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Thursday, December 27, 2007

For Context: Diabetic Basics

In order for the remaining post or two on corporate diabetes issues to make sense, we need to cover some fundamentals to provide context for non-diabetics or those newly diagnosed .

Diabetes is a condition whereby the body fails to process blood sugar properly, resulting either in abnormally high (hyperglycemia) or low (hypoglycemia) blood sugar levels in the body. The World Health Organization categorizes all diabetes into three types: Type 1, Type 2, and Gestational. You might best remember Type 1 as genetically caused and most commonly associated with people who have required insulin since childhood. Gestational diabetes is typically temporary, associated with pregnancies in some women, and generally resolves itself after delivery. For purposes of our discussion we'll be concentrating on Type 2, also commonly known as Adult Onset Diabetes.

Depending upon which health organization's data you believe, there are between 18 -21 million Type 2 Diabetics in the U.S. I am one of those. For years this disease was also referred to as Obesity Diabetes as those with it are typically overweight. More recent studies indicate that the disease itself my cause obesity, so this label is now more rare. Type 2 diabetes is usually diagnosed in adults from early middle age or older, and is defined by a fasting blood sugar >126 mg/dl and two-hour post-meal blood sugar of >200 mg/dl.

In Type 2 diabetics, the receptors in the pancreas that accept and process sugar from the blood stream fail to open or otherwise reject the sugars. Since sugar enters the blood stream during digestion, and most foods contain some amount of sugar, the level of sugar in the blood increases to an unhealthy level. Imagine leaves in a swimming pool when the skimmer stops working; after a time, you don't want to swim there. Its the same principle.

An overabundance of sugar in the blood stream has both immediate and long-term negative impacts on the body. In the short term, high blood sugar causes various symptoms such as headache, blurred vision, loss of cohesion, etc... The real damage, however, is in the longer term. The cardiovascular system, especially the smallest blood vessels, are damaged over time from high levels of blood glucose. The ultimate fate of untreated or uncontrolled diabetes include permanent vision loss from blood vessel damage in the back of the eye, loss of extremities such as feet and legs from poor circulation, heart disease, stroke, and from some combination of these, death. While that all sounds like really morbid, the good news is that this disease is imminently controllable and can even be reversed up to a certain stage.

So how do you control it? Aside from medication, exercise causes the receptors in the pancreas to open and thus process blood glucose. It is also critical to control how much sugar you take in, through limiting sweet foods, breads, pastas, rice, potatoes, or any other type of starchy food. This is a vital point for anyone planning corporate meals or breaks; starches metabolize into sugar when they are digested. Any lunch or break that includes all breads, fruits, cereals, pasta salads, etc... leaves nothing we can eat that doesn't raise blood sugar.

So the good news is that the three-pronged approach of medication, diet, and exercise slows or stops the progression of the disease. Starting next time we'll examine how work requirements such as schedules (and people who won't respect yours), meeting planning, corporate meal planning, and work-life balance can help or totally inhibit controlling your glucose.

Tuesday, December 18, 2007

I Got Silly Stringed in Texas!

I'm in Plano at our Live Events offices for a couple of days and was preparing for my first interview when one of our sales executives stuck her head in the door. "If you hear thunder, we're about to reach 100,000 over in Revolve." Interested, I followed her to the Revolve sales area and learned that:

  1. as of that minute they had reserved 99,998 slots for girls and young women at our Revolve arena events so far this year, and
  2. one of our GRCs was on the phone finalizing the booking for two more people.

All around me were giddy young sales women shaking cans of something I couldn't make out, and jumping up and down giggling. The one remaining seated salesperson looked up and yelled that she had the booking, and silly string flew everywhere and on everyone. Someone pulled the string on a pinata hung from the ceiling, and "100 Grand" chocolate bars rained down through the group. Then, the team leader assembled everyone for a prayer of thanksgiving for the 100,000 young and impressionable lives that have been or will be touched this year. Through the last conference 5,565 first time professions of faith have been made at Revolve with four more conferences to go. When you think about the fact that most of these young women will go on to have families and raise up children in their new found faith, the multiplier of that impact on our world is impressive.

Thirty minutes later I had an interview with a mid-career professional whose once-Christian company has new private equity owners who are intentionally scrubbing all aspects of the old Christian culture from their new holding. Morale is down, the workforce is disengaging, and (no surprise) sales are down resulting in waves of staff reductions. For the new owners, open Christianity is an expensive distraction and doesn't align with their own personal values.

So while we complain about the daily imperative at Thomas Nelson and other Christian businesses to balance faith and commerce, the fact that we take the time to struggle at all makes our workplace special. Today in Plano I saw the two extremes of Christianity in the workplace within 30 minutes time, and an affirmation that finding and keeping that balance is worth the struggle.


Saturday, December 08, 2007

New Series - Diabetes and the Corporate Life

In August 2001, just four months after joining Thomas Nelson, I was diagnosed as a Type 2 diabetic. Outside of a few people in the company I tried for the longest time to keep that fact quiet. After all, personal health information isn't anyone else's business, there's a great lack of understanding about this condition and nobody wants to be the guy who can't chin the bar. I was fortunate to have an endocrinologist and dietitian at Vanderbilt, and a great Assistant with diabetes in her family who could help me manage through the day. Why not keep it quiet outside my staff and just those people who need to know?

I know of others in the company who have my same condition. From time to time people struggling with diabetes who heard about my situation have come to see me after being diagnosed. Unfortunately, there is scientific disagreement between health care organizations and professionals as to what is acceptable blood sugar and how tightly to control it. I've heard stories of people whose diabetes is being managed by GP's and Nurse Practitioners who haven't kept up with the latest science, and even one EMT who was a friend of the family. One of the big problems with diabetes care in the workplace is that some diabetics get really bad, outdated advice that makes managing their condition harder than it should be.

Recently two events happened that lead me to believe that information on managing this condition in the workplace was needed. First, we distributed ice cream to everyone in our Nashville facilities one afternoon "just because" and my staff noted the number of people who turned it down stating they were diabetic. Also, I attended three recent required management events of 3-5 days where the available food choices and time demands of the agenda resulted in high blood sugar and complications in managing my condition. During the most recent event, we worked with the event planners in advance and they made a well-intended and admirable effort that still feel short because of mistakes made by the venue's food service team.
One afternoon in the office, as Dawn was telling me about the ice cream distribution, I felt instant and profound conviction about my lack of leadership on this issue. If my problems occurred in spite of the quality of my care and my administrative support, what do other diabetics experience at work?

So for the next two or three postings let's discuss what complications happen when diabetes and the work life collide, and how people with this condition and their supervisors and co-workers can help in making the corporate life a little more livable for those struggling with an uncooperative pancrease.