Taking Care of Business
By Catherine O'Neill Grace photos by John Hubbard
For people with diabetes, positive action lightens the load
Researchers from the University of Chicago reported recently that many people with diabetes believe that the inconvenience of managing the condition affects their quality of life more than the fear of future complications. Between 10 and 18 percent of patients even said that, if they knew they had 10 years of healthy life left, they would be willing to give up eight of those years to avoid dealing with treatments for diabetes!
Amateur stargazer Carmine Panichelli takes the long view of life, too.
But don’t tell that to Carmine Panichelli. When he found out he had diabetes, he did not let the news get him down for long. There’s no question that living with diabetes is a lot to manage, but for Panichelli, 64, of Deptford, N.J., taking care of business quickly became part of his daily routine.
Panichelli, who retired after 43 years as an ironworker, underwent a five-artery bypass 11 years ago. Seven years ago he was diagnosed with type 2 diabetes. That combination means he has to manage a complicated array of medications every day. He admits he doesn't exercise as much as he should, but he does pay close attention to his medical care and his diet.
"I'm down to 200 pounds from 240," he says. "I test two to three times a day. I really keep track of my numbers."
Panichelli says he is rigorous about adhering to his medication schedule. "Yes, I take a lot of medicine," he says. "I have to — I have grandchildren to watch grow up." He's also careful to see all his physicians — his cardiologist, endocrinologist, podiatrist, ophthalmologist and dentist — on a regular schedule.
"I see them religiously," he says. "By now I'm friends with all my doctors."
Panichelli also credits his success and positive attitude to his involvement with Pennsylvania Hospital's American Diabetes Association-accredited outpatient Diabetes Education Center in Philadelphia. The Center offers a monthly series of classes, focusing on meal planning, day-to-day health management, good health and control.
"I know diabetes is something I have to live with, and I manage it," he says. "You've got to care. If you don't care, you go home and eat what you're not supposed to eat. But not me. I care. It upsets me greatly when I see people who have reached their 40s and 50s and just let themselves go. We see these guys with these monstrous bellies, and it bothers me a great deal. I think, 'Dear Lord, don't let me be that way.'"
Panichelli offers this advice to people who are just starting to deal with the complexities of diabetes management:
- Keep in touch with what's going on in medicine — read, join a group, search the Internet.
- Test, test, test.
- Contact your doctor if you think there's something wrong.
MEET YOUR PHARMACIST
"Many people with diabetes have to take a therapeutic soup of different drugs," explains Charles Ponte, PharmD, a professor of clinical pharmacy and family medicine at West Virginia University. "Cost and adherence become an issue. You get tired of taking pills!" He says that pharmacists can become important members of a team that helps a person with diabetes manage — or even streamline — their care routine, making it less stressful.
Managing diabetes is a full-time job, Ponte says. "You can't do it alone," he says. "A person with diabetes has to buy into his self-care. Often a pharmacist is the most accessible professional for patients with diabetes to talk to when they have concerns. The landscape is changing, and the pharmacist is becoming a proactive educator."
Regina Linehan, RN, MS, CDE, guides newly diagnosed and long-term patients through education and self-management skills training at the Diabetes Education Center. "Diabetes presents a different burden to everyone who gets a diagnosis," she says. "About 85 percent are overweight at the time of diagnosis for type 2, and everyone they go to see talks to them about behavior change. It can be overwhelming. For many of the patients I see, the first step is full education. Let's try and get rid of the fears — the fears can be paralyzing. Diabetes does not have to intrude as much as you may think in your life."
Linehan goes for simple, direct solutions, such as getting people to use a logbook with print that's big enough to read. Some people may need to use day-by-day pill containers. Others find it helpful to put their medications on the table where they eat breakfast or on the nightstand.
Her work, says Linehan, is all about helping people understand that good control can reduce their complication rate. "There are studies that show that some patients would rather take several years off their life than comply," she says. "They think, 'It doesn't matter that I won't live to be 85.' But it does matter! We tell people control is really helpful for right now — and for 20 years from now."
Panichelli watches his diet very closely, but he admits that he needs to exercise more.
Thinking about the future is what got David Jennings, 46, of Sewell, N.J., on track after his diagnosis. After the father of two learned he had type 2 diabetes, he threw himself into understanding the disease and started classes at Pennsylvania Hospital. He told his doctor he wanted to avoid taking medicine, and he has succeeded at taking control of his diabetes with diet and exercise.
"I said to my wife, 'This is what I am going to do. I have you and my two boys to live for,'" he says.
Jennings, an electrician, learned to eat right and exercise, and has lost 47 pounds. At 6 feet and 199 pounds, he says he's now "the small one," in his extended family, several of whom also have diabetes.
At his last checkup, it was clear his hard work and optimism had paid off. His physician said no medication was necessary — and he didn't need to see Jennings again for eight months.
"It's all determination," Jennings says. "I want to live. I can't let something like this that I can control kill me."