Archive for the ‘Uncategorized’ category

Ah. We Are Still Discussing Diabetic Diets. Hmm.

June 9th, 2011

I can’t believe we still discuss diets.  As in, what we eat, what we should eat, what supplements to take, who makes them, why we need them, why we don’t need them, what we do need, what we never need, what someone on the other side of the planet needs, what someone with green eyes needs, what an apple shape should eat and what a cantaloupe shape should eat and what a dear me pineapple shape should eat.

It’s enough to drive a person crazy.

And, then there is of course the dreaded DIABETIC DIET.  Cookbooks for DIABETICS and DIABETIC CANDY BARS and DIABETIC DRINKS and wow I’m surprised they haven’t come out with DIABETIC EAR CLEANERS by now.

I guess I feel the best when I don’t consider life in terms of “diabetic” and “non-diabetic” because I like to choose when I put on that moniker myself and not give that choice to others. 

It’s my disease, my choice when to be labeled. 

(Hey, I’m not saying I make a lot of sense all the time.)

I think my feathers get the most ruffled when it comes to a DIABETIC DIET.  Type one diabetes has a load in common with type two diabetes, but the advancements in insulin delivery technology over the past 30 years means to me that as a type one I don’t need to avoid much of anything when it comes to food.

(I need to avoid some of it for other reasons like my overall health and size, but that’s not what I’m talking about.)

And then Joslin enters the fray and I feel all hope may be lost.

Joslin, one of the most highly regarded and prolific diabetes knowledge and care centers in the world, and I’m getting miffed when they put up a blog about a DIABETIC DIET.

My prerogative, I guess.  Like I just said, I’m not one to make sense all the time.

Since I have found that the more I shoot for healthy eating the easier things go.  The less I think about “how many grams of protein am I eating” and the more I think about “how many different fruits and veggies can I eat in a day” the better things go.

So when Joslin puts out information with phrases like “ability to prevent or manage diabetes” then I really do request that this preeminent diabetes center be more responsible and specific.  I want them to say, in their own blog written by their own expert, something along the lines of “ability to prevent type two diabetes”. 

I just want those two extra words.  Heck, one of them can even just be a digit.

With news reporters discussing the various types of diets out there and they say things like “prevent or reverse diabetes” it makes my job that much harder.

I didn’t think any of us needed any of this to be MORE difficult.

And, for the record, the top three in the Joslin blog?  Each incorporate HEALTHY EATING and EXERCISE.

Maybe not as marketable, but definitely more effective.

The Plain and Simple Truth About Taking Insulin

June 8th, 2011

I know a lot of people living with type 2 diabetes want nothing to do with taking insulin.  To me, that doesn’t make a lot of sense since from my perspective insulin is the greatest liquid I can think of.

But I digress.

I know a lot of people with type 2 don’t want to take insulin because they feel like some sort of failure if “their sugars get so bad they have to take shots.”

Well.

Let’s go through this. 

One. If you are doing all you can with your diabetes management and your body is doing its own crazy thing and your doctor believes that your health will improve if you start taking insulin… may I suggest that you are perhaps risking cutting off your nose to spite your face?

Two. If you need to take insulin, you need to take insulin.  In fact, every single living human needs insulin, so again I ask what you are trying to prove by avoiding it.   (There are a number of different types of insulin and different ways they work; you and your healthcare team will figure all of that out based on what works best for you and your body.) 

Three.  Since you were diagnosed with having type 2 diabetes, has your body ever done what you wanted it to do?  Probably not.  You haven’t been totally in charge for some time, not that you ever were!  So why would you feel like a failure at this point?  I sincerely hope no healthcare professional ever told you that you would 100% be able to avoid taking insulin, or that you would be somehow less of a person or a bad patient if you needed it.  If they did, I suggest you report them to your state medical board.

Four. If you are trying to avoid taking insulin for fear of gaining weight, there are several strategies to help you keep yourself a healthy weight.

First off, when it comes to managing your weight when you take insulin, you simply need to move and grove just like everyone needs to in order to keep fit. 

If you take more insulin than your body needs you will be at a higher risk for low blood sugars and at a higher risk for excess storing of the food you eat.  That’s why simple sugars are such a danger for everyone: they require a big load of insulin to maintain blood sugar levels as they quickly climb.  That big load doesn’t always work efficiently, and it increases your body’s tolerance (and decreases sensitivity) for excess insulin.  With the excess come the added pounds.

Keep yourself active and moving every day, keep your nutrition nutritious, and take as close to the perfect amount of the right insulin for your body and you will do great on insulin.

You and your body need that.

Today’s topic was inspired by Sheri Colberg PhD’s blog.

And Then Sometimes I Don’t Worry About Us

June 7th, 2011

Yesterday I explained how I worry sometimes about most of us.  As I sat down to write this afternoon I picked up the June Diabetes Forecast next to my computer and (for some reason) read the guest editorial.

Maybe if more people were like this associate editor I wouldn’t worry quite as much!

The editor, clinical pharmacist Craig Williams, discussed two patients he and his team saw in the hospital on the same day.  Both had type 2 diabetes, both had lived with diabetes for some time, were physically active and not too overweight.

One of the patients took almost 400 units of insulin a day and needed more while in the hospital.  The other took no insulin and used only a small amount of metformin. 

The insulin user’s A1c was above 9 percent and the metformin user’s A1c was 6.1 percent.

The authors’ point was that as a scientist, he wanted to know why the difference and he was frustrated that we don’t have all the answers.  (Yet.) 

I’m still back there worrying about the patient with an A1c of 9 percent, doing all she can, and still getting less than optimal results.  And I’m fairly certain the one with a 6.1 wasn’t having an easy time of things, either. 

But I also feel for the healthcare providers.  I think patients come to them and expect that the provider than prescribe something for them that, if they do what the doctor orders, will give them the expected result.

Not so when it comes to diabetes!

So I feel a level of sympathy for them because I think for some of them they may feel like they aren’t doing, or can’t do, their job when it comes to each of us and our diabetes.

It’s probably frustrating.

Add in the various forms of denial, anger, fear, frustration, ambivalence, you name it, and the desperate need patients have of their medical team to help with daily life with diabetes and it just has to be a demanding profession any day of the week.

So I really appreciate this author’s laying it on the line and sharing how frustrating the science is for him, from his side.  I almost wish more medical professionals we work with could be as frank with us as we ALL fight the good fight to keep our bodies healthy every day.

With everyone on the same team, it makes me worry a little bit less about each of us– what a great thing!

I Worry About Us

June 6th, 2011

I worry sometimes about most of us.  I worry because I think having diabetes is really difficult and I see people in the “spotlight” that is the internet and I don’t see their struggles as often as I feel my own.

It’s a little hard to describe.

I worry about the people who are lurking around reading blogs and tweets and random snippets of the lives of others with diabetes.  I worry they see the public successes of these few people and feel badly about themselves and their own diabetes.

It’s kind of a mess.

In a lot of ways, I say “congratulations” and “great job” to those people online.  To myself, I often say “oh crap.”

And I’d say I’m one fairly in tune with myself and my disease.  So I extra worry about those who may not be as accepting of the ups and downs of living with diabetes, or even of life in general.

I know people want to point to others as a way to show us we can do it.  Just look at Sue: she’s doing it!  Look at Joe: he’s doing it!  It’s possible!  But sometimes it doesn’t feel like encouragement. 

Sometimes it feels entirely different.

Since diabetes is such a personal disease and it matters who we each are, what we do, when we do it, what insulin or medications we take, what the weather is, how our immune system is working each day, what our hormones are doing, what we eat, etc that it is almost impossible to compare apples to apples

Yet the numbers we deal with (A1cs and regular BGs) are dangerously identical.  Dangerous to us because they promote a very simple comparison between our own numbers and the numbers of complete strangers.

Clearly, I haven’t solved how to tackle this issue in my own life or in the lives of others.  So I do what I can: I recognize it, I think about it, and I do my best for me and my life with diabetes.

And, I worry too.

I hope everyone is able to recognize that a tweet of a number doesn’t tell us a bit of a thing.  It tells us at one moment someone had a certain blood glucose reading.  Or, for one 2-3 month segment of time someone had a certain range. 

It certainly doesn’t tell us who they are or what they are about.

I wouldn’t want to be judged on my numbers alone and I don’t even want to meet anyone who would want to be judged solely on their numbers either.

There is just so much more to us, as people, than a number.

So I’m still going to worry, just for the record.  I’m going to keep worrying about the people who have determined they are either never diabetics or those who have determined they are always diabetics.  I am going to worry for those in denial in either direction, because we each have a lot of living to do and I don’t think anyone can really live when they are busy denying something as big as diabetes. 

I don’t want you to deny your disease, but I don’t want you to be consumed by it either.

We’ve got a whole figurative fruit basket comprising our identities.  Sure, we have apples and oranges, but I’m betting some of us have kumquats and kiwis and dragonfruits and starfruits and pineapples and even a few bananas and peaches, too.

(Or maybe we’re all fruit loops.  I’m not always sure!)

Happy National Donut Day!

June 3rd, 2011

I found out this morning when I checked facebook that today is National Donut Day

Not only is it National Donut Day, but Krispy Kreme is giving away a free donut to every customer.

Yes!  Free.  Donut.  Every.  Person.

Well, that news changed my day quite a bit.  In a good way.

Happy Friday!!

Every time I see a donut I’m about to eat I think about the donuts our Sunday School teacher brought us when I was in confirmation in junior high.  As it was common knowledge I have diabetes, and since everyone knows DIABETICS CAN’T EAT SUGAR, he brought me a muffin each week.

Really quite kind of him if you think about it.

Now, this was back before I had a sliding scale or counted carbs or anything like we do now.  But let me tell you: this muffin was HUGE and it had nothing but pure sugar.  I probably would have been better off just eating a donut!

And then I started thinking (I was well into my third donut by this point- the second paid one) about how many people have commented on what I can and cannot eat in my 23 years of living with type one diabetes.

Add to that the fact I’m a fitness professional and used to weigh about 50 pounds more than I weigh now, and a marathoner, and someone who is just trying to do her best—but  it so often feels like any and every person who knows me has said something about something they’ve seen me put in my mouth.  I’ve stopped eating meals with others sometimes simply because I didn’t want them to evaluate my lunch.

But THEN you have to add in the fact that I don’t want to just tell everyone to leave me alone and scram—I want them to not keep asking or keep wondering.  I want to tell them the truth about eating with type one diabetes.

The truth is, it’s a lot of calculations.  It is a lot of trial and error.  It’s probably more “error” than “trial” really.  And the consequences range from uncomfortable to dire crisis to not being able to feel my legs as I stand 60 years from now.  It’s a lot of guessing and measuring and reading and thinking and trying and feeling like a failure.

It’s a lot of doing my best every day and feeling frustrated that perhaps my best isn’t going to be good enough.

And yet, if someone asks something about what “can” and “should” I eat, or makes a comment about me eating candy… I rarely get to tell them all of that.

I usually settle for saying something like “I can eat anything I want; I just need to count how much sugar is in the food.  It used to be that you had to eat your food to match your insulin, but now I match my insulin to the food I want to eat.”

Still, on a perfect day I wouldn’t need to explain anything—I could just eat—but for now, I guess I’ll stick with my standard response.

And enjoy my donuts.

Mind Your Posture/ Sit Up Straight!

June 2nd, 2011

Did we all have that aunt or uncle figure in our lives who would admonish poor posture?  I think I had a few…a neighbor when I was little, even my last boss couldn’t help but make comments about how I sat as he passed me at my computer. 

I get it.  I need to stop slouching my shoulders.

“Stand up straight!” is at times much much easier said than done.

Why should we care about our posture?  It matters for our psychological and physical health.  Not only has it been shown that individuals with poor posture are more likely to have poor self-image and less self-confidence, but different postural stances reveal muscle imbalances throughout our bodies that have an impact on our bodies’ efficiency and overall joint health.

Working to strengthen your core muscles can help you improve your posture and make it easier for your body to support itself as you move through a pain-free range of motion.  (We love pain-free! We love full ranges of motion!)

Think of your core as a box in the mid-section of your body.  (Think of a low strike zone encompassing all sides of your body, if you’re a baseball person.)  You probably know where your abdominals are already: they are in the box.  The top of the box is your diaphragm (I think it’s easier to think of my bottom ribs because I can actually touch them).  The bottom of the box includes your gluteal muscles and sides of your spine (paraspinal muscles) and torso (oblique muscles) and your pelvic floor.

Got all that? 

Now, take a thinkHow strong is your core box?  Can you take a hit from any side?  Can you hold a plank with all of those muscles activated and working for you?  What happens to your core box when you climb a set of stairs?  When you perform bicep curls with 15lb dumbbells?  When you brush your teeth?

Working to strengthen your core muscles will go a long way towards improving your posture.  Yes, it takes constant vigilance and yes, it requires you keep your computer height at proper angles for your body, and yes, it requires you get up from that computer chair several times throughout the day, but it is worth it!

Thanks to IDEA Fitness Journal, April 2011 “Perils of Poor Posture” for the studies mentioned here.

Madison Marathon Report (May 29, 2011)

June 1st, 2011

My husband swears that the time I spend running a marathon simply FLIES by as he watches all of the comings and goings of the staff and successive events and finishers.  I’ll just take his word for it on that one—to me, a marathon can seem endless.

Endless, and not always terribly interesting.  But, in the event you can snag a piece of trivia or useful information from my report, I beg your indulgence for the next few hundred words.

I will say this for myself: this time around I did a really good job getting past all of the things that could normally have tripped me up for the duration of the event.  Things like not having enough port-o-potties for the marathoners so I couldn’t go one last time before the gun went off, and my sensor reporting no signal so I was trying to fidget with that as people at the start line crammed in and elbowed me like crazy, my running gadget not working at the start line so I was perpetually a half mile off on my time and distance calculations.

These things I acknowledged and let pass.  That was pretty darn amazing.

The weather was something I just wasn’t sure of at the start line.  I had a ton of glucose with me—I didn’t have enough the last marathon I ran—so I was happy to have an extra pocket in my shorts to stash more stuff!

Because I wasn’t sure how I was going to fare in the relative humidity and the route I’d never run before (unknown hills and terrain), I wanted to be a little high to stay on the safe side so I could finish the event without having to walk home.

You’ll see a lot of 200 numbers here, but then you also need to know that I was on a lowered basal and consumed about 125 grams of carbohydrate in the four and a half hours it took me to finish the marathon… which is about how many grams I eat on a normal day, so that tells me I was wise to raise my comfort zone this time around.

I had a few bites of oatmeal (forgot a spoon so I drank it from the hotel paper cup) and a Larabar after I woke up; I only took just a little insulin to cover that.  You’ll see I started at 257; I still had some active insulin left from that breakfast bolus and I came down as I started to run.

My sensor had been relatively accurate prior to the marathon, so I didn’t check as often as maybe I would have.  I did have trouble regaining my pace after I stopped to check one time, so I was glad for the sensor’s relative accuracy that day.

153         5:00       

208         5:45am

____ MARATHON START: 7AM____

257         7:50

204         8:45

204         9:10

161         10:30 (right before it started to rain!)

____ MARATHON FINISH: 11:30AM____

The rain at the last hour was a refreshing change from what I’d been used to the previous hours.   And, I figured it washed some of the sweat away.  I wasn’t up to checking at that point, anyway, which is good: a raindrop will ruin a strip.

Anyway, it really was a beautiful course and I got to spend some quality time with my extended family who lives in the Midwest and drove to Madison to see us over the holiday.  It was nice to see them at a non-life-changing-event like this; stress was pretty low for all of us and we really had a fun time.

Maybe I’ll do this one again next year.

As for the marathon itself, I still feel simply grateful that I can run a marathon.  Not everyone would be able to put up with it. 

They’re kind of a lot of work.

But 100% worth it!

We are such ANIMALS

May 27th, 2011

For all of our things and our systems and our routines and our gadgets and our knowledge and our buildings and cars and concrete and glass and keys and computers and grocery stores and what have you… we are still, at our basic level, animals.

Proof of this can be found in the following research studies of humans.  Turns out, we aren’t much different when it comes to nature than are captive animals in a zoo.

I’m including the entire Science Daily article here; it isn’t that long (considering a three day weekend looms).  Take a gander and then get outside for some fresh air and nature!!

ScienceDaily (Apr. 26, 2011) — Research shows that a walk in the park is more than just a nice way to spend an afternoon. It’s an essential component for good health, according to University of Illinois environment and behavior researcher Frances “Ming” Kuo.

Through the decades, parks advocates, landscape architects, and popular writers have consistently claimed that nature had healing powers,” Kuo said. “But until recently, their claims haven’t undergone rigorous scientific assessment.”

Kuo is also the director of the Landscape and Human Health Laboratory at the U of I and has studied the effect of green space on humans in a number of settings in order to prove or disprove the folklore notions.

“Researchers have studied the effects of nature in many different populations, using many forms of nature,” Kuo said. “They’ve looked at Chicago public housing residents living in high-rises with a tree or two and some grass outside their apartment buildings; college students exposed to slide shows of natural scenes while sitting in a classroom; children with attention deficit disorder playing in a wide range of settings; senior citizens in Tokyo with varying degrees of access to green walkable streets; and middle-class volunteers spending their Saturdays restoring prairie ecosystems, just to name a few.”

Kuo says that although the diversity of the research on this subject is impressive and important, even more important is the rigor with which the work was conducted.

“In any field with enthusiasts, you will find a plethora of well-meaning but flimsy studies purporting to ‘prove’ the benefits of X,” Kuo said. “But in the last decade or so, rigorous work on this question has become more of a rule than an exception. The studies aren’t simply relying on what research participants report to be the benefits of nature. The benefits have been measured objectively using data such as police crime reports, blood pressure, performance on standardized neurocognitive tests, and physiological measures of immune system functioning.”

Kuo said that rather than relying on small, self-selected samples of nature lovers such as park-goers, scientists are increasingly relying on study populations that have no particular relationship to nature. One study examined children who were receiving care from a clinic network targeting low-income populations. Another looked at all United Kingdom residents younger than retirement age listed in national mortality records for the years 2001-2005.

“Scientists are routinely taking into account income and other differences in their studies. So the question is no longer, do people living in greener neighborhoods have better health outcomes? (They do.) Rather, the question has become, do people living in greener neighborhoods have better health outcomes when we take income and other advantages associated with greener neighborhoods into account?” That answer is also, yes, according to Kuo.

After undergoing rigorous scientific scrutiny, Kuo says the benefits of nature still stand.

“We still find these benefits when they are measured objectively, when non-nature lovers are included in our studies, when income and other factors that could explain a nature-health link are taken into account. And the strength, consistency and convergence of the findings are remarkable,” she said.

Kuo drew an analogy to animals. “Just as rats and other laboratory animals housed in unfit environments undergo systematic breakdowns in healthy, positive patterns of social functioning, so do people,” she said.

“In greener settings, we find that people are more generous and more sociable. We find stronger neighborhood social ties and greater sense of community, more mutual trust and willingness to help others.

“In less green environments, we find higher rates of aggression, violence, violent crime, and property crime — even after controlling for income and other differences,” she said. “We also find more evidence of loneliness and more individuals reporting inadequate social support.”

The equation seems too simple to be true.

  • Access to nature and green environments yields better cognitive functioning, more self-discipline and impulse control, and greater mental health overall.
  • Less access to nature is linked to exacerbated attention deficit/hyperactivity disorder symptoms, higher rates of anxiety disorders, and higher rates of clinical depression.

If that isn’t convincing enough, Kuo says the impacts of parks and green environments on human health extend beyond social and psychological health outcomes to include physical health outcomes.

  • Greener environments enhance recovery from surgery, enable and support higher levels of physical activity, improve immune system functioning, help diabetics achieve healthier blood glucose levels, and improve functional health status and independent living skills among older adults.
  • By contrast, environments with less green space are associated with greater rates of childhood obesity; higher rates of 15 out of 24 categories of physician-diagnosed diseases, including cardiovascular diseases; and higher rates of mortality in younger and older adults.

“While it is true that richer people tend to have both greater access to nature and better physical health outcomes, the comparisons here show that even among people of the same socioeconomic status, those who have greater access to nature, have better physical health outcomes. Rarely do the scientific findings on any question align so clearly.”

Because of this strong correlation between nature and health, Kuo encourages city planners to design communities with more public green spaces in mind, not as mere amenities to beautify a neighborhood, but as a vital component that will promote healthier, kinder, smarter, more effective, more resilient people.

Parks and Other Green Environments: Essential Components of a Healthy Human was published in a research series for the National Recreation and Park Association.

Four (4) Days. Four!

May 26th, 2011

Have I ever shared with you how extremely bad I am at packing?  More specifically, packing my supplies?

The air traffic safety people haven’t made the task any easier.

It amazes me how much I can bring “just in case” I need it.  When it comes to supplying myself with potential medical necessities when running a marathon with type one diabetes, it gets even worse!

I am even more amazed by Nat Strand after packing for this short little nothing trip.

I think this time around it was my Mastisol that got me.  I know that anything that may seem “attached” when I start a run will quickly become “not at all attached” once I break a sweat were it not for my Mastisol.

(If you just shuddered, as many do at the thought of Mastisol on their skin, let me assure you: I sweat a lot.  I would not be able to keep anything attached to me without Mastisol.)

And of course Mastisol is crazy expensive so I bought it in the big 2 ounce bottle since I am most often at home when I change sets and sensors and the bigger bottle was cheaper.  But, I have also had a little 15mL bottle of Mastisol spill in my luggage (fortunately for me it was in a Ziploc!) so I’m not interested in bringing or risking the big momma bottle.

But, it’s a marathon.

And, thank you air travel, I cannot wear my sensor in flight.  I’ve tried turning it off in the air and back on on the ground, but that doesn’t work at all.  I’ll need to insert a new one and get it started once I’m on the ground.

All of this means I’ve got to bring my Mastisol with me.  And, of course, I’m realizing this last night and I leave later today.  And I’m not into paying $20 for someone to ship me a small bottle to the hotel and deal with it that way—diabetes is expensive enough.

SO, to fill you in on completely random information that doesn’t really have anything to do with anything, I feel like a genius for what I realized I can do.  I’m going to stick some Tegaderm on my hip with Mastisol before we leave, and then I’ll put in my sensor when we land.  (If I put on my sensor without putting Mastisol and Tegaderm down first, it falls off.  Every time.  I’ve tried more than seven times to do it the way that .)

That way, I’ll accomplish a few things with little hassle. 

The tricks we learn from years of diabetes, years of pumping, years of CGM’ing, and years of running. 

It’s getting better all the time!

It’s A Little Sad We Need the Government for This

May 25th, 2011

It’s a little sad to me that we need the federal government to tell us to get a move on every day.  In an ideal world we wouldn’t need that—we’d be able to live our lives without the stress of an urban or suburban environment relegating us to a life of boxes.  (Lie on a box, eat from a box on a box, get in a box, drive to a box, sit at a box, stare at a box, get back in the box, drive to your box, sit on a box, stare at a box, lie on a box, and repeat!)

However, not only am I unable to change the world just by wishing for a change, I am also not likely to inflict my desires on an entire population.  (If only!)

So despite my sadness I find it somewhat useful to periodically check in on the federal guidelines for physical activity for Americans.  I think they are fairly weak requirements as I’m positive most would benefit more from somewhat higher standards, but I also understand a majority of citizens are very far from achieving even these daily amounts of physical activity… which brings on another wave of sadness!

How do you measure up to these standards?  How does your family measure up?  Your friends?  Are you doing what you can to achieve these recommendations for your body and health?

Children and Adolescents (aged 6–17)

  • Children and adolescents should do 1 hour (60 minutes) or more of physical activity every day.
  • Most of the 1 hour or more a day should be either moderate- or vigorous-intensity aerobic physical activity.
  • As part of their daily physical activity, children and adolescents should do vigorous-intensity activity on at least 3 days per week. They also should do muscle-strengthening and bone-strengthening activity on at least 3 days per week.

Adults (aged 18–64)

  • Adults should do 2 hours and 30 minutes a week of moderate-intensity, or 1 hour and 15 minutes (75 minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic physical activity. Aerobic activity should be performed in episodes of at least 10 minutes, preferably spread throughout the week.
  • Additional health benefits are provided by increasing to 5 hours (300 minutes) a week of moderate-intensity aerobic physical activity, or 2 hours and 30 minutes a week of vigorous-intensity physical activity, or an equivalent combination of both.
  • Adults should also do muscle-strengthening activities that involve all major muscle groups performed on 2 or more days per week.

Older Adults (aged 65 and older)

  • Older adults should follow the adult guidelines. If this is not possible due to limiting chronic conditions, older adults should be as physically active as their abilities allow. They should avoid inactivity. Older adults should do exercises that maintain or improve balance if they are at risk of falling.