Archive for the ‘Living with Type 1 Diabetes’ category

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AAWPP

July 6th, 2011

No; that title isn’t the cry of an angry bird.  (That’s “ca-caw!” or “squawk!”)  It’s the official acronym from the United States Coast Guard and the Department of Homeland Security for the Assumed Average Weight Per Person.

Why would they have such a thing?  Well, just like elevators, I guess, ships and boats need maximum loads posted and obeyed so people have a better shot of staying afloat (or suspended, in the case of elevators).

Why would I know that such a thing as an AAWPP exists?  Because it matters in a professional sense for a fitness professional to know that the AAWPP is changing December first.

It’s changing from 160 pounds to 185 pounds.

It feels somehow more official when the Coast Guard says it, doesn’t it?  We are, on average, gaining weight and staying heavier than our bodies were designed to weigh. I don’t like this trend.

I automatically translate this from boats to elevators simply because I have been on far more elevators (and stared at the maximum capacity signs) than I have boats. This means that when 10 people used to fit on a boat together, now the Coast Guard says only 8 people can fit safely.

That’s a LOT of difference when it’s ten people; imagine how many fit on a cruise ship!  This is going to make our vacations MORE EXPENSIVE!!  It isn’t just the Coast Guard, either.  The airlines are doing it too, I’ve heard.  (That one is much harder to find through the FAA.)

Being shorter than average, I am curious how tall the Assumed Average Height Per Person is, if it exists. But being shorter than average, it feels strange that I’ve been both AAWPPs in my past.  Eek.

I myself need to weigh less than the AAWPP.  What about you?

I know how it is a lot of the time: we feel like we have to pay SO MUCH ATTENTION to our blood sugars, and now you’re supposed to manage your WEIGHT, too?  AND exercise??!

Well, yes.

It’s the hand we’ve been dealt.  So we can either be sad and fold early, or we can play the best game possible with that hand.  You just never know what’s going to happen.

Our job is to do our best to stay afloat.

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

My Latest (and Perhaps Greatest) Rant

July 1st, 2011

If you’ve read my blog for any length of time, you probably know I don’t hold back when it comes to sharing my opinion on nearly anything.

(We all have them, what’s the big deal with sharing them? If you wanted all Technicolor rainbows and butterflies you’d probably be picnicking in a meadow anyway, instead of reading this.)

But here’s the thing.

I think it should be considered medical malpractice for a general or internal medicine doctor to diagnose and/or medicate someone with diabetes.

It simply happens too often. I’ve heard too many stories (that I consider horror stories) of a GP or IM diagnosing a patient with type 2 diabetes and prescribing whatever popular drug and both doctor and patient carrying on without further changes or appointments.

ARE. YOU. KIDDING. ME.???

Diabetes requires accurate diagnosis. It requires a knowledgeable prescriber and correct dosage and medication.

Heck, for a lot of people, it requires a hospital stay.

And everyone needs fantastic education, guidance, and support.

So what are they teaching these doctors in medical school and reinforcing in the medical community?? That diabetes is a “try this drug and come back in three months” kind of disease?!

The whole thing simply frightens me.

It frightens me because I hear about people who were incorrectly diagnosed as type 2 who, upon seeing an endocrinologist after months or years with deteriorating health, are correctly diagnosed with LADA, MODY, or in some cases, type 1 diabetes.

If you live with diabetes of any kind, you know what it takes to manage the disease. You know how intricate the work can be, and how helpful (and not as helpful) doctors can be when it comes to the ways in which you need their help.

So when I see these stories it amazes me that there are so many general practitioners who think they can diagnose and treat a patient’s diabetes without help from an endocrinologist.

It concerns me what they do with other diagnoses. I can’t see them thinking they can diagnose and treat cancer—or at least I HOPE they don’t.

Let me assure anyone who has been treated exclusively by their general doctor for diabetes: you need an expert’s help with this disease. You can’t get it online; you can’t find what you need in the Diabetes Online Community. You can’t find it on WebMD or from a friend.

You need to do this TODAY. Start by making a phone call. This is your health and no one cares about it in the same way as you care.

But you need to take charge. You need to make sure you understand enough about the disease to evaluate whether your diagnosis feels correct. If it doesn’t, make another phone call, get another lab test, see another expert.

YOU AND YOUR HEALTH ARE WORTH IT.

No matter what your general doctor might say.

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

Is Diabetes Getting the Best of You?

June 30th, 2011

Watching some of the “You Can Do This” videos this morning, someone said “diabetes isn’t going to get the best of me.”

And, although I understood what they meant, when I heard him say that I thought: MINE WILL.

I deserve my diabetes receiving the best of me as often as I can.

My best effort.

My best enthusiasm.

My best intelligence.

My best patience.

My best forgiveness.

My best discipline.

My best physical body.

The best technological tools.

The best medical professionals.

The best insulin for my body.

The best understanding and supportive friends.

My diabetes deserves MY BEST EFFORT.  It deserves that because I deserve that.

Doesn’t yours?

If you are concerned that you aren’t giving your diabetes the best you deserve, reach out and ask for help.  I’m here; and you are not alone with this.

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

Keep Your Body Guessing (And It Will Keep You Guessing!)

June 29th, 2011

One could say that we are all, at our core, lazy creatures.  One could also say that we are simply incredibly efficient creatures.

Same difference, I guess.

Our bodies are so much smarter than we give them credit for being.  As we push the constraints of our current fitness level, our body adapts and learns to live at that fitness level, until we push beyond that one.

It is gloriously without end.

As I run more, the act of running does not cause such a crisis in my body.  I have to run farther or faster or on challenging terrain in order to create that same “crisis” response.

One of my favorite experts, Jason Karp, PhD, describes it as threatening your body with what it considers near-death experiences.

If you aren’t saying “woah” or “wow” at any point in any of your workouts, you aren’t at that crisis point.  Your body is yawning while you are telling yourself you’re working “hard enough”.

It’s the same with lifting weights: you need to challenge yourself and your body.  If you don’t challenge yourself, you aren’t going to change your body.  You won’t increase your fitness level without change.

I know there was a time in my life that if I had to run a block, I would go low.  My body was being threatened by that run and it recruited everything it needed to accomplish my goal… including glucose.  Now, it takes a lot more than running a block in order to create that same crisis.  My body learned how to run… and it learned how to run efficiently.  I can run several miles now before a low becomes likely.

But, of course (and this is one of the great parts), if my body is busy learning how to do one thing very efficiently, if I do something else that my body isn’t used to, I’m back to creating a new threat.  If I rowed 100 meters this afternoon, I think I’d need to watch my glucose levels very closely!

As another example, I changed from an endurance weight training “maintenance” kind of routine for myself and began a heavier weight training routine this week.  I’ve been doing about a half hour each night before dinner of various dumbbell and barbell exercises.

And for the last three nights, I’ve been low at 3am. 

Changing things up with the number of repetitions, the speed of the move, the weight lifted, distance travelled, or any number of typical ways to increase intensity of an exercise will affect your blood glucose levels.  It will happen every time your body perceives a threat to its survival.

It’s pretty incredible, when you think about it.  Be it efficient or be it laziness, it’s an amazingly intelligent system—even if its pancreas has some issues.

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

Educate Educate Educate

June 28th, 2011

There is a lot of education required to live well with any diabetes diagnosis, from pre-diabetes to type one diabetes. 

I tried to explain what life is like to a group of nursing students yesterday in an hour and a half.  You can imagine how little I was able to explain! 

Beyond our own diabetes, we need to educate others about our disease.  I think it helps cut down on misunderstandings, eradicate myths, and hopefully increase support.

Yet, in a quick conversation about diabetes I rarely get beyond explaining there are two types with different pathology and management.

So when Joslin blogged today about the SEVERAL known types of diabetes that exist today I thought I would share the information.  I think it’s useful for a lot of us to know, in light of news articles about cures and treatments that surface nearly every day and our friends and family send our way. 

If you don’t have time to read the entire article, I’ll give you the six broad types they include:

–          Gestational

–          Type 1 (autoimmune)

–          Type 2 (not autoimmune)

–          LADA (latent autoimmune diabetes in adults)

–          MODY (maturity onset diabetes of the young)

–          NDM (neonatal diabetes mellitus)

I find this information fascinating; like I said, I’m not going to explain it to someone in an elevator as we travel together for a few moments, but it helps me figure out some of the wacky information I’ve seen and heard through the years.

Maybe you’ll find it useful too.

________

HOW MANY TYPES OF DIABETES ARE THERE?

This is a question that we get asked regularly.

If we asked this question to the general population twenty years ago, a majority probably wouldn’t have any idea.  But today, unfortunately, so many people have diabetes that everyone seems to at least have heard of  type 1 and type 2.

And—due to the rising rate of obesity in pregnant women—the public is becoming much more familiar with gestational diabetes.

However, when you get to the details of this complex disease, things get less and less clear cut—not only how many types of diabetes there are, but also how they’re characterized.

For example, type 1 is an autoimmune disease, and people require insulin at diagnosis. Usually the diagnosis is in childhood, adolescence or early adulthood, but not always (people can be diagnosed with type 1 at any age).

Type 2 isn’t autoimmune,  and it may take years before a person requires insulin, if at all—and patients are usually older and often overweight, but again this is a generality, particularly as the number of people who are obese grows and gets younger.

Gestational diabetes occurs during pregnancy and blood glucose returns to normal after delivery, but often it doesn’t.

In addition, researchers have discovered another category of diabetes called latent autoimmune diabetes in adults (LADA). Think of LADA as a slowly progressing version of type 1 with some of the characteristics of type 2.  In fact, some people call it type 1.5.

People with LADA have antibodies to the disease like those with type 1 but they don’t need insulin right away.  Their blood glucose can be controlled on lifestyle or oral agents for months or sometimes years.

There’s more.  Type 1, 2, gestational diabetes and LADA are polygenic—this means that it takes the involvement of many genes to cause the disease.  But there are other, much rarer forms of diabetes that are monogenic, meaning a change in only one gene is responsible for the condition. There are two types of conditions in this category: Maturity Onset Diabetes of the Young  (MODY) and Neonatal Diabetes Mellitus (NDM).

MODY

Between 1 and 5% of people diagnosed with diabetes are thought to have MODY.

MODY usually presents in childhood or adolescence but because its symptoms are often mild, many are not diagnosed until much later.  Unlike those with type 2, people with MODY are usually of normal weight and don’t have high blood pressure or high cholesterol levels.

Physicians may start to consider a diagnosis of MODY and do genetic testing if there is a history of diabetes in successive generations in the family—grandparent, parent and child.  Most often people with MODY can be treated with lifestyle or oral agents.

NDM

Type 1 diabetes is diagnosed after 6 months of age.  But there is a rare condition called neonatal diabetes mellitus that can occur from birth to 6 months.  Unlike other forms of diabetes, about half of the cases of NDM are temporary.  This type of diabetes will disappear in infancy, although it may come back in adulthood.  The other half of the cases will continue to have diabetes throughout their lives.

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

Double Dipsea Report

June 27th, 2011

I’m only giving a report on this one because I gave you one from the practice last week.  It isn’t the most exciting report… in fact, it will probably read a heck of a lot like the one from last Monday.

Kinda like the run.  It felt incredibly familiar.

I’ll start off by saying that we started from the ocean side and ran inland 7ish miles before we turned around and went back to the ocean.

I hadn’t looked at the time the run started, but I thought we would get out around 8:00.  (Did I mention we kind of did this one on the fly?) So I set my basal rate for that start time.

We started at 9:00.  Ooops.

I was very glad to know, this time, just what I had ahead of me.  I mean that I was glad to know when it came to my eating and insulin… not that my mind was happy to take my body up and down those hills again!  I knew my first three miles had only climbs… and stairs.  The stairs were very steep and tall; I wished I was taller so my hips wouldn’t hurt with the angles. 

Oh well.  Not the first time I’ve wished I were taller!

I think I started in the 170s with my BG.  I can’t recall, since I was purposefully NOT thinking about what it was going to be like out on the trail and that meant I kind of tuned out some stuff.  I know we got to the second aid station before I realized I should probably eat something, and check.  I was 105 at that point, which should tell you (again!) how steep that climb was.

I had 25 grams of gu and kept on trekking.  My next check was 108, maybe a half hour after the first stop.  I ate something at the rest of the aid stops along the course: a few pretzels, some gummy bears, more pretzels, etc.  I didn’t want to grab too much, as I don’t generally eat anything other than gu when I run.  So I played it safe.  I think I was 150 by the end of the four hours we were out there.

(Speaking of playing it safe, my friend didn’t have her trail-running shoes on and I swear she stubbed a toe on every third rock and nearly tripped three hundred times.  I was so scared she was going to fly off the trail and head down the side of the mountain.  I am SO GLAD she remained vertical most of the time, and didn’t have any lasting injuries.)

We were fairly smart about the whole thing, this time around.  We decided we weren’t going to try to run up any of the 4,500 feet of trails.  We hiked/walked uphill and ran the few feet of flat and few hundred feet of downhills. 

We beat last week’s time by 15 minutes.

The part I liked the best, and my friend agreed, was that although we didn’t go very fast (530 people finished before we did… and about 30 people finished after we crossed the line) we still did it, with smiles on our faces.  Some people run that thing all the time since they live nearby, and some train and plan for months to complete the course.

We found out about it about three weeks before we ran it on Saturday. 

And that is what we are so happy about: we knew we could do it.  We never doubted ourselves.  I had the knowledge about my running and my insulin and food requirements and I just took care of what needed taking care of.  We kept going the whole time, we worked hard, and we had fun out there together.

Why else would anyone want to do the Double Dipsea?

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

We All Deal So Differently

June 24th, 2011

Living life with type one or type two diabetes requires a lot of work.  It’s amazing how we all deal so differently with that workload.

Some people stay in denial and don’t do a thing: don’t take their medication, don’t change their habits after diagnosis, do precisely what they know is damaging to their bodies, or fight every day to not acknowledge what living with diabetes takes.

Some people immediately take their doctor’s instructions to heart, learn all there is to learn, do everything precisely “right” and are probably their doctor’s star patient.

Some people learn quickly that routine is their best friend, and never vary from day to day: breakfast is food X, drink Y at time Z with insulin A at the same time every day.  Any variance is a threat.

Some people think “I just have to do this until…” and some people think “I will be able to get off medication” and some people think “It’s no big deal.”

Some people change everything.  Some change nothing.

Some people fight for their child: 504 plans, Americans with Disabilities ride passes at Disneyland, attendance at every JDRF event imaginable: Let’s Get Rid of This Horrible Disease.

Some people participate in clinical trials, some people see a physician once a year to get their insulin prescription renewed. 

Some people live with diabetes, others are diabetics, some are persons with diabetes.  Some are patients, some are advocates.

 

Some people tell everyone.  Some people tell no one.

Some people see their diabetes as the hardest thing they’ve ever dealt with.  Some people struggle every day.

Some people ask “why me?” Some people don’t care.  Some only ask in the dark.

Some people won’t go to the grocery store without their meter.  Some people don’t know where their meter is right now.

Some people can recite their past three years’ of A1cs.  Some couldn’t tell you what the last one was, nor when it was taken.

Some people make charts and graphs.  Some people don’t.

Some people go by how they feel.  Some people can’t recognize a low.

Some people love their doctor.  Some love their Diabetes Educator.  Some can’t stand any part of a medical visit.

There are of course a lot of extremes and most of us probably wander between the extremes through the years of life with diabetes.  Certain times of our lives will prompt greater focus on our disease, and some periods will necessitate greater distance in favor of a different focus.

It’s always there, always a part of us, no matter what we do.

It’s our diabetes.

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

Re-Motivation

June 23rd, 2011

Have you fallen out of your exercise routine?  Do you need a figurative shot in the arm when it comes to your workouts?  Are you afraid of getting your hopes up and then dropping out of a new class or new plan?

You aren’t the only one.

In fact, you are so completely NOT alone that people write about it in nearly every fitness magazine out there.  They write about it because it’s a fact of fitness life: our minds can work against us.

Runner’s World included a tip list in their May 2011 issue from runner Kara Goucher about how to get started and stay strong when it comes to running.  I of course know not all of you are runners, so I’ll include the tips I think are multi-disciplinary in their approach.  (Did you forget I’m a lawyer?) 

Talk It Through

New runners think it’s not “real” running unless you’re gasping for breath.  Not true.  If you can’t talk, slow down.

AG: I say, if you’re working hard, you’re exercising.  Try to go faster on some days and always push yourself, but don’t worry about actual speed and try to keep at least 80% of your workout where you could have a conversation of at least 5 words at a time.

Take Pride

A lot of people think they look slow, or fat, or sweaty.  Don’t let any of that stop you.  Among runners, you are golden.

AG: How true how true.  Do you care what someone else looks like when YOU are exercising?  Didn’t think so.  Get out there and be kind to yourself and the work you are doing!!

Have a Key Word

Use your key word when things get tough during a run.  Or use it before your run if you don’t feel like heading out.  Say it to yourself, mantra-like.  A word I used during a really tough time in my career was fighter.  That was what resonated for me, and it worked. 

AG: Have a phrase or way to encourage yourself and keep your mind strong during any workout.  Anything encouraging will work.  I have used “keep going” “you can do this” and always smile at “suck it up Buttercup.”  (Like I said, anything encouraging will work.)

Focus on Yourself

If you think about other runners, you’ll end up thinking, She looks faster than me. Keep things inner directed.  Be aware of others, but keep yourself front and center.

AG: You aren’t exercising for the person on the stationary bike next to you.  You aren’t exercising for the person with the locker next to yours.  You aren’t exercising for anyone else’s body: keep yourself and your goals front and center.  You are there for YOU.

It’s easy to let what others are doing get to you.  It’s easy to compare your blood glucose or A1c to that of your friend’s.  It’s easy, and it’s potentially damaging when something your body does or needs differs than what someone else does or needs.

Take the high road on this one, challenge yourself, be kind, and reap the rewards of your efforts.

You can do it, Buttercups!

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

When It’s Crazy Hot

June 22nd, 2011

We are having a bit of a heat wave in my area. I personally love the heat, but it definitely requires a different strategy for exercise.

My friend and I tried to beat the heat yesterday and we went out for a run at 7:20am after bootcamp. We planned a good, difficult 8.8 miles… and we thought we could beat the heat.

We were sorry to be wrong. We cut our route short and added in a load more walking than we intended.

Sometimes heat will do that to you!

It was the kind of heat where I had 30 grams before I started running, lowered my basal lower than I usually do for a run, checked 30 minutes in and was 98. I had a 25 gram gu, ran another 15 minutes, checked again and was 99. Normally, I would have maybe had 20 grams that entire run, and a more normal temp basal for my run.

I’m telling you, it was HOT.

(When we got back, I needed an immediate nap. I slept for 90 minutes! My friend told me she still feels wiped out today—normally that route would have been no big deal for either of us.)

So what can you do when it’s a zillion degrees out, shade is nearly nonexistent, you are sweating as soon as you open your door, but you still want to get in a workout??

Many runners suggest starting a run as early in the day as possible to avoid the heat. I think tomorrow I may try a before-bootcamp run, if I can get to bed early enough tonight. Some say wear a hat to protect your head from the sun. Everyone says to keep hydrated by drinking a lot of water and electrolytes during the day.

But what if getting outside is simply not feasible for you and you still want to work out??

Here’s my latest suggestion. Try something new INSIDE when it’s crazy hot. Check out a workout via Netflix Instant.

If you have air conditioning and you have space, any regular cardio workout is great. If you don’t have A/C, try the coolest spot you can find and go for a short stretch or yoga workout.

It’s fun to keep things interesting and try new things despite the weather.

You’ll find the Netflix workouts in the “Sports & Fitness” genre, Workouts. You can try an Ab, Glutes, & More workout, a Yoga, Low Impact or even Qigong!

The 10 minute Solution workouts are nice because, well, if you don’t like them, you’ve only got 9 minutes left. (Although I’ve also just stopped and tried another option.) I’ve also heard good things about the Crunch Candlelight Yoga workout. What’s the risk involved in trying it out on your instant queue?

I’d try Yoga Booty Ballet or Yoga Zone workout if I were willing to wait for a DVD. I’ve done some of the Yoga Zone workouts and they are okay. I also like Rodney Yee, and always appreciate the blissful beaches where they film.

Read the member reviews and check out the star ratings—you never know what will work for you and what won’t work as well. Remember if it is a new activity for you, your insulin needs will probably be lower than normal even for exercise, and on hot days you may need more or less overall; be smart about what you’re doing with your insulin and keep some juice nearby. Always have water within reach and be sure to stay hydrated as you work, A/C or no A/C.

Close the drapes and ban others from the room (if they aren’t joining you) and then just bust a move. It’s fun, and safer on crazy hot days!

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

Amazing Benefits of Exercise

June 21st, 2011

You feel better when you exercise.  It helps you manage your diabetes.  It helps you lose weight or keep your weight in check.  It helps you fit in your clothes.  It helps your heart stay strong.  It helps your blood fat levels get to and stay in a healthy range.  It keeps your bones strong.  It helps you manage stress.

AND it helps you stay young.

I’m telling you, exercise is an amazing thing.

I think I blog more about cardiovascular exercise than I do resistance training, mainly because what I do for my cardio exercise is more interesting and exciting to write about.  (I mean, did you see yesterday’s blog?!)

When it comes to resistance exercise, however, I’m a huge fan and wish I were able to devote more time to it (marathons have taken precedence for the past two years).  Resistance training to help me stave off muscle loss as I age is crucial.  I also have one body so it’s hard to do everything I want to all the time. 

I’m sure you understand.

So you can imagine how fun it is for me to spread the word about TELOMERES. 

Telomeres are little pieces at the end of our cells’ DNA.  With every cell division, a tiny bit at the end of that telomere is lost. 

You can imagine how this story ends up.  If you can’t, look at your grandparents.

With every cell division snipping off a teensy piece of DNA, we are on a limited time budget.

The 2009 Nobel Prize in Medicine was awarded to three scientists whose work showed that telomeres are vital to protect our cells’ DNA.  Not only did their work show that the longer our telomeres the biologically younger we are, but they showed that the telomeres of middle-aged people who exercised regularly were only marginally shorter than those telomeres of people half their age who didn’t exercise regularly.

Gotta love scientific proof that regular exercise (and of course good sound nutrition) help our bodies significantly slow the aging process.

Just add it to the list of the amazing benefits of exercise.

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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, Weight, Weight, Don't Tell Me-- Does it have to do with what I eat?