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Transitioning

May 24th, 2011

I hold my morning and afternoon bootcamp classes at a high school campus, which means I’m on a high school campus every day.  The energy radiating off even the buildings has changed through the school year as you can I’m sure imagine. 

Which is to say, SUMMER and GRADUATION is on my mind these days.

I remember graduating from high school: it was, in a word, awesome.  Having had diabetes for seven years at the time and living with giving myself shots in front of everyone at school for the past two years I thought I had it all wrapped up. 

Yeah, at the time my A1c was routinely 12.5-13.4.

(I didn’t say I actually had it all wrapped up; I just thought I did.)

I was concerned about my supplies and prescriptions while at school, but I found where my new pharmacy was close to my college campus, and my doctor was in the same state so there wasn’t any problem with getting my insulin.  (I didn’t go on a pump until mid-way through my freshman year at college so I was still taking shots.)

But you know, I could really have used some actual help learning how to be myself and how to be me with diabetes.

Having had the opportunity last week to chat with a group of teens with diabetes, I heard them echo the same things from my memories.

I admit I felt a little sorry for them; I know that life with diabetes while transitioning from parent-care to self-care is incredibly difficult—especially when as a teen you are trying desperately to not need adults for much of anything!

I don’t want them to have to do it alone.  Ever.  It’s just too much, too complex, and too much is at stake in their lives and in their bodies.

Of course I don’t think there is a lot I can do about some of it: teens are sure nothing will happen to them and far be it from me to ever be the one to shatter that illusion.  Time will take care of that.

But what options can I help out with?  And what can we, as people who have gone through the transition from high school to college and beyond while living with diabetes, offer as help for those walking in our footsteps?

I have a list.  It includes discussing plans for every day regimens, medications and supplies, the financial side of things, dealing with insurance hassles, roommates, and actually leaving for college.

It’s one of the reasons I started Diabetes OutsideI don’t want anyone to feel as scared and alone as I felt, or be in as much denial as I was.  Don’t hesitate to contact me if you want some real help with this transition.

It turns out, it isn’t worth it to try and face life with diabetes on your own.

You’re worth way too much for anyone to let you even attempt it.

Can You Feel THIS, Doc?

May 23rd, 2011

I thought this was an interesting study: researchers followed 891 patients with diabetes for three years and the study involved 29 doctors.

They rated the doctors on how much the doctor understood their patients’ perspectives and how much that understanding factored into the doctors’ desires to help.

The doctors who were rated the highest in this type of empathy had patients who were 16% more likely to have tighter management of their blood sugar levels and 15% more likely to have better cholesterol levels than the patients of the not-as-understanding doctors.

It makes me wonder how many people think about taking care of themselves better in order to please a doctor they like.  In some ways that makes sense, but in other ways it makes me somewhat sad: isn’t taking better care of yourself and your body a big enough motivation?

I guess sometimes it isn’t.

But it also makes sense sometimes when you think about teens with diabetes: they aren’t in it to please ANYONE else, and they may not have the same perspective on their lives as the adults they know. 

And then I think about how much work it must be for a physician to feel the difficulties of daily life with diabetes on behalf of his patients.  Or how often someone cries or yells in front of her in response to a simple “how are you doing” type of question.

I guess it isn’t necessarily easy for any of us.

Unless we turn off our emotions.  Which really doesn’t seem like a good idea for those of us living with diabetes since diabetes can take up so much of our brains!  And from the doctors’ side of things; who would want to get into healthcare in order to stop feeling?

It’s a very interesting thing to think about: does how you feel about your diabetes doctor determine how you care for yourself?

I’m sure it does in some ways.  I just hope we are each smart enough to ensure that in the doctor/patient relationship, WE as PATIENTS get top billing every time.

We deserve it!!

Judgy Judge Judged

May 20th, 2011

When you’re a little kid or trying to raise a little kid into a healthy adult, or when you’re an adult trying to stay as healthy as possible with diabetes, the self-care involved gets really old really fast.  But so many of us are doing such a fantastic job despite the endlessness and micromanagement and frequent feelings of failure of our self-care, I think we don’t stop enough to congratulate ourselves.

It doesn’t help when others don’t seem to understand what all goes into life with diabetes or seem to judge us for our lack of perfect results all of the time.

I had a strange experience today when I was on the phone (for two hours) with my new health insurance company and mail-order pharmacy and doctor’s office (and then the mail order pharmacy and the doctor’s office again).  The mail-order pharmacy would not deal with me until I spoke with someone (I think at the pharmacy) in the Diabetes Program.

What?

Maybe I’m old-fashioned, but I don’t like it when someone other than me or my doctor gets involved in my care.  Or when a pharmacy won’t follow my doctor’s orders until I jump through a hoop.

I’m on the phone and the Diabetes Program lady is asking me all sorts of questions.  Questions like “when were you diagnosed?” that I don’t think have anything to do with anything after 23 years and questions like “do you know your most recent A1c?” and “when is the next time you are going to see your doctor?

I was feeling so completely judged by that point I was glad I was playing solitaire on my computer and could disassociate from the phone conversation.

I don’t understand what on earth she needed to know any of that for, aside from data for the insurance company to compile about the Diabetes Program.  And then they’ll mail me junk mail forever about checking my feet or having my eyes checked.

Oh, joy.

I had to tell her twice I have type one diabetes so I check roughly 12 times a day.  She in turn asked me how often my doctor told me to check my blood sugar.

I tried to not sound like the brat I felt when I replied “she told me to check as often as I feel necessary.”

I wonder if I pulled it off.

I think I at least got through the conversation without calling her any names.  I’m going to feel successful just for that!

What Are Health Insurance Companies Paying For?

May 19th, 2011

The title of this article is great news for trainers and type 2 diabetics alike: Structured Exercise Programs Help Lower Blood Sugar, Study Finds.

This is one of those “study of studies” kinds of studies, which I find fascinating in the research field.  Not having any idea how a regular study with actual people is performed, I think it’s entertaining to learn that you can just study the studies other people have performed and call THAT a study and move on.

But that isn’t my point.  My point is: the people living with type 2 diabetes who were told to exercise and what to do didn’t fare as well when it came to their A1c levels as those who were told to (and did) join a “structured” exercise program.

Makes sense when you think about it.

If you told a kid “brush your teeth” and never showed them how or brushed your teeth at the same time as they were brushing their teeth, it would make sense that eventually the kid would stop brushing.  (If they ever started.)

Adults really aren’t all that different than kids!!

If the study participants were assigned to a structured exercise class that included both aerobic and resistance training, they on average lowered their A1cs by 0.67 percent more than the control group. 

Not bad!

Those who were simply instructed to exercise and given advice on what to do lowered their A1cs by 0.43 percent compared to the control group.

Still not shabby.

My favorite part of the article, though, comes in the editorial by another doctor who pointed out that in one of the studies studied the adults who went to a gym two times or more per week for two years, they incurred $1,252 less in health care costs than their less-active peers.

Sweet!

That doctor went on to advocate for insurance reimbursements for structured physical exercise programs.

I couldn’t agree more.  Exercise is a vital part of our health—diabetes or no diabetes—and given the overwhelming evidence in support of lower health care costs (from this and other studies) it no longer makes sense (if it ever did) for health insurance companies to ignore the importance of exercise. 

What say you, Insurers?  Are YOU ready to help us get healthier through exercise??

A Little Perspective is Always Good

May 18th, 2011

We all know that living with diabetes and trying to manage our blood glucose levels as they fluctuate throughout the day with food, stress, sleep, weather, exercise, wow sometimes it feels they change based on how clean our socks are, is simply a struggle.

It’s hard to micromanage our own bodies every moment of every day.

And because I like to keep things in perspective when I begin feeling overwhelmed with what daily life with diabetes really takes, I thought it would be good to see things in a slightly different light.

That little drop right there you might miss at first glance is a unit of insulin.

If I’m off by a unit every day, it will affect me.  If I have that much more than I need, I’m in need of urgent food intervention and if I don’t get it I’ll need an EMT.

If I’m missing that one unit every day, I will suffer the more traditional long-term complications in the future we’ve all heard about because the glucose in my bloodstream will damage my micro- and macro- vascular systems.

And I take the units through my pump in increments of 0.05 units.  (I didn’t even try to take a picture of that!)

It isn’t very much, is it?

The bigger drop here is 40 units, the average amount of insulin I take every day.

40 units of insulin-- my daily average

It’s amazing how much thought we each put into our lives with diabetes, isn’t it?  Sometimes getting a little perspective and seeing what a massive task we have on our shoulders can help us see that it makes perfect sense we don’t “get it right” all the time.

We’re doing a pretty complex thing here on a fairly minute level.  Most people don’t even realize how much work we are doing in our brains all day every day just to balance our blood sugars with this infinitesimally small tool that is keeping us alive.

I think we’re each kind of amazing just for that—not to even mention our regular lives!!

Yup, we rock.

New Wacky Thing I Did When Checking My BG

May 17th, 2011

I did something yesterday that I’ve thankfully never ever done before when checking my blood sugar.

It was totally weird; almost like when I had that black dot on my finger for what felt like months.

I really hurt my finger!!

Not with the lancet, either.

No, I hurt myself when I was trying to get blood onto the strip!

I guess I squeezed and turned my fingers and hand just so, and I heard something pop, and I felt (omg ewww) gristle or something and it really HURT and now I have a bruise on my knuckle.

 I must have broken a blood vessel of some sort.  Geez.

A person shouldn't be able to do this to herself.

I hit the roof every time I wash my hands and try to dry them off with a towel.  It’s that sort of pressure and twist combination that really does it.  Ouch.

Now, please don’t say it must be because I’m older now after my birthday last week—that just isn’t fair.  I could have done this at any time and at any age.  I just haven’t ever done it before, and it hurt a lot so I’m hoping to never do it again!!

(You can, however, commend me on my massive strength.  Tee hee; that’s what my husband did!)

Of course, it was on one of my favorite fingers that I’ve probably used more than any other in my 23 years with type one. 

And, of course, I was checking in front of someone who had never seen me check my BG before.  So I was acting all brave when what I really wanted to do was hop around and whine like a six year old.

I do have favorite fingers to use to check, and here is probably my MOST favorite and I’m busy breaking it.  Sigh.

It was just so weird.

It’s a good thing I have nine others to use while I wait for it to piece itself back together.

Diabetes is weird.

Almost There!

May 16th, 2011

I ran less than 17 miles yesterday.  Do you know what that means??  It means I’m getting really close to the marathon—it’s TAPER TIME!!!  My longest runs have already been completed and after months of slowly gearing up for the Memorial Day event, now is the time for me to ease back and rest up.  Fun!

However, I did not have a great time out there yesterday.  Sure, I missed out on the rain, which was fantastic, but it was still me running the same routes I’ve been running for the past what seems like eternity.  I let the boredom in and it was almost all over right at that moment.

Training blahs have set in with a vengeance.

I shouldn’t be concerned about the training blahs: I know I’ve been here before, and I know I’ll be there again.

What I CAN do at this point is remember to simply plan better.  It seems I have to keep re-learning the same things as I search for balance between being too rigid with my training and too flexible:

1.       Plan a fun new run.

Sometimes I wonder why I don’t listen to my own advice!  I don’t vary my routes significantly in large part because I don’t like to drive someplace to start running.  That means I’m limited to where my two little legs can carry me, leaving from my front door.  Granted, the farther I run while preparing for a marathon the more sights I can see, but those first few and last few miles are always either on route A or route B.  Yawn.

Yesterday I left my house without a firm route set in my mind.  That wasn’t a great idea, because I let boredom get the better of me!  My “oh, I’ll just see what happens” was really not a good way to plan for 16-18 miles. (I ended up getting in just 16.7)

2.       EAT no matter what my blood glucose levels are.

I think yesterday that was my biggest blunder.  I had eaten oatmeal before I left and didn’t bolus for that, so I knew I had enough glucose in my body to get through the run.  Looking back at it, I see that I did just fine keeping pace for the first 75 minutes before I let myself stop due to boredom and never really got anything back to where it had been.  I kept stopping and starting for a variety of reasons, but I’m betting that if I had taken a little extra insulin and eaten something at mile 4-5 I would have had a much better time of things, and wouldn’t have lost the mental or physical edge. 

3.       REST an additional day if necessary.

This advice I DID take this past weekend.  I have two days I can run in the mornings: Saturdays or Sundays.  (The other mornings are full of bootcamp!) That means that Fridays I generally spend thinking about where I’m going on Saturday (as I really do usually plan a route!) and trying to rest up. 

But the previous weekend I didn’t rest when I should have, and just stuck to my plan of going on Saturday when I probably would have done better had I run on Sunday instead.  This weekend, I knew on Thursday evening I shouldn’t run on Saturday because of the way my legs felt.  So, I saved it all for Sunday instead.  That was smart of me, because at this point, I’m not into getting hurt and not being able to participate in the run!

Like I said, it’s a balancing act to train for a marathon.  Thankfully, I’m almost there.

Now This Seems Weird to Me

May 13th, 2011

I don’t even know what I was doing when I found this on the American Diabetes Association (ADA) website.  The ADA sells wedding favors?!

Yikes.

(It’s actually a donation I think the bride and groom make to the ADA, and then they put the card on the tables instead of favors to let the guests know about the donation in lieu of favors.)

I’m all for accepting and embracing your diabetes—in fact, I think that’s the only way you can really emotionally survive with the disease, much less thrive—but wedding favors with little ADA logos or what have you seems over the top.

Full disclosure: I have an ADA keychain on my keys that says something about “stopping diabetes” by Living Well, Being Fit, and Having Fun.

But wedding favors seems to me to bring the disease into a realm in which it does not belong. 

Maybe it’s the idea that a wedding raise money for the ADA?  Is the ADA a charity that needs money?  (If they needed money so badly why is all of their promotional material printed in full color?)  Seems like the ADA has a lot of money.  A lot.  At least it looks that way from my perspective!!

I think it is really the idea that EVERYTHING be about diabetes.  I know it’s a bit hypocritical of a blogger who writes about diabetes to say it isn’t all about diabetes… but I really don’t think it is.  Nor do I think it should be!

I think it should be figuring out how to be who YOU are, with AND without diabetes.  If you have brown eyes, you had about as much control over that as you have about your type one diabetes.  So why make everything about your brown eyes?? 

I insist that people ask me how I am before they ask me how my numbers are.  I don’t routinely put my numbers on facebook, I don’t put my numbers in my blog, I don’t put them out there for others to see.  I want and need everyone to see ME, first and foremost, before anything diabetes related.  (I will put up crazy numbers and swings for my friends with diabetes because it’s the simplest and best way to portray a current struggle and garner needed support!)

It’s a choice I made and one I encourage everyone living with diabetes and everyone living with someone else living with diabetes to make as well.

I simply believe that we as individuals are bigger than our disease.  It’s a big ole huge daily pain in the patootie, but that’s kind of my point: even with how big diabetes can be, we are bigger than our diabetes.

Using a day as special as a wedding and as beautiful as a wedding table to promote a donation to the American Diabetes Association doesn’t spread that message in my world. 

Although, to also be fair, I should tell you that the tables at our wedding were named after the decks at camp.

Tiki, one of the decks at Bearskin Meadow Camp

So maybe I am a hypocrite after all!

No.  We MET at camp.  Camp was where we started the whole shebang we were celebrating as we married.

It’s what a wedding is for: celebrating the union of two PEOPLE –not raising money for a national charity.

Surprised by the Ranking of National Weight-Loss Programs

May 12th, 2011

I just read a report that Consumer Reports ranked weight loss programs this year and put Jenny Craig in first place, followed by (can you believe it) Slim Fast in second and Weight Watchers in third place.

Huh.

(I find it rather amusing that I got all huffy with the article as I read it.  Apparently, I found that Weight Watchers worked for me and am offended that anyone could possibly put it in third place!!!)

It makes sense, of course, that for weight loss, if you eat only what someone else puts in front of you that you will likely lose weight—because you aren’t making choices throughout your day.  Since Jenny Craig is a program with counseling and prepackaged food, there aren’t as many choices as you would face in the grocery store, food court, amusement park, cafeteria, or restaurant.   With the second place winner in the ranking none other than Slim Fast, I’m seeing where the dieters were going with this.

They wanted easy.

And simple.

And fast.

And no thought.

And no work.

Hmm.  Sounds like a lot of “we know we should but it’s just sooo muuuch wooorrrk” things out there.  Like, for example, keeping yourself healthy!

I don’t know where anyone got the idea that staying healthy and fit was supposed to be easy.  I don’t think it was ever supposed to be easy.  Sure, living with diabetes makes a lot of things more complicated than average, but I don’t think anyone has anything easy! 

Maybe the yo-yo diets have a lot to do with the “on a diet/ off a diet” concept, where you eat dramatically differently (or, in the case of Slim-Fast, you drink dramatically differently) when you are “on” than when you are “off.”

The thing is, though: your body needs to always be ON.  It functions best that way!!!  You can’t really have months where you do exercise or watch what you eat, and months where you don’t care.  As it goes with your blood sugars, you know it doesn’t work to your benefit that way!!  You need to keep a closer watch on yourself and your body.

All the time.

In real world scenarios.

So that when you DO need to find something to eat at an amusement park or vending machine, you can make good choices for yourself.  When you have a high you can’t seem to bring down, you know that taking a walk after a meal can help as much as an extra shot of insulin.

It’s all about real world living every day.

How could it be anything else, really, when it comes down to it?

You can do it.  You can make your life work with the body you have.  You can make your body work better for you if you work on it slowly but surely and steadily.

Go for it!

Mix Things Up and Do Something Good For Your Body!

May 11th, 2011

I know I’ve said this before, but it always bears repeating: our bodies are waaaay smarter than we are.  And, our bodies are always looking out for us by responding to a stress by getting stronger.  One of my favorite experts, Jason Karp, Ph. D, said it best when he refers to training as threatening your body’s survival.  In turn, your body does what it needs to do to prevent that threat the next time it comes around.

It’s one of the ways you get stronger and faster!  It’s how lifting a 10 pound weight that used to be incredibly difficult seems easy by comparison when you’re strong enough to lift a 20 pound weight for the same exercise.  And how running a ten minute mile is no longer as difficult once you’ve gotten used to running a nine minute mile.

All of that being said, it’s still critical to mix things up if you want to increase your fitness level and protect your body from injuries that can occur with repetitive stress of unvaried training.  It can be a fine line between not enough and too much!

One of the best ways to keep yourself in tip top shape and free of injury is to MIX THINGS UP when it comes to your exercise routine.  For me, that means doing a lot more than simply running.

I like these ideas from Active.com

Take a Dance Class

Replace a day you would normally spend cross training with a Zumba, hip-hop or salsa class. Runners often focus so intensely on forward movement that their quadriceps can become over-developed and as a result, the gluteal and adductor muscles that provide for stability and lateral movement can atrophy. 

These small and often forgotten muscles are necessary to keep the body balanced and to prevent injuries to the IT band, knee and ankle. You can hit the gym and build these muscles by lifting weights, but why not take a dance class that gives you a cardio benefit as well?

Zumba, hip-hop and salsa provide a balanced workout because they require dancers to move in 360 degrees around their bodies. They strengthen all major and minor muscle groups in the legs; provide a core and cardio workout, and the bonus? A dance class once a week helps break up the daunting mental block that training can inflict on the psyche.

Do Speed Work in Spin

Sprints in a high-intensity spin class have the same benefit on fast-twitch muscles as a track workout, but the impact on your joints is far less. Plus, if you aren’t part of a running group, putting together a speed workout can be overwhelming.

If you take a spin class, you get the social benefit of sweating amongst your peers and the added inspiration this brings.

Replace One Day of Strength Training With Pilates

Abdominal muscles are an integral part of running. Not only do they protect your back and keep you stable and upright, your pelvic floor helps lift the two tree trunks below your waste. So the stronger your abs, the easier each step, and the less likely you are to pull a hip flexor.

Another benefit to Pilates is that it lengthens muscles. Repetitive motion like running and standard weight lifting causes muscles to contract and tighten, which can lead to injury.

Pilates provides a balance to this shortening. It also helps bring the body into alignment by using small movements to reverse the bad habits we develop in our everyday lives. Since most injuries occur because one part of our body is compensating for another due to misalignment, Pilates is an important way we can protect ourselves.

Strengthen and Stretch Your Feet

Your feet are the most important body part when it comes to running and the common maladies of Plantar Fasciitis and a pulled IT band often start here. To remain injury-free, your feet must not only be strong, but flexible.

If you don’t live near a beach or lake with sand, and you’re not into the barefoot running shoes, then for ten minutes a day, sit with your bare or socked feet on a towel, repeatedly squeeze and try to pick it up with your toes.

To stretch your feet after this exercise and every run, sit on your heels with your knees on the floor and your toes curled under for as long as you can stand it. This yoga pose (called “Hero’s Pose”), stretches the bottom of your feet and is the single best way to prevent plantar fasciitis.

It will be painful at first, but eventually you’ll be able to get through an entire 30 minute television program.  

Replace One Short Run With a Stair Workout

Running stairs is a great cardio workout and training tool because you’re still running, but the motion is different than if you were on a flat road. It strengthens your core, all of the major and minor muscle groups in your legs, and helps with stability.