On Wednesday, April 20, 2005, eleven persons concerned with the delivery of
insulin by means of infusion pumps gathered at Holy Trinity Lutheran Church, 516
Victoria Avenue, Belleville, ÊOntario 7:00 to 9:00 pm.



Special Guest



During the introductions that commence every meeting, it was discovered that
Mary Anne Adams, a new member, was on a break from her usual occupation of
caring for the special diabetes needs of two young people, a boy, fourteen and a
girl, twelve, in Saudi Arabia.  Both are on insulin pumps through a California
hospital.  As a nurse, Mary Anne is familiar with procedures, but was happy for
the opportunity to discuss the challenges posed to caregivers of teenage Type 1
diabetics.  In return she gave us some insights into the unique lifestyle of
these young people that make the application of Western World medical
expectations formidable.



Issues



1. Ownership

The common concern for caregivers, whether in the Quinte area or in the Middle
East, was having the young people assume responsibility for their own
well-being.  Often it is simpler, safer and faster for an adult caregiver to do
the remembering, testing and record keeping needed for diabetes management.  We
imagined a young man watching television languidly extending his hand to be
tested. This means that that teenager is relying on others to maintain his
healthy blood sugar levels.  Thus, later, when they are supposed to be living
independently at university or at work, these cherished diabetics are often
ill-prepared.  Who owns this diabetes anyways?  How do we get the kids to manage
their own daily routines?



2. Routines



The norms for insulin intake have been established with North American customs.
However, Western ideas for eating and sleeping differ greatly from those in
Saudi Arabia. Mealtimes in North America are fairly stable, with youngsters
coming to the table at predictable times, eating a fairly predictable number of
carbohydrates and then leaving the table in fifteen minutes or so.  In an Arabic
situation, mealtimes are more social, lasting two hours or more, with multiple
choices, perhaps as many as thirteen options, available. Furthermore, following
Islamic teachings, complete fasting may occur during daylight hours. At other
times, they may snack all day long. Young people may go to bed at 3:00am on
weekends, and nap throughout the day. ÊTime in Saudi Arabia is managed in a
different way and each day will have its own programme. On school days, they may
be exposed to temperatures over +40 C and come in from playing outdoors
exhausted. There was agreement that in both cultures high humidity is hard on
Type1 diabetics.  No matter how delightful a vacation, there is no holiday from
diabetes.



3. Compliance



It is not what we know.  It is what we DO.  Young people are clever and they can
have an excellent intellectual understanding of diabetes.  They know the proper
responses to give the doctors, and the doctors believe that everything will be
done according to plan.  One doctor has a twoöstage approach.  äTell me what you
should do.ä · ãNow, tell me what you really do.ä ÊThe young person may be told
to write everything down, but experience shows this does not happen.  The
teenager may not even bother to remember!  At least with a pump, the caregiver
can go back to check whether a bolus was given. With regards to compliance,
teenagers seem to be the same all over the world.



Next Meeting



The next meeting of Quinte Insulin Pumpers will take place on Wednesday, May 18,
2005, 7:00 to 9:00 pm at Holy Trinity Lutheran Church, 516 Victoria Avenue,
Belleville, Ontario. Guest speaker: Meg Archibald presenting the Cozmo pump.