Category Archives: Fun

How Can We Engage Doctors to Change Behaviour?

Melinda Seed

Lots of talk of patient engagement around the traps of late and following some discussions on Twitter I’d like to share some  common problems with engaging doctors to change their behaviour.

Just switch the word “patient” in this definition of patient engagement to “doctor” in each case and we’ve got a handy way of thinking about doctor engagement.

Patient<Doctor> engagement…a concept that combines a patient’s <Doctor’s> knowledge, skills, ability and willingness to manage his own health and care with interventions designed to increase activation and promote positive patient<doctor> behavior.

My concern here is with engaging doctors to improve care for those, in any way involved with providing medical services to people with type 1 diabetes. The scale of the problem with inpatient care of people with diabetes and its consequences are well known and documented. The UK diabetes inpatient audit showed:

40% of inpatients on insulin experienced one or more insulin errors.

1 in 4 people with type 1 had a severe hypo

1 in 25 patients with type 1 developed DKA during their hospital stay.

One of the most common problems is doctors’ lack of education, or is it poor behaviour that makes then deny people with type 1 insulin when they’re not eating?

Whilst we’re at it, anyone asserting that there are lots of reasons why people with type 1 develop DKA whilst in hospital needs some activation towards further education.  There aren’t lots of reasons, the only reason somebody with pre-existing diabetes develops** DKA whilst in hospital is severe shortage of insulin. This is an example of not holding people accountable, ‘lots of reasons’ lets HCPs off the hook. THIS behaviour of excusing inadequate medical care needs to stop too if we’re ever to change the behaviour of those providing medical services.  As page 8 of the summary report correctly states:

“DKA and HHS are serious conditions which can have very serious consequences for the patient. They are preventable and should not occur during a hospital admission.”

Let’s get behaviour change happening in hospitals. How about some motivational interviewing of staff when we’re admitted? I think I’ll start asking a few questions to assess their knowledge and then take the opportunity to provide a learning experience for them, perhaps refer to some structured education? Maybe scare tactics? What about some cool tech that sends them an SMS every time a patient’s sugar goes out of range?

I don’t know about you but I’m still needing more strategies to deal with these non-compliant avoiders    Do you have any ideas, maybe we could write a paper or run a course or something?

*Quote from,

**The one in 25 stat refers to those who enter hospital without DKA but develop it whilst in the ‘care’ of the hospital, not to those who may enter hospital with DKA.

2017 The Diabetes Year That Was

Melinda Seed

There’s been WAY more good in my life, both diabetes and otherwise than bad or ugly this year. A fact for which I’m grateful but as the year lurches towards its conclusion I’ll add to the nostalgia doing the rounds with some reflections of the good, the bad and the ugly as I see it in the world of diabetes in 2017.

The Ugly:

If low carb works for you, that’s great and if you want to share your success on social media, great, go for it. What is not cool is lecturing/haranguing and shaming people who don’t treat their diabetes in the same way you do. Everyone’s metabolism is surprisingly different so lay off the judgement and assumption that because it works for you, it must work for everyone.

It’s 2017, the internet has been a thing for over 20 years. Why are health professionals in Australia still relying on faxes to do referrals etc? This is ugly or maybe bad or perhaps both.

The Bad:

Insulin has been available to sustain life in people with diabetes for 97 years. Why are people with type 1 in one of the world’s richest nations having to ration insulin because they can’t afford it?  The answer is that companies are doing what they are obliged to do,maximise profits. Society is failing in its duty to limit that profiteering. Democratic governments should act in the best interests of their people, it is a disgrace that the US government has failed for decades to do this.  #insulin4all and @T1international are great but they shouldn’t be necessary.

Whilst I am enormously grateful for the level of taxpayer subsidy we receive in Australia, it is disappointing that we’re still waiting for the “imminent” announcement regarding subsidisation of the Freestyle Libre and that CGM has been subsidised based on age rather than clinical need. (Notwithstanding that the subsidisation is wonderful and due in no small part to tenacious advocacy work by those in the type 1 community).

I also take this opportunity to remind everyone that the price paid for NDSS products has risen with the CPI for people with diabetes BUT the government has not paid anymore for the products and is in fact, looking for a reduction in price from the producers. Let’s not be complacent about the cost of living with diabetes.

The Good

My diabetes year was excellent. I was privileged to have the opportunity to meet up IRL with diabetes friends and make new ones in Melbourne at DX2, to hear from some great health advocates and be inspired in Sydney.

It was fabulous that Diabetes Australia recruited social media junkies 🙂 with diabetes to report on the ADS-ADEA Annual Scientific Meeting. This conference was great in that not only were a small group of us enabled to attend to share the proceedings with others, but there were many voices of people with diabetes throughout the conference.

The social media world made my life so much easier when my out of warranty pump failed. A million thanks to the person who sent me their “spare” pump to save me from injecting Protaphane and also to the endo who communicated with me so quickly and facilitated my new pump. The system worked for me despite me not being as ontop of things as I should have been (shouldn’t really have let my pump get so far out of warranty.)

Diabetes actually gave me more than it took this year-opportunities to travel, shared experiences and friendship. I don’t know whether the “gift” that keeps on giving will strike back  in 2018 or beyond (and some years it’s definitely taken a lot) but to all my friends with type 1 D thanks for your support and comraderie here’s to kicking diabetes’ arse for another few decades.  Cheers! 

Diabetes Christmas Gift Guide, Just Don’t!

Imagine being gathered around the Christmas tree and and unwrapping  a startling visual reminder of diabetes complications. Well this is what some British diabetes organisation is suggesting people with diabetes might like to find in their Christmas stocking.

What about…No? Continue reading

Sitting on One Butt Cheek for Diabetes


Melinda Seed writes for Twice Diabetes
Melinda Seed writes for Twice Diabetes


I’m officially burnt out, not from my 4.5 decades of diabetes but from the  relentlessly pathetic public awareness campaigns.  I give up*, you just have to laugh otherwise you’d cry or lapse into depression. The dust has just settled on National Diabetes Week in Australia and each year just seems to get worse.

Who  could possibly think that DNSW’s Standing on One Leg event was a responsible, constructive way of doing ANYTHING for diabetes let alone being an appropriate way of tackling preventable amputations?  Seriously, do they put some PR interns with no knowledge of healthy psychology, fear appeals or diabetes in a room and tell them to come up with an idea in 10 minutes and then run with the most ridiculous one? Certainly seems so. Continue reading

Top 7 Ways to Recognise if You Have Diabetes Burnout

Melinda Seed writes for Twice Diabetes
Melinda Seed writes for Twice Diabetes

I was doing some research about burnout and stumbled upon some wise words from a very naughty diabetic (he maintains a top-secret identity as Llambo but he knows who he is) from a strange virtual land that existed long, long ago.

Anyway I read this list and realised I didn’t have burnout haha, I’m maybe just a bit singed around the edges. How about you? Where do you sit on the burnout spectrum? Not a spark in sight, a pile of ashes or somewhere in between?

If laughter really is the best medicine (except for insulin of course) here’s a possible antidote to burnout.

Top 7 Ways to Recognise if You Have Diabetes Burnout

7. You go to order test strips but they’re no longer on the NDSS form.

6. You have a donut, go to bolus, but realise that instead of bolusing, you’re changing TV channels.

5.You stop enjoying Halle Berry in “Catwoman”. Mmmm Lycra

4. You are out driving and whilst stopped at a red light this guy pulls up next to you with the top down on his new Porsche. You have no idea who it is. That was your endocrinologist.

3. Somebody asks if you are type 1 or type 2 and you can’t remember.

2. You own 5 Novopens (including that ridiculous multi-coloured one) but you can’t find any of them.

And the #1 way to recognise that you have Diabetes Burnout is….drumroll purleeez

1. You finally make an appointment to see an endo, and they tell you that they found a cure 5 years ago. Bugga.

Seriously (or not if you like), do you have ideas about beating burnout or just surviving it? I’d love to hear them.

Hypos, Science and Train Smashes

Melinda Seed writes for Twice Diabetes
Melinda Seed writes for Twice Diabetes

I attended the consumer outreach day of the ADS-ADEA 2014 scientific conference last week and it was during the session on hypos that I realised that the intersection of scientific “evidence”, clinical expertise and the lived experience of diabetes is a total train wreck.

ADS-ADEA 2014 are to be commended for dipping their toes into the murky waters of consumer involvement in scientific sessions, bans on pharmaceutical companies (who are the major source of sponsorship for such conferences) and affordable and meaningful involvement of people with diabetes in conferences that talk about rather than with them. Most countries fail to accommodate consumers at all.  There is much to be done to integrate consumers into these conferences and we’re not there yet, but credit where it is due, the 2014 ADS-ADEA was a really encouraging start.

So back to the train wreck….

The first part of the morning session on hypos was a presentation on the effects of hypos on the brain. There was good data from studies to show that severe hypos are neurotoxic and particularly so to the developing brain.  The most injurious thing to the brain of somebody under 6 is severe hypos combined with hyperglyceamia.  Hmmmm, this was extremely depressing listening for me who was diagnosed at the age of 16 months, but the science was clear.  During question time, it was asked how you would talk about this with your patients and the response was “With great caution, these effects (on the brains of those who’ve suffered severe hypos and hypers) aren’t obvious in everyday life/interactions.”   It’s too late for me, my brain might have been injured but I guess I’ve been able to hide it pretty well.  I did, however, feel for the parents in the room who are faced with the daily battle of achieving optimal a1cs and avoiding hypos. I honestly believe I would make the decision to run my diabetic child’s sugars a little higher in order to avoid hypoglyceamia after listening to that evidence-based presentation. Continue reading

Diabetes ‘Hacks’ from Dr Suess


“Today you are you, that is truer than true. There is no one alive who is youer than you”

Diabetes doesn’t explain everything about me, but it does explain some things (at least my insulin pump and occasional frantic binges on glucose). My experiences growing up with diabetes  and living with it now has shaped me, I’m not sure how exactly, but every experience goes into making you who you are and diabetes is a part of me-believe me it’s the part I’d most like to ditch but until that can happen I accept that it is part of what makes “me” me and I accept it. Continue reading

Endos and Don’ts

Melinda Seed writes for Twice Diabetes
Melinda Seed writes for Twice Diabetes

Kate’s post last week got me thinking about why I persevere with paying a lot of money to see an endo (see my reasons below) and I got a sense of deja vu. Way back in the day when we were younger and brasher I recall having similar conversations and I dug out an anecdote of a visit to the endo sent to me in the early 90s by a D friend that seemed to sum up how he and many of us felt-enjoy, I still get a good laugh out of this….


Today I trotted off to see my endo. I’ve been pumping for about 6 months and have not had the need to see anyone since than but the main reason I went was to get my fitness to drive form filled out.

I rock up and he asks me who I’ve been seeing since I started pumping and he’s not at all happy with my answer. I told him that I’ve met with several pumpers here in Adelaide and in Melbourne and have received all the information I’ve required. That as a result of that I’m feeling content and confident with my treatment. I was quite furious at his blatant disregard and lack of interest in a peer education and support strategy especially seeing that there exists no adequate medical support for pumps in SA. 

dTraBenT9I would like you to go and see Ms Latoya Jackson, the new educator down at the Shithole Royal Hospital” he says in his smug endo manner. Continue reading

A Worrisome Malady & It’s Not Diabetes.

Melinda Seed writes for Twice Diabetes
Melinda Seed writes for Twice Diabetes

The sunlight dapples the autumn leaves outside the window and whale song gently drifts around me.  I am lying on a massage table, and a track-suit clad man is kneading the soles of my feet, part of my five day “Pamper Package” at a health retreat.  Unfortunately as I should be lapsing into a calm and meditative state I can feel my muscles tensing as I grow increasingly irritated.

As a type 1 diabetic for over forty years, I figure I know the limitations and failings of western medicine better than mostContinue reading