Archive for March, 2010

(Like you need more reasons to exercise:) WORKING OUT IS GOOD FOR YOUR BONES

March 31st, 2010

Take a calcium supplement?  Worried about osteoporosis?  Want to improve the strength of your bones?  EXERCISE.

See this article: Exercise and Bone Strength by Mariana Shedden, M.S and Len Kravitz, Ph.D.

Your bones grow and strengthen in response to stress.  In order to impose stress on a bone and encourage increased bone mass and bone density, you need to intentionally overload your skeleton with specific exercises to impose a controlled stress on your bones so that your bones will grow stronger and denser in response to that stress.   You need to do weight-bearing activity.

Weight bearing activity is easy to accomplish in two main ways: through impact and through weight training. 

(Whenever you are aiming for overload it is critical you pay attention to your body.  Make sure you know proper form for weight training activities to prevent injury; please be smart about how you start your exercise program.  We all want you out there enjoying life for a long time.)

Assuming your joints are healthy, you need to add a little impact to your exercise routine in order to boost bone strength.  Swimming, bike riding, and low impact aerobics aren’t going to strengthen your bones.  Add impact in a smart way: start slow, learn about and listen to your body’s signals, back off when you need to, wear great shoes, find the right surface on which to pound.   Running, jumping, even brisk walking (and I mean out-of-breath and sweaty!) will help you overload your bones to encourage strength.

Another great way to impose controlled stress on your bones is weight training.  Best done when you aren’t sitting down (what bones does that strengthen), add enough weight to your skeleton that you have to exert effort to move—you are shooting for OVERLOAD in order to see marked improvement in bone strength.  If you know your grocery bags when loaded each weigh five pounds, be sure and do some squats with at least double that amount of weight.  Your body has big muscles (legs, back, butt, chest) and smaller muscles (triceps, shoulders, biceps) so make sure you load appropriately—bigger muscle groups can handle heavier weights.

When you are able to truly challenge your body you will be amazed at what it will do for you.

Has Carbohydrate Counting Made Us More Stressed?

March 30th, 2010

I read a snippet in the ADA’s Diabetes Forecast magazine (April 2010, page 24) this morning that said many parents and kids living with type 1 diabetes reported that they tend to eat more  packaged food than bulk foods because the carbohydrate count is clearly labeled on the packaged food and not on the food made at home.

Startling to me, and extremely sad, is their further report that they avoid eating fruit because they are concerned about the carbohydrate count involved and that the incorrect counts can lead to glucose spikes.

First off, let me say I understand how it is much easier to simply read a box than it is to guess how many carbs are in any given food.  I really do.  It’s hard to visualize just how much a half cup of rice is.  Or even harder for me, spaghetti!  Long stringy noodles visualized into a half cup measuring cup is conceptually close to impossible for me.

But eating whatever we want without paying attention to it isn’t the card we have been dealt; we have been dealt a malfunctioning pancreas and we get to manage that instead of eat with abandon.  We need to recognize everything we put into our mouths.  (All things considered, especially now with made-up chemically concocted foods, though, I think it’s probably a good thing we have that skill.)

I also understand that when faced with a box of nearly any kind of cracker, I usually guesstimate, eat, then do a re-count and see what percentage of the box I have eaten.  I did this with Weight Watcher points, too.  (How many carbs or points per serving, how many servings in the box, how many points or carbs in the total box, how much of the box did I eat…)

Did you clue in on that word?  GUESSTIMATE.  This is all an educated GUESS.  Carbohydrate counting has gotten us so much closer to living our lives first and being diabetics second that to exclude eating real food so that we can more closely count the number of carbohydrates to me undermines the entire effort.  Really?  Do you mean to say you don’t eat strawberries or cherries in summer or apples in the fall because you aren’t sure if the fruit has 17 grams of carbohydrate or 23 grams?  Really?!?

Please.  Recognize that loosening our grip on some of our goals for controlling our blood glucose opens up a life lived with less stress, more options, and in the end, greater control over ourselves.

Here’s to us.

My Six-Step List of How to Start Exercising

March 29th, 2010

Today started the annual “Spring Into Fitness Week” at bootcamp. It’s a free week designed to get more people involved in the program. Fun stuff.

As I watched a new mother/daughter team working out together, I asked whose idea it was to attend—the mother’s or the daughter’s. The daughter grinned sheepishly and said her mom turned 60 in December and the daughter thought it would be a good idea for them both to get involved in regular physical activity. I couldn’t agree more.
That is one of the greatest things about striving for fitness: you can start anytime. You can always do more, or do it differently, and reap results. Yes, your body will respond the best and your rate of metabolism will increase with regular, intense, and varied exercise. But even if you can’t commit to six days a week of exercise, you can still make small changes and see improvements in such a short time, it’s always worth an effort to get out and move.

So, here it is: my Six-Step List of How to Start Exercising. (I made it six steps just to use two hands when I say it aloud, but you can probably shorten it for yourself if you need to. It’s not complicated.)
1. Start.
2. Move.
3. Relax.
4. Keep Moving.
5. Have Fun.
6. Rest.

Don’t worry about how old you are, or what you did in high school, or what your neighbor does, or what your spouse thinks. If you live with diabetes, know what your blood glucose is before you start exercising, feel free to stop and check in the middle of your exercising, and check again at the end. Have glucose with you. Experiment with your activities and find out what works for you.

Again, your new plan for starting to exercise at whatever age or life situation you are in depends on a very, very few things: Start. Move. Relax. Keep Moving. Have Fun. Rest.
Get out there, and do it!  You will feel so proud of yourself and so happy that you started exercising, you’ll wonder why you didn’t start before.

Springtime Sunday Hike

March 28th, 2010

11am Sunday

Going on a hike today with my husband!  I’m excited.  I’m counting it as a workout because I’ve been working my legs fairly hard the past couple of days so this will both work me and not feel like I’m working… what a combo!!

I know I always go low when I hike.  It’s weird.  No matter how often I hike, no matter how fast I hike or how steep the hills, I go low.  Totally wacky, since nearly everything else eventually has less and less of an effect on my blood glucose the more I do the activity. 

It doesn’t help that I still have some breakfast bolus on board.  I’ve cut my basal way down to 10% and I’m bringing extra food; beyond that I’ll just plan to check like always and pay attention.  I’m starting at 210 and expect with my basal cut way down, I’ll head up as my hike starts and I head down.  We’ll see!

 You can check out what the hike looked like on my Garmin: Garmin Connect – Activity Details for Untitled.


Fun 5 mile hike!  Not too strenuous, which was nice.  Gorgeous spring day.  Love those!!  My blood glucose was 130 at mile 4 and 110 after the fifth mile.  I felt a little guilty that I wasn’t one of the runners I passed, but I can handle that kind of guilt.  Now on for my post-hike sandwich!!!  Yum!!!

Diabetes and Depression– My Rundown

March 27th, 2010

I am not a medical provider.  If you think you or someone you love is clinically depressed or needs professional help, please seek out that help immediately.  Now.  You have everything to lose.

People often ask me if I think there is a link between depression and diabetes.  In short:  you can bet I think there is a link!  However, I do not think there is necessarily a genetic link between depression and diabetes.  I think depression in people and in kids living with diabetes is more situational than chemical, at least at the outset.

Diabetes and Depression—My Rundown

Trying to tie it all together a bit here when it comes to living with type one diabetes:  We have a goal.  We have information.  We have tools.  We have factors we can control and we have factors we cannot control.  We know that if we control what we can control, it may consume us.  We know that if we don’t control any of it, it may kill us. 

We know that living with type one diabetes requires a constant unyielding attention and there is never a vacation from that requirement.  We know that our response to a specific event on one day may not work the next day in response to the identical event.  We know that we have a socially misunderstood disease, overall, and that knowledge makes some of us want to hide from public acknowledgement of something we must face every moment of every day

This is not a system that appears structured for success or for emotional health, if you ask me.  So what are the main things can we do? 

  • I think it is important to be open about your disease with the people you care about.  Don’t hide from it—that gives the disease much more power than it deserves. 
  • Know that your blood glucose meter reading is giving you information, not telling you what kind of person you are.
  • Talk to others living with the disease.  We are all our own experts and can always learn from each other. 
  • Learn about how different factors work on and in your body.  Keep trying, keep learning.  Do your best as much of the time as you can.
  • Plan for what you can plan for, prepare for what you can prepare for, and let go of the rest of it.  Live your life.

Because, at the end if it all, that’s what matters.  It’s how we lived our lives, not what our blood glucose readings were.

Diabetes and Depression—The Double Edged Sword of Managing your Disease

March 26th, 2010

I am still not a medical provider.  If you think you or someone you love is clinically depressed or needs professional help, seek out that help immediately.  Do it now.

I think depression in people and in kids living with diabetes is more situational than chemical.  If there is a link between diabetes and depression, how can we avoid negative consequences of depression while we take care of our diabetes, or support someone living with the disease?

Diabetes and Depression—The Double Edged Sword of Managing your Disease

Diabetes is a double-edged sword: telling someone they have the power to keep their diabetes under control can often result in that person feeling like a failure when it doesn’t stay there.

One of the worst parts of living with diabetes, for me, is that I am always reflecting on what I did and second guessing my actions.  If I go high or low, I feel like there was something I could (and should) have done to prevent it.  I want the reason behind nearly every glucose reading my meter displays.

As you have probably read this week, I understand there are certainly a lot of factors outside of my control that affect my blood glucose levels.  For me, I still want to know what those factors are so that I can adjust what I do the next time.

I need to keep reminding myself that while it is important to understand what factors play into each glucose reading, I am only gathering data and not creating value judgments about myself.  Diabetes is a data-driven disease and when I can remove emotions from the mix, I can better manage my disease. 

The only real way to “fail” when it comes to living with type one diabetes is to ignore it or make it bigger than it is.  Once you put your disease in its proper place in your life, you are already succeeding.  You know that your management is sometimes beyond factors you can control, and after you can accept that and learn to manage the information in a way to keep you healthy and happy, you are already there. 

You rock.

Diabetes and Depression– Who Has the Power

March 25th, 2010

I am not a medical provider.  If you think you or someone you love is clinically depressed or needs professional help, seek out that help immediately.  Go.  Now.

I think depression in people and in kids living with diabetes is more situational than chemical.  If there is a link between diabetes and depression, how can we avoid negative consequences of depression while we take care of our diabetes, or support someone living with the disease?

Diabetes and Depression—Who Has the Power Here

When you are first diagnosed with type one or type two diabetes your medical team probably had you attend at least one educational class.  If not, they probably had you see a certified diabetes educator (CDE) who told you what your blood glucose parameters are.  You may have even heard magic numbers in an ad, or seen it on a lab result.   

What you probably didn’t learn at that time was just how DIFFICULT it was going to be to keep your blood glucose levels steady or in range.

There are just so many variables in your life and in your body that when you have to function for your pancreas AND live your life simultaneously you will always face a tradeoff.  Do you want to keep your levels in range 100% of the time?  Likely that will take 100% of your brainpower and 100% of your focus and oh yeah 100% luck in there too because outside forces like the weather, hormones, stress, exercise, even the way a restaurant prepares your food all need to be factored into the mix.

Because so many things are literally outside your control 100% of the time, you will max out if you try to “control” your diabetes.  You very plainly do not have the power to control your diabetes.  There are simply too many things that your body is doing and so many things you encounter in the world that don’t have anything to do with your diabetes that you would need to control in order to control your disease all day every day and at night too.

Just like your family pet or your teenage brother, your disease has things it will do that you cannot control. 

It is probably better to try to “manage” your disease than to “control” it. 

So, what you CAN do is try and strike a balance.  Shoot for keeping your blood glucose levels in range a majority of the time.  Try to minimize the effects of those outside forces.  Above all, keep your diabetes in perspective: your diagnosis was never meant to fundamentally change who you are.  You are YOU and you have an additional job to do.

Yes, there will be times that you need to focus 100% on your diabetes.  For me, that includes times I need to stop and eat something to combat a low blood glucose.  It has included times I needed to leave work because my pump was malfunctioning.  I have postponed or cancelled countless workouts because of my blood glucose. 

Do not give your disease the power to consume you and never let diabetes define you.  YOU CHOOSE HOW YOU LIVE YOUR LIFE.  Your diabetes doesn’t have that power on its own.

Diabetes and Depression—Anxiety

March 24th, 2010

I am not a medical provider.  If you think you or someone you love is clinically depressed or needs professional help, seek out that help immediately.  Now.  This is what matters.

I think depression in people and in kids living with diabetes is more situational than chemical.  If there is a link between diabetes and depression, how can we avoid negative consequences of depression while we take care of our diabetes, or support someone living with the disease?

Diabetes and Depression—Anxiety

Living with anxiety is a part of living with diabetes.  Most of the time this is just an underlying constant check of my body that I run throughout every day.  Sometimes, though, it affects how I treat myself and my disease; I wish I did a better job for myself on that.

The other day I was leading bootcamp and for some reason I went low with about 10 minutes left of class.  I’m not always good at knowing when I am low versus when I’m just hungry (especially at bootcamp, when I eat a little something before but have breakfast after class) so I thought maybe I was just hungry.  My meter was in my car, about 10 yards away from where I was leading class, but they would not have been able to see or hear me if I went to my car.  I don’t have a problem checking in front of others, nor do I have a problem eating in front of them.  (Although I could deal with less “are you eating CANDY?!” teasing from those who don’t yet know I have type one diabetes.)  I was just trying to make it through the stretches at the end of class and go to my car to check and drink juice.  So, I made the decision to just keep going and then end class two minutes early.

I understand that no one would have asked or expected me to keep leading class if I needed to go check and drink some juice.  Sometimes, though, especially when I’m low, going through the “type 1 versus type 2” conversation and questions from others feels overwhelming.  It can also be too much for me when I say I’m low and seven people nervously ask me what they can do.  I’m just low; it isn’t a big event for me.  For others who don’t live with diabetes I guess it’s a bigger thing.

When I got to my meter, I was 49. 

Now, please keep in mind:  I eat the exact same thing every morning at the exact same time and take the exact same amount of insulin.  When I lead bootcamp, I generally demonstrate a few moves and then watch and correct the bootcampers’ form on the exercises rather than exercise myself.  I still can’t explain why I went low that day.

I know one low isn’t a big deal.  I’ve had diabetes for 22 years and so there have been a lot of lows, and a load of experiences exactly like the one I just described.  But for someone new to diabetes, and for someone not as comfortable with their disease or who wants to hide it from others, this situation creates a lot of anxiety.  

I think a good approach is to lay everything out there, for a few key people in your life.  You can’t explain everything to everyone all the time, and that’s okay.  I know at my law office I am always open to questions about my diabetes.  I don’t have a problem explaining something to someone, and would always rather answer than perpetuate misinformation (“so you can’t eat sugar?” etc).  But sometimes I just say “diabetes” if someone I don’t know looks quizzically at me and what I’m doing.  That one word shuts them up pretty quickly, believe it or not.

Living with diabetes means I need to plan and prepare for a complete range of glucose readings, and I know that even if I plan and prepare for it all I still won’t get it 100%.  The more I can make my diabetes simply a part of who I am and not something foreign and scary that requires seven anxious people to run and get me a juice box, the better. 

Although, maybe I should appreciate anything that gets those bootcampers to run even faster…

Diabetes and Depression– Worry

March 23rd, 2010

Again: I am not a medical provider. If you think you or someone you love is clinically depressed or needs professional help, seek out that help immediately. Now. You have everything to lose.

Diabetes and depression appear to go hand in hand in recent studies. While I don’t think there is necessarily a genetic link—I think depression in people and in kids living with diabetes is more situational than chemical. If there is a link between diabetes and depression, how can we avoid negative consequences of depression while we take care of our diabetes, or support someone living with the disease?

With each medical visit comes the obligatory “how are your numbers running” or the antiquated “how are your sugars” or “is your diabetes well controlled” questions. (I always fantasize about actually responding to that question with a real answer, just to watch their face!) People who do not live with diabetes miss a lot when they ask me those questions; if they understood the worry involved I doubt they’d ask so routinely. They apparently do not comprehend the amount of worry involved in living with diabetes.

The most difficult part of having diabetes, for me, is that there is a goal. There is a magic number. There is a test result that will get your doctor to say “good job”. There is a number that will make your parents relax when they see it. Problem is, that number is so difficult to achieve regularly it can feel like a fluke when you do reach it.

Even bigger problem? Each of those reactions from others who do not live with the disease tells you that they have attached a value judgment to your test result. You check your blood multiple times a day, and instinctively with each number that shows up on your meter screen you attach that value judgment and corresponding emotional reaction.

Over 170 = bad? 227 = really bad? 121 = relaxed? 372 = really really bad? 104 = happy?

How exhausting.

(If you are a parent of a kid with diabetes, check out their most recent log. Write out the numbers from any given day, and write down corresponding one-word emotions next to it. Look at that list of words to see what I mean.)

So what to do?? Diabetes involves a load of extra work in daily living. We know that. But relieving as much of the emotional contingent as possible really does lighten the load. Yes, the goal is to regularly keep your blood glucose levels as close to nondiabetic levels as possible. Yes, you should look at trends and see if you need to work with your medical team to adjust your insulin amounts or delivery methods. Yes, you need to check your blood glucose often so that you can correct for the highs and catch the lows. But accept that living with diabetes needs to be LIVING first, DIABETES next.

Your blood glucose levels will not be “between 80 and 110” all the time. (If they were, I suggest you wouldn’t have diabetes.) Your diabetes is a major player in your life. Don’t give it any more power than it needs.

When you get a number on your meter, practice saying to yourself “okay” or “alright” or even “I thought so”. Try to see if you weren’t holding your breath, even a little bit, while the meter counted down. If so, next time leave the room when the meter starts its countdown. Next time you get a 300+, smile first, and then do your insulin calculations. Think of a compliment before you check next and say it aloud before your meter displays a result.

There are a lot of ways to lighten the emotional load of living with diabetes; you just need to find some that work for you!

If you have some methods or some mantras that have worked for you, I invite you to share them here. We are in this together!

Diabetes and Depression—Feeling Alone

March 22nd, 2010

Important reminder worth repeating: I am not a medical provider.  If you think you or someone you love is clinically depressed or needs professional help, seek out that help immediately.    Don’t keep reading—ask for help instead.  Now.   You have everything to lose.

People often ask me if I think there is a link between depression and diabetes.  If you caught yesterday’s post you know that I believe there is a link and I believe there are some pretty good common sense reasons to support a connection between diabetes and depression. 

Given that depression can be debilitating, I think it’s safe to say we all hope to avoid it in our lives and in the lives of the people we love.  But if there is a link between diabetes and depression, how can we avoid negative consequences of depression?

Taking the first point from yesterday’s post, what can one do to prevent depression in ourselves or our loved ones?

Know that you are not alone with your diabetes. 

Sure, maybe you’re the only person in your family with insulin dependent diabetes.  Maybe you are the only person you know who takes shots, or wears a pump.  But that doesn’t mean we aren’t out here!  Reach out and find a camp, or a program, or ask your medical team for some recommendations. 

Just because you live with diabetes doesn’t mean you are going to like or enjoy everyone else who has diabetes.  That’s okay; diabetes affects all kinds of people throughout the world.  If the camp or group or program doesn’t feel right to you, it’s okay to find another one. 

If living with diabetes is feeling like a lot, ask your mom or your dad or siblings to spend a day or a week being diabetic—quiz them instead of the other way around!!  Have them check their blood glucose before eating, ask them how many carbohydrates are on their plates, and tell them what you think about their (pretend) insulin calculations.  Ask your doctor if they will let your family have a vial of sterile saline to practice injecting themselves.  You are the resident expert when it comes to diabetes in your family—but a word of warning: if you are obnoxious in how you treat your family members on their “Day of Diabetes” they probably won’t want to repeat it next time!

What is important, and worth finding for yourself, are others who know some of your struggles with diabetes and others who understand what you feel like when you say “I am 52” or “I am 317”–make those friends and you will go a long way.