Archive for the ‘Living with Type 1 Diabetes’ category

It’s So Emotional

January 12th, 2011

Yesterday I went to see my diabetes doctor.  (I somehow like that term better than “endocrinologist.” I like the alliteration!)  I’ve been a mess for the past few days because I knew I was going to see her.  I was a mess driving over to her office.  I was a mess sitting in the room waiting for her.

As I sat in the room I could hear a man in a nearby room speaking to another doctor.  (He was speaking dramatically louder than “classroom voice” so it isn’t like the walls are thin.)  He had a woman with him, perhaps his wife, and I could hear her nervous laughter as he spoke to the healthcare provider.  He spoke of boluses and blood pressure and over-corrections and all sorts of pump- and diabetes-related topics.

My anxiety levels skyrocketed as I listened to him speak. 

He didn’t seem normal.

He seemed incredibly anxious.

I recognized it from my own doctor visits and my own emotions just this week.

I don’t know what it is, but the visits I have had with my diabetes doctors have always felt emotionally superchargedI’ve observed it in many other people living with diabetes, too.

I can’t figure it out: the good medical providers are there solely to help.  They want us to be as healthy as possible, and they want to support us in our efforts to achieve the same. 

So what’s the deal?

The only reason I’ve been able to come up with this afternoon is that perhaps we feel like we don’t need to explain anything about the disease to these medical experts: we expect they know all of the intricacies and daily difficulties of living with the disease.  We expect they will be able to understand our difficulties better than a layperson.  Maybe they are the only ones we feel comfortable will listen.

Or maybe we do our best every day and it still doesn’t feel like we’re doing enough.  Maybe we assume our medical professionals think we should be doing more, or better, or smarter work with our disease.  Maybe we doubt ourselves because we know, if we just said “no” to that cookie or took our medication at a different time that day or if we had just managed our holiday stress a little better we would be healthier and we wouldn’t need to be sitting with a medical professional.

It sounds so illogical when it’s written, doesn’t it?

Yet it’s that dang double-edged sword again: telling someone they have the power to keep their diabetes under control often results in that person feeling like a failure when it doesn’t stay there.

I know my doctor kindly teased me I’m trying to be a perfectionist, and that is certainly true (although I told her I’m just MOTIVATED).   I’m sure I’m being less than logical when my anxiety creeps in and I think “I should be able to do my diabetes better.”  I do my best all the time!  And my body does amazing things in response, and I don’t have much to complain about when it comes to my diabetes.

But because living with diabetes is so constant there isn’t a good way to separate all emotion from management.  Minimizing the emotions by recognizing all blood glucose readings are simply “data” from which to make educated decisions and do not carry any judgment with them at all is a major step in the right direction—a direction we would all benefit from taking. 

We all need to remind ourselves that our best is enough, and the right medical professionals aren’t judging our efforts.  The good ones are in fact trying to provide additional tools we can use to make our lives easier and healthier.  Maybe they’ve got some tricks up their sleeves they want to share.

I fortunately think my doctor is doing exactly that, if I’d just stop with my own stuff and listen.

I bet that guy in the other room could say the same.  I hope, for his sake, that he can.

We Have To Be So Smart!

January 11th, 2011

Reading the introduction to Mindless Eating: Why We Eat More Than We Think by Brian Wansink, Ph.D.  I am amazed at all of us living with diabetes.  Seriously.  Wansink says the average person makes an about 200 food or food-related decisions every day.

Those of us living with diabetes are WAAAAY above average.  I am a bit frightened to think how many decisions about food those of us with any type of diabetes make in our average day. 

I for one think about what will taste good, what it might do to my blood sugar in the near and far term, what kind of caloric hit it will take, what I ate an hour ago, what I think I’ll eat later, what I ate yesterday, what exercise I plan on performing in the next few hours, whether  I know what all of the ingredients are in the food or whether there are hidden sugars, whether there is a lot of fat or fiber that may slow down my digestion… and that’s just what I’m thinking as I type right now! 

I do a lot of it so often I am not sure I am actually consciously aware of most of my (more than average) food decisions.

Beyond that, Wansink’s position is that manipulating these (average) decisions is done far before any decision is actually put in front of us: advertisers, packagers, marketers, even architects and interior designers all play a role in our food choices.

And he isn’t even factoring in a disease like type one or type two diabetes.

 Wansink discusses how whether we eat in bright sunlight or a dark movie theater, or whether we eat off a small green plate or a big red one, or whether the food is 90 degrees or 92 degrees when we put our plate down on the table all have subtle psychological influences on our food choices: how much we eat, how much we enjoy it, whether we regret eating it later and so forth.

Those of us counting every carbohydrate need to be aware of at least some of this because, simply, we are counting the grams of carbohydrate in the food we put in our mouths, not what we put on our plates.  (Or our bag or box or carton or what have you.)

Yes, those of us living with diabetes have to be pretty darn smart.  We have to be so smart that we can sometimes outsmart ourselves!  Managing our food choices requires being aware, as much as possible, of many of the psychological effects external factors have on what we do and what we eat.

Sounds difficult.

But we can do this.  We’re smart, you know. 

Pretty darn smart.

Learn from your Dog: Have FUN with Exercise!

January 10th, 2011

Have you ever had a dog?  I haven’t been so lucky to live with a dog but I know a few fairly well.  I know that they have learned to spell some of their favorite 4-letter words like “f-o-o-d” and “w-a-l-k”.  I know that they know the patterns of their humans better than their humans do.  I know that if you walk within 4 feet of their leash and have spelled “W” “A” “L” and “K” within the last 5 minutes they will be all over you. 

They wag their tails at the thought of going for a walk.

They get to be outside, they get to see other people and other dogs, they get to smell smells they don’t get to smell inside their home and yard, they get to bond with their human, they get to go as fast as their legs will carry them in pursuit of FUN.

Wow; kind of makes exercise sound like it has a lot of benefits!  A dog kept pent up without time for exercise becomes destructive and anxious.  I think the same could be said about adults and children.

With or without type one or type two diabetes, all kids need to be active as they grow just like adults need to stay active. 

An online article caught my eye today from Men’s Health: 20 Ways to Raise a Healthier Child. (Now, I’m not saying I read Men’s Health very often.  Sure, I’ve stolen a workout or two from the magazine, but it isn’t one of my go-to resources.  I promise.)

Did you know that kids with active dads are 3.5 times more likely to be active themselves?  And not only that, kids with active moms and active dads are 6 times more likely to be active themselves! 

So set an example for the kids in your life.  All the kids in your life, not only for your own children.  Make movement FUN, make activities SOCIAL, make them EVERYDAY OCCURRENCES and you will all benefit from being more fit both physically and mentally. 

Day 1: All you need is a ball and a little creativity. Throw a football, catch a baseball, kick a soccer ball, or whack a tennis ball against a wall. Use old tires for targets, as you might see in a football skills competition. Even a game of catch has social and physical effects.
The benefit: Develops agility and hand-eye coordination.

Day 2: Jump, lunge, and skip to various markers around the house. Or collect a group of objects, such as medicine balls, basketballs, and tennis balls, and toss them for height or distance.
The benefit: Builds strength and flexibility.

Day 3:
Run wild. Organize relay races with neighborhood kids and their parents; create obstacle courses using cones or trash cans. Tow your kids on wheeled toys or in sleds when it snows. Then try the wheelbarrow race with them or set up a course that alternates sprints and crawling around on all fours.
The benefit: Boosts speed; teaches kids to apply and resist force.

(Can you imagine how much MORE FUN these activities would be if you let your dog join in the fun??  Wow.)

Getting Into A Celebratory Mood

January 7th, 2011

I tried to make this week all about motivation but I changed my mind a bit this morning.  I was paging through a book I have about raising kids’ self esteem and thought about how motivational tips and tricks end up meaning nothing if you don’t celebrate your hard work and resulting accomplishments along the way.

I’m serious.  If it means dressing up and going to a fancy dinner, or getting a pedicure, or opening that bottle of wine you’ve been saving, even if it means raising your glass of ice water at lunch, recognize and celebrate as many accomplishments as possible.

What do you have to lose?

I can’t go so far as to say every kindergartener needs a 2-hour graduation ceremony at school, but I will say they most assuredly need one in their family room.  (Cap and gown optional, but seriously fun!)

Nowhere is this more important than when you live with someone with diabetes, or if you have diabetes yourself.  Diabetes, type one or type two, requires such constant and unflagging vigilance with so few measurable “rewards” we must create them for ourselves and our loved ones.

First time your child has given himself a shot?  First time your child checked her own blood glucose?  Three in-range numbers in a row?  Five whole days of workouts this week? CELEBRATE.

Clearly, the celebration here is not the motivation.  But let me assure you, when you watch a young one race around the dining hall at camp collecting high fives for that first shot in his abdomen or first time drawing up her own insulin, you see how much JOY and PRIDE they place in accomplishing these soon-to-be-daily routines.  They know diabetes is a big deal, no matter how you slice it.  Give them some credit for knowing the seriousness of their disease in everyday life, and celebrate to recognize their hard work.

Living with diabetes is difficult in its simultaneous unpredictability and pervasiveness in our lives.  That’s simply the nature of the disease and NO ONE IS TO BLAME for it.  We don’t get any satisfaction from finding someone to blame someone for it, but we get to deal with it on our shoulders all the time.  So take a break from the difficulties when you can recognize a milestone for yourself or for your child or for your friend and celebrate that accomplishment.

When we stop the flow of life to ring the bell and announce a special moment for all to savor, not only do we deepen our awareness and appreciation of life, but we publicly proclaim the place and accomplishments of those we are celebrating.  (Will Glennon, 200 Ways to Raise a Girl’s Self-Esteem)

We don’t have much of a choice when it comes to living with either type of diabetes.  (Do it or die doesn’t seem like a choice to me.)  But we can chose how we deal with making it through a rough spot or a change in management or a goal accomplished. 

I choose to celebrate as much as possible.  Celebrate!

Are You Watching the Biggest Loser?

January 6th, 2011

A lot of bootcampers have been buzzing this week about the Biggest Loser reunion show and new season.  I can’t say I’ve ever seen a full episode (I did just hear you gasp at me) but I appreciate that many regular folks find the participants inspiring.

Since the show has been on for a few years, most of you have probably realized that it isn’t easy to lose 18 pounds in your first week.  Nor, for the record, is it a good idea.  The recommendation of 1-2 pounds per week doesn’t sound good when you’re first out of the gate, but it can last for a good long while if you do it right!  It took years to get to your current weight and it will take a while to get where you want—there are no easy short cuts when it comes to your body!

Runner’s World did a spread in their February 2011 issue and consulted with Robert Huizenga, M.D., the designer of the show’s fitness regime.  He gave some recommendations for those of you unlucky souls who didn’t make it onto the Ranch… and who don’t have five hours a day to spend exercising!!!

  1. Work Out Twice A Day—an hour in the morning and an hour in the evening for a total exercise time of 10-12 hours every week.  Huizenga also advised to go to bed early so you can get up early, as sleep is essential to weight loss.  (Sounds like yesterday’s recommendation to recover just as hard as you work!)
  2. Walk, jog, or run for your morning workout.  Huizenga says “people naturally use a higher level of exertion—and as a result burn more calories—with jogging compared with exercising on equipment like a stationary bike or elliptical machine.”  (Think about having to support your entire body and move it simultaneously and you’ll see why.)
  3. Mix It Up Huizenga recommends you alternate circuit training with any aerobic exercise for your afternoon exercise.  Strength training with weights will build muscle mass and speed your metabolism all day long.  (Circuit training = an alternating mix of weights and cardio.)
  4. Work out at an intensity that feels difficult.  This one is tough for a lot of us: “you should find it hard to carry on a conversation for as much of the workout as you can” Huizenga says, and suggests you increase your intensity with each workout.  He also says that an obese adult would have to walk for more than 33 hours at a moderate intensity to lose one percent of their body weight in fat; jogging would result in the same fat loss in 11 hours.

So does this mean you should go out, join a gym, exhaust yourself and starve yourself to be happy?  I don’t think so, and I can’t imagine the folks at the Biggest Loser think so either.  Recognize that long term dramatic weight loss is best done slowly, and you must be committed for a long time to that goal.  You will have to weather some storms, some plateaus, some frustrations and celebrate every victory possible in order to remain focused on the goal of a healthy body.

The best thing is?  This isn’t for only the people lucky enough to win a place on the show.  YOU CAN DO IT TOO.  Sure, the scenery may not be as nice and you won’t have maid service for your stay at the Ranch, but every single thing they do there, you can do, too. 

This one isn’t an elite group: fitness is for everyone.

Everyone! 

(Don’t forget I’m here for you and I’m on your side: let me know if you’re looking for specific help from me as a trainer and Lifestyle and Weight Management Coach.  I’ve been there and I know how it feels.)

Resolutions Take Time

January 3rd, 2011

Yay!!  A New Year!!!  I’m sure at the end of 2010 each of us had mixed emotions reflecting on the year behind us.  Was your A1c where you wanted it?  Is your weight what you want?  Are you eating as well as you want to eat?  Are you exercising as often as your body wants you to exercise?

Maybe, maybe not.

Part of those mixed emotions is for me what makes a new year so exciting.  It’s just like back to school shopping: fresh new binders, books, pens and paper with only hope ahead, even though we suspect a year from now we may not be as excited or as hopeful.

But 2011 is filled almost entirely with hope in these early days.  Not many of us have gotten lab results back yet, our deductibles haven’t come due, and most of us have yet to even return to work or school.  A perfect time to make some resolutions.

Do you have resolutions for 2011 down on paper yet?  They don’t have to expire if you haven’t reached your 2010 resolutions yet, either—you can re-use your resolutions from last year as long as you remain focused.

I spent some time over my break from bootcamp to get certified as a Lifestyle and Weight Management Coach.  Yes, that was a 2008 resolution, but better late than never!  Sometimes life situations cause us to reorganize our priorities… but don’t ever lose your focus on goals that are important to you.

The marathon I ran in January last year was a resolution from 2003, believe it or not.  Yes, my stress fracture in 2004 meant I had to bide my time and strengthen my legs to prepare for both of the marathons I tackled in 2010.  But I never lost faith in myself or my ability to achieve that goal.

I can’t say I made a resolution to lose weight back in April of 2000.  I just knew that waiting another day was only going to delay my reaching my healthy goal.  It took me until October of 2002 to reach it, but man did it feel good when I got there.

Resolutions are wonderful things if they are done right.  I think a resolution involves a lot of hope, a lot of focus, some flexibility, and confidence in yourself and your abilities.  A proper resolution holds with it a fair amount of fear, too—enough to make sure that you really DO want to achieve that goal and that YOU are willing to put in some work to get there

My best resolutions haven’t been accomplished in a single year: they took daily effort and a lot of baby steps and considerable focus.  As you may have read on FaceBook a few months ago: “Discipline is remembering what you want.” -David Campbell

What do you care enough about that you are willing to go after in 2011?

Ever Thought Having Type 1 Meant You Were Limited?

December 17th, 2010

Some of these studies lead me to so many more questions than there are answers.

For example: who thought of the initial study in the first place?  What made the originator wonder about it?  Do they have diabetes themselves?  Who do they know, and what is that person doing, that made the question come to mind at all?

Alas, these questions remain unanswered for me on today’s study.

The title of this one is Aerobic Exercise Capacity and Pulmonary Function in Athletes With and Without Type 1 Diabetes so you can see why it caught my eye.

Of course, if I wanted to read more than the abstract I’d have to pay for it and I’m not one to do that… although maybe I’ll head to the health library and check it out someday because I’m curious.

The abstract describes the research design and methods and I’m already offended: they differentiate between those with type 1 diabetes and those without by describing them as “individuals with type one” and “healthy.” 

Ahem.   (Although maybe I should perhaps blame a translator for that one, though, because the study comes from Brazil so maybe they originally phrased it in a more palatable way.)

The researchers also broke the groups into athletes and non athletes; as expected, the athletes had a higher maximum volume of oxygen (V02 max) than the non athletes.  (An increased V02 max is one of many results of consistent aerobic training.)

The only real difference it seems they found between those with type one diabetes and those without was that the type one participants had a lower anaerobic threshold.  This anaerobic threshold is the point at which the body uses a different energy source (lactic acid rather than oxygen) to fuel muscles and interval training is the way to raise this thresholdOne of several reasons I am always in support of interval training! 

In all, the conclusion is what I consider a happy one: aerobic capacity in subjects with type 1 diabetes with programmed exercise is similar to the capacity of normal athletes despite lower anaerobic threshold.

Yet more proof that type one diabetes has no business getting in the way of your being a fit and healthy exerciser.

So what are you waiting for?

You Give Me 20, 30, or 40 Minutes… I’ll Give You A WORKOUT

December 16th, 2010

Okay.  So.  I’ve been whining about you getting outside for months now and I bet you don’t even hear me anymore. 

Which is okay.

But. 

I still want you to have awesome workouts, even if (especially if!) you are in the same gray gym on a gray snowy day in the middle of winter.

SO!  Let’s do it.  You give me 20, 30, or 40 minutes and I’ll give you a longer post-exercise burn and more sweat and if you aren’t careful, a low or two.  (So you need to pay attention and plan for these: try to have as little boluses on board as possible when you start or even try decreasing your insulin for an hour before you start the workout.  Your insulin is going to work like dynamite here so make sure you watch yourself and have glucose available nearby.) 

The following routines are GUIDELINES not rules… do what works for you!!

High-intensity exercise burns more calorie than long steady-state sessions, yes, but not so many more that you “deserve” the extra cookie or ice cream.  You’re going to get out of it what you put into it and you are what you eat and do unto others what you would have them do unto you and an apple a day keeps the doctor away… (oops; I got on a roll there for a minute!)

You’ve got 30 minutes to spend on the treadmill?

Minutes (counting up) Minutes (counting down) Speed Incline RPE (rate of perceived exertion on a scale of 1-10)
0-3 30-27 3.5 3 4
3-5 27-25 4.0 3 4-5
5-7 25-23 5.0 3 5-6
7-9 23-21 4.0 4.5 4-5
9-11 21-19 5.5 4.5 6
11-13 19-17 4.5 4.5 5
13-15 17-15 6.0 6 6-7
15-17 15-13 5.0 6 6
17-20 13-10 4.0 6 5
20-22 10-8 5.5 4.5 6
22-23 8-7 7.0 4.5 7-8
23-24 7-6 6.0 4.5 6
24-25 6-5 5.0 3 5-6
25-27 5-3 4.0 3 4-5
27-30 3-0 3.5 0 3

 

You’ve got 25 minutes to spend on the bike?

Warm up fully for five minutes.  Then start the following:

10 seconds of DIFFICULT intensity

60 seconds of RECOVERY

15 seconds of DIFFICULT intensity

60 seconds of RECOVERY

20 seconds of DIFFICULT intensity

60 seconds of RECOVERY

20 seconds of DIFFICULT intensity

2 full minutes of recovery, then

10 seconds of DIFFICULT intensity

60 seconds of RECOVERY

15 seconds of DIFFICULT intensity

60 seconds of RECOVERY

20 seconds of DIFFICULT intensity

60 seconds of RECOVERY

20 seconds of DIFFICULT intensity

And a 5-10 minute warm down on the bike. 

You’ve got 40 minutes to spend on the elliptical?

Minutes (counting up) Minutes (counting down) Resistance/Level RPE (rate of perceived exertion on a scale of 1-10)
0-5 40-35 2-3 4
5-6 35-34 4-5 5
6-7 34-33 8-10 7-8
7-9 33-31 4-5 5
9-11 31-29 8-10 7-8
11-12 29-28 4-5 5
12-13 28-27 9-11 8
13-15 27-25 4-5 5
15-17 25-23 8-10 7-8
17-18 23-22 4-5 5
18-19 22-21 9-11 8-9
19-21 21-19 4-5 5
21-23 19-17 8-10 8
23-26 17-14 5 6
26-27 14-13 4-5 5
27-29 13-11 8-10 8
29-31 11-9 4 5
31-35 9-5 5 6
35-40 5-0 2-3 4

Let me know what you tried, how you did, and how your blood sugars ran with these interval workouts.  Way to rock your winter workout!

Whatever You Call It (Sugar/Carbohydrates/Glucose/ATP/Energy) We Need It!

December 14th, 2010

For someone with either type one or type two diabetes, how messed up is our digestion process?  At the basic levels, we share a missing proper function.

When we eat food, the body extracts carbohydrates from the food we ingest and break the carbohydrates down into glucose.  From the walls of our small intestines, the glucose goes one of three places.

  1. Into our bloodstream.  In our bloodstream, the glucose is immediately available to be converted into adenosine triphosphate (ATP).  ATP is what the body really uses as its actual source of energy.
  2. Into our skeletal muscle system.  In this form, glucose is converted into glycogen.  Glycogen is a long string of simple sugars stored as a complex sugar in our muscles.  As glycogen, the sugar can’t be released into our bloodstream but the glycogen can be used by our muscles to produce ATP. (various methods of endurance training teach our bodies how to perform this process more efficiently)
  3. Into our liver.  The liver stores glucose as glycogen.  When functioning properly, the pancreas produces one of two hormones that work in tandem with the liver to regulate blood sugar levels.  When the pancreas senses blood sugar is too low, it produces glucagen to stimulate the release of stored glycogen from the liver in the form of glucose into the bloodstream.  When a normal pancreas senses blood sugar is too high, it produces insulin to stimulate the liver to release less glucose.

Clearly, it is that third process that doesn’t work so well for those of us living with diabetes.  You can see our bodies are a maze of thousands of signals and communications and sensors and responses… it’s amazing that we even know this much!  Not to mention how losing a critical hormone production in our bodies and still being able to survive is simply amazing.

Lucky us.

Is It Really Such A Small Thing After All?

December 13th, 2010

I was checking out of the grocery store yesterday and the checker leaned over the counter to me, looked to my side, and returned to a normal stand.  He said “that a pump?”

Geez.  It makes me so happy when other people know what it is!  I felt like a cornball for the grin I showed him.

Then again, HE reached out to ME so maybe he feels the same way I do.

He has type one diabetes just like me.  He showed me his tattoo of an insulin syringe on his forearm.  He said he’d tried a pump but didn’t like feeling attached.  I told him I eat too often to always give myself a shot.  He said he takes about 8 shots a day to accomplish the same thing.

That was about it, but he’s my current favorite employee at that grocery store.

It is such a small thing– meeting another type one and sharing less than 30 seconds together.

But it doesn’t feel small; I assure you.

I feel in a way I’m preaching to the choir now but it seems that I feel I can only truly relate to someone else who lives with type one just like me.  Someone who has been 400+ after being 35 an hour before.  Someone who knows how many ways a low can feel and how frustrating every high can feel.  How the volume of our internal monologues may increase or decrease, but will never be silent.  How we’ve learned through the years to do our best to take it all in stride and keep moving through life.

I don’t mean to minimize the importance of support from friends and family: that is huge.  But this one is a different and very touching feeling for me.  This one is one that doesn’t require anyone to say “I know how you feel”.  I know it just meeting him.  It’s a kind of quieting inside and rather difficult to explain.

But I felt in those 30 seconds I had made a friend.  A friend who could be closer to me than most, in fact, despite the many different experiences leading to our meeting at the grocery store. 

It’s a very cool thing to meet another type one. 

Very cool.

AND, you know what else is super cool??  Watching a fellow type one race around the world and WIN.  Congratulations to Nat and Kat!!