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H is for Happy

April 26th, 2011

Hey!  Remember how I’m not a doctor?  Me, too!  If you have specific questions about any of this, please ask your doctor about it—I’m just presenting my understanding of this study.

If you have either type 1 or type 2 diabetes, you know cardiovascular (heart) disease is a major risk.  You may also know that my personal approach to dealing with that looming unknown is to keep myself fit and active every day to take care of my heart.

You may know the common positive risk factors that signify a higher risk for developing cardiovascular disease: smoking, poor diet, inactivity, and (ut oh) diabetes.

You should probably know, whether you have diabetes or not, what your cholesterol situation is.  You need to know this so that you can understand how at risk you are of developing coronary heart disease. 

We should each want to do all we can to decrease our risk.  One way to do this is to look at negative risk factors for cardiovascular disease. 

High-density lipoprotein (HDL) cholesterol can be a negative risk factor for developing cardiovascular disease.  This is because HDL’s main role in metabolism is to transfer cholesterol from plaque deposits in our blood vessels to the liver for excretion. 

So the HDL cholesterol actually functions to remove cholesterol.  (Tell me THAT makes sense, calling them both cholesterol.)  The more HDL we have, the better off we are.

H is for HAPPY!

Want to raise your HDL?  A recent study suggests a four-pronged approach: (1) aerobic exercise; (2) diet; (3) moderate alcohol intake; and (4) stop smoking already!

Since I’m a trainer and exercise is my specialty, that’s the one I’ll discuss.  (You can Google the others.) 

The greater your aerobic capacity, the greater the association with elevated HDL levels.  Sweet! 

At minimum, get 120 minutes a week of aerobic exercise and you are doing yourself a world of good.  Happy-HDL levels-protecting-your-heart kind of good!

You want to have a great volume of blood pumped by your heart per beat, and you want the amount of oxygen travelling through your blood into your muscles at high levels while simultaneously having a high amount of oxygen-poor blood travelling back from the muscles to your heart.  (V02 max)  The higher each of these is, the higher your aerobic capacity.

You want to challenge your cardiovascular system so that it improves in response.  To improve your aerobic capacity during those 120 minimum minutes per week, yes, you’ve guess it: INTERVAL TRAINING. 

Work as hard as you can for 3-5 minutes, then recover for 1-2 minutes.  Recovering isn’t sitting down, though.  Stay moving during your recovery and get back to the hard work ASAP!!

Makes me HAPPY just to think about all the great things we are doing for our hearts.

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Posted in I Can't Believe Someone Got Paid to Conduct This Study, Living with Type 1 Diabetes, My Soapbox, My Workouts, Random Musings, Uncategorized

Why Don’t I Weigh Less?

April 25th, 2011

As my Memorial Day marathon approaches, I’ve gotten the same question from my boot campers a few times. 

I don’t keep my mileage on my long runs (Saturdays most often, this week I woke at 4am to get it done) a secret.  I doubt anyone would, when they get up crazy early and run 17 miles before most wake up for their weekend!

So when a bootcamper asks on Monday how far I went this weekend, sometimes they ask more questions.  The past few weeks, someone has asked me why I don’t lose weight when I run so much.

(Fortunately, I haven’t yet been offended by a weight-related question from a bootcamper.  I figure they ask because they’re comfortable with me, and as a trainer, my body is at issue for my clients.  So why not.)

But back to the question: Amy, why don’t you lose weight when you’re running 17 miles at a time??

Well, there are several reasons I maintain my weight regardless of the number of miles I run.  Two reasons in particular.

Most importantly, I maintain my weight because I eat more as I run more.  It’s just how it works.  I also eat WHILE I run to maintain my blood glucose levels and my energy. 

I also don’t run off that many calories, all things considered.  I burn maybe 80 calories per mile, so really, it isn’t that much weight.  (I’m a pretty small creature compared to most and have been running for a long time.)  If I eat 200 calories while I’m running, and if I ran 17 miles at 80 calories per mile, that’s a net calorie loss of 1160.  Spread out over a few hours, and discounting the amount of calories I would have used sitting at my computer or sleeping, and it simply doesn’t end up a huge calorie toll.  (I’d have to do those 17 miles four times to come close to burning off a pound.)

The other part is much more complicated and one I think is often too complicated for a bootcamp discussion: remember—they are at bootcamp to exercise, not to talk!  (I heard that snicker, Bootcampers!)

One of the other reasons I maintain my weight regardless of the number of miles I run has to do, I think, with my diabetes.  My daily insulin requirements aren’t much different from the months I run and the months I don’t run.  Sure, the basal rates are different (lower when I run more), but the amount of insulin I take to cover the increased carbohydrates I eat ends up evening things out when I compare it to the higher basal rate I need to take when I’m not doing the aerobic work and don’t eat as many carbohydrates to fuel the work. 

Since the amount of insulin I take affects storage of body fat and my weight, if I take the same average amount of insulin then I won’t really change my weight much at all.

The third reason is that I’m not trying to lose weight.  If I were trying to lose weight, I’d eat less food and take less insulin and keep up my exercise regimen… but I wouldn’t run marathons at the same time.  Those two objectives (losing weight and running a marathon) place competing, intense, high-powered demands on my body and I don’t want to ever place that much stress on my body—I need it to last me the rest of my life!!

If you want help making your way through any distance or achieving a weight goal, I’m here to help!! Contact me at www.DiabetesOutside.com/be_fit.html

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Posted in Living with Type 1 Diabetes, My Workouts, Random Musings, Uncategorized, Weight, Weight, Don't Tell Me-- Does it have to do with what I eat?

Earth Day with Diabetes (Vegans, beware!)

April 22nd, 2011

I’m always frustrated that I can’t recycle my pump supply packaging, nor can I recycle my strip vials.  I know there is some sort of sterile reason for this, but knowing that doesn’t help so much on a day like today: Earth Day.

Happy Earth Day!

Earth Day is a day to focus on our impact on our environment.  I was reading an article about how much of an impact eating meat and dairy has on the environment, in a substantially negative way.  One of my reactions as I read was “do you want to take protein away, too?”

I think living with diabetes makes me feel like my carbohydrate choices are somewhat limited, and I’m curious if you can relate.  I don’t mean to say my choices ARE limited, and I certainly cannot keep up my fitness and running without some serious carbohydrate support, but it’s more of a mental thing than literal.

I have to watch my carbs.  Literally: I need to count every gram I eat!  But I don’t do that with my grams of protein in the same way.

(Sure, I have counted all of my foods in various ways for various reasons, most notably counting Weight Watchers Points for a few years as I worked to get myself to a healthy weight.  It’s an important skill to have, but it isn’t something I enjoy doing all the time.  If I think too much about the food I’m eating and if I try to micromanage the eating experience more than I have to, I’ve noticed my life becomes generally less enjoyable.)

I appreciate having some things on my plate I don’t have to care about, or count.  It used to be vegetables for a long time, until one CDE said to me once a very long time ago “I don’t recommend diabetics eat carrots on their own as a snack” and that shifted the way I see vegetables a little.  (It was a sad day.)

But so far, lean protein has remained a respite from my food counting, and I appreciate it if only for that reason.  I like eating a stick of low fat string cheese and not touching my pump for that.  I like snagging a few almonds and not touching my pump.  I like grabbing a hardboiled egg and only bolusing for the fruit or toast I have with it.

So, while I am happy to applaud efforts to minimize our carbon footprints, I’m happier still if I can minimize any counting when it comes to animal protein. 

I may take this idea into consideration, though, as it isn’t like I really enjoy eating a lot of meat:

Substitute a vegetable protein source for an animal protein just one day per week, and over the course of a year, you’ll shave off the equivalent of driving 1,160 miles per year.  If every American did this, we would save 1.7 billion gallons of fuel annually.*

As long as I can still have something on my plate that I don’t need to count, I’ll be happy.

What about you?

Happy Earth Day!

*Go Green Get Lean by Kate Geagan (Rodale 2009)

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Posted in Living with Type 1 Diabetes, Random Musings, Uncategorized, Weight, Weight, Don't Tell Me-- Does it have to do with what I eat?

Who’s Afraid of the Big Bad Low?

April 21st, 2011

I used to not mind being low, at all.  I mean, it used to be a fantastic opportunity to drink a Coke or eat candy.  A license to eat?!  YES!

I’ve noticed over the past 10 years or so that going low just isn’t’ as FUN as it used to be.  That’s a little sad.  I’ve spent lows feeling just fine, and I’ve spent lows feeling like I cannot see or hear or some other loss of sensation that is discombobulating to say the least.

I’ve met people who feel pain when they are low, I’ve met people who have passed out with a BG of 70.  I’ve met people who, like me, always experience a low just a bit differently each time.

I’m not sure I’d say that I’m AFRAID of being low, really, but they do seem to take more out of me with each passing year.

Then again, I don’t like the flip side, of running higher than I need to in order to avoid being low!

I find it interesting that someone did a study of 777 adults with type 1 diabetes about their fears of going low.  (I’ve never been able to say hypoglycemia very well; it’s “low” to me.)  Many of the subjects had experienced a “severe” low in the past year and a half before the study.  I don’t think I’ve had a “severe” low too many times… but then again, maybe I have.  (Have I mentioned being low isn’t any fun anymore and it seems to take a lot out of me?)

In terms of study results, it isn’t surprising that those who had experienced a severe low were more likely to be afraid of going low.

It’s a curious thing to me these days.  I wonder how I’ll feel in another few years.  Then again, maybe I’ll have a D4D by then and being low (without an awesome helper to help signal to me) will seem like a thing of the past! 

How do you feel about your lows?

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Posted in I Can't Believe Someone Got Paid to Conduct This Study, Living with Type 1 Diabetes, Random Musings, Uncategorized

Those Precious 23 Inches

April 20th, 2011

I think I’ve mentioned that I’m working towards getting help with my diabetes… in all forms.  I always feel great when I can help someone else, and it’s usually such a small effort for such a great reward, I don’t feel like I’m burdening someone else with my disease.  I’m just asking for a little bit of help sometimes when I need it!

That said, you know as well as I do just how much work life with diabetes can be.

So, I’m making an effort to get help from my husband.

Which, not surprisingly, involves teaching him how to use my pump.

As a little background here, I met my husband almost thirteen years ago.  My husband has always been very good at the carbohydrate side of things (I absolutely love that I can eat a meal—usually at a restaurant—and then ask him how many carbs he thinks I just ate!  He’s really pretty good at the estimation, based only on what he saw my plate looked like before and after a meal.  Crazy great!!)

But I’ve determined it would be a great thing if he knew how to work my pump, too.  My CGM sometimes keeps me from getting a good night’s sleep and it would be lovely if, before he goes to bed, he can check my blood glucose and tell my pump and deliver insulin without me being involved or having to wake up.

Maybe it’s a pipe dream, but I’m willing to give it a try.  (And, most gratefully, so is my husband.)

It’s going to be weird.  He’s going to completely invade my personal space… those precious 23 inches between me and my pump… I’m about to start sharing that space.

Talk about trust!!

Wish us luck.

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Posted in Living with Type 1 Diabetes, Random Musings, Uncategorized

The Yearly “Fun” Side of Life With Type One Diabetes

April 18th, 2011

My husband started a new job a few months ago, which is fantastic in general, but also a sort of a pain for me a couple months after he starts.

It’s time to choose a health insurance plan.

Which again I should say is a blessing to have a husband who works for a large company that has fairly good health insurance coverage.  (This company “is so good” this one will even provide pet insurance, if you pay for it.)

But the fancy colored brochure and the guy who came to explain the plans to the employees and all of the fancypants HR people employed to help us decide what plan will work best for us don’t really mean much, as they aren’t really helping.

Do you know what I mean?

Sure, I can figure out that if I took Drug X every day and that didn’t change and I saw my doctor once a year and had labwork it would be better for me to sign up for Plan A instead of Plan C.  That would be easy. 

I can even sign into my account at the medical clinic and look up what visits I had, and add up those copays and see how much a pair of glasses or contacts costs and see how much I should set aside in a flexible benefits plan.  I can estimate based on my records and prior year’s expenses just like anyone else. 

But life with diabetes isn’t that easy.

The thing I can’t figure out, mainly because it isn’t in the brochure, is how much they cover for Durable Medical Equipment, or if they cover test strips and how much I pay for either of those.

And, not to ignore the fact I’m an attorney and I did medical billing for eleven years so it isn’t like I don’t know how to read the book.

So I read the brochure and it says “for any other questions contact your HR department”.  I show it to my husband, who dutifully heads to his HR department and asks.  (He asked the guy who came to explain the plans and that guy didn’t know nor has he gotten back to my husband as promised.)

They don’t know.  So, they (which I think is nice) call up the main insurer, who suggests they call the plan administrator, who says it’s different whether it’s prescribed by my doctor or if it isn’t prescribed by my doctor.

Gee, thanks for the help.  (And FYI, I can’t get pump infusion sets without a prescription.  But that shouldn’t change the allowed amount for payment of the code.)

So now I have to go through my records and find the codes for my pump supplies, and find the codes for my CGM, and my husband has to go ask for the specific code payments/classifications. 

I’m serious.  This is what he’s spending his day at work doing today.

Two years ago, I just did what I think most people do, and looked at the prescription coverage and saw it was identical for each option, and I looked at what I actually see doctors for, and I made my best decision at the time.  I didn’t go into the code-by-code analysis.  I tried to simplify things and not treat myself like I needed special treatment.

THAT was a bad decision!  We ended up with some hefty medical bills that year.

It just frustrates me sometimes.  I am a rather healthy and fit person, were it not for this one little thing, also known as 250.01…

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Posted in Living with Type 1 Diabetes, My Soapbox, Random Musings, Uncategorized

You Smarty(Exerciser)Pants!

April 14th, 2011

We are always trying to separate things out in a somewhat strange way… I mean, do you really ever think you can isolate one muscle group?  Try moving your bicep without recruiting any of your shoulder muscles.  Try doing a pushup or lunge without using your back muscles.

Difficult, isn’t it?  I’d say it is actually impossible.  (A lot like trying to separate emotions from blood glucose swings sometimes… sure, they are different… but they are also inseparable.) 

Those weight machines may not be as useful or functional as you’d like.  Try grabbing a set of dumbbells to enhance your body knowledge and shoot for functional movements instead!

But why should your brain be any different?

Every year more research comes out that supports my long-held belief that exercise supports brain health as well as physical health.  Not only does regular physical exercise support your body, it supports your moods and can help stave off depression. 

More specifically:

One of the more exciting discoveries in neuroscience in the last 20 years has been that the adult brain can continue to make new neurons throughout the lifespan.  It doesn’t happen equally in all brain areas, for reasons that are not totally understood, but it happens readily in one specific area: the hippocampus.  This is an evolutionary older part of the brain that is concerned with forming memories and processing emotion, which may help explain some of the cognitive and emotional benefits of exercise.

Interestingly, aerobic exercise can increase neurogenesis (generation of new neurons) within the hippocampus at many stages of development, including in the neonatal (Kim et al. 2007), juvenile (Lou et al. 2008) and adult brains (van Praag, Kempermann & Gage 1999).  The fact that the hippocampus is a critical brain structure used in memory may explain why aerobic exercise can enhance learning (Vaynman & Gomez-Pinilla 2006).  Furthermore, we know that stress reduces neurogenesis, an effect that may contribute to depression and anxiety (Lucassen et al. 2010).  Therefore, the enhanced neurogenesis brought about by exercise may represent the neurobiological mechanism by which regular exercise reduces depression.

(“Exercise and the Brain” Jeffrey Kleim, PhD March 2011 IDEA Fitness Journal)

Just think of all the benefits regular aerobic exercise can bring not only your body, but your brain as well!! 

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Posted in I Can't Believe Someone Got Paid to Conduct This Study, Living with Type 1 Diabetes, My Soapbox, Random Musings, Uncategorized

Big Efforts, Small Rewards Part 1

April 12th, 2011

(You thought it should be the other way around, didn’t you?)

There is no way around it: losing weight takes a LOT of effort.  It is a heck of a lot easier to gain weight by not paying attention to every calorie (most of us already count carbs; now you want us to count calories too?!) than it is to lose weight by following the calories in, calories out fail-proof method.

Especially when that jug of peanut butter or ice cream is calling to us.

We all have a special notion of how big we are, and we all have a special notion of how big we should be.  (That’s “should” for ourselves, from our own mind.)  When we find out those two notions are very far away from each other, it can be a life-changing moment.

For me, I was 23 years old, standing in the second floor women’s department at the Robinson’s-May in Santa Barbara.  I was staring at the displays of QUEEN-sized underwear, about make a purchase.

Yeah; that’s a life-changer right there. 

(And yes, in case you didn’t know, the size on the label is literally in all caps: QUEEN.)

But then once you are fortunate enough to have that moment and know there is no going back for you, there is a heck of a lot of work for the next several months and years ahead.

So you’ve got to recognize that you have a lot of work ahead of you AND you have to work on ways to mark your sure progress along the way.

If you think you should be a size 6 yet all of your pants you can put on say size 22 on their labels, you’d better make temporary friends with size 20, 18, 16, 14, 12, and so forth.  (I say “temporary” friends because you want to make this journey a ONE WAY ticket, never to return to the bigger sizes.  Never ever is your goal!  Seriously; are you enjoying the work of losing weight?  If not, do it right and only do it once.)

I can also tell you the day I was standing in a Macy’s and realized I could shop just as easily in the women’s department, plus sizes, and petite department.  Wacky!  It was kind of like standing in that spot where you can stand in four states at once…. (I think I spent a lot of time shopping for clothes before I realized some self confidence was in order.) 

Recognizing and marking your progress as you move towards a weight loss goal is essential.  Without recognizing the progress you are making, you will undoubtedly lose momentum, lose your way, begin to feel badly about yourself, and head back to the jug of food.

Some weight loss plans suggest you stand on a scale every week.  Some say every day, and some say never stand on a scale but judge your progress by the way your clothes fit and feel.  I think there are ways that work for each of us, but I do think that avoiding a scale altogether can be as dangerous as avoiding the idea of losing weight.

I think you need to see for yourself the way the numbers on the scale change: how they climb, how they fall, and how they seem to stand still for days on end.  It’s exactly like a blood glucose check: just data. 

Just data to help you figure out the next steps you will take.

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Posted in Living with Type 1 Diabetes, My Soapbox, My Workouts, Random Musings, Uncategorized

20 Minute Workouts—Jumping Rope

April 11th, 2011

Did you know you can jump rope with and without a rope?  You can jump rope even if you don’t lift your feet from the ground… so long as your effort is up and energy is high, you’ll get a in a great cardio workout.

Give it a try.  Find 20 minutes for yourself, or even set your alarm for 20 minutes earlier tomorrow and squeeze it in before you do your regular morning routine.

See what happens! (Depending on your cardiovascular fitness, your regular routine, and your dawn phenomenon, you may not need to adjust your insulin as you jump in the morning, but watch for changes in the hour or two after you jump.)

If you do have a jump rope, use it.  If you don’t have a jump rope, hold out your hand right now.  Feel that?  I just handed you an invisible rope! 

Now everyone has a rope, visible or not. 

Find yourself a nice space where jumping rope doesn’t involve breaking anything. 

Ready??

Set??

 

GO!!

Light 20 minute jumprope workout:

Think about keeping your torso erect, standing tall, keeping your abdominals tight and staying light on your feet.

Minutes 1-4: march in place (or around the block and start your timer when you get back), keeping your hands and arms free and mobile

Minutes 5-8: invisible rope for all: jump rope without a rope, alternating feet as you jump, essentially shuffling your feet.  No need to get your feet too far off the ground!

Minute 9: jump rope with alternating feet for 30-60 seconds.

Minutes 10-13: lay your rope on the ground, standing to one side of it the edge of your foot should be parallel with the rope.  Now, hop from one side of the rope to the other from side to side.

Minute 14: jump rope with alternating feet just like in Minute 9.

Minute 15-17: alternate jumping lightly from your right to left foot just like in Minutes 5-8.

Minute 18: one solid minute of double foot jump roping!

Minutes 19-20: cool down by leaving your rope on the ground and marching in place or circling the block in the other direction.

When the 20 minutes are up, take a couple of minutes to stretch your calves, quadriceps, and hamstrings.  Lift one arm up overhead and reach to the opposite wall to stretch your torso; change sides.

Good job!!

Moderate 20 minute jumprope workout:

Same thoughts as above. 

Minutes 1-4: warm up as in the Light workout above.

Minutes 5-7: invisible rope for all: jump rope without a rope, alternating feet as you jump, essentially shuffling your feet.  No need to get your feet too far off the ground!

Minute 8: pick up your rope and continue the same footwork technique as the previous minutes 5-7.

Minute 9: jump rope with both feet for 60 seconds.

Minutes 10-13: sidestep by jumping from the left foot to the right foot, tapping the left foot to the right after skipping over the rope.  Repeat with the right foot.

Minute 14: jump rope with alternating feet for 60 seconds.

Minutes 15-17: put the rope down and jump lightly from left to right foot, swinging your invisible rope with your hands.

Minute 18: pick up your rope and jump with your right foot for 30 seconds and then with your left foot for 30 seconds.

Minutes 19-20: cool down and stretch as in the Light workout above.

Fantastic!!!

(Workouts designed by June Kahn and Lawrence Biscontini, Morning Cardio Workouts.)

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Posted in Living with Type 1 Diabetes, My Workouts, Random Musings, Uncategorized

Yes or No?

April 8th, 2011

I went for a run last night after my afternoon D.O. it Bootcamp class.  Going out for 7 miles at 5:30pm was one of the last things I wanted to do right then, and knowing I had some tough hills ahead didn’t make it any easier!

It was really cold, and I only had a pair of shorts to run in.  I was very glad I had a long sleeved shirt and gloves if I wanted them.  But still: it was very windy, and just the thought of being out for an additional hour was just making me sad and tired!

So I puttered around for a few minutes, checking my voicemail and email.  Anything to put off my departure!

And then I realized I had puttered away 15 minutes, waiting around in the cold in my shorts.  That seemed pretty silly, so off I went.

I got to run downhill for about a mile, and then start the trek up my first hill.  I was running at a busy time for cars, in an area I needed to watch the sidewalks for cracks, so I was concentrating on being aware of my surroundings as I went.  I was happy gravity was helping me start my first mile.

After about 15 minutes, I was on my way up my first steep hill and suddenly it dawned on me: I never regret getting out there and DOING something. 

My run was still only a third of the way done and here I am getting all nostalgic over what running has brought to my life!

Great.  Maybe I should run by a friend’s house and ask for a tissue.

But in all seriousness, this is a very good thing for each of us to think about.  What are you going to let stand in your way?  What are you going to learn how to figure out so that you can keep going toward your goals?

I was lucky a number of years ago to work for a doctor who ended up being a friend as well.  I still remember the day he came out of an exam room after seeing an 85 year old woman.  I guess the two of them were discussing her life and he asked her if she was happy with what she had experienced over her eight and a half decades or if she had any regrets.  In response, she hit the arm of the chair and said “I wish I had said YES more!”

That lady and her saying that to her doctor has stayed with me ever since. 

I try to say YES to new experiences even if they scare me.  The way I see it, saying NO can be the scarier option.

It’s why I never regret getting out there: I’m saying YES.

What about you?

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Posted in Living with Type 1 Diabetes, My Soapbox, My Workouts, Random Musings, Uncategorized