As you know, I have been doing a lot of writing and research about my own relationship to Type 1 Diabetes.  I have studied and practiced yoga and meditation in an attempt to find a metaphor for the balancing act we must engage in 24/7.  I have explored alternative “body work” like acupuncture, cranial sacral therapy, Chinese herbs, supplements, and other modalities.  The results I have realized especially over the last 3 years have been significant and profound.  My A1C results have been all under 7.0 and when I am really on it I am below 6.5.  Beyond the numbers I have achieved a paradigm shift in my degree of certainty I am able to apply to my life.
I know that my purpose is to help others with the disease and those affected by it which is everybody.  When I went on the pump and you trained me I was ready.  I had 28 years under my belt and I had already been on track to gain better control (balance) over things.
Here are my initial thoughts……..

As a trainer I have learned a few things:

You can basically train 3 things.  You can impart knowledge.  You can introduce and develop skills.  And you can impart and enhance the thought context or attitude which maximizes the ability to “get the job done.”  Most training is focused on knowledge and skill development.  Current diabetes and pump education training is as well.  Most trainings deal with the different attitudes of the trainees as best as can be dealt with and then there is hope that the knowledge and skills stick.  In the development of my training protocols I have made the assumption that attitude is at least 80% of the battle.  I have therefore ingrained throughout the training process tasks and exercises that challenge current attitudes and mold desirable ones.  One of the most important things I have learned in my 32 years in dealing with this disease is that my attitude is the most critical component.  The challenge lies in theAcceptance of the situation at hand.  And it is a persistent and sometimes insidious situation that Type 1 Diabetes presents.  Therefore, I have thought about and written about the optimal attitude for training for this disease.  For example, going on the insulin pump is a change in the insulin delivery function of a system that includes many other functions.  Perhaps going on the Animas pump is an opportunity to present a training that is a whole system training.  It is really the only way it will work for most people, I believe.  Some will get it.  You are probably getting the most motivated diabetics with the best adjusted attitudes.

Acquiring Diabetes at the age of 14 vectored in a lot of fears, insecurities, worry, adjustment, relationship and social challenges.  All of these things combined with the constant presence of the disease and its ups and downs naturally has an affect on the way one thinks about things and does things.  Over the past 7 years and especially the last three I have gone inward to push against the negative and find the positive.  I have realized a level of acceptance that I never thought I could achieve.  And that has yielded a higher level of responsibility – The ability to respond to the task at hand.  We, as type 1 diabetics are always walking on a high wire, trying to stay in a range.  We will fall out of the range often.  The pump is one of the best tools in assisting us in our balancing act.  But it is only one tool.  Persistence, Patience, Faith, Courage, Restriction, Compassion make up a few of the foundational pillars of being able to stay up on the wire
and perhaps, more importantly, being able to get back up when falling off.  These attributes can be ingrained throughout the Animas training program to both their clients and extending out to their caregivers.  These are the ingredients that make up the optimal attitude for a type 1 diabetic.  It is a bold approach but when one considers the present state of diabetes education and training it is a badly needed approach that, in my opinion, will increase sales dramatically.  And when you increase sales you are going to be lowering the A1C of the Type 1 Diabetic population, reducing complications, easing the worry and concern of parents, siblings and friends, and enhancing the performance of primary care physicians and endocronologists.  That is a noble mission with very cool results.

I have sometimes used the concept of addiction as a metaphor for Type 1 diabetes. Think about it for a minute. We, as type 1 diabetics, must inject insulin daily. If you are still taking shots then you might have to partake in a “fix” up to 8 or more times a day. If on the pump we are constantly “hooked” up to our drug of choice. But, Michael, we don’t crave insulin?? Try not taking it for a day or two and see if you begin to crave it. But, Michael, it is good for us unlike being addicted something like drugs or alcohol?? Yes, it may be good for us but we are addicted to it. We need it. And without it we will have symptoms of withdrawal. What I am asking you to do by contemplating being a an addict by being a type 1 diabetic is to hold a mental perspective that you perhaps may not have thought about. When thinking of our disease as an addiction there are a few pathways that may open up. Explore these. Think about the people around you. Are they acting like co-dependents or enablers? Are you treating them like co-dependents or enablers?  Do you hide your disease? What is it that caused the addiction in the first place? Do I own any responsibility for the onset of my situation? Is the goal to overcome my addiction? Check out the 12 steps of AA. The first step says…..”We admitted that we were powerless over alcohol and that our lives had become unmanageable.” Does having diabetes imply we are powerless over something and that our lives have become unmanageable? What is the something that we are powerless over? For sure the goal is manage our disease. If we don’t our lives do become unmanageable. I don’t bring this thought exercise out to be provocative. No, my intention is to offer a momentary shift in the way in which you see your disease so you may obtain additional tools to combat it. I have had type 1 diabetes for 35 years now. I can tell you with 100% certainty that if you are able to increase your level of acceptance you will increase your ability to respond to your disease on a moment to moment basis. Denial is one of the hurdles in the recovery of an addict. The opposite of denial is acceptance. Work on acceptance and the quality of your disease control will increase.

So, I am thinking about writing both an orientation training manual and a more extended training manual.  My initial thought is to do it on a website and conduct a twice yearly one week training in South Florida that would be experiential.  This is my introduction to the orientation.

This Orientation assumes that you are either on Lantus and using a short acting insulin to cover meals or you are on the insulin pump.  If you are using another insulin therapy it might be interesting reading but not applicable when it comes to the insulin delivery section.  I know that some doctors use a different approach.  I have been on most of them.  While insulin delivery is just one aspect it is a critical one and it is my opinion that the insulin pump is, by far, the best method for insulin delivery. Lantus combined with short acting insulin is often referred to as “The Poor Man’s Pump” because it attempts to simulate what the pump can do but it offers much less flexibility and certainty.

There is one other assumption that is instilled within this training;  You are motivated.  Dealing with Type 1 diabetes is an extremely challenging thing.  The initial diagnosis is a shock to the person and to the family.  It is a crisis that must be dealt with. Everyone reacts to crisis in a different way.  In my 31 years of experience with the disease I have been through many periods of time when I just did not want to deal with balancing my blood sugars.  I did things that were dangerous and that did not lead to being well.  I always took my shot but I did not always test my blood sugars on a regular basis to know what was going on.  I really did not want to look at the reading from the meter.  I often went off of how I felt or what color my urine was or how much I peed.  I did not want to check.  I crossed a point where I made a decision that I wanted to feel better and master this thing and it happened.  I was lucky and blessed with tremendous support from family and friends and good doctors. Thank you to all of them.  I assume you are motivated because you are reading this. However, I will give you a few reasons to become more motivated.  First, if you can consistantly receive A1C results below 7 you will significantly reduce your chances of acquiring complications.  Complications stem from the detriotion of blood vessel integrity as a result of high blood sugar levels.  Good control greatly reduces this from happening.  Second, you will feel better and be more productive.  Third, you will achieve success in a proactive manner.   This fosters a sense of control where control has been absent. And fourth, you will affect others around you.  It is very difficult for people who love you to know you have diabetes. They feel for you and wish they could make it better.  When they see that you are mastering it you will provide them joy.

If you are motivated then this orientation will provide you with a base level of information that is necessary to achieve success.  I do not know everything about the disease but I have lived with it for 31 years and have a profound understaning of what it takes to survive and then to thrive.  I want to share that with you.  The Extended Training Program is designed to be an intenisve thrust in strategies outlined in this orientation section.  If you find the orientation helpful and are not getting the support you need from your health care professionals then it might be of benefit to you.