Archive for the ‘My Soapbox’ category

Whoomp There It Is

September 30th, 2011

We’ve got new cardiovascular recommendations, Ladies and Gents.  The American Heart Association wants us all, by 2020, to improve our cardiovascular health by 20% and reduce deaths from cardiovascular diseases and stroke by 20%.

That seems like a lot to accomplish in eight years.


Taken from the IDEA Health and Fitness Association’s September newsletter, the goals set by the task force assigned to make this all come down to 4 Health Behaviors and 3 Health Factors:

The new Impact Goals document declares that as men and women raise their levels of physical activity by increasing the intensity, frequency and/or duration of that activity, they experience much healthier lives. Moreover, coinciding with the release of the new AHA goals, new evidence suggests that low cardiorespiratory fitness (CRF) is as strong a predictor of cardiovascular disease (CVD) and other health causes of mortality (referred to as all-cause mortality) as are well-established risk factors such as smoking, obesity, hypertension and diabetes (Lee et al. 2010).

Confronted with how to define and measure ideal cardiovascular health, the task force identified four health behaviors and three health factors:

4 Health Behaviors

  • nonsmoking
  • body mass index < 25 kg/m2
  • physical activity (150 minutes per week of moderate-intensity exercise or 75 minutes per week of vigorous-intensity exercise, or a combination of these two)
  • consumption of a diet that promotes cardiovascular health (emphasis on a low glycemic load, high fiber, high marine omega-3 fatty acids, high polyunsaturated to saturated fat ratio, and low trans fat content)

3 Health Factors

  • total cholesterol < 200 milligrams per deciliter (mg/dL)
  • fasting blood glucose < 100 mg/dL
  • blood pressure < 120/80 mm Hg

Clearly those of us with diabetes have missed the Avoid Diabetes Boat (some of us by a long shot).  However, we still can do so much to reach fantastic levels of cardiorespiratory fitness we are missing another bigger boat if we don’t do our best to keep up with the other recommendations.

Let’s get after it.


On Your Own (?)

September 29th, 2011

It’s sometimes the things someone says when they don’t even realize they’ve said something.  I met a woman at my recent talk on Diabetes and Exercise, and she said something in a way that made me instantly know I will never ever forget her.

She probably didn’t even hear what she said, but it struck me and has been on the edge of my consciousness ever since.

She said she has to do her diabetes all by herself.

(Realistically, I understand that I just got a bunch of readers who said in their heads something along the line of “of course!” or in some way agreed with that.  And, depending on how your day is going, you may feel various ways about that, and there are probably about three hundred different ways to say “of course!” But keep reading because this is important.)

But here’s the thing.  I think she’s wrong.  I don’t think she has to do her diabetes all by herself.

For one thing, her boyfriend was attached by her side the entire two hours she was at the event.

For another thing, I think she is pretty damn brave for showing up when she’s feeling like her diabetes life is not where she wants it.  She was in a room full of people who know E.X.A.C.T.L.Y. how that feels.  I’m proud of her for getting herself to that chair.  I’m proud of her for speaking to me when I plopped myself down next to her because I hadn’t seen her say a thing to anyone in the entire room and felt compelled to introduce myself.  (Seriously; what IS that?! I find myself do irritating sometimes.  But, in all, it was important and I’m glad I elbowed my way into her world for that brief time.)

I’m thrilled she knew enough to ask for help.  I’m honored she felt I could be a good resource for her.

I was thinking later about other people I have known whose actions tell me they feel the same as this woman: doing diabetes all alone.

One person hid her diabetes from everyone and didn’t let anyone else have a chance to share the burden.

One person kept his diabetes to himself but went low often enough that his entire office knew what to do for his lows, and they called in a nearby doctor when it was necessary.

That doesn’t sound to me like he was alone with his diabetes.

One person asked for help from some smart people, received it, and has since spent most days speaking, explaining, educating, and venting to friends, acquaintances, and maybe the entire internet about diabetes and how it is to live with the disease.

Oh, wait; that’s me.

Life with diabetes is not meant to be a solo enterprise.  It simply doesn’t work in any significant, long-term way to keep it that way.  But you do have to recognize that you are responsible for sharing your diabetes burden if you want to feel not alone.  You do have a responsibility to yourself to check your blood glucose levels, and deal with them however best you and your doctor have decided, and to keep living your life.

You have a responsibility to speak to the people you share your life with.  You aren’t getting rid of your diabetes any time soon, and like it or not, your diabetes is a huge part of that life.  So share some of your diabetes.

Teach your best friend to count carbs.  Teach your girlfriend how to deal with you when your blood glucose is 50 and getting to the fridge for juice on your own is too much.  Teach your kids what you’re doing and why it matters.  Invite your boyfriend with you to your next visit with your CDE.  Show up at a diabetes event.

Be brave.  YOU CAN DO IT. Diabetes gets a hell of a lot lighter off your back when you share it.  If you aren’t getting the response you want or need, try again.  If the people still aren’t willing to help, ask someone else.  Ask your CDE.  Ask your counselor.  Ask me.  Ask someone you met at that diabetes thing you went to three years ago.  Whomever you share something with will then be helping you do your diabetes.  Not alone.


You Either Do, or You Don’t

September 28th, 2011

Some of these studies have just such goofy titles I have to blame the editors.  I mean, you have to think about the researchers who came up with the study idea in the first place: they probably already suspected the answer, but wanted proof so they came up with the study to prove/disprove the theory.

In any case, the study that brought this up for me is called: Does Blood Glucose Monitoring Increase Prior to Clinic Visits in Children With Type 1 Diabetes?

If you have ever BEEN a child with type one diabetes, you probably have already answered the question.  Assuming you are anything like me, the answer is most assuredly Y.E.S. (with a twist)

I sort of think that’s why they make us come in every 3 months, and why my endo in high school made me come in more often than that.  (She is an entirely different story and one not quite appropriate for me to discuss here.)

But this study is I’d say completely accurate when it says, essentially, that those who already checked a lot increased the checks the month before the visit but those who didn’t check in the first place weren’t likely to check any more often just because a visit loomed.

I can just hear the thoughts of those unlikely to check: “I’m not afraid of you, doc.”

I can hear them because I’ve said and thought them.

(The twist comes in when I say that downloadable meters haven’t always been available so I used to have a pending visit and drag out a couple different pens and pencils and make up a “realistic-looking” blood sugar log book before the visit.  So in that way, I did increase my activity related to BG checks… they just weren’t in any way BG checks.)

The goal, of course, is to use the doctor as a tool just like any other we have at our disposal for managing our disease.  If you’re smart, you write down your questions in the weeks before you go in, and check often so that you can discuss periods of your day or specific issues you’re dealing with.  (They are supposed to be great at that kind of detective work.)

If you have a funky chirping or whirring noise when you drive your car, you try and see how you can replicate the noise for the mechanic.  I don’t see checking blood glucose much differently than that.  If it’s an issue with something that only happens when your car is cold, write down when it happens and leave it with the mechanic overnight so they can hear it, too, and then trouble shoot and hopefully fix whatever is weird in your car.

Same here, in my world.  If you’re smart about it.

Having been on the other side of things, I agree with the results as they seem realistic.  If you aren’t responsible enough to check your blood glucose levels on your own for yourself, you aren’t likely to check them for a doctor visit either.

Growing up with diabetes is tough stuff.

Really tough.

Here’s How I Figure It

September 20th, 2011

Being a fitness professional, I know more than the average bear about what aging can do to a body.  Being a type one professional (in training and education for longer than any other professional schooling, I see myself as a type one professional… aren’t you?) I know more than the average bear about what my diabetes can do to my body.

So here’s how I see it.

  1. We need cardiovascular health.
  2. We need muscular strength and endurance.
  3. We need great management of our blood glucose levels.
  4. We need to be happy and healthy as many days as we can, for as long as possible.

I think only #3 on that list makes me different than any non-diabetic.

I think it’s critical for my cardiovascular system that I engage in challenging
regular cardiovascular workouts
.  I want to increase my body’s ability to handle stress and one of the best ways I can do that is to train it to work under some extreme conditions.  Every time I do, my body reacts by building a few more bone cells or making a few more mitochondria.  Thank you, Body; I will need those!

I think it’s essential for my skeleton and my muscles and my wellbeing overall to challenge myself with resistance training a few times a week, every week.  We all begin losing muscle mass by the age of 30—and the only way to fight that is to pick up something heavyHeavier.  And heavier still, as our muscles grow and we get stronger.  You need to lift  something heavier than you thought you could lift last week, or hold it longer, or move it  faster or slower to always work against a challenge.

If you’re bored, you aren’t challenged.

My blood glucose levels are always going to be a challenge for me, and I need to keep my head on straight about those.  I need to work with all sorts of health care professionals who are my allies on this.  Life is too short to be stressed out when I see a doctor or dietician.  I don’t want to carry anxiety about working with someone around with me.  I want to check as often as necessary and not have any part of me afraid to see that little screen.

Life just has so much more crammed into it that is so much more important than spending time afraid or anxious.

And on that note, if I can manage those items #1-3 I think that #4 will kind of take care of itself.  Work hard, work smart, and keep everything in perspective.

Go to it!

Unlocking Medical Mysteries

September 16th, 2011

I don’t think seeing a doctor should involve emotional discomfort.  I know it absolutely does, but that doesn’t mean I don’t want to fight that.

Yes, I think that’s at least a quadruple negative right there.

Yesterday I saw my family practice doctor and we were talking about a few things and I realized how uncomfortable I was.

Uncomfortable, as I sat fully clothed on a crackly piece of paper on a table I had to climb up onto and she sat two feet below me and typed on her computer.

So I interrupted myself and asked if she minded that I sit in the chair instead.

Her response was the best: Yes of course; this is a conversation.

See; she gets it.  She understands that when it comes to my health, I am the expert and she is a consultant.  Not to undermine her education or experience or knowledge in any way at all… but not to undermine my education, experience or knowledge either.  We were having a conversation.

It was a good thing, and I’m glad I was able to say and do what I said and did. 

I’m on a writing roll here today aren’t I.

(Green underline there since I didn’t put a question mark!)

Anyway, while she was out of the room I made my obligatory tour of the surfaces of the room.  (What can I say.)  I found a sheet of paper that had some information that I don’t know if you will recognize.

On the off chance you don’t, I’m listing them here.  The medical world isn’t meant to be so confusing; it is just big (huge) and they use codes and you can end up feeling lost before you even are allowed through the door.

I think we all deserve better than that.

So here are diagnosis codes your doctor uses when they see you.  They need to use at least one diagnosis code (called an ICD-9 code) for any medical procedure code (called a CPT code) they use to (hopefully) get paid by your insurance company. There are big books of codes that change every year, so doctors usually have one sheet of paper that includes their most typical codes to make things faster as they zoom from room to room and patient to patient.

For diabetes:

250.0… type 2 diabetes, non-insulin dependent, not stated as uncontrolled

250.1… type 1 diabetes, insulin-dependent, not stated as uncontrolled

250.2… type 2 diabetes, non-insulin dependent, uncontrolled

250.3… type 1 diabetes, insulin-dependent, uncontrolled

And then there are more!  Each specific complication has its own code, or way of coding.

250.5x(0-3 above) and 362.01 is diabetes with retinopathy

250.6x and 337.1 is diabetes and neuropathy

250.7x and 440.20 is diabetes and peripheral vascular disease

250.4x and 583.81 is diabetes and nephropathy

250.8x and 405.99 is diabetes and hypertension

250.8x and 272.4 is hyperlipidemia

Some codes have 5 digits and some have 4.  Usually the 4 digit codes are for the general diagnosis with the fifth digit getting more and more specific.

It’s pretty interesting from a coding point of view (which may be about the most boring thing ever if you don’t care about it) but I think anyone with a chronic disease like diabetes really should know the basics of this stuff.

It’s a way to take charge.  As my Dr. Joe would say, it’s your time!!

Real People, Real Life, and CDES

September 15th, 2011

My talk to the CDEs (Certified Diabetes Educators) yesterday about Diabetes & Exercise was kind of interesting.  I mean, I spent a long time talking about myself so of course it was the most riveting talk anyone has ever attended.  (HA!)

What I found interesting was how many people there were (1) used to discussing type 2 diabetes and very excited to switch over to a discussion of type 1 and (2) had no idea how exercise works in real life when it comes to diabetes.

Real life.

Yep.  Hard to escape it!

One lady started asking me my background as I was setting up; she assumed I was another CDE and seemed surprised I am not.  I assured her I was plenty qualified to discuss diabetes—24 years of constant experience will do that!

As we got into it, I got some great questions from the group.  Some wanted to know if I eat before I work out. (not really)  Some couldn’t figure out how I can check as I run. (very carefully, or I’ll walk)  Some wondered if I take my meter with me on every run.  (nope)

Real life.

I ended up checking during the talk, as I was standing at the front of the room.  I didn’t notice I don’t think that I was checking so much, but omg one of them apparently timed me from start to finish (I did take a correction bolus).  She was
excited that it took me 40 seconds to do it all.  (I was a little weirded out that someone timed me.)

I am now that person that she’s going to tell a future patient about.  She’ll be sitting with someone complaining about how much time diabetes takes and she’s going to say “no; it takes 40 seconds.”  (Sorry about that one, if you’re the patient on that one!  That seems so annoying when others do it to me and I truly apologize.)

They all seemed flabbergasted that I could check and continue with my activities simultaneously.

Um, I do it all the time.

Real life.

When they were warmed up, they started firing questions at me about more specific types of exercise.  It was fun to fire questions right back at them about other factors I involve in my decisions before/during/after I work out: heat, workout intensity, food today, food yesterday, elevation changes, insulin on board, temporary basals, etc.  Then I’d tell them what I would do and I’d tell them about what I would expect.

Real life.

I told them about one of my clients whose blood glucose wasn’t what I expected at the end of a workout.  (I expected 110  and she was 155.)  I asked her if she had set the temp basal for 30 minutes like we had discussed.  She said she had set it instead for an hour.

Timing affects a lot.

These are the kinds of things it takes a lot of experience to manage.  It takes that constant vigilance.  It takes a lot of trial and error and a load of strips.

But the funny thing is, it is all so worth it for what you get in return.

Real life.  LIVING with diabetes.  Life.



September 14th, 2011

I think I had maybe two phrases that carried me from about age 2 to age maybe 16 (when I promptly added the obligatory third phrase involving driving):

ONE: if my sister can do it why can’t I do it too [because she’s older than me]


I’ve never gotten over either one of them, quite frankly.

But this study would have made me even more preposterous on that second issue.  (The dog issue.)  Every time my parents wanted me to go out and stop irritating them or otherwise entertain myself I could have shown them the results of this study, and explained to them how important exercise is for kids.

It would have been AWESOME.

Researchers studied 618 pairs of adolescents (12.5-17.5 years old) and parents for about 18 months to get the data.  They looked at how active the kids were on a daily and weekly basis.

The families with dogs in their homes and lives were much more active, and correspondingly I presume healthy, than those without a pet in their home.  (The study mentions dogs in particular and pets in general so I do too.)


It wasn’t necessarily that the kids were in charge of walking the dog (I mean for real how often does THAT happen).  It was the fact that the dog was around that got people off the couch to feed, water, clean up, open the door, close the door, find the ball in the backyard, throw the ball, hide the leash, bend down to pet, bend down to scoop and bag, kneel to hug, crouch to defend against love attacks, dry off with a towel after the sprinklers went on at the new time, and on and on and on.

I’m telling you:  We all, every single one of us living with and those living without diabetes need to be as active every single moment of every single day as we can manage.

If we get a bunch of CRAZY FUZZY LOVE at the same time, we score bigger than a rock star.  No joke.

So who’s going to adopt a new fitness friend?!  Let’s go, Mom and Dad!!  I’m ready!!

She doesn't look like she would make me more active... but she does!! (on one of her white mats!)

(I also must be completely fair and say that my cats get me off the couch just as much as I think a dog would.

They chase each other and crash into things and I need to go check what broke.  They want dinner.  They want breakfast.  They want to see who is doing something outside and they look so curious that makes ME curious too.  Gracie will see us coming and race to a white mat and expect to be petted on that mat.
George will jump onto the bed and want to be brushed.  Yes, we cater to them.  Yes, they have us convinced we wouldn’t have it any other way.

We are so lucky!)


September 12th, 2011

A lot of people, at least with type one diabetes, say they don’t have a functioning pancreas.  That isn’t entirely true.  Our pancreas serves to produce several necessary things: insulin, of course, and digestive enzymes and various other hormones.  So for those of us with type one, it’s our beta cells that live in the land of those “Islets of Langorhans” that we’re missing.

It sounds almost like a place found at Disneyland, that Land of Langorhans.


At the cellular level, insulin grabs glucose and helps transport it into the cells.  If you’re like me, you learned this about thirteen thousand times in the four days you were in the hospital at your diagnosis: insulin is the key that unlocks the doors to your cells so that your body can use the food it eats.

Yup.  The key.   INSULIN IS THE KEY!

But then there is that other, much less discussed, function that insulin serves in our bodies.  Insulin doesn’t just help your body use glucose. 


It essentially helps your body store fat, too.  THAT one I only learned a couple of years ago.

THAT one I would have liked to have known a long time ago.

Insulin doesn’t do anything with the fats themselves, but it can serve to prevent the BREAKDOWN of your already-stored fat.


So it’s important to keep yourself on as little insulin (be it self-made or self-injected insulin) as possible.  One way to do that?  Why, remain as insulin-sensitive as possible!

How can you do that?  Two primary ways: (1) don’t need as much insulin to cover the food you eat (keep away from those big boluses to cover high-glucose spikes) and (2) EXERCISE to keep your cells happy and burning glucose as quickly as possible.

Exercise is awesome for more reasons that I can list in my “less than 500 words/blog” goal.  BUT, one of the reasons is that exercise helps to activate glucose transport… to me, in my life, that means that my insulin becomes SUPERCHARGED when I do cardiovascular exercise, or a weight training circuit that keeps my heart rate elevated.  (Love that supercharge!)  I simply don’t need as much insulin in my body.

If you exercise long enough to decrease the amount of glycogen stored in your liver, you ALSO get to replace that for the next day or so… my husband reminded me last week that I tend to go low the night after a half marathon.  (I’ll have to remember that next time.  I mean, I’ll have to remember that this Sunday because I have another half then!)  If I planned
better for it, it’d be like FREE EATING a little.

Hey, you’ve got to get it while you can.

(It’s also good to know that everything changes AFTER you’re done with a bout of exercise.  If you’ve had a lowered basal
rate, you may need to take a little bolus to cover a blood glucose climb.  Additionally, you need more insulin immediately after a strength workout to shift amino acids from protein into muscle cells where they can be used for muscle growth and repair.  It’s complicated, as you know.)

INSULIN ROCKS even if it’s complicated and challenging and makes those of us who have to manage our levels externally sometimes want to pull our hair out.

No matter what, I still like it.  Life really sucked when I didn’t have any insulin.  This way is MUCH BETTER.

Don’t you agree?

To Continue The List of Healthy Options to Feel Good About

August 30th, 2011

I just love that Prevention magazine somehow came up with a percentage by which these changes can improve your health.  I’m betting they have similar percentages for health improvements for taking stairs versus elevators, drinking coffee versus tea, and maybe even crossing the street on a flashing “do not walk” sign.  (Okay probably not that one.)

It’s precisely the kind of article that keeps me buying magazines.  Full of short, fun ideas that just might work.  On this list (there were only 12 on the original list so this is it) my favorites are: 8, 9, and 12.  Which ones look good to you?

7. Keep your doctor on speed dial

Health boost: Slash medical mistakes up to 25%

Don’t assume that no news is good news when you’ve had a checkup: Physicians fail to inform 1 out of every 14 patients whose abnormal test results are clinically significant, according to a recent study published in the Archives of Internal Medicine; among some doctors, the number of no-calls was as high as 1 in 4.
Delayed diagnoses can be linked to thousands of serious injuries and health crises—and even deaths—each year.

“If you are subjecting your vein to a needle, you have a right to know what the test is for and why it matters,” says Katz. Talk with your doctor about when you’ll hear about results, and if she finds something that requires treatment, when you might expect to hear from her again. You can always follow up with her after that date.

8. Squeeze your [spouse]’s hand

Health boost: Slash stress by 200%

A brief hug and a few minutes of holding your {spouse]’s hand can fend off stress, according to a study reported at the American Psychosomatic Society. Researchers asked two groups of participants to speak about a stressful event, an exercise that typically causes a spike in blood pressure. BP readings of those who did so without holding their spouse’s hand before speaking were more than double those of people who held hands; their heart rates also rose twice as much.

9. Strike a warrior pose

Health boost: Ease back pain by 56%

Spending time on a yoga mat can significantly reduce chronic lower-back pain, according to a study from West Virginia University. Researchers  asked 45 people whose back pain caused mild to moderate disability to do a 90-minute yoga workout twice a week for 6 months. Compared with patients who only continued whatever therapy they’d already been doing, the new yogis reported significantly less pain and better function and fewer symptoms of depression (down almost 60%). They also continued to see these benefits even 6 months later.

10. Grill some fish for dinner

Health boost: Lower risk of dementia by 19%

More evidence that fish is brain food: A study of nearly 15,000 adults  worldwide found that regular fish eaters (those who have it more than once a week) were just one-fifth as likely to have dementia as those who never ate the food. It also found that those whose diets contained the most meat were slightly more likely to have dementia than non-meat eaters. Omega-3 fatty acids (found in oily fish like salmon, mackerel, and tuna) may help protect nerve cells in the human brain and are known to limit inflammation, which is associated with dementia.

11. Drink milk at breakfast

Health boost: Shed 5 pounds

Women who consumed a large (20-ounce) glass of fat-free milk in the  morning ate, on average, 50 fewer calories at lunch, compared with days when they drank fruit juice with the same number of calories, according to a study published in the American Journal of Clinical Nutrition. Researchers say the milk drinkers felt more satisfied and were less likely to overeat at their next meal. Over a year, that translates to a 5-pound loss.

12. Pour a glass of Pinot

Health boost: Live 5 years longer

A Dutch study following 1,300 men for 40 years found that those who regularly drank up to a half glass of wine each day boosted their life expectancy by half a decade, compared with teetotalers. Study authors say the polyphenolic compounds in wine (especially red) may have heart-healthy effects that are probably seen in women as well. “Alcohol raises levels of ‘good’ cholesterol and can increase levels of tPA [tissue lasminogen activator], a protein that helps break down blood clots; both benefits can help minimize potentially life-threatening ailments such as stroke and heart disease,” says Katz. But remember, because even modest alcohol intake is associated with an increased risk of breast cancer, if you are a social drinker, keep your daily intake low—no more than one glass per day (men can have up to two).

I May Have to Put My Foot Down for This One

August 23rd, 2011

I may have to stand up and request a different name for my disease (currently called type one diabetes) if they end up doing this.

I don’t think we’ll stand a chance to ever clarify in the public’s mind what our lives are really like as we live with type one diabetes if they expand the label of “prediabetes” to include who knows how many people.

Seriously; these researchers looked at patients for several months and determined that of the 14,000 patients who had blood drawn, those with blood glucose levels of 51-82mg/dL had a less than one percent chance of developing type two diabetes.  Those who had blood glucose levels between 91 and 99 mg/dL had a more than three percent chance of developing type two diabetes.  So now the researchers are proposing to lower the threshold of “prediabetes” to 91 from its current 100-126mg/dL.

(If you check your blood glucose you know that you can check at home five seconds apart and get a 90 and a 120 result due to the machine’s margin of error.  I imagine the labs have a margin of error as well.)

It makes me wonder if they are splitting hairs in order to fan the fire of the money-churning machine that is type two diabetes.  The sooner they can call you “prediabetic” the sooner they can get at you and sell you socks, meal replacement shakes, diet meal plans, it’s a wonder they don’t have diabetes cruises by now.  (Okay; the cruise could be fun.)

Here’s my beef: I have type one diabetes, yet the majority of information out there refers only to “diabetes” without clarification.  The origin of
type one diabetes and of type two diabetes are vastly different and by grouping the two under a single umbrella the public stands zero chance of comprehending what’s going on.

We share the name “diabetes” because the two diseases share a major symptom (high blood glucose levels) and similar complications as a result of the elevated glucose levels.  But is that enough to call them both “diabetes”?

To me, sharing a symptom should not be enough to name the disease identically.  (If one disease caused someone to vomit, and a different disease also caused someone to vomit, I don’t think the medical field would say the two diseases should be called by the same name.  So what’s so special about blood glucose?)

For me, I didn’t have any period of prediabetes.  So it’s not a term that makes any sense to me.  It seems like a term doctors are happy to throw around in an effort to scare their patients into changing their habits.

I didn’t get a “pre” period of time to do anything at all about my disease.  I had no chance to prevent my disease.  I got so sick I lost my hair.  I was skin and bones because my body cannibalized itself to find some useable energy.  My body’s pH was dangerously acidic.  I was dying without insulin at the age of ten.

Let me make this clear: I believe both diseases are important and real and difficult to manage and require constant vigilance.  I think people need to do what they can as soon as possible to take care of themselves.

If it takes referring to a blood glucose lab reading of 91 to 99 “prediabetes” well, then, go for it.  More power to you, advertisers.

While those ads are showing and confusing the public, I’ll be over in the corner with my friends, the others with diabetes caused by genetic or autoimmune diseases, maintaining our own sort of constant vigilance.