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DISCLAIMER AT THE BEGINNING TODAY

I work for Diabetes Australia and have been involved in our National Diabetes Week campaign. I am referring to this year’s campaign in this post, as well as previous campaigns (which I have also been involved in). This is a commentary piece on what I think works and what doesn’t. This is all my opinion – thoughts my own and mine alone.


It’s National Diabetes Week in Australia this week, and that means the socials are all in the key of D, with lots of news and stories about that little health condition that many of my friends and I know a little bit about.

And campaigns. There are lots of diabetes campaigns.

The other day, I re-watched a lot of old NDW campaigns from years gone by. It was no secret at the time that I wasn’t all that enamoured by some of them. The campaigns that really concerned me was the ones about complications using graphic images of an eye being operated on, or a heart that was (apparently) seriously damaged, or what a kidney looks like when on dialysis. While some people’s concerns about these ads was on the ‘unintended consequence’ of how people already diagnosed with diabetes might feel when seeing these, mine was that have always struggled with isolating body parts from the whole person living with diabetes. It doesn’t work that way – even if we have a diabetes-related complication in one part of our body, it still remains intact and attached to the rest of us. (I think this piece I wrote with Grumps for diaTribe explains best why this is problematic.)

In recent years, I feel that we have become a lot smarter and more systematic about our campaigns. This is as much about the approach to how we have done things, as well as the actual campaigns themselves. Previously, there was a theme and it was rolled out for a year, and one year only. Each new NDW meant a new campaign theme. And then, as soon as the week was over, we shelved it.

It’s not just diabetes organisations that are guilty of throwing all their energy at ‘their’ health week and building up a big campaign that they yell and shout about for the week and then, in a puff of smoke, it all disappears – often never to be heard of again. It’s as though there is a collective sigh and then everyone ticks a box as if ‘that’ issue has been done and doesn’t need to be done again.

Back in 2016, Diabetes Australia ran a campaign called 4,400 Reasons which addressed diabetes-related preventable amputations. There was clear calls to action behind the campaign and one was to highlight the need to reorientate the Australia health system towards early intervention and the implementation of more foot care teams across the country.

The campaign wasn’t graphic – there were no images of amputated limbs or blaming and shaming those who have had a limb amputated. It had a very clear focus on how the system is letting people down – not that people with diabetes were not looking after themselves.

Since then, we have continued to push the message of this campaign. Screening is important and it needs to happen systematically.

And then yesterday, at the start of another NDW, the federal government made an announcement about a new funding initiative that would start to build a national screening and treatment program called ‘Foot Forward’.

That’s how to do it – find a way to address an issue, make it a focus, keep going, continue to push the same messages, talk to the right people, make it happen. We’re not done, by the way. This is the start of a national screening program, but until we know that preventable amputations are happening far less frequently – or not at all – we keep working at the problem.

For this NDW, we are continuing to promote the importance of early diagnosis of both types 1 and 2 diabetes.

Our T1D campaign is the 4Ts and is a community awareness initiative to increase knowledge of the signs and symptoms of T1D.

Why are we doing it again? Because each year there are well over 600 Australians who are diagnosed with diabetes when they are very, very unwell. Most will have already been to the GP once, twice or even more times and have been misdiagnosed. Type 1 diabetes is fatal if it is not diagnosed in time. That’s the bottom line here. Until this stops happening, we need to teach people the 4Ts.

And when it comes to T2D we need a national screening program that means people are not living up to seven years with type 2 diabetes before they are diagnosed. Early diagnosis equals early treatment and that means better outcomes. That is a goal we keep working towards.

What can we learn about how to put together a meaningful public health campaign?

Time and time again, I hear people say, ‘Why can’t you run a campaign about the difference between the types of diabetes?’I want to ask you if you knew what those differences were before you or a loved one was diagnosed with diabetes. Think about other health conditions and just how much you know about the realities of life with those.

When it comes to health messaging, the airwaves are flooded. We have but a second to grab people’s attention. If we only talked diabetes 101 education to the general community, who do you think is really going to listen to that? I reckon it will be people already affected by diabetes – people who already get it. Do you sit there and watch or read about every other public health campaign for conditions that don’t have anything to do with you or someone you know? I know I certainly don’t.

I know nothing about stroke, however did learn FAST – because it was simple and important to know. Have I bothered to learn about what day to day life with someone who has had a stroke is? Or about the different types of stroke? Not really.

This week, you will see a lot of diabetes out there in traditional and social media. Share what you will and can. We already will share the things that are more relevant to our own experience – that makes sense. I’ll admit my bias and say that I am committed to getting the 4Ts message out that you’ll be seeing a lot of that from me. I have heard too many of my type 1 tribe talk about their horrid diagnosis stories.

I keep saying this – I don’t want or need or expect people to know the intricacies of my life with type 1 diabetes. Honestly – I don’t particularly to know that. But I would like people to be diagnosed with type 1 sooner. I would like them to be diagnosed correctly. I would like HCPs to know the 4Ts and have them front and centre.

I don’t want shock campaigns that scare people into inaction. But equally, I don’t want wishy-washy campaigns that offer nothing and have no call to action. I want more campaigns that deliver. And I think we’ve made great strides in that direction.

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With National Diabetes Week launching tomorrow in Australia, I’m resharing this post today.

Once again, Diabetes Australia (disclaimer again – I work there, but sharing this becuase I am choosing to be because it’s so important, not because I’ve been asked) is once again running parallel campaigns about the importance of knowing the signs of type 1 and type 2 diabetes.

I’m really pleased with this year’s campaign, because we’ve gone harder than in the last two years by highlighting that not diagnosing diabetes in time is fatal. I know that sometimes we get nervous using words like that, but the reality is that missed or misdiagnosis of type 1 diabetes is fatal. People have died. And that is not good enough. (Melinda Seed wrote a powerful piece about this just yesterday – please read it.)

I echo Mel’s plea and ask that you will share the poster below with your non-diabetes networks. Do it now, and do it regularly. Sure, share it in your diabetes support groups and with your mates with diabetes. But if that’s all we’re doing, nothing is going to change. 


I am certain that almost all the people who read this blog are in some way affected by diabetes. (Because, really, if you are not, why would you be reading?) It makes sense that the people who want to hear about my real life with diabetes have their own real lives with diabetes.

Most of the blogs I read are to do with diabetes. Most of my interactions online are to do with diabetes (with the occasional detour down avenues of language, Nutella recipes, Effin’ Birds, and idolising Nigella).

It makes sense and there is nothing inherently wrong with focusing on things that we understand, or that is interesting to us personally. Of course we feel a connection when reading stories by others going through similar experiences, and that makes us feel safe and less alone.

This week, however, I am hoping that a lot of what we are talking about is received by people outside the diabetes world. Because #ItsAboutTime that others know and understand the importance of early diagnosis and treatment of diabetes.

It’s National Diabetes Week (#NDW2019) and Diabetes Australia’s campaign this year is building on the 2017 and 2018 campaigns of raising awareness of the signs and symptoms of type 1 diabetes, and the fact that there are 500,000 Australians with undiagnosed type 2 diabetes.  (Disclosure: I work for Diabetes Australia. I am writing about this because it is an important issue, not because I have been asked to.)

These days, my loved ones and I know all about the symptoms of diabetes. And somehow, I knew them just over 21 years ago when I walked into my GPs office and said ‘I’m thirsty all the time, I can’t stop peeing, I’ve lost weight and I’m exhausted. I think I have type 1 diabetes.’

My GP told me that she thought I was being a hypochondriac, so I’m actually not sure if she would have sent me off to pathology for a fasting glucose check as quickly as she did had I not prompted her with my (as it turns out correct) self-diagnosis. (In hindsight, getting me to pee on a stick would have been an even better idea, but I didn’t know that at the time…)

The rest of the story is that a few days later, I was told I had type 1 diabetes. That’s my whole story. It’s utterly, completely, totally uneventful and, quite frankly, I love that it is.

But that’s not the way it is for a lot of people. In fact, each year 640 Australians end up in hospital because the signs of type 1 diabetes have been missed. In many cases, these people have already been to see their GP one, two or more times because they , or their families, have known that there was something not quite right, and they were not checked for type 1 diabetes.

Is that your story?

Here’s the thing: if you have diabetes, or someone you are close to has been diagnosed type 1 diabetes, you know the signs. You may not have known them beforehand – in fact, you may have your own diagnosis story that mirrors those that we are sharing throughout NDW – but you know them now. You are not the target audience for this campaign.

The target audience is people in the community without a connection to diabetes. It’s GPs who are not routinely asking people to pee on a stick so they can quickly and easily check if a person has glucose in their urine.

We need to tell those people. Because we can talk all about this amongst each other all we want, but then all we are doing is adding to the noise in the echo chamber. We need to step outside of the diabetes world and shout from the rooftops 4Ts of type 1 diabetes:

These symptoms need to trigger people – everyone – to automatically think type 1 diabetes.

Share the poster. And ask everyone you know to share it too – including people not affected by diabetes. #ItsAboutTime we ALL knew the 4Ts so that we can diagnose and treat type 1 diabetes sooner

The Diabetes Australia NDW2019 campaign can be found here.

And here’s a Facebook Live video that Grumps and I did yesterday where we speak about the campaign and some other things too.

 

 

 

Let’s imagine, just for a moment, that a television program or newspaper claimed that there was a cure or treatment for type 1 diabetes that you could brew in your kitchen with a few pantry items.

It’s not really all that hard to pretend that this scenario is real: almost every week there is something somewhere that claims to be a way to treat diabetes, and sometimes, this mythical treatment is for type 1 diabetes.

What happens when we see this? Well, usually, it starts with some low level ranty outrage from a first responder who caught the piece and feels that they need to share it with the diabetes world (hashtag – DOC).

Then, as it gains momentum, others get onboard, because we all love a little SoMe outrage. Inevitably, there will be some comments about how ‘This might work for type 2 diabetes, but I/my child has type 1 diabetes, and I/they did nothing to cause it and this is the serious type of diabetes so stop it now.’ (Because adding some ‘type wars’ to the discussion is always helpful.)

There will be blog posts written about it (possibly/probably by me) and someone will demand an audience with the reporter, so they stop perpetuating myths about type 1 diabetes.

Right?

The outrage can be exhausting, but I do get it. We don’t want people to simplify our condition, of have people thinking that there is an easy fix. We want people to understand that it is hard work to manage diabetes and that every time there is a claim that it can be easily treated, people move further away from what it is really like. We want people to know that, so we talk about it loudly and everywhere.

So, after watching the ridiculous claims from Medicine or Myth the other night, I turned to Twitter to see what people were saying about the idea that hemp kombucha was miracle cure or to hear the criticisms about the poor study design of the trial.

Was there a barrage of people questioning the idea that simply drinking 100ml of a fermented drink a day could possibly be all it is going to take to treat the incredibly complex health condition that is type 2 diabetes? Or tweet after tweet probing whether the ‘trial’ that decided that we’re on a winner with Kombucha would pass any sort of test? Was there a choir suggesting that this was really all a lot of hocus pocus and it was undermining just how serious type 2 diabetes is – and how hard it is to treat it?

There was now tweet from Jane Speight…

…and that was pretty much it. (It is a very fine tweet, and that #sciencefiction hashtag deserves accolades!)

And there was no one up in arms about the way the merry band of doctors was talking about type 2 diabetes in such sensationalist and stigmatising ways. If they had been talking about type 1 diabetes, our response would have been swift.

What we saw on this program this week is actually dangerous. We can’t dismiss it as yet another ridiculous claim from a nut like Pete Evans, or Sarah Wilson, or the latest footballer’s wife. We can’t attribute it to an Instagram wellness guru. Instead, we saw three qualified healthcare professionals – a neurosurgeon, a GP and an immunologist; healthcare professionals that people trust with medical advice.

And – showing some bias here – perhaps it would have been easier to dismiss and discredit the whole show if it was broadcast on a more traditional tabloid program such as A Current Affair. An SBS show, with three Australian practising HCPs? People will think this is legitimate.

The way Medicine or Myth whitewashed type 2 diabetes was a disgrace. And as diabetes advocates, we should be calling out this sort of garbage, the same way we would ludicrous claims about type 1 diabetes treatments.

Totally unrelated, but I live in the most hipster street in the most hipster suburb of Melbourne and there is a place on my street that brews and sells seventeen different types of kombucha.

One thing that is somewhat of a consolation while dealing with jet lag, is that while I’m not sleeping in the middle of the night, Twitter is right there keeping me company! There is always someone from the DOC up and ready for a chat. And if I don’t feel like chatting (because honestly, at 3am when I’ve not had enough sleep, stringing words together is a challenge), there are always things to read.

And that is great.

Also great is when people jump on board to support each other, or cheer when others are involved in an exciting initiative. (Seeing people in the DOC welcome and embrace the amazing young advocates from the Philippines as they have launched their online activities is one such example.) There is comfort in the reliability of the way people respond in those situations.

But then there is frustration in the reliability of how people react and complain about being left out when it seems some folks in the DOC are doing something. It may be an event, a conference, or people just doing stuff like starting peer support campaigns. It could be people giving talks, writing pieces or coming together on advisory committees.

I wrote a whole thing about this at 3am. Words were strung together, and I started getting strung out, so I deleted it after wise counsel from a Twitter friend who reminded me that sometimes just writing stuff down is therapy enough. (Thank you to that wise person.)

She is right.

What is also right is that there is an Effin’ Birds moment for everything in life. Even when you don’t think there is and you put a call out, the nice folk at Effin’ Birds direct you and then deliver. And it’s perfect.

As a parent, I learnt there is this magical thing that happens when you are in a really crowded and noisy place with your kid/s. Somehow, over the roar of the crowd, you can always hear your kid if they are calling out to you. It’s some sort of sorcery that blocks out the din, and allows your kid’s annoying angelic voice to still be heard.

That kind of happened to me the other day when I was sitting in a café minding my own business, working away and savouring the always excellent coffee at my favourite local. There was a table nearby that seemed to be made up of a mum, twin two or three-year-olds and grandparents. They were talking loudly, the kids were playing and talking over each other. They were a little rowdy, but it made no difference to me. If you want to work in a café, you have to be prepared for the noise! I wasn’t listening to their conversation – I was focussed on what I was writing. I couldn’t tell you what was being said.

Until I heard the word ‘diabetes’ through the racket, clear as a bell. I looked up, to hear the rest of what the mum was saying ‘…and it’s like a sensor you wear – I think on the back of your hand – and you just run something over it and you get your result. I want to try it so I can stop having to prick my fingers.’

I have had a statistically significant number of diabetes in the wild encounters recently. It looked like I was about to add another one to the tally.

‘Hi,’ I said. ‘I have diabetes. I also am a diabetes advocate. I think you’re talking about the Freestyle Libre. It’s a small sensor that you wear on your upper arm, and you scan your smart phone or other reader device over it to see what your glucose level is. I wear a continuous glucose monitor. That transmits my glucose readings to an app on my phone. It’s different, but kind of the same in that it limits having to prick your fingers.’

We chatted for a bit and then a friend joined me. She was actually wearing a Libre sensor, so (after ordering her coffee) she did a quick show and tell to so the woman could see how it worked. (For the record, not all my friends have diabetes. This was a fluke!)

I passed on my contact details to the woman and encouraged her to reach out and get in touch for a chat. Because that’s what we do. That’s how this community works.

I’ve been thinking about our diabetes community a lot recently. After being in Manila (please read my disclosures on this post), I have felt that strong pull towards people who gather strength from each other because of our shared experience.

One of the sessions in Manila addressed some community initiatives that have really relied on that community spirit, and we talked about why they work. Grumps and I led the sessions and discussed Spare a Rose, #TheLowdown2019, and #TalkAboutComplications. These were examples of different ‘campaigns’ that all had similar results.

Spare a Rose is owned by the diabetes community and it is for the diabetes community. It works because no individuals own it – that’s not how it works. You want to support it, great! Do your thing and get the word out. No one directs what it looks like apart from encouraging others to reach into their pocket to support Life for a Child and save the lives of children living with diabetes.

#TheLowdown2019 is a campaign out of Diabetes Australia (disclosure: I work there), but it isn’t about us. It is us creating a platform for the community to share their stories and come together. What we heard as people shared their hypo experiences was others connecting to those stories.

And #TalkAboutComplications provided an opening statement and ongoing support and encouragement for the community to talk about a topic that is often seen as taboo, and filled with blame and shame.

As I wrote in this piece, the group in Manila was already a community, even if they hadn’t quite started calling themselves that yet. And since then, they have found their voices – loud, passionate, smart voices – and are showing what community does. They support each other; they build each other up; they share what they know.

We use the word ‘community’ a lot in diabetes. We talk about it in terms of face-to-face groups, we talk about it when it comes to meeting others with diabetes and welcoming them into the fold, and we talk about it in terms of our online connections. Some people struggle to find just where they fit in there, but I genuinely believe that there is a place for everyone. You just need to find the tribe that makes sense to you and your perspectives of diabetes.

I have written and read a billion words about why community matters, and how, when it’s right it can be an absolute saviour. When I try to explain the value, it’s easy to get lost in superlatives, and sickly sycophantic gushing that start to sound empty, so I often show this video and throw the hashtag #Simonpalooza at people, making them promise me to look it up and learn about it. Now, I can add the story to what happened in Manila last month.

I became part of a new community when I was in Manila, and those advocates became part of our bigger one. I feel that their experiences add to the diversity and the experiences of the DOC. Their stories start to meld into the fabric of other stories, and I so love that we now get to hear them too.

When those diabetes in the wild moments come my way, I can’t overlook them. I suppose I could have ignored what the woman in the café was saying and let her work it out on her own. But why would I do that? I have benefited from the no-agenda-other-than-wanting-to-connect attitude of many in our diabetes community – honestly, I benefit from it every single day. There is no way that I could do anything other than say ‘hi’. And connect.

(Video of Day 1 of the Manila workshop made by one of the advocates, Kenneth.)

Last Thursday morning, still wracked (and wrecked) with jet lag from having just returned from ten days in Europe, I boarded a flight to Manila. I would be co-facilitating a workshop for people with diabetes from across the Philippines about how advocacy, community and engagement. If I’m completely honest, I had no idea what was in store for me.

I knew that the PWD who would be attending had all been through a diabetes camps program in the Philippines. They were all young and very eager to step up as advocates. They were the reason the workshop was happening – they realised it was time to elevate the PWD voice in advocacy efforts in their country and they wanted some help in doing just that.

And so, the idea of a workshop was conceived, and the two facilitators were flown in from opposite sides of the planet to pull it all together. Enter me and the Grumpy Pumper (who for once had to travel further than me and was more jet lagged than me).

As the facilitators, we were there to talk about some examples of effective grass roots advocacy, talk about how engagement with other stakeholders is important, and highlight just why the voice of those living with diabetes is critical when it comes to lobbying. We had an vague outline of just how we thought the workshop would run, but we really wanted to ensure that the attendees could shape it the way they wanted, asking relevant questions and walking away with information that would help them.

Once the workshop started, it was very, very quickly apparent that we already had a thriving, dynamic and enthusiastic community in the room. They just weren’t seeing themselves that way. Over the course of the workshop, we saw the ten PWD realise that their own stories and voices are important and have real currency, and they are an unstoppable force when they came together. If ever I needed a reminder of the power of community, I’d have found it there in that room in Manila!

There will be a lot more about the weekend workshop in coming days. I’m still getting my head around it all and am not really sure what to write just yet. It may take me some time. What I do know is that the DOC now has some new voices. Their perspectives will be different to those we often hear about, and that diversity is always good in a community.

So, while I’m getting my words together, get to know these amazing young advocates. They’re on Facebook here; Twitter here; and Instagram here.

 

DISCLOSURES

Novo Nordisk covered costs for the advocacy workshop. Grumps and I were invited to facilitate the workshop as part of our involvement in the Novo Nordisk DEEP Program. Novo covered by flights, accommodation and ground transfers.

Some weeks in diabetes feel longer than others. This week has felt like a millennium. And it’s felt nasty.

I took most of the Easter long weekend off Twitter because there was some mean stuff happening, with the usual suspects rearing their bullying heads. I ventured in once but didn’t want to spend my weekend seeing what people were saying about my tweet. Apparently said tweet also wound up on Facebook, because being held up as an example of the hopelessness of the diabetes mafia on just one social platform wasn’t enough.

Whatever.

If I had to say something positive about it all, (being the Pollyanna type), it would be that I do appreciate the lack of passive aggressiveness of these bullies. They let you know where they stand – no Vaguebooking or subtweeting from them!

But then, I also lack subtlety. And so, here’s an unambiguous reminder for everyone. Because after the week that was, I think we could all do with a little bit of kindness.

A few years ago, I was introduced by my endo for I talk I was about to give. I was there to do a bit about how I like to be treated by HCPs, and there was a whole bit in there about how I was more than my numbers.  We’d chatted about how I would like to be introduced and I suggested she should read my bio and then say ‘And Renza’s last A1c was…’ before I would cut her off. It was a good lead into my talk.

My endo is one of the very few people who actually does know what my A1c is. As a matter of course, I don’t share it. It’s my data. I own it. Sure, I may post a screenshot of a recent CGM trance because right there and then it contributes to how I am feeling. But it is my own and my decision to put it out there for others to see. I understand that there may be judgement from others, or they may want to share their opinion. That’s fine. I can take it.

I would never, ever ask another person with diabetes what their A1c is. Or what their blood sugar is in the moment. In fact, I deliberately look away if someone pulls out their glucose meter or checks the CGM app on their phone. Of course, if someone wants to tell me what their numbers are, I’m happy to listen.

But I would never, ever ask. And would very pissed off if someone asked me. Imagine if someone asked you your weight? How would you feel about that?

Why is it that even though there are so many different aspects to our health that are measured, it is glucose levels or A1cs that are the ones that get shared around – by ourselves and by others. Get onto any online diabetes group and you will see this happening. I have to sit on my fingers and keep them away from the keyboard when the data being shared does not belong to the person doing the sharing. Some groups have regular ‘roll call’ threads where they ask for most recent glucose results. People sharing their own numbers is one thing – sharing someone else’s is another thing altogether, especially when it is annotated with what the person ‘did wrong’ to ‘cause’ the out of range number.

How can we truly believe that people see us as more than our numbers if that is what is shared? That was the point my endo and I were making during her introduction…she read my bio outlining all the things that I do believe go towards defining me. Yet there she was at the end focusing on a number that I refuse to believe does.

Imagine participating in a ‘current weight’ thread. How comfortable would anyone feel doing that? Or would they even consider sharing someone else’s weight online? (Step down now if you’re a Kardashian and that’s just regular Insta fodder.) I know that there are weight loss groups who do online weigh-ins. While I would never do it, they’re adults making the decision to do it.

I have a number of adult friends who use CGM share apps so that their friends, HCPs or loved ones can keep an eye on what’s going on with their glucose levels. (I’ve done this in the past, but don’t do it now.)

I asked some of them if they set up rules around how this sharing works. Some do. For example, they share only at certain times; they are clear about when they want the person they’re sharing with to get in touch, (one friend said that her partner is allowed to call her if she is low and hasn’t messaged within 20 minutes to say she’s on it – if she messages, he leaves her alone); they do not want to hear any judgement calls from the person seeing their data (and that goes double, triple, quadruple if that person has a functioning pancreas), they do not want to be asked if they have bolused as their trace inches (gallops) higher.

I guess what everyone is trying to do is make sure that they don’t feel as though they are under surveillance.

I asked these friends if there had been a conversation about ‘on-sharing’ – that is, the person who had access to their CGM data sharing it with others. No one had. I never had that conversation when I was using share apps because I knew that no one would think for a moment that was okay. They knew that flashing what they could see on their app to anyone around them was not okay – the information was not theirs to share. My friends said they knew their data was safe too.

Some people may think I am making too much of a deal about nothing. That it is just sharing a number in the moment and that is it. Or it is a moment of pride, sharing a loved one’s A1c they have worked hard on or CGM graph for the day, or snapshot showing how much time they’ve been in range.

But actually, I think it is more than that. I see it as saying that in that moment, that person with diabetes is only about a number and data. That is never, ever the case.

POSTSCRIPT

I wrote this piece a while ago and have been reluctant to publish it but changed my mind after seeing a conversation about this online earlier this week (that I stayed well clear of).

Please see my musings through the lens with which I am writing: I am an adult with diabetes. I was diagnosed as an adult. My perspective is my own and I don’t for a moment claim to understand anyone who is not a woman in their mid-40s, diagnosed with T1D at 24, living near the middle of a large city, who drinks too much coffee. And is called Renza.

Yesterday, Diabetes Australia launched a new campaign called The Lowdown (please read my disclosure statement at the end of this post). It’s all about hypoglycaemia, and designed to get hypos out in the open by encouraging people with diabetes to share the realities of what hypos mean, look and feel like.

I love this campaign because it’s truly about people with diabetes. You’ll see and hear our stories and our experiences, and it will provide a forum for us to learn from each other. (Vote 1 peer support!)

There is stigma associated with hypos. Have you ever had a low and been asked ‘What did you do for that to happen?’. Or has someone ever asked you why you are not better prepared if you find yourself without enough (or any) hypo food on you? Has someone overreacted when you have been low, making you feel that you need to manage them at the same time as dealing with your hypo? Or has someone told you that you shouldn’t be having (as many or any) hypos?

All these things have happened to me and the result was that often I simply wouldn’t say when I was low, or I would downplay the situation. Reading stats such as ‘people with diabetes have on average <insert arbitrary number> of lows a week’ always made me feel like an overachiever, because I could guarantee that I was having more lows than whatever stat was quoted.

One thing I could rely on was that my friends with diabetes never made me feel like lows were my fault, or that I was hopeless because I didn’t have enough stuff with me. More likely, they would silently pass me a few jelly beans or fruit pastilles and leave me to deal with things myself, which is exactly what I need to do when low.

The last thing I need is someone throwing a million things at me (‘Here…I have juice, sweets, sugar, a glucose IV…’)and stressing out (or even worse – saying that Iam stressing them out) and asking every two minutes if I am okay. (I know that people are doing this out of concern. But seriously, the last thing any of us need when we are low is dealing with someone more flustered around us!)

This campaign is for PWD by PWD and that is why I love it. I’m hoping it will help us understand that others are dealing with the same crap around lows that we are. And that it is nothing to be ashamed of. Getting things out in the open is always a good way to reduce stigma and make people feel comfortable talking and seeking the help they may need.

So, let’s talk about lows. Share your story and read what others have to say – remembering that, as always, we are not a homogenous group and you are likely to read a variety of different stories. That’s great! Hypos affect people in different ways. For some they are significant and can be terribly scary, and for others they are simply an inconvenience that just needs to be dealt with and then they can move on. No one’s experience is any less or more legitimate than another’s.

Just some of the people who have already contributed to #TheLowdown2019

 

How to get involved

It’s easy!

Share a video or photo about how hypos make you feel. Share your post on your social media account (Facebook, Twitter, Instagram etc.) using the hashtag #TheLowdown2019. Please make sure you use the hashtag so we can find your contribution and share it and add it to our website.

If you’re not on social media, you can email a photo of yourself (perhaps holding up a card with one word which best describes how hypos make you feel) to thelowdown@diabetesaustralia.com.au

This page of The Lowdown website explains more.

Disclosure

I work for Diabetes Australia and have had some input into the development of this campaign. I am writing about it because I hope that it will get more people engaged and interested in what the campaign has to say, and encourage contributions.

I have not been asked by anyone at Diabetes Australia to write about The Lowdown here or on any other social media platform (but I’m sure they’re pleased I have).  

Transparency is always important to me and I declare everything relevant (and not relevant!) on Diabetogenic. You need to understand and consider my bias when I am writing and sharing. You can always contact me if you have any questions about this.

We all do a good job at undermining ourselves at times. We use a four letter word that diminishes what we are doing, and limits the value of our experience and expertise. That four letter word is ‘just’.

In diabetes, we hear it all the time: ‘Oh, I just have type 2 diabetes’ as though it is insignificant and doesn’t have any challenges. ‘I’ve lived with diabetes for just a couple of years’ because we think there is only currency in decades of living with the condition, when really any length of time with diabetes is meaningful.

And we are all about minimising our experience when it comes to the treatment of our diabetes. ‘just use diet and exercise to manage my type 2 diabetes’ or ‘I’m just on tablets’ or ‘I’m just on injections twice a day’ or ‘I’m just on MDI’. The list goes on and on. And on.

I realised just how ridiculous we have become with this when I heard myself, during a conversation with a fellow Looper, ‘Oh, I just use Loop’. (More on that later…)

At the Ascensia Social Media Summit at ATTD we spoke about this, specifically how there is almost a stigma within the diabetes for those seen to not be using the shiniest and brightest and newest of technologies. It seems that some people almost feel embarrassed if they are not constantly updating their technology toolkit with the most recently launched product.

The idea that anything that we are using today is ‘yesterday’s technology’ is wrong. Blood glucose monitoring can’t be ‘yesterday’s tech’ if it is what most people are using to track their glucose. And syringes and pens can’t be considered the ‘old way to deliver insulin’ when that is how the vast, vast majority of inulin-requiring people with diabetes get insulin into their bodies. Plus, every single one of us using a pump must be able to deliver insulin this way because machines break.

Somewhere in discussions about our treatment technologies, we seem to have forgotten that, actually, not everyone wants to be using the latest kit. And that is okay. There is a spectrum of diabetes technology, and as long as we are on it somewhere and managing our diabetes the way that works best for us, then elephant stamps all around!

There is clearly an over-representation of people at one end of that spectrum dominating on and off line conversations. Spend a couple of hours in a diabetes Facebook group and it would be a reasonable assumption that most people are wearing pumps and CGM. But that’s not true.

And it could appear that DIYAPS is the way to go for most people with T1D, when the fact is that numbers are relatively low. It’s hard to estimate exactly, but there may be somewhere between 2,000 and 3,000 worldwide how have ‘built their own pancreas’. That is just a drop in the type 1 diabetes ocean.

It’s fantastic for those of us interested in this technology to be able to (virtually) congregate and talk amongst ourselves. I learn so much from my peers in these groups – just as I have with all aspects of life with diabetes. The lived experience continues to trump any other way of learning about diabetes.

Of course, that doesn’t mean that we shouldn’t be talking about technology used by limited numbers. Of course we should. We want others to know about it so they can make an informed choice about whether it may be right for them.  We want our HCPs to know about it and to support those of us using all sorts of technologies and treatments.

Where it becomes problematic is when there is the misconception that this is the norm. Or when those not using the newest technology feel that they are wilfully doing diabetes the ‘old way’. It’s unfair to think for a moment that those who are not using the tech ‘don’t care’ enough about themselves – especially when decisions are made based on a very good understanding of what is available and what they have decided works best for them.

So, back to my ‘Oh, I just use Loop’ comment. It was directed to someone far more technologically advanced than me; someone who runs all sorts of other programs alongside their DIYAPS. They generate lots of reports and make lots of changes and seem to have far more bells and whistles than I even knew were available.

I nodded as they told me all they were doing and then, when they asked me how I manage my diabetes, I answered that I just use Loop. I heard myself saying it and stopped and corrected myself. ‘I meanI use Loop. It works for me. Perfectly.’

We don’t need to make excuses for doing diabetes our own way. If we truly have choice (which I know is not always the case), and we have made the choice based on what we believe to be the best possible treatment and technology for us at that moment, then surely that’s a great thing. We shouldn’t ever be made to feel less committed to our own health and wellbeing. That’s not how it works.

DISLCOSURE

I was invited by Ascensia to co-chair the Diabetes Social Media Summit at ATTD (#ATTDDSMS). I did not receive any payment or in-kind support from them for accepting their invitation. I have co-written a piece for the blog, however this was not edited (apart from inevitable jet-lag-induced typos) and all words are those of mine and the piece’s co-author. You can read that piece here.  

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