Endocrinology (including Diabetes)/Non compliant T1

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Question
Your "credentials" are amazing...I am looking for help in how I can best help my 18 yr. daughter, T1D for 20 months....her last A1c was unmeasurable...over 14%...she does not want to deal with it....lives at home but really rather independent...won't eat the good food I prepare...obviously feels crummy all the time and is just not motivated.....discouraged....we're very rural, so not much in the way of connecting with other T1D's.....I know your expertise is with excersise, but how does one who is so discouraged begin to care?  Where do you start when you are completely out of shape and feel bad all the rime?  As the parents,  what is our best recourse to help her?....I am sort of waiting for her to "own" it....but how much damage is being done in the meantime?  This is probably more of a psychology question...but isn't there a correlation of psychology and exercise?  Any recommendations appreciated.  Thank you.

Answer
Lisa,
 It sounds like your daughter is still angry and in denial about her diagnosis, which is understandable for someone her age.  She needs to realize, though, that having type 1 diabetes is not the end of the world and that it is a manageable disease.  However, if she chooses not manage it, not only will she feel crappy all the time, but she is a lot more likely to have health problems associated with it down the road.  She won't have any short-term ones, though, with the possible exception of developing diabetic ketoacidosis (which can be fatal if not treated), if she fails to take her insulin and keeps her blood glucose levels running high all the time.
  So, what can you do?  It really depends on your relationship with her and how she responds to your suggestions.  So far, it sounds like not so good with regard to food.  She probably doesn't realize how truly crappy she is feeling at the moment and that it doesn't have to be that way.  It sounds like she needs to start getting introduced to people who are living well with type 1.  There are a number of social networks now that she could access to read more about that and to interact with others with it.  For example, TuDiabetes.org is a great site with lots of info and members, as well as several for more extreme athletes like InsulinDependence.org.  You may even be able to get her a copy of "50 Secrets of the Longest Living People with Diabetes" (you can see more about that book on my web site at www.shericolberg.com) and see if she will read it.  Sne needs to deal with her emotions first to start dealing with her diabetes better.
  As for exercise, if you can even get her walking more or moving in any way, she'll start to feel a bit better (it can help lower her blood glucose), and that may inspire her to do more.
  Sheri

Endocrinology (including Diabetes)

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Sheri Colberg, PhD

Expertise

I am an exercise physiologist with a PhD who specializes in diabetes--as such I CANNOT answer general questions about other endocrine problems as I am neither an expert in all areas of endocrinology nor am I a medical doctor. My expertise lies in answering questions about diabetes (of any type) and physical activity, so please limit your questions to those areas. I can help you if you want to begin exercise or if you're already a diabetic athlete, and I am prepared to respond to questions about physical activity to which even your diabetologist may not know the answer. I can give suggestions about changes in your diabetic medications that differing types and intensities of exercise may necessitate, but I will have to refer you to your regular health care team to get final approval to make such changes. I can also answer questions about physical fitness, exercise metabolism, prediabetes reversal, and prevention of type 2 diabetes and diabetic complications.

Experience

I have both personal and professional experience in the areas of diabetes and exercise/physical activity. On a personal level, I have had type 1 diabetes since 1968, and I have been an avid exerciser since I was a child. Professionally, I have been conducting clinical studies on diabetes and exercise since 1992, largely with funding from the American Diabetes Association. I am also the author of 8 books related to diabetes, exercise, and more: The Diabetic Athlete (2001), Diabetes-Free Kids (2005), The 7 Step Diabetes Fitness Plan (2006), 50 Secrets of the Longest Living People with Diabetes (2007), The Science of Staying Young (2007), Matt Hoover's Guide to Life, Love, and Losing Weight (2008), Diabetic Athlete's Handbook (2009), and Diabetes? No Problema! (2009).

Organizations
I am a Fellow of the American College of Sports Medicine, a professional member of the American Diabetes Association (and professional volunteer for the ADA), and a former member of the Board of Directors of the Diabetes Exercise & Sports Association.

Publications
I have published research and review articles in the following journals and magazines: Diabetes Care, Diabetes, Journal of Diabetes & Its Complications, Diabetes Self-Management, Medicine & Science in Sports & Exercise, Journal of Applied Physiology, The Physician and Sportsmedicine, Journal of Clinical Investigation, International Journal of Obesity, FASEB Journal, The Diabetes Educator, Journal of Physical Education, Recreation, and Dance, Clinical Exercise Physiology, Clinical Diabetes Reviews, Insulin, ACSM's Health & Fitness Journal, Biomechanics, On the Cutting Edge, Diabetes Technology & Therapeutics, Microvascular Research, Drug Benefit Trends, ACSM Certified News, Diabetes Health, SportEX Health, Diabetes Focus, Diabetes In Control, dLife-For Your Diabetes Life, Pediatrics for Parents, and My TCOYD (Taking Control of Your Diabetes) Newsletter. I have also been interviewed in myriad other magazines, such as Men's Health, Men's Fitness, Diabetes Forecast, Countdown Magazine, Joe Weider's Muscle & Fitness, Health, Tidewater Parent, Barron's News, Diabetes New Day, and Newsweek International.

Education/Credentials
I have an undergraduate degree (1985) from Stanford University, a Master's degree in exercise physiology (1987) from the University of California, Davis, and a Ph.D. (1992) from the University of California, Berkeley, in the same field. I also spent two years in an NIH-funded postdoctoral research position in endocrinology (studying obesity, diabetes, metabolism, and exercise) at the University of Pittsburgh School of Medicine (1993-1994).

Awards and Honors
Fellow, American College of Sports Medicine (FACSM) - 1996 Old Dominion University Darden College of Education Young Investigator Grant Award 2003 Honor Society of Phi Kappa Phi, Old Dominion University Chapter 2004-Present Great Women of the 21st Century by the American Biographical Institute 2005 Edition Old Dominion University Darden College of Education Largest Research Grant Award 2006 Old Dominion University Darden College of Education Publications Award (for greatest number) 2006 Saint Louis University, The Max K. Horwitt Memorial Lecture Distinguished Lectureship Award 2008 Old Dominion University Darden College of Education Publications Award 2009 Old Dominion University Darden College of Research Grants Award 2009

Past/Present Clients
I have consulted for numerous groups, including Can-Am Care, Numera|Social, California Commission on Peace Officer Standards and Training(about candidates with diabetes), Animas Corporation (an insulin pump company), Therasense, Inc. (makers of the Freestyle blood glucose meters), Council of Healthcare Advisors, and the City of Chesapeake (Virginia) Health Department.

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