Archive for April, 2010

Timing is Everything

April 30th, 2010

Last night I ran that same run I did a couple weeks ago when I went low while out on the hills and ate all my low food. 

Last night I finished at 303.


I knew I had a run coming, but what I didn’t know was that I had heard my running buddy say 5:00 and my running buddy had thought 5:30… so I planned for a 5:00 departure, not a 5:45 departure.

This matters when adjusting basal rates before exercise.

I try to time my temporarily lowered basal rate precisely for the moment my body has different requirements—when I run, my insulin responsiveness is much higher and essentially the insulin in my system becomes more “powerful”.  As a result, any insulin I have on board at the base of that hill can work against my efforts as it did the other day.

So yesterday, I tried to outsmart the system.  I lowered the amount of insulin about an hour before I expected to go for the run.  It should have been as beautiful as a symphony.

Except for that extra 45 minutes I hadn’t factored in.

As I drove to the run, I also ate a dried fruit bar, 10 grams CHO.  Should have all worked wonderfully to sustain my blood glucose levels.

Except for that extra 45 minutes.

So what ended up happening was that I was already heading high from not having enough basal insulin in my system without any exercise and I added more glucose to my system, in the form of that bar.  So I overloaded my body with glucose and had insufficient insulin to use the glucose.  Result?  38 minutes of running as my glucose levels climbed steadily.  (Insulin can’t be powerful if it isn’t in my system!)

I’m not sure if I run as well when I’m at 300+ as I do when I’m at 150; it doesn’t seem like I should.  Although, I ran my fastest half marathon last fall at 250-320 (same reason- basal rate and my start time). 

I will say, that run last night was no personal record.  And I know I struggle with my timing on temporary basal rates all the time. 

It bugs me.

But the insulin I took after I checked at my car worked well, and I still did a good thing out there last night. 

Next time I’ll make sure me and my running buddy synchronize our watches.  Maybe that’ll help.

When was the last time you skipped like a kid?

April 29th, 2010

I watch a lot of people move their bodies.  It’s an occupational hazard, I guess, and I often do it even when I’m not being paid to correct form and avoid injury. 

I love to watch runners run.  I love to watch baseball pitchers pitch.  I love to watch ice skaters skate.  I love to watch gymnasts… um… gymnast.

One of my most favorite things to watch, though, of all time?  Watching my bootcampers skip.  Skip like little kids skip up to a neighbor’s door or across the parking lot to the family car. 

It’s impossible to skip without at least looking like you’re having fun. It’s impossible to skip without looking like you are about five years old.  I think it’s impossible to worry and skip simultaneously. 

When I make my bootcampers skip, they turn into a pack of grade schoolers.  It is so fun to see

No matter what age you are, skipping is great for your body and mind.

Better yet, it’s good exercise too!  When you really swing your arms (hands above shoulder height, the straighter you keep your arms and really swing the better) and go for height and/or distance, you can get your heart rate soaring. 

By landing differently than you do when walking or jogging, you strengthen different stabilizing muscles in your ankles and feet.  By strengthening your feet and ankles, you increase your ability to avoid falls and sprained ankles due to weak stabilizer muscles.

By swinging your arms as far as you can as you keep your torso tall, you increase your aerobic output and recruit your core muscles to keep your body working as a cohesive unit.

By skipping high and long, you use fast twitch muscle fibers to get and keep you airborne.  Think about POWER.  Training your fast twitch fibers improves your speed overall as well as your power output in any quick intense movement.

And yet when I watch my bootcampers skipping down the street, I often forget all of the cardiovascular and strength benefits there are in a simple skip because they simply look like they are having a great time.  We need more opportunities to suspend our worries and have some good, old-fashioned fun.

So next time you’re heading down the hallway or into the grocery store from your car, start a little skip.  Have fun with it.

I do!

Really? We need a study for this??

April 28th, 2010

The ADA reported today on a study published in the Journal of Adolescent Health about teens and type 1 diabetes.  Researchers followed 147 teens and their A1c levels as they moved from teenage years into young adulthood.

The study concluded that not only do teens have to face the typical stresses of adolescence, but they have to deal with increased responsibility for their disease: “a rise in HA1c levels is common in adolescence and early adulthood, researchers noted, as patients with type 1 diabetes transition from parental guidance to personal responsibility in managing their blood sugar levels.”


Few things.

  1. Duh.  (I can’t believe people get paid to conduct some of these “studies.”)
  2. No mention of hormones… or how fluctuations in hormone levels affect blood glucose levels.  You’d think a study about teens and management of blood glucose levels might mention hormones.
  3. No mention of emotional stresses between parents and teens, and how emotional stress affects blood glucose levels.  Strike two.
  4. No mention of how many of those emotional stresses are directly related to the teens’ diabetes and their self management.
  5. Props for the title “Managing Type 1 Diabetes Can Stress Teens” yet I still see the word “control” running rampant throughout at least the abstract.  (I couldn’t access the full Journal of Adolescent Health article online; if you have it, please send me a copy!!)

Apparently teens don’t check their blood glucose as often as they did when they were younger and when (I assume) their parents told them to check and they were still doing whatever their parents asked. 

This would seem pretty obvious to me.  Teens don’t think a whole lot about managing their body on the whole, with or without diabetes—they are busy figuring out how to navigate into adulthood and more importantly, where the car keys are! 

But here is what I’m looking at. 

We need to find for you and your family a way to remove diabetes as a hot spot in as many interactions as possible.  Clearly, parents are better able to see diabetes as a lifelong disease for their son or daughter.  Yet parents are also so full of love for their son or daughter that perhaps there are times they can’t see ways they really might help.  Use your experiences and really listen to your teen and try to figure out what help they really need to deal more directly with their disease.

I’m not saying stop caring, and I’m not saying stop checking.  Sometimes, though, it’s important to recognize that your teen may be doing as much as they can do with their diabetes at any given moment, and unseen factors like stress and hormones may well be working against those efforts. 

Keep up the work you all do to recognize that a check is just gathering data and not a chance for a value judgment.  Recognize that your love for your teen and your need for them to stay healthy despite their disease may feel overwhelming to both you and your teen.  Recognize the efforts they already make every day.  They won’t always make the “right” choices when it comes to their disease.  They won’t always make the “right” choices in any aspect of their lives. 

Love them anyway, with open arms.

Doctor versus Patient: Does your Doctor Judge You?

April 27th, 2010

I went to a talk last week given by a type 1 psychologist (you may have read my earlier post stealing from an article about her).  She highlighted her own experience growing up with diabetes, and many of us in the audience (too many) could relate.

It doesn’t just happen to kids.  After being diagnosed with diabetes, we have all faced a doctor or health care professional and gotten that absolute sense of being evaluated, judged, and found not worthy.

Is it something we did?  Maybe. 

Probably not.

Is it something we didn’t do?  Maybe. 


Is it something we should have done?  Maybe. 

Maybe not.

Does it make us see the healthcare professional as our ally in our fight for health and normalcy? 

Not me.

Does it make me have confidence in their knowledge, skill and expertise? 


Living with diabetes is not something I can do by myself.  I need as much help as I can get from people I can see as my ally, my friend, my advocate, my resource, my guide.  That is a fairly tall order for anyone to fill, and when I need my doctor to fill this role, perhaps I am asking too much of someone I see for less than an hour every few months or weeks.

I know there are some out there who can fill my tall order with gusto and with grace every day; my hat is off to you.  Thank you.

It’s the ones who far outnumber you that concern me.

Because here is what I do need my doctor to be: understanding of the complexity and unforgiving perpetual nature of life with diabetesThat most often, I do nearly everything I’m supposed to do, and after a while, someday the plan that was working so well suddenly no longer works at all for me.  That there are so many factors—seen and unseen, known and unknown—that there is no way for me to both live my life and manage my disease 100% of the time with 100% success.  It makes me want to cry in frustration more often than I care to admit.

I need my healthcare professional to understand that most of the time it isn’t my fault that I’m not in range.  I’m not trying to be irresponsible or deny my critical role in my disease management; I’m trying to be understanding of the fact that I can’t always see a kinked infusion set under my skin or a site stuck in scar tissue or even an infection that has not manifested itself.  I’m trying to accept that those unseen unchangeable factors may just add together and shorten my life.  While struggling with that understanding and acceptance, I don’t need a healthcare professional to purse their lips and remind me that I should keep my blood glucose readings in range.

I do need my healthcare professional to know about even more ways something I haven’t thought about may affect my blood glucose levels, and perhaps offer ideas and suggestions for ways I can head off or even avoid the resulting swings. 

I need them to share the experiences they and their patients have had when faced with similar situations and similar road blocks and similar slippery slopes.  I want to know that others are like me and that others have had days of success with the various tools my doctor shares with me.  I don’t need to hear “my other patient could do it” because even though my doctor maybe didn’t say it, you can bet I heard the “so why can’t you”.  I need to know how, and hopefully why, and what else I can try.

I do feel sorry for the healthcare professionals, though.  They have to say the same things to different patients nearly every day.  That has to be hard for them.  Not as hard as living with diabetes, sure, but still, not a fun part of the job.  I’m sure they’ve heard the same complaints and an unfair number of whines for as long as they have had patients living with diabetes.  I do wonder how some of them get from that to judgmental, though.

The basic truth is: I’m not here to waste your time or to make you angry, Doctor.  I’m just a person who needs your help.

So hold the judgments, please.  I’m doing the best I can.

I would like to add that one of my doctors, Joe Prendergast, is one of the good guys.  I appreciate his efforts throughout his career to empower his patients with his constant message: IT IS OUR TIME.  Thanks Dr. Joe!

Spring is a great time to sign up for a run!

April 26th, 2010

I signed up for a road race today.  I haven’t run many this year since I was a bit over the concept after I finished my January marathon, but this one is kind of fun and my friend invited me (I need little more reason to run!).

So during the registration, there was a yes or no question:

Are you an athlete with special needs?

Well, yes.  Of course.  But do I need the race organizers to be involved in my running with diabetes?  (How would they even do that, with 35,000 runners?  Make me start first?  Run alongside someone with glucose?  How weird would that feel??)   

I honestly don’t think I am an athlete with special needs.  I always run with glucose, have a Road ID on my shoe and my Medic-Alert card in my pocket and always mark my bib number with my diabetes and pump information when I do an organized event like the one I registered for today. 

But none of that seems like a special need.  Just like tying my shoelaces, it seems like how I run.  I think each of those 35,000 runners all run with our own certain ticks and tricks and strategies for success and plans for potential failure.  It’s part of life!

I think I simply assume these questions about special needs don’t apply to me.  I’m not sure if that is some kind of denial, but I never think about special treatment first.  I think about how to reach my goal, and then factor in my diabetes along the way. 

It’s just like saying I am a person with diabetes instead of a diabetic person.  Some would say it’s just semantics, but others know how important it is for me to define myself on an individual level and separate from my disease in a basic and elemental way.

Because really, I am separate from my diabetes.  My identity isn’t tied into what I look like, either, or how tall I am or what clothes I wear.  It’s tied to what I think and what I do and how I treat others and how I treat myself—not my insulin pump or my blood glucose meter or the holes in my fingers or the numbers streaming through my head. 

So I will line up at that start line in July with 34,999 others beside me, and I will know we are all athletes with special needs.  I’ll just be the special one with extra sugar in my pocket and a great friend next to me.

The Man I Ran Behind

April 24th, 2010

Today’s post is dedicated to a certain WILD woman who embarks on her first marathon this weekend.  I hope you enjoy it as much as I enjoyed mine, Mari!

I received a true gift when I ran my first marathon in January 2010 at Walt Disney World.  I don’t know my gift’s name but a part of me loves him.

I think I first saw him about 5 miles into my 26.2 that day.  He was outrageously tall; he easily beat me by 14 inches (making him 6’4” at least).  His gait was rather lopsided, which made for a blessed break in the rhythmic monotony that is distance running.

His gait was lopsided because he had only one foot.

One knee.

One leg.

And one prosthetic “Cheetah” leg.

And I was running behind him.

The entire rest of the way.

He stopped every few miles to unscrew his Cheetah and wipe off.  I stopped every few miles to check my blood glucose.

Yet we stayed in tandem, occasionally leapfrogging in front of one another for the next three and a half hours.

I’m fairly certain that my gift doesn’t know I ran that day. I’m fairly certain he didn’t see me or notice me.  I’m fairly certain he would not have cared if he had seen me, even if he had seen me stop and check my blood glucose.

But because of him, I felt certain the marathon was no longer a challenge for me.  I knew that he was doing something that others could see required a mental and physical journey, one he (I hope) considered himself fortunate to experience.

Just like me.

I never once felt sorry for him.  I never once felt sorry for myself.  I knew that other runners might have looked at him and said “what an inspiration” and “how amazing” but I didn’t really get that from him.  I got that he was working on a goal that he wanted to accomplish; one that would take him inside himself and one that would only re-affirm what he already knew about himself and his own strength.

Kinda like me.

So when I think about my marathon, I think about the gift I received that day when I found myself next to a man with one leg.  I know everyone was watching him as he ran.  I am fairly sure no one saw my insulin pump on my hip as I ran, or what it means.  I know people who saw him probably thanked their stars they had both legs they were born with.

I wonder if anyone thought about their beta cells.

But that’s what was so amazing about the marathon—everyone out there that day had to work to be there.  Everyone had to take a lot of time inside themselves if they wanted to get through.  Everyone had challenges that they probably wished they could trade away, and challenges they would never wish to face.

I have never once wished to trade away my diabetes.  I know that with any challenge that I will inevitably come across, I will deal with it and, with work, continue to thrive.  Legs, pancreases, blisters, ripped shorts, they are all just things.  The true test of success in a marathon is what happens inside yourself as you keep going and watch yourself succeed.

What a gift that man gave me that day.

What a gift I gave myself.

What is Physical Fitness, Anyway?

April 23rd, 2010

Yes, I want to be physically fit.  But what does that mean? 

Does it mean I can do a certain number of straight leg pushups, or run a mile in a certain amount of time?  Does it mean I can lift a certain amount of weight?

Sure, that’s how you can measure fitness in a controlled environment, but who lives there?!  Not me. 

So what is physical fitness?

To me, physical fitness is a couple of things.  It is having a knowledge of and confidence in my body that it will most often respond to a physical stress in a way I expect it to respond.  Fitness is making choices every day to keep myself moving without pain and with as much energy as possible.

My goal of being physically fit continues to motivate me even when I’m not wearing my running shoes.  My aspirations of physical fitness manifest themselves whenever I park far away from the door and when I take the stairs instead of the elevator.  It’s when I shake someone’s hand with a hearty grip and when I maintain good posture as I sit, stand, and move.  It is when I spend a long time in the produce section and when I drink plain water all day long.

Physical fitness also means listening to what my body tells me.  It means some days, I take it easy and some days I push it.  It means some days I skip the run and opt for a lower impact workout.  It even means some days I don’t do a thing.

It has taken me a long time to figure out how to make these changes a part of my life.  I have figured out ways to make exercise a daily part of my routine and how to get some dedicated exercise in when I don’t think I have the time.  I have figured out how to forgive myself for those days I really don’t have the time—there will be a new chance to work on it tomorrow. 

As long as I keep my goal of physical fitness in my sights, I can relax more about my exercise routine.  I know I won’t abandon it for long.

The more often I make these choices and opt for physical fitness with little, routine things the easier the choices become.  The more often I challenge myself when I can and push my own limits, amazingly enough, the limits evaporate as though they never really existed.

When you put it that way, who wouldn’t want to be fit?

Doctor versus Patient

April 22nd, 2010

I went to a talk last night given by a type 1 psychologist (you may have read my earlier post stealing from an article about her).  She gave me some things to think about in an interesting new light.

I liked hearing from her “therapist” point of view, as opposed to my “attorney” point of view.  We very much agreed, but my spin is a bit different than hers.  We agree that there are too many factors outside of anyone’s control that affect blood glucose levels to give patients the blanket instruction of “control your diabetes.”  (Dr. Bernstein calls the various factors and how they can affect blood glucose “inevitable imbalances”.  I’m planning to use that term; I like it!)

Given these inevitable imbalances of factors affecting blood glucose, Dr. Bernstein wants doctors to assure their patients they are not at fault when their blood glucose levels do not fit in range all the time. 

Knowing that “success” in this endeavor must be re-defined as something much much looser than 100% of my time in range, I want doctors to help me figure out what factors do what, when, so that I can plan accordingly and try, essentially, to outsmart the factors as often as possible. 

For her, a visit to a doctor is a chance for a virtual hug.  For me, it’s a chance to learn more about the game and to modify my strategy.

Interestingly, Dr. Bernstein asserted that people in Western culture fundamentally do not deal with mortality or suffering, and western medicine is designed to fix physical ailments and eliminate suffering.   

Living with diabetes involves recognition of our own mortality and daily dealings with our body means tricking it into staying alive with insulin injections.  This leads a person living with diabetes to a different psychological place than where a doctor usually meets her patient.

A doctor went to medical school I expect because they wanted to heal or fix patients with physical ailments.  But you can’t heal or fix diabetes.  You can’t even control blood glucose levels!  So in order for a doctor to approach a patient with diabetes with compassion, she must first acknowledge that diabetes can never be about achieving control or fixing or alleviating suffering.  Type 1 diabetes is most basically about an effort to stay alive with the use of insulin, precisely timed and precisely planned in an incredibly imprecise environment.

Whatever support a patient needs as they struggle with the inevitable imbalances and imprecision, I believe a doctor thinking that success with diabetes just takes the patient doing something differently will always fail

Diabetes is about doing your best, knowing as much as you can, thinking as much as you can about what you do, doing it intelligently, letting the rest happen, and always making sure the person with diabetes knows that they are not alone with their struggles and that there is no blame involved in a glucose reading.  We have enough going on to inflict any blame on ourselves–we have a body to take care of!

Here’s to the work you do every moment of every day.  Here’s to you.

In Order to Quiet your Fears, Look Critically and Directly at Them

April 21st, 2010

We all know that living with diabetes is a load of work for each of us.  And how we handle that load affects how much work we will have to endure later with any complications of our disease. 

I, for one, I spent the first 10 years of my life with diabetes with an A1c between 10 and 13.   Not great, and my body felt the effects of my constant attempt to avoid dealing with my disease.  When I first found an environment that allowed me to face my fears of living with diabetes and showed me ways to live with the disease and stay myself, I came home with an A1c of 6.9, and have stayed between 7.0 and 7.5 since (with a brief stay at 7.8 while taking the California bar exam… can anyone say “stress”?!).  While training for my marathon last January I had my lowest result of 6.7 (not sure if that was the training or a switch to Apidra; time will tell).

I am of course afraid of potential complications of diabetes.  But for me, a vague term like “complications” is scary just on its own. 

So what complication in particular scares me the most?  I’m not sure.  I think a heart attack scares me the most; I am afraid of realizing I am having a heart attack and what that may do to the people I love.  Going blind doesn’t scare me; I don’t really think that’s a likely complication given my overall lifetime treatment of my diabetes.  Losing a limb is hard for me to comprehend for the same reason.  (I always have to laugh when a doctor asks if I can feel a sensation as they check my feet; I am too busy giggling to answer because they are tickling me!!) 

It’s all so vague, all this talk of “complications” when I was diagnosed at ten and am thirty two years old and fitter and stronger than ever.  It is simply too hard for me to comprehend.

And yet, I’m still afraid of “complications”.  They just sound scary, even when they aren’t guaranteed and aren’t even identified as they potentially apply to me.

So I do what I can to address the complications I am afraid of.  I don’t waste my time denying they are possible.  I look at them, head on, and ask myself: (1) how realistic is it that this complication in particular will affect me (2) what do I need to do now to lessen the likelihood that the complication will affect me.  Then, once I’ve figured that out, I put my fears away on a shelf.  They’re there, but as long as I am doing what I can, in a way I can manage right now today, I rest assured that I will not passively meet any complication ahead of me.

Just like monsters under the bed.  Turn on the light, look, and they disappear from your fears.  You have that power.

Boogah boogah.

I am low, I ate all my low food already and I’m 2 miles from my car

April 20th, 2010

I debated telling you this story.  It makes me look a little less than smart.  Then I remembered you might learn from my experience—you might learn that you aren’t alone—and that is what I want for you, so here it goes. 

I went for a run on Friday after work.  I had spent the afternoon high, so I knew I still had some insulin still swimming around in my body that would make me go low if I ran without modifying my plan.  So I started a temporary basal about 45 minutes before I thought I was going to start running, and I had a bar with 16 grams of carbohydrate.  The combination of all of this should have meant I had about the right amount of everything (energy, active insulin, carbohydrates) for the run.

Now, this is one of the hardest runs I do.  I run about a mile uphill and then start a four mile loop that has about 6 of the most heinous hills in the area before returning to my car, parked a mile from the loop.  I hate it, but it’s good for me.  (I am running a trail 10k in May and need to prepare myself for those hills!)  I also had plans for a pizza dinner when I got done.  Pizza is a food I always enjoy that much more if I feel I have earned it. 

I should also say that there are a zillion walkers and runners out on the loop.  Knowing that I will not be alone affects how I plan and how I pack for my runs.  On this run, knowing I was high before and knowing I had just eaten, I brought a bag of sport beans (24 grams), my car key and my phone.  (I didn’t even have my Garmin Forerunner with me—this was bare bones running!)

I was about 4.5 miles into the run and I thought about eating my sport beans.  Generally, if I find myself thinking “maybe I should eat”, I know from my years of checking while running that I absolutely should eat.  Where is the down side if I’m wrong?  Not that I am wrong often—running is a big glucose-lowering activity for me.

I should also mention that during the first 30 minutes of the run my CGM stopped working.  Usually, I can’t count on my CGM to be at all accurate for me while I run, but it still makes me feel better to have it.  I later discovered that I had dislodged the transmitter from the sensor when changing into my running shorts, but I didn’t know that while I was running and the little guy was alarming like crazy.

So here I am, out on this crazy hard course, my CGM is out of commission, I’ve worked all day and am just trying to get in a good hard run to round out a not-great work week, and I have the thought that maybe I should eat.


I had one more hill after that one, so I ate a few sport beans and kept going.  As I went up the final hill, though, I was still wondering if I had had enough beans.  That’s it; game over.  I’m still wondering, that’s enough.  EAT.

Eat and walk.  Great; that was so not my plan for the run nor was it the workout my psyche needed!!  Sigh.  Oh well, I got in a good 50 minutes of running and I was sweaty.  I guess diabetes wins this round.

There is a little guard hut at the bottom of the loop, and I thought about stopping there and asking the guard if he had any sugar in his hut.  I knew from my experience that my beans would bring me up if I gave them a chance, though, so I skipped the question and kept walking to my car. 

I did call my husband and tell him what was going on and where I was and how I was getting to my car.  (I hate to think how he would feel if someone else called him to let him know his wife had collapsed.  I hate to think how he would feel if I disappeared someday and he would have to look for me.  These are reasons I always let him know where I plan to run.)

He was incredibly sweet and offered to stay on the phone with me as I walked back to my car (taking a shorter route back).  It was a nice chance to chat with him and to see a different route; I ended up walking alongside a creek and you would not have believed the croaking frogs!!  They were so loud my husband asked me if he had just heard frogs through my phone chatter.  When I was at my car, I checked and was 60 so I had some juice. 

I don’t have a moral for this story.  I’m just saying: we do the best we can, we make the best choices we can make, and sometimes we win and sometimes diabetes wins.  I feel lucky and strong to know that I win way more often than my diabetes does.

Although, I’m considering giving the guard hut a pack of glucose tabs to keep in there.