Archive for the ‘Living with Type 1 Diabetes’ category

Exercise Is Medicine—I love it!!

August 12th, 2010

I’ve been writing for a while about how much I use exercise as a tool to help me stay healthy with type one diabetes.  The American College of Sports Medicine (ACSM) has launched a campaigned called “Exercise is Medicine” with various tools to help those with all sorts of health issues think about how to exercise to improve their health.

 I of course zoomed over to the Type 2 Diabetes page to see what ACSM has to say.  Yup; pretty simple from my perspective.  The page just outlines what many of us already know about our diabetes and physical activity, in terms of increased insulin sensitivity and a resulting increased need for carbohydrates.  We are lucky in that we don’t have any physical limitations our disease created and (absent any complications) our mobility is not compromised.  We can do what anyone else can do.  We just need to think about it a little bit more.

Speaking of thinking about exercise in our lives, I invite everyone to check out another tool at the ACSM’s Exercise is Medicine page.  It’s a way to think about exercise in our lives.  I know I posted yesterday about my questions why someone might not exercise and I think the grid on the ACSM’s Decisional Balance page is a fairly good reflection of reality.  (Including my questions why someone would chose the “inactive” side of things.)

So spend a little time at the Exercise is Medicine website and see if there are any tools you can use to re-think exercise in your life.  Keep thinking, start doing, and let me know if you need some help. 

You’ll thank yourself.

Tools of the Trade: My CGM

August 10th, 2010

So I was driving home last night and realized for like the fourth or fifth time in the past few days I was really happy to not be wearing my CGM.* 

I know a lot of people aren’t big fans of the CGM for various reasons, and I’ve heard from my doctor that not many people wear it for more than 2-3 years.  I still find mine useful, and I think I’m coming up on two and a half years.

This is the kind of thing I wonder about when I drive.

Why, when I think it’s useful and relatively helpful, does it make me so happy to NOT wear it?

First of all, let me assure you that this CGM has significant issues.  The delay factor and margin of error is just ridiculous—not to mention the sensors being rather let’s say fickle.  The CGM doesn’t work for me when I run, which is unfortunate, and that thing has caused me to lose more sleep than anything ever in my life.  (I’m a rock-hard sleeper so if something wakes me up, it’s news in my world and this thing gets to vibrating my pump under the covers and I nearly jump out of my skin every time.  My cats chewed my pump cord once when they were kittens so now my pump sleeps under the covers every night.)

In addition to the untrustworthy readings I get from the CGM, it also is actually painful for me.  I wear it most often on my hip and butt, so any time I sit down I run the risk of knocking it or hitting it or just moving in a way the little stick of metal doesn’t enjoy and it simply hurts.  I ran with it in my arm a few weeks ago and I guess my arm was sweaty so the thing fell out as I ran—that hurt.

All of this said, I still wear the thing.  Why?  Because it reminds me to check my blood sugar more often, and it yells at me when I’m high.  I think both of these things are good ideas for me.  So I put up with the CGM, and I defend it to my type one friends and doctors who look at me like I’m crazy because I still wear it.

But I do love taking a break from the CGM.

And I decided last night I know why.

It’s because I CAN take a break from wearing it.  It’s the only diabetes tool I have in my arsenal that I don’t NEED.  I could throw it off a bridge some day and never get sick as a result.  I probably wouldn’t even know it was gone for a number of days.

I can’t really do that with my pump;  if I go off my pump my life changes because I’m looking at the clock, taking shots and counting and doing math and figuring more than I do now.  If I stop my CGM my life doesn’t change at all.  It’s just gone.

I can’t take a break from my blood sugar meter, either.  Yes, I go to the grocery store sometimes without my meter and don’t miss it.  But have you ever run out of strips when you got to work and realized you can’t check again until you’re back at home?  Weird feeling, to say the least.

And I can’t take a break from being high, or being low.  I can’t take a break from much of my disease.

But being without my CGM?  Kind of feels like a vacation in some ways.  And that makes me happy.

*CGM= continuous glucose monitor

Exercise and Hunger

August 9th, 2010

Do you feel more hungry after you exercise, or less hungry?  Is that hunger real, or is it just you telling yourself “it’s okay to eat” because you just worked out? 

I am probably not the best person to discuss hunger.  I don’t have the best sense of real hunger after so many years of eating when I’m not hungry because I’m low, not eating when I think I’m hungry because I was trying to lose weight, stopping when I’m full versus stopping when I’ve eaten enough carbohydrates to cover the insulin I took 15 minutes ago—always trying to eat enough but not too much gets fairly difficult while trying to simultaneously manage the nutrients my body needs to perform and all of the social aspects of eating.

It gets difficult. 

Which is why I find it so curious that after a long run, I’m rarely hungry.  (Long run = 90+ minutes)  I would have thought that I’d come home and be starving!  But that just doesn’t happen.  I don’t get “hungry” for a couple of hours after a long run. 

I also know that the old trick of taking a walk around the block when you think you’re hungry can really work when you’re faced with a clock that is slowly turning from 3:30 to 4:00 and dinner isn’t until 6:30 or 7:00… a lot of damage can be done in that hour if you haven’t had a good breakfast and lunch!

So I thought this study evaluating the hunger levels of 11 male university students over three 8-hour sessions was worth a blog post.

The participants ran for 60 minutes on the treadmill for one session, did 90 minutes of resistance training for another session, and did no exercise for the third session.  The researchers studied two key appetite hormones in the subjects’ bodies: ghrelin and peptide YY.  (No worries: no quiz at the end of this!)  Ghrelin is the only hormone known to stimulate appetite, while peptide YY suppresses appetite.  The study participants also answered questions about their hunger after each session.

The researchers found that during the treadmill session, when the participants were performing aerobic exercise, ghrelin levels dropped and peptide YY levels increased—the hormones were suppressing appetite.  In the resistance session, the ghrelin levels dropped but the peptide YY levels didn’t change. 

According to the participants, though, both aerobic and resistance exercise suppressed hunger, but the aerobic exercise did so to a greater degree. 

This would explain my long run phenomenon.

So next time you’re feeling ravenous and can’t quite figure out why, maybe it’s just that your ghrelin is out of whack. 

No Wonder We All Love Saturdays!

August 6th, 2010

This one just strikes my funny bone for some reason.   I love that somebody was able to convince someone this needed scientific study!  And these results are a crack-up!

It turns out; we eat more on Saturdays than the rest of the days of the week.

Researchers published the 2008 study in Obesity research journal and describe that they followed 48 non-obese adults between ages 50 and 60 for one year.  Some were assigned to change nothing, some assigned to reduce calorie intake by 20%, and the remainder were assigned to increase activity by 20%. 

At the end of the year, the researchers found consistent results across the board: weight loss slowed dramatically over weekends throughout the year—not just during the holidays—and Saturdays were the day for mass calorie consumption.  The calorie reduction folks stopped losing weight but the exercisers gained weight on weekends!

So this means we can now relax, as it isn’t “just me” here.  We all love to eat more on Saturdays!

I assume we eat more on Saturdays because we have a change in our routines on the weekends and because I think we tend also to be more social.  More social activity and less structure usually means more wacky blood sugars for me and more food eaten on the run.  Both are in line with what these researchers found.

But I do want to point out a couple things with these results:

(1) they still lost weight and

(2) even when you are active you still need to watch what you eat.

When I did Weight Watchers I used the point system new at the time and was able to put extra points in the bank for the week.  I always used my points for nachos.  I’d dream about those nachos all week long!  They were so tasty.

After reading about this study, I betcha I ate them on Saturdays.

My August Adventure: August 4, 2010

August 5th, 2010

I wanted to spend some QT in the outdoors yesterday, after work.  I wanted to have more than six minutes of nice outdoor time.  And, I wanted to get a run in too.

Usually when I run I am so busy huffing and puffing that I don’t always look around and enjoy my surroundings.   (This is designed to keep me fall-free and twisted-ankle-free as well.)  I don’t think that is a bad thing, but I got myself thinking with the August Adventure post the other day and I thought about running in nice places that would make me happy and relaxed.

I was hoping to get in 7 or 8 miles, but I also wanted to run them on the slow side and keep my heart rate nice and low while I ran.  It’s a good idea for me to run some nice ones every now and then, just as it is a good idea to run some hard ones too.

Of course, as I was changing out of work clothes and into running clothes I checked and was 138.  Not terrible, but there was some active insulin left too so I ate some food and hoped for the best.

I left from work, and ran over onto Stanford campus.  Usually I run a 4 mile loop, but last night I wanted more.  I thought of running the loop twice, but it isn’t really a pretty loop and that wouldn’t really get me the “nice outdoor time” I was going for. 

So I started and didn’t think too much about the route.  I went where I wanted, when I got there

It was so fun! 

I did stop at mile four because that fourth mile felt just as hard as the first three, but was nearly a minute slower.  Problem.  When that happens, I know I need to stop and check.  Not part of my plan, but my workout last night wasn’t about a plan. 

And of course, 63.  Bummer.  I stood right there on the corner and had a gu.  I stood there for 7 minutes and checked again; 103.  Yay!  I guess the sport beans I ate at mile 3.5 had started working, and I knew the gu wasn’t far behind.  But I also used the low as a reminder to keep my effort level in check and just relax as I ran; speed wasn’t the point last night.

The second half of my run was simply lovely.  In fact, I named the run a Lovely Stanford Random Run.  I ran through neighborhoods I’ve not run through and in fact discovered a street ran all the way through that I would never have guessed from the other side.  I ran past some really cute houses with beautiful flowers and ran past some gorgeous estates whose photographs belong in magazines.

And I ended with a blood sugar of 84.  Tired, and energized at the same time.  What more could I ask of the great outdoors?

I Admit It

August 4th, 2010

I admit it—I don’t understand what point all the anger is supposed to serve for people living and dealing with diabetes.

I’m not at all saying that I don’t get or have never been angry about having diabetes—that would be a lie—I just don’t spend much time in that mental space quite simply because being there exhausts me and it rarely gives me anything in return.

Sadness, sure.  Frustration, sure.  Confusion, sure.  But anger, just not that much. 

I read an old blog post from Parenting Diabetic Kids this morning where they listed the Top Ten Things the parents hate to hear.  Mainly it was what you might expect from a loved one forced to give a little one a shot or finger stick, and who is concerned with lows and highs. 

It was the unadulterated anger when faced with comments from others about sugar, what the kids can eat, how they got the disease, unknowing comments and related assumptions there is only one type of diabetes that concern me.  One of the comments in response to someone learning a child has diabetes that topped the list was “at least it’s not cancer.”  The response from many parents to this comment alone was less than gracious.

It was rather startling and I wonder how they make it through the day with all that anger inside and leaking out when they have to also deal with diabetes.

I’m not saying I don’t understand these frustrations.  What I don’t understand is the repeated messages I see online and have seen over the years in “support groups” for people with diabetes.  I don’t understand how so many can “live” so long in such an angry space.

And of course it isn’t just the parents or caregivers I’m talking about.  I meet many people with diabetes who were diagnosed forty years ago and still live with pure anger about it every day.

I think diabetes is a really hard thing to live with.  I think type one diabetes is crazy hard to balance, and I can’t imagine how it is to deal with the rather limited tools and restrictions imposed on people with type two.  I understand that these difficulties can be opportunities to spur more research and education about ways to remove the harmful eventualities of the disease progression and new methods and new medications.  I’m all for that.

Maybe I just get confused because I wonder what guarantees anyone thought were waiting for them in life?  I look around and see so many terrible things happening in the world and I look down at my digital pump and its sterile infusion set and my fancy insulin and get my blood sugar result in 5 seconds and I just wonder: what does all the anger do for anyone?

I do want to applaud one comment I read from someone who has two family members with type one.  I think she gets what it is like, even if her own pancreas works, to live with the constant checks.

My husband and daughter are both diabetic and we always get these comments. But I have to say I agree with the “at least it’s not cancer”. There were kids in hospital when [my daughter] was diagnosed at age 2 last year, who were dying – of cancer or other diseases. Those parents were losing their kids. My husband’s colleague had a 2-year-old boy diagnosed with MD a few years ago. That family watched their child die and there was NOTHING they could do about it. At least [my daughter] has a pump and a blood meter! I’m not going to lose my kid. OK she’ll face physical problems and many emotional issues but with the help and support of her family and friends she can get through them and lead a normal life. My friend’s little girl is highly allergic to a number of foods and can actually eat less at parties than [my daughter] can. If she eats the wrong thing she might die immediately. I think I’d be far more scared about that! We’ve all got challenges to deal with in life, and our job is to get on with them and help our kids lead as normal a life as possible. And who knows, dealing with diabetes might just make them stronger, healthier adults. I have certainly learned a lot and grown up a lot in the last 15 months since [my daughter’s] diagnosis, even though my husband has been Type 1 for nearly 10 years now. He has learned a lot too. Hang in there, keep smiling and keep raising awareness!

Fitness Product Infomercials: Who is Buying What They’re Selling

July 26th, 2010

I was thinking this weekend about all the fitness-related infomercials that I’ve seen over the years.  So many of them, while entertaining, set a poor example for most of us by portraying unrealistic results and setting unrealistic expectations

It’s kind of sad, I think, and yet completely understandable.  We are all looking for the best, fastest result possible with the least amount of effort.  Money rarely factors into the equation when someone is telling us that abdominal six-pack only requires three—now for a limited time, only two!—easy payments of $19.95 plus shipping and handling.

So, this week I want to talk about some things I’ve learned about fitness that have stood the test of time and I rarely see mentioned in fitness product infomercials.  (Have you ever read the fine print on the before/after photos?  Try it sometime and you’ll see what I mean.) 

Far from only selling you a one-sided rosy picture, I want you to recognize what I think fitness really involves.  I know you’re smart enough to recognize that with diabetes in your life, you need to take care of your body and I know you know that exercise is one of the best ways to do so.  Even if you don’t have diabetes, exercise helps you live your life to your fullest potential.  It’s good for me to know that I’m not hiding the ball from you, and it’s good for you to know these things without having to squint at the fine print. 

Let’s get started.  Here are both sides of what I consider to be the top four Fitness Truths, in random order:

____ 

(Sad) Fitness Truth #1: Getting Fit- Truly Fit- Can Take A While

(Happy) Fitness Truth #1: Getting Fit Shows Continual Objective and Subjective Improvements

 ____

(Sad) Fitness Truth #2: Calories Burned While Exercising May Not Be As Many As It Appears

(Happy) Fitness Truth #2: You Continue to Burn Calories With an Elevated Metabolism Even After You Stop Exercising

 ____

(Sad) Fitness Truth #3: Reaching Any Goal Takes Good Old-Fashioned Work

(Happy) Fitness Truth #3: Fitness Goals Are Obtainable

____

(Sad) Fitness Truth #4: 30 Minutes a Day Doing the Same Old Thing Isn’t Going to Do It For You

(Happy) Fitness Truth #4: Mixing Up Your Routine Keeps You Interested, Involved, and Improving

____

I’ll talk more about each of these this week.  Hopefully you’ll start to broaden your horizons or learn something or change your thinking or, at the very least, crack a smile once or twice as you read.

Bring it on.

My Tuesday Workout

July 22nd, 2010

On Tuesdays, I like to run a medium-long run because I have the time that day to make it work.  For the past year and a half or so, I’ve tried to make Tuesdays my Treadmill Day and head to the community center down the street from my house for some interval and sprint work on the treadmill.

Because I’m gearing up to run the Silicon Valley Marathon in October with Run the Coast, I have been gradually increasing the length of my runs.  On Tuesday, that meant I wanted to get in eight or nine miles.

However.

If I tried to run the type of intervals I enjoy for that long, I would be exhausted and unable to continue at the speed I want.  If I skipped the intervals and just ran on the ‘mill, I would be so bored I’d slow down.

So on Tuesday, I decided I would run 5 miles outside first, then go to the community center and spend the next four miles doing intervals. 

Whatta plan!

Except for that 65 meter reading at mile 3.5 of my outside run.  Hmm.

With that reading, I had some decisions to make.  I could have just stopped my workout and walked home (I basically did a strange loop that kept me somehow within about a mile and a half of my house at all times), or I could keep going and skip the treadmill workout, or I could cut the outside run short and figure out how to do the treadmill workout, or I could do what I did: I walked the remainder of the outside run and also ran on the treadmill. 

Of course, there were some other things in there, too. 

I ate two “servings” of carbohydrate for the low at 65.  If I were going to walk home, I would probably have only had one.  But of course I was at the base of a big hill when I checked, and I wanted to keep going on my planned route.  I know that if I keep walking at a moderate effort when I’m in the middle of a run and low like this, I will continue to go low.  So I had two servings.  (I think I had about six with me, left over from my recent 13 mile run on the weekend.)

And then I checked again after the crest of the hill.  Oh yeah.  48.

So you and I know by now that a 48 isn’t going to get me running sprint intervals on a treadmill.   Which is perfectly fine, except that I just haven’t gotten to enjoy a Treadmill Tuesday in a few weeks and I plain and simple wanted to do it.  Harrumph

And this is when genius struck.  (I love when genius strikes me at 48.)  I recognized that I have been carrying this $5 bill with me on every long run I have done for the past two years.  I decided today was the day to spend it.  So I walked to the grocery store that was in between where I was and the treadmill.  And I bought a Gatorade. 

Now, I had Gatorade in my fridge at home, but home was 4 blocks past the treadmill.  I knew I wasn’t ever going to get over to that treadmill if I set foot inside my house, though, and since I had that $5 bill, I essentially gave myself permission to call my situation an emergency.

Right; a running emergency.  I had to buy that drink in order to keep running the way I wanted to run. 

By the time I got to the community center, I was 94.  Woot!  I hopped on, ran my sprints for another 35 minutes, and walked home.  When I got off the ‘mill, I was 136. 

I also bolused as soon as I got home.  I had been on a drastically reduced basal rate for an hour and a half and knew that all of the carbs I had consumed to get me through the workout would need some help after I stopped since there was pretty much no insulin remaining in my body. 

I think the highest I got was 226.  Not bad, considering all the jockeying I had done with basals, boluses, fast carbs, slow carbs, liquid carbs, intervals, and steady-state running. 

And best of all, I declared a Running Emergency and spent that $5 bill, and it all worked out pretty well.  Yay!

Now I’ve got to go find another $5 bill…

Fitting Fitness In

July 19th, 2010

Cardiovascular fitness is a big thing for me: I like knowing I can run if I need to, and I like knowing I can keep running longer than most.  I find my long runs perfect opportunities to work out whatever obstacles have arisen in my personal and professional life since my last run.  I enjoy the sense of accomplishment I feel after running X number of miles (when X > 10) and I think it’s fun to tell people at lunch how many miles I ran before they woke up that morning.  I generally think any run less than an hour shouldn’t really qualify as a workout.

Yet I know I’m in the minority.   (It has also taken me nearly a decade of running to reach that point, for the record.  I’ve worked to get there because it was something I wanted to do.)

I’m not saying I’m right and I’m not saying I work harder or less hard than anyone during a workout.  I’m saying that for me, running gives me a lot. 

And it also takes a lot.  A lot of time.

Good thing that several shorter bursts of cardio throughout the day can have multiple benefits for your overall cardiovascular health!

Give yourself 10 minutes before you take a shower in the morning, 10 minutes at lunch and 10 minutes before you read your mail at home, and you’ve squeezed in 30 minutes of cardiovascular activity that day.  You’ll get your metabolism kick started several times throughout your day, you’ll have the energy to make it all the way through your shorter session without too much fatigue, and you won’t have as many mental demons to battle for a shorter workout.

You know you can fit in those 10 minute segments.  Honestly; you know you can

I’m not saying that if you’ve signed up for a 5k all you need to do to prepare yourself for the run is to jog for 10 minutes three times a day.  I’m saying that if your goal is increased cardio health, try taking smaller bites out of the apple and choke down that exercise in a manageable way for yourself. 

My experiences with exercise and my insulin needs deal almost exclusively in exercise sessions longer than 30 minutes.  I know that for me, I need to be exercising at least 15-20 minutes before I sense any drop in my blood sugar (absent any other strange happenings in my day).

When I first started to exercise, I couldn’t jog a block.  If I did, I’d be low within 15 minutes.  So watch yourself and your effort levels and how they affect your blood sugar levels if you are just starting out.  You can easily benefit by having several shorter bursts of exercise spread throughout your day—if you do it regularly enough you may need to lower your overall basal rates due to your increased metabolism.    

Pretty cool.

What a Huge and Beautiful Opportunity

July 16th, 2010

Get Up, Get Out!  and No Child Left Inside!  Are two slogans of the Karno Kids Foundation, organized by ultra endurance athlete Dean Karnazes. 

Dean blogged today about the fact that kids are not participating in being outdoors in nature and being as active as any of us would like for them.  I think we all have fond memories of the summers we spent on our bikes or skates or flip flops to and from the community pool.  We want that for today’s kids, too.

Yet how do parents of diabetic kids feel comfortable taking their kids out and having them run and play and fall and scrape and get all mucky and then check their blood glucose with dirty fingers? 

(alright, that one was an easy one: alcohol swabs and more snacks and less insulin)

I think with diabetic kids it’s easy for a parent to see them as “broken” because they do have a malfunctioning pancreas.  Yet it is essential for them to get out and behave just like any other kid and get their elbows scraped, knees skinned, and every now and then an arm broken, just like their friends.

Our lives are more complicated by diabetes, absolutely.  Yet we still need fresh air and sun-streaked hair and dirty knees, too.

The blog comments are fascinating at Dean’s blog today; if you are a parent and/or someone interested in helping get kids out and active, I suggest you check it out here!  I’ll stop writing so you still have time to go over there and read.  

But, in case you don’t have that kind of time, here’s one of my favorite comments posted by Jason Hayden:

It’s up to us as parents to set an example for our kids. We should be our kids best role models and expose the to all of the amazing activities out there. Bring field guides when you hike so that you can look up everything the kids find, teach kids how to fix their bikes, get out of your own comfort zone and try new things so that the kids see it’s ok to be uncomfortable when trying something new.


It shouldn’t matter what the weather is the kids can still get outside…20 below or 100…appropriate gear, appropriate hydration and food, appropriate duration for the conditions…everyone can still have fun if you plan these things out right.

Get outside, get in the dirt, have fun!