Sharps Disposal

Sharps Disposal

by Nicole Johnson, MPH, MA, DrPH (Candidate), Miss America 1999

This is a topic that we don’t think about often, but it is quite important.  When you live with diabetes, you undoubtedly have sharps around your home which means you could be a hazard to someone else and not know it.  If you are like me, not that I am advocating this, you might have syringes in your purse, test strips in your pocketbook and lancets in your coat pocket.

It is important for all of us to think about what we are doing with our disposable sharps.  Do you have children running around your home?  Do you have a spouse, partner or even housekeeper that helps empty garbage cans? Most of us can answer yes to at least one of those questions.  Because of that, we need to talk about sharps. (Are you feeling as much guilt as I am?)

Each year, Americans use over 3 billion needles, lancets and syringes, to manage medical conditions like diabetes at home.

Sharps are defined as any products with sharp edges that are used to draw blood or inject medications. One could also throw in anything that could puncture the skin or harm another if touched.

Recently, a new coalition was formed to address concerns related to sharps and other hazardous medical waste.

The Coalition for Safe Community Needle Disposal, comprised of medical, government and waste association and private sector companies, is working with the Environmental Protection Agency to evaluate and promote alternative disposal methods for used needles and other medical sharps.  This coalition is supported partially by Becton Dickenson, one of the largest manufacturers of sharps equipment.

This coalition was formed because improper management of discarded needles and other sharps can pose a health risk to public service workers. For example, discarded needles may expose waste workers to potential needle stick injuries and potential infection when containers break open inside garbage trucks or needles are mistakenly sent to recycling facilities. Used needles have the potential of transmitting serious diseases like HIV and hepatitis.

The coalition has identified several types of safe disposal programs for those using sharps at home.

*            Drop Box or Supervised Collection Sites

Sharps users can take their own sharps containers filled with used needles to appropriate collections sites: doctors’ offices, hospitals, pharmacies, health departments, or fire stations. Services are usually free, but sometimes have a nominal fee attached. Check with your pharmacist or other health care provider for disposal availability in your area.

*            Mail-back Programs

Sharps users place their used sharps in special containers and return the container by mail to a collection site for proper disposal. This service usually requires a fee. Fees vary, depending on the size of the container. Check with your health care provider, pharmacist, yellow pages, or search the Internet using keywords “sharps mail back.”

*            Syringe Exchange Programs (SEP)

Sharps users can safely exchange used needles for new needles. Contact the North American Syringe Exchange Network at 253-272-4857.

*            At-home Needle Destruction Devices

Several manufacturers offer products that allow you to destroy used needles at home. These devices sever, burn, or melt the needle, rendering it safe for disposal. Check with your pharmacist or search the Internet using keywords “sharps disposal devices.” The prices of these devices vary according to product type and manufacturer.

(Information found at www.bd.com)

The Food and Drug Administration (FDA) notes on their website that according the American Diabetes Association, an easy way to get rid of used lancets or needles is to put them in a heavy-duty plastic or metal container with a tight-fitting lid (such as an empty laundry detergent bottle). When the container is full, you dispose of it according to your local waste-disposal rules.  The trick is figuring out what those local rules are.  You can call your local health department for information or even you Chamber of Commerce.  These agencies should be able to give you appropriate direction.  Another good resource, as mentioned before, is your doctor.

The Occupational Safety and Health Administration (OSHA) requirements for sharps disposal containers. The container must be:

*            closable

*            upright and stable during use

*            puncture resistant

*            leakproof at sides and bottom

*            properly labeled with the biohazard symbol and legend or color coded

No, My Insulin Pump is NOT a Cell Phone!

By: Ashley Muscatell

After dealing with diabetes for over 12 years, I shouldn’t be so easily surprised by the misunderstandings that surround the disease. More than once, I have found myself in an awkward position where I must explain why I’m pricking finger or dialing numbers into my pump (which is all-to-often mistaken for a cell phone.) It’s difficult to put yourself in the shoes of someone who has never dealt with diabetes, but if you take a second to think about it, all gizmos and gadgets that come with diabetes may be just about as familiar as the controls inside of an alien’s UFO.

Just about a year after starting the pump I experienced a rather interesting incident involving some misunderstandings about my diabetes. On this day, I finished my lunch and casually whipped out my pump to bolus for what I had just eaten; nothing out of the ordinary compared to any other day. I was scrolling through the numbers, and then I saw stern hand stretched out in front of my face. Utterly confused, I looked up and then it finally registered to me that my assistant principle thought I was blatantly breaking school rules and texting at lunch. Once I told her that it was my insulin pump, she turned bright red and attacked me with a giant hug, profusely apologizing for her “silly mistake.”

Of course, there are two sides to this situation: my view, and then there’s the way the AP was seeing things. If you don’t have diabetes and don’t know much about it, you’re first thought when seeing someone staring down at a small handheld device probably won’t be “ah, that’s probably just an insulin pump.”  From my perspective, I felt offended that an administrator wouldn’t have the courtesy to ask before she shoved her hand in my face; this is the hard part, because, well, how could she have known? To provide a simple answer, this whole incident could have been avoided if teachers and staff were better educated about diabetes. Informing others about diabetes is something that we all must work together towards in order to make everyone’s lives a little easier. I hope the day comes when I can hold out my pump, tubing and all, without others speculating. Education is the key to understanding, so I want to make it my goal to inform people before the misunderstandings even have the chance to occur. Speaking up can be scary, but it’s a must when living with diabetes.

A Joke of a Disease?

By:  Ashley Muscatell

Lately, it seems as if more and more television shows and movies are choosing diabetes as the seed of their jokes. I’m generally all for making light of a hard situation by kidding around, but when the jokes get out of hand, it can make diabetes seem as if it’s not all that serious. Typically my friends know to be hands off, unless they notice the occasional tell-tale sign of a high or low. The fact that my friends know not to hover is great, but sometimes it leaves them uninformed and left with their own assumptions. Friends have said things to me like “I don’t understand the big deal about diabetes. It’s not like it’s as serious as other diseases.” Of course I never want to wallow in sorrow about diabetes, but my nonchalant attitude can sometimes lead my friends and peers to believe that diabetes is no more severe than a common cold.

Figuring out exactly how diabetes should be depicted to the rest of the world is a difficult task to take on, especially for a 16 year old. The teenage years come with enough misunderstandings as it is! I would never in a million years hope for a friend to pity me for having diabetes, but I still feel the need for my peers to have an understanding about diabetes. A teenager without diabetes won’t realize that this disease is something that we must deal with every single day; there are no breaks. This idea of diabetes as a never-ending battle seems to be one of the most important messages to get across to teens that wouldn’t normally have exposure to diabetes. It feels sort of like a slap in the face when someone tries to tell me what diabetes is or is not. Holding back the anger and reverting to patience is the smartest way to handle an uneducated friend, but that doesn’t always mean it’s the easiest.

Patience has definitely been one of the top skills that diabetes has forced me to acquire. Ignorance or lack of understanding must be confronted with the patience that diabetes has diligently instilled in me; without patience, it wouldn’t take long to resort to lashing out at those who just don’t quite get it. From these confrontations, I have taken away the knowledge that not everyone understands. Informing my peers that diabetes is a chronic disease that requires constant attention is great for an introduction to what it’s all about. Once my friends understand that diabetes isn’t some silly little affliction, the next step to take is to explain that I can handle it, and live a relatively normal life just like everyone else. Challenging, rewarding, and a never ending fight, diabetes is one complicated disease; but with time and patience at hand, the road to understanding can be less daunting.

Living With Diabetes: The College Years!

By Paige Wagner

I feel like I have always lived with diabetes. I was diagnosed at the age of 5 and my first memories surround my diagnosis. No matter how used to living with diabetes I am, new beginnings tend to remind me that I am one of a relatively small number of people living with Type I diabetes.

When I was younger, my parents did an excellent job educating the parents in my New Jersey hometown. When we moved to Florida I was more responsible for educating the people around me. So my friends knew that I had diabetes, I didn’t make it seem serious. My parents had my back, so I didn’t think it was as important to thoroughly educate my peers. As I headed off to college, it dawned on me that no one would know that I had diabetes or what that means exactly. At first I was frustrated, because I didn’t want to have to explain it to every person I met… but then I realized that I had a great opportunity to educate whoever my new friends would be better than I had through high school.

The college years have been a great time for me to figure out who I am and what I want. I’ve discovered maintaining a healthy lifestyle is very important to me. I think, as a diabetic, living healthily entails eating well and exercising, but it also includes having a network of reliable friends that understand highs and lows. That support used to come from my parents, but it now comes from my roommates, my coworkers, and my close friends. I feel blessed by being surrounded by such wonderful companions. Though I am part of a small population with Type I diabetes, I never have to feel alone.

Walking Your Way to Better Diabetes Care

by Nicole Johnson, MA, MPH, Miss America 1999

Pedometers are all the rage these days.  You see them everywhere.  Companies and hospitals are promoting and giving them away and the message is loud and clear – walk for your life!

With the 10,000 steps a day program in hand and a slew of new promotional campaigns to assess, let’s look at how to get you into ClubPed.

It all seems to have started with Secretary Tommy Thompson.  A few years ago, he created a program called Big Steps, Big Rewards.  At the launch of the initiative, he gave employees of HHS pedometers and told them he was putting the Department on a diet and shaping up the health care system of our country.  Since then, Secretary Thompson has lost more than 25 pounds and is more fit than he has been in a long time.  He attributes much of his success to his pedometer.  10,000 steps a day for health maintenance, 12,000 steps a day for weight loss.  The Department hasn’t done badly either.  There are stories of drastic changes in dress size and the loss of suspenders.  Walking works!

I decided, if it was good enough for the Secretary of Health, it is good enough for me and for the last year or so, I have been wearing a pedometer too!  I feel great, my legs are stronger and I am working my way to better control of my diabetes.  I too attribute much of this to the little counter on my belt.  What a great motivator!  However, sometimes it is a little scary too.  Especially the busy days that are packed with meetings and classes where my pedometer falls far short of the 10,000 step goal.

Why Count Steps?

It has been proven that as we quantify we gain motivation for change.  This theory has been proven in the effectiveness of meal journaling and exercise logs.  The same is true with a pedometer.

The Japanese developed the first electronic pedometer and named it “manpo-kei” literally meaning “10,000 steps meter”. Exercise physiologists who used them in research to measure daily activity of their subjects brought the devices to the United States in the mid-1990’s and continue to use them in their projects today.

The health benefits of bodily movement are well documented and include reducing the risk of heart disease, diabetes, cancer, and high blood pressure. Moreover, these benefits can be achieved with regular moderate physical activity such as walking. However, even though we know the clear benefits of movement, society is still not heeding the advice of health professionals.

1996 Surgeon General Report:

-More than 60% of adults do not achieve the recommended amount of physical activity, and 25% of adults are not physically active at all.

-Among young people aged 12-21, almost 50% are not vigorously active on a regular basis. Physical activity declines with age during adolescence.

-High school students’ enrollment in daily physical education classes dropped from 42% in 1991 to 25% in 1995.

These numbers are a little old, but highlight the pervading situation.  We need lifestyle change.  For people with diabetes, movement is absolutely necessary for success in preventing the complications of the disease.

Now there are a ton of pedometers to choose from…high tech, mileage counters, fat burners and digital marvels.  There are also easy, basic models.  The latter is what I have.

How to get started:

In my research, I found this great list of tips on starting a walk plan from www.Shapeup.org.

Here is what we learned about getting started on the 10,000 steps program

*          To avoid injury, you need to work up slowly. If you have any concerns about your joints (ankles, knees or hips) discuss your exercise plans with your physician.

*          You will need a good pair of sneakers. We actually prefer a running shoe with plenty of cushion. We noticed that we are wearing out our sneakers and replacing them every six months or so.

*          Start out by wearing the pedometer each day for two weeks and don’t do anything to change your normal routine. Before you go to bed, take care to log your steps at the end of the day each day for the entire two-week period. At the end of the second week, take a look at how many steps you are taking each day in the course of living your life. Perhaps on some days it is as few as 700 steps in a day and on other days, it may be as high as 2500 steps.

*          If you feel comfortable doing so, take the highest number of steps you have walked on any given day and use that number of steps as your daily step goal. Feel free to select a smaller number of steps as your goal if you prefer. To avoid injury, do not select a higher number. Aim for your goal each day for the next two weeks. Let’s assume your first step goal is 2500 steps. That means that for the next two weeks, you are going to try to walk 2500 steps each day. Before bedtime each night, be sure to log in the number of steps you actually took.

*          At the end of that two-week period, review all the steps you took each day and decide if you are ready to add another 500 steps to your goal. Your new step goal is now 3000 steps a day for the next two-week period.

*          Continue in that manner, working up as slowly as you wish, until you finally reach the goal of 10,000 steps a day.

*          Check with your physician if you experience any pain or discomfort that concerns you. We consider pain a warning signal that something may be wrong. Our goal is to keep you active for the rest of your life. So don’t go overboard and pull a muscle that will put you out of commission. Take it slow. Take it easy.

The best piece of advice in this list is to take is slow.  The key is consistency.  If you walk more every day, you will achieve your goal and you will see results.  Remember, always talk to you medical team before starting a new exercise program.

Starting a new routine or even staying in a routine is always difficult.  It is important to remember that activity should be fun!  You should enjoy yourself.  If you are not happy, you will not be consistent.

Here are a few tips to help you use your imagination in increasing your step count.

*          Take a walk with your spouse, child, or friend

*          Walk the dog

*          Use the stairs instead of the elevator

*          Park farther from the store

*          Better yet, walk to the store

*          Get up to change the channel

*          Window shop

*          Plan a walking meeting

*          Walk over to visit a neighbor

*          Get outside to walk around the garden or do a little weeding

A Hidden Member of Your Support System

By Amanda Mezer

A strong support system is key whether you are at home, away at college, newly diagnosed, or celebrating your 13th anniversary. At any stage, you need a support system that includes your endocrinologist, friends, family, and many others. But, there is someone else that is often forgotten…the pharmacist.

At first you may think this sounds crazy, but your pharmacist is actually a very important person on your team. They are not there everyday for your highs and lows like your friends and family. They don’t see you once every 3 months and check your A1c. However, you see them every time you need a refill of your medication, which may be once a month or every 90 days. They make sure that you have the right insulin, correct medications, and check the interactions of different medications that you may be taking.

Since I was diagnosed at age 6, I have been lucky enough to have had the same pharmacist, Rick Davis, at my local CVS. He is almost like family. I bring in a prescription and he immediately checks to make sure that there is no adverse drug interaction or will impact my blood sugars.

Many medications are labeled “do not take if you have diabetes” or “may caused an increase in blood sugars” but others may not. My pharmacist double checks that the meds I might be prescribed for a cold are not going to cause more chaos to my diabetes than the cold already does.

While in college in North Carolina, my second endocrinologist said that the antibiotics do not make my blood sugar high, but the illness actually does. However, I found it strange that I might be over the illness, but still be taking the medicine and still have high blood sugar. But magically within 24-48 hours of going of the medicine my blood sugars go back in the normal range.

So, nobody knows exactly how a medicine will impact my diabetes, but my pharmacist does all that he can to make sure that the medications won’t be harmful. Every doctor tries to make sure that medication won’t conflict with my diabetes, but there are so many medications that it is almost impossible for him or her to be completely sure. However, my pharmacist is my safety net so that I don’t end up with a medicine that could be bad for me. Believe me, it has happened.

Almost all medications make my blood sugar high, but certain ones do not do it as much. I have also found that every person reacts differently to medicine. One time a doctor had prescribed a medicine that was in a liquid suspension, but they did not realize that the liquid suspension had sugar in it. My pharmacist caught that and talked to the doctor. In conclusion, we found a long list of sugar free flavors. Try watermelon!

So, whether you are at home, away at college, or just changing pharmacies, it is important to get to know your pharmacist. In North Carolina, it was hard to get to know a pharmacist, but luckily I could call Rick and he would be able to straighten out any confusion.

Airport Security and Insulin Pumps

By: Amanda Mezer

How will the recent increase in airport security and more intense “pat downs,” affect those of us who wear insulin pumps? As a college student with diabetes, I find that I am traveling more and more by plane. I can’t count the number of times a security person asked me to “take my cell phone or I-pod off (which is known to us as “insulin pump”)” but sometimes the conversation goes further or becomes comical or embarrassing.

One time, the security guard sternly said “take that off!” but once I said it was an insulin pump, he replied in an equally stern manner, “keep that on!” and smiled. It is actually a cute story as I step back from the situation and think of it from someone else’s perspective. However, at the moment, it was a little unsettling.

I have been told by Minimed that I should not go through the newer security machines that look through your clothing because it could harm my pump. So, every time I am told to go through one of these devices, I ask for the pat down instead. Sometimes the security person says, “Oh, its okay, it won’t hurt anything,” but I stand up to them (a hard thing for me to do) and make sure my pump is safe.

However, my most frustrating situation happened at JFK Airport Security. When I walked through the regular metal detector, the alarm did not go off, but the security person saw my pump and said that I had to take it off and go back through again. I said “I can’t, its an…” but he kept interrupting me. I kept attempting to say it was an insulin pump, but he wouldn’t listen. He said “I don’t care what it is, take it off!” I soon found out that he was new and was in training. His boss stepped in as I got tears in my eyes and told me I could go through. The boss then explained to the trainee that it was an insulin pump.

Over the years, airport security agents have become more aware of insulin pumps. Surprisingly, at some security points, they have actually asked if it was an insulin pump instead of assuming it was not. I think this is great and I really appreciate that there is an effort being made to make security more comfortable for all of us.

It is important to remember that going through security when you travel can be stressful, but knowing what to expect and what you can do to protect diabetes and your diabetes supplies will make it easier and more pleasant. Stand up for yourself! Do what you need to do! Travel the country and the world!! Don’t let wearing a pump or having diabetes stop you from anything!

How to Avoid the “Freshman 15” and a High A1c when eating on campus!

By Amanda Mezer

Going away to college is filled with adjustments and learning curves.  Food was one of the biggest learning curves for me during my freshman year.

When I was living on campus, I did not have a car and therefore was dependent on the dining hall or campus eatery’s for meals. This became a huge frustration, especially since my health depends on nutritional information and sound decision making related to food.  Let’s just say, the food at the main dining hall where everyone eats was unpredictable.  You never knew exactly what you were going to get!  Sometimes it was actually good and sometimes not so good.  The salad bar often held the most mystery.  At times the “fresh” food seemed anything but fresh.  Plus, there were no carb counts or anything to judge how to dose the right amount of insulin for the foods throughout the dining facility. I was often directed to nutritional information on web sites, but unless you carry your laptop through the food line or know in advance exactly what you are going to eat, the benefit from this information was very limited.  Who would look online before they went to the dining hall?

With time, I started to settle into a routine.  I then had to fight the “freshman 15”…that is a whole other story!

To get you thinking about how to strategize your food patterns in college, here are my top 5 tricks to avoid pit falls:

1. When drinking Starbucks coffee (a necessity to stay awake during the long days), I found that asking for half syrup and adding a sugar substitute to sweeten the coffee to taste helped reduce carbs. It also makes it taste less sweet by not adding as much sugar substitute
2. I would eat a low carb snack before dinner so that I would not go completely hungry and would not end up eating a carb-loaded dinner.
3. During the day, I would eat lots of small snacks and only eat at the dining hall at breakfast or at night to reduce calories and carbs.
4. I would limit myself to one dessert a day that I would eat at dinner. It was a challenge because I had never had the access to the “all you can eat” dessert bar.  We certainly did not have one of these at home.
5. I would try to drink water with all of my meals to reduce the added calories and carbs from beverages.

The food at college was different than at home. There were many higher carb foods and even the food that I thought was healthy at home seemed to contain a lot of hidden carbs at school.  The salad and fruits were often unreliable.  And since I am a vegetarian, I guess you could say many days I was trying to decipher “mystery tofu” instead of “mystery meat.”  So be prepared when you go away to college to be a detective when heading to the dining hall and watch out for those hidden carbs.

Going Away To College

By: Amanda Mezer

When I made the decision on where I would go to college, I was met with mixed reactions.  At that point, none of my friends with Diabetes had gone away from home, so there were few people around who could give me good advice about adventuring and learning to be truly independent.  I felt ready to face the challenge, but also nervous. My support team always reinforced that, “Diabetes should not stop you” from doing anything you want to do, including going to college.

So, I did it.  I moved out of state to college and it was definitely scary, but I learned so much and am so much better for it.  I did have a few nights with insulin pump failures/ or infusion site failures,  but I learned to manage them.  In a dorm, there is always someone awake at 3 in the morning! When I would wake up with a high blood sugar, typically one of my friends would keep me company until my blood sugar came down and I could go back to sleep.

One time, my pump site got pulled and I did not know it. That night, my best friend sat with me for over an hour. She talked to my Mom on the phone and said she would call her back if I had a severe problem that night, because my blood sugar was over 500 and I was really sick.  She was an incredible support!  That night, I knew I had found a true, lifelong friend.  We are still best friends and are looking forward to getting an apartment together next semester.

I think the best gift is when friends understand when to ask and when to not ask about diabetes.  This requires a little education and patience on our part as we help them learn how to react to our disease.  My friends have helped me when I have been in times of need, but also do not treat me differently. My best friend does not say much about my diabetes unless I look starry-eyed or pale.  In those moments, she simply asks if I am okay.

Nothing about being away from home for college is easy, but I have no regrets.  I would recommend that anyone who can, go away to college. I am learning how to live “on my own” while still feeling the protection of having friends close by and a health center on campus.

I have learned that communication with roommates, hall mates and friends is incredibly important.  There are some things about diabetes that may not be understood and some of the mechanics of living with the condition may need to be explained.  For instance, there are times when it is important to have the privacy to change insulin pump sites.  That could be misunderstood and blown out of proportion if not communicated about.  Also, it is important to plan for a place to securely store insulin supplies.  A little planning will go a long way to making the college experience positive and the transition to independence a little easier.