, CDE, RN is an active contributor to Project Diabetes and an Advisory Board Member of Three Questions, LLC, which operates Project Diabetes as part of My Health Projects. Three Questions also operates Healthcare Fellowship Networks.

Diabetes by Design – Part 1

Thursday, July 24th, 2008

I recently read Donald Norman’s classic book The Design of Everyday Things. Originally published under the title The Psychology of Everyday Things, Norman provides a number of intriguing insights into product design and utility. You should read it – you’ll never look at the world the same way again.

It got me thinking. What would happen if we thought about diabetes as an “everyday thing” (and other diseases for that matter)? While diabetes is not an “everyday thing” in the sense that Dr. Norman uses the term, it is very much a thing that diabetics (to use the politically incorrect term) live with every day. I think it can fit. So, what do we make of it? What if we thought of and adopt lifestyles that allow us to own the disease, rather than being owned by the disease? What would that look like? How would it work?

In my personal experience, I consider diabetes to be a blessing. In the two-plus years since being diagnosed with Type 1, I have changed my lifestyle in a number of positive and constructive ways. I eat better, I exercise more and generally try to make more healthy lifestyle choices. As a result, I feel better than I have in 20 years. Basically, I proactively changed my lifestyle taking into account the ongoing reality of diabetes. The alternative course would have been to resign myself to reacting to the day-to-day or moment-to-moment demands of the disease. To me, the alternative wasn’t an appealing option. Diabetes-wise, following this approach, I have been able to consistently maintain an A1c of 5 and enjoy my life in the process.

Years ago in a business meeting, one of the guys I was meeting with said something that has stuck with me (and I have often repeated). He said, “On the other side of every problem is an opportunity. Our job is to figure out how to get on the other side.” Applying this to my situation (and, frankly, to anyone with diabetes), what I figured out was that the disease is incurable, so it’s not going away anytime soon – so I can either take control of it or let it take control of me. By choosing to take control, my choices became pretty clear. I think the same is true for anyone in a similar situation.

What will you do?

In Diabetes by Design – Part 2, I will think out loud about some of the questions raised above.

Woody Runner is Founder and CEO of Three Questions, LLC which operates Project Diabetes as part of My Health Projects. Three Questions also operates Healthcare Fellowship Networks. Woody.Runner@ThreeQuestions.net

How Project Diabetes Started

Wednesday, July 2nd, 2008

Hi, I am Woody Runner and I was diagnosed with type 1 diabetes in 2006 at age 48. My personal experience led me to start Project Diabetes out of a commitment to help other people with diabetes improve their health. The initial motivation to start Project Diabetes came when I discovered from my endocrinologist how successful I was at managing my blood sugar – after my diagnosis I reduced my A1c from 12.1 to 5.0 in less than 90 days. I assumed everyone did what I did. When I learned otherwise – that very few people are tightly controlled – I committed to find a way to share what I was doing.

I got started with Project Diabetes about a year and a half ago. It didn’t start out being called Project Diabetes, but the idea was always the same – to help people with diabetes to be healthier and improve the quality of their life. Frankly, it’s taken longer to get to this point than I would have liked.

The first attempt turned out to be way too big. It was a sprawling, custom, enterprise-class social networking platform with enormous scale and potential, but too cumbersome to maintain and operate for our purposes (I will share more on that experience at a later date).

Among the things I learned from that initial attempt was that diabetes tracking tools needed to be easier for users to get to and apply. I hope and pray that the My Project Diabetes user experience reflects our commitment to ease of use and access. Project Diabetes users can access their tracking diaries through the website, through widgets, via their iPhone and through our voice application. In the coming days and weeks, we will be adding new ways to enter and access information that fit the needs of Project Diabetes users.

The Project Diabetes philosophy is to keep it simple and easy. The tools and solutions that you will find at Project Diabetes are designed to complement the lifestyles of people with diabetes.

Woody Runner is Founder and CEO of Three Questions, LLC which operates Project Diabetes as part of My Health Projects. Three Questions also operates Healthcare Fellowship Networks. Woody.Runner@ThreeQuestions.net