Archive for May, 2010

Planning, Doing, and 500 miles

May 17th, 2010

I looked at a tag when I was doing laundry this weekend and saw “Just Do It.”  What a slogan.  I guess I’ve been looking at slogans lately because I saw a new variation on another old one the other day: “got milk?” and remembered the Bearskin Meadow Camp shirt “got insulin?” I love it.

Anyway, back to my point: Just do it.

I think hundreds of thousands of athletes identified with that slogan when it first began, and continue to identify with that slogan.

Planning is important.  But planning is safe.  Nothing happens when you’re in planning stage.  Planning is paper and pen.  Doing is movement and progress. 

So plan a little, and get going.

EACH IS CRITICAL.  Don’t get me wrong; without a plan you can end up running around like a chicken with your head cut off and only exhaust yourself with no result.  Just don’t keep thinking about doing something, and then think about it again and again and again.

Instead, get up and go do it.  Start putting your plan into action.

Don’t let anything stop you once you’ve begun.  Tie your laces before you go.  Double knot them.  Go to the bathroom.  Check your blood glucose.  Take food.

When you show up, be ready to start.  Don’t take time to outline in detail all of your aches and pains, or things you’re worried about.  Monitor yourself, be smart and be conscious of your body.  Just don’t spend all of your time in that mental space.

Free your mind from all unnecessary noise. 

Just do it.


Now, About Those 500 Miles…

I have been invited to run with Team Iron Andy and Run the Coast this fall!  Check them out on FaceBook at Run The Coast and become a fan! 

I will spend a couple days with the team and run a portion of the 500 mile course from the Golden Gate Bridge down to San Diego over fourteen days.    I’ll need some help, though: the Dean Karnazes Silicon Valley Marathon is October 31st and I want as many folks as possible to join me on either the full marathon or the half marathon!  We can work together to design a plan for you to make the distance you desire, be it running or run/walking.  Everyone can do this, as there are kids events as well on the same day.  More details to follow, but for now, think about it, make a commitment to yourself, and clear your calendar!!

FUEL your workouts!

May 14th, 2010

I have been there; the I’m-trying-to-lose-weight-so-I-need-to-eat-less-and-that-includes-when-I-exercise place.

But here’s the thing. Kind of like “fake it til you make it” you MUST eat if you want to really burn your calories when you exercise

You need to BURN while you exercise—that means sweaty effort—if you want to see changes in your body.    Study after study has shown that if you are hungry or do not have food in your system when you exercise, your perceived exertion is much higher and your effort output is diminished compared to when you exercise when properly fueled. 

Calories in, calories out is true.  You need to get those calories OUT, though, and the only way to do that is to exercise at an intense level.  The only way to reach that level is through proper fuel IN.

Because you want to get the most out of your exercise time as you can, if you aren’t properly fueled you are in a sense wasting your time because you just can’t bring a good level of energy to the session when you haven’t eaten.

Nature being what it is, you need to eat properly as much of the time as possible.  Know that I am not preaching here, and I understand.  (My greatest weaknesses are nachos and Cheez-its.)  But no one champions over adversity on a breakfast of Cheez-its.

So do your best to eat right (fruits, vegetables, lean protein, whole grains) as often as possible.  Try to stop eating things that come out of boxes. 

And when you eat, think about the calories you consume as fuel rather than as food.  Do you want to run that 3 miles today on a breakfast of Hershey’s kisses or on a bowl of oatmeal with banana slices?  (I assure you, the run will go much MUCH better on the oatmeal.)

Experiment with what works for you and your exercise.  If you roll out of bed and head to the gym, munch on half a banana in the car on the way.  If you exercise after work, snack on a couple crackers with peanut butter in the middle of the afternoon.  You’re shooting for 100-250 calories, 15-30 grams of carbohydrate.

These are the calories that you will put to work when you exercise.  Make sure they are good ones and make sure you reach that sweaty effort in your workouts.

You are worth it.

In need of some Weekend Fun (and yes, today is only Thursday)

May 13th, 2010

I subscribe to several diabetes news feeds.  Sometimes, the headlines make me laugh. 

Using the term “diabetes” in mainstream media nearly always means “type two diabetes”.  A person with type one diabetes can feel wildly overlooked when it comes to the term “diabetes” meaning in fact “type two diabetes”— as type ones, we had no way to prevent our disease from developing and we have no way to help it get any “better” or regrow our pancreatic beta cells or help our bodies work more efficiently. 

Keeping that in mind, you may be able to hear my laughing at some of these headlines about “diabetes”.  Enjoy!

Bran May Reduce Risk of Death from Diabetes 

Women with Type 2 diabetes who eat a diet rich in bran may be less likely to die from heart problems, a new study suggests. Researchers at Harvard Medical School found that women who ate bran-rich diets were 35 percent less likely to die from heart disease, and 28 percent less likely to die from all causes. Bran is full of fiber, vitamins, and minerals, experts say.

(I’d also like to point out that I much prefer the more truthful “death from complications of diabetes” from the more sensationalized “death from diabetes”…)

Overeating Prompts More Weight Gain in Diabetes-Prone People

People who have a family predisposition to Type 2 diabetes may be more likely to gain weight after overeating than those without a family diabetes link.

So you mean if I overeat I’m likely to gain weight??  I’m sure the study itself wasn’t so badly presented, but the headline and abstract are too funny!

No Association between Arsenic Exposure from Drinking and Diabetes Mellitus

I don’t even know how they got to wondering on this one.  Apparently: there is a controversy over the long-term effects of arsenic (As) exposure from drinking water at levels <300 µg/L on the risk of diabetes mellitus.

Who knew.

Surgery ‘Should Be Last Resort for Obese Children’

Health experts report that weight-loss surgery should only be used for the most severely obese of children, and then only with extreme caution and as a last resort.

The terrifying thing about this headline is that even in the most black and white terms possible, some people and parents are missing this message.

One of my favorites:

Diabetes product packaging challenges consumers

This Mayo Clinic RN totally cracked me up with this one.  She’s talking about the insensitivity of manufacturers of glucose meters because the meters are packaged in that hard plastic you can’t open without hurting yourself (like a lot of Costco packages; you need a knife and a set of heavy duty pliers to open that stuff!).  Her concern is “for those people with diabetes who are faced with dexterity issues from aging, peripheral neuropathy or carpel tunnel syndrome, which can occur frequently in individuals with diabetes.”

I read that and thought “she has never been really low and tried to open a Starburst, or a roll of Lifesavers.” 

Now THAT is tricky.

Diabetes: Help or a Hurt?

May 12th, 2010

I wonder how living with diabetes has changed who we are. 

I know several nurses with diabetes, and I wonder if they would be nurses if they had not been diagnosed with type 1 in childhood and seen the ins and outs of medical supplies, bleeding, shots, hospitals, labs, and doctors’ offices. 

I know quite a few attorneys with diabetes and wonder if they would be attorneys had they not been diagnosed as a kid.  Diabetes can make you feel different enough that you feel like you have something to prove, and a legal career is often about proving something to someone else.

I know a number of people who work with others living with diabetes and wonder if they would do the same work with the same passion if they hadn’t been diagnosed with the disease.  Working with kids at summer camp, or working with adults and kids at the city recreation center, or pursuing graduate degrees in disease management and public health all seem to stem from an internal knowledge that the world is a pretty big place and we are lucky to share a corner of it with each other.  I think that internal knowlege stems from my living with diabetes.

I wonder if our inability to escape from our disease has been a help or a hurt. 

I am certain in my life it has been a help.  Living with insulin dependent diabetes has certainly given me discipline, and at a very young age.  Struggling to figure out a way to manage my disease and to stay healthy as well as pursue my law degree has shown me how my hard work can pay off.

Then again, some days my diabetes and my career feels like a heck of a lot of work, just to get to a point I can work even harder.  Not quite what I had hoped for, I admit.

I talk a lot about being able to separate your own identity from your diabetes.  It may seem like I’m being hypocritical since my passion is helping others deal with their diabetes in healthy ways.  I’m certain I wouldn’t have that passion if I didn’t live with diabetes in my life.

I wonder if I would have found such passion elsewhere. 

I guess it doesn’t matter, really, as I cannot turn back the clock, and I don’t want to try to turn it back.  I just think it’s good sometimes to acknowledge that sometimes the hard parts of our lives make us be better humans to ourselves and to each other.

Has your diabetes led you to a specific career, or has it helped you in the career you have?  I’m in a wondering mood today and would love to hear about how your diabetes has affected your path.

Juggling Life With Diabetes

May 11th, 2010

I worry that now I’m becoming too attached to my CGM.  Alright, this one isn’t really a “worry” but just an occasional thought.  At least for now.

I took off my CGM yesterday afternoon because the sensor was kaput.  I didn’t put in a new one since I didn’t want to deal with the timing required of a new sensor and the fact I would need to check in the middle of either dinner out (knowing I wouldn’t hear my pump beeping at me over the restaurant noise) or in the middle of the night.  I hate when my pump wakes me up in the middle of the night, so when I can avoid it, I do. 

Which meant that last night I went to bed with a blood glucose of 159, a correction suggestion of 0.6 units, a bolus suggestion of 0.0 units, and active insulin of 3.5 units.

Ut oh.

I know from recent history that I won’t wake up for a low until I’m really really low, and that will basically ruin my next day because I’ll be extra tired from waking up and from being so low.  For now, I rely on my CGM and dream of my as yet unborn and may-remain-a-dream diabetes dog.

But it’s very difficult for my CGM to alarm when I am low if I don’t have a sensor in and my CGM is in the bathroom, recharging.

So, I lowered my basal for a while and had a little snack, and went to sleep with hope on my mind.

And woke up this morning at 303.

I guess that snack wasn’t so little.  But you know what?  I slept GREAT. 

And sometimes, that is important.   I know I won’t hit my target 100% and I know I need to plan for as much as I can plan for, but after I’ve done that, I just have to let it go.

And that includes when I guess wrong, or eat more than I think I’ve eaten, or when I forget to bolus or when I didn’t see the “active insulin” number on my pump screen. 

This is the kind of thing I mean when I say live your life first.  Do what you need to do and keep your diabetes in its place.  You know you can’t get 100% of your meter readings in range, and you know that you have a lot to juggle.  Sometimes, when one of the things you’re juggling flies away, just take a deep breath first.  Enjoy that one moment and the deep breath and know you need it. 

Then go get it and start juggling again, with a renewed appreciation for the work you do with your diabetes and your life.

You deserve it.

Running Up and Down (Weekend Run Report)

May 10th, 2010

I ran a 10k this weekend.  I need to remember that when I sign up for a run and the word “Hill” is in the title, there will be some uphill running!!  I can get rather excited about an upcoming event that I forget the actual work involved.

It was a neighborhood run relatively near my house with a relatively inexpensive registration fee.  When I say “relatively near” my house, it was in the hills and in a neighborhood the houses are so big they don’t  see their neighbors’ houses and where they can ride their horses in the streets without fear of cars passing by.

A little hoidy toidy.

But, great for a run! 

I have done enough of these runs to never expect them to start on time.  As you know, timing my insulin is critical for me, so I always try to relax about my insulin timing needs when I am at an unfamiliar start line.  On Saturday, I checked at the planned start and was 172; they were about 10 minutes late with the start time.  All in all, a good place to start.

I also need to factor in the first quarter to half mile of the runs; sometimes my insulin needs would be better served if I could run straight out of the gate but the kids, strollers, dogs, and walkers on the course rarely let that happen.  I again need to plan for this and coach myself to relax.

I looked at the elevation map a few days before the run (obviously not before I signed up for the 10k, or I may have instead signed up for the 5k!).  Yes, the 10k map is the one on the bottom, looks like two capital Ms side by side.

I know that running uphill on a trail like this one will always encourage my insulin to work amazingly well, so I really didn’t want to start at any number below 150.  So 172 was perfect.  I had lowered my basal rate an hour before the planned start and had it set to keep on the lower rate for an hour and a half.  If they had started on time, it would have meant I ran the first half on the lower basal rate, and the second half at my normal basal rate.  Usually this works out fairly well for me.

Looking at the elevation map, I knew I needed to get up that hill at mile four, but I would have been running for three miles already when I got there.  Running up or walking up the hill, I knew that was going to take extra energy, so I made sure and ate a few jelly beans after I passed the mile 3 marker, and then I checked again at the top of the mile 4 hill.  162.  Phew.

After that, all I needed to do was finish. 

You may have trouble seeing the crazy treacherous downhill at mile 5, but that one was scary.  They had railroad ties fashioned as steps, but the ground was a little slippery and some people were still trying to run it; that took a lot of concentration to keep myself upright. 

And then again there was ANOTHER hill.  I swear, I must have forgotten as I ran the leisurely downhill three miles at the beginning that I was going to have to pay for that later…

But then I saw the finish line.  Yay!  My parents had done the 5k and I knew I was good when I heard them cheer for me.  :) After I crossed the finish line, I stopped my stopwatch and checked my blood glucose.  95.

Awesome.  Now, onto the important things in life

Where’s breakfast?

(á la Le Chic) REACH OUT!!

May 7th, 2010

Conclusions from a 2009 study of more than 3,500 non-depressed adults living with type one and type two diabetes:  a lower propensity to reach out to others is associated with higher mortality* over 5 years.

The study categorized the subjects into two groups:  Patients with a greater propensity to seek support were classified as having an interactive relationship style and those less inclined to seek support as having an independent relationship style.  

I think the subjects with an interactive relationship style were better able to weather those typical storms we all face as we live our lives with diabetes because we know we aren’t alone, that others face the same storms, and that there are people and tools out there to help.

I feel sad for those with an independent relationship style and who are less inclined to seek support.  Diabetes is not a disease you should try to face alone

If you are a person with an interactive relationship style, maybe you have already joined online groups or attended different diabetes-related functions.  Better yet, maybe you know some other people who also live with diabetes. 

If you are a person with an independent relationship style, use the internet to read about the lives of others living with the disease, or use other more passive ways to get some support for yourself.  Look around the next time you see your doctor and see if there are any brochures of events you can attend.  Even signing up for a few blogs and reading them regularly can help. 

There is something about being able to answer “how are you?” with a blood glucose number and knowing the questioner really understands what that number feels like.  Something powerful and good.  You deserve that feeling in your life on a regular basis.

So what kind of person are you? 

*I hate these studies with conclusions that simply say “higher mortality”—we each have a 1:1 inescapable relationship with mortality.  Upon review of the study abstract, though, it qualifies the “higher mortality” by studying it over a span of five years.  I’m not sure how old the group was, but either way, let’s shoot to extend our mortality out as long as we can!  :)

Sunny Exercise Days Can Help Keep You Active All Year Long!

May 6th, 2010

(I started a new category on the blog today.  I have seen so many studies that have made me wonder how on earth someone is getting paid to study whether or not someone perceives the sky blue on a sunny day that it makes me think I got into the wrong field when I went to law school.  I should have gotten into research!)

Have you noticed you seem a bit happier lately?  Are you excited by the thought of a lazy weekend that includes a picnic at a park?   Do you feel more active when the sun shines?

For myself, I feel better about exercise when the day is longer and drier; I don’t enjoy the thought of running in the dark and cold hours before bootcamp starts at 6am when I know I’ll still be out in the dark and cold hours after the second bootcamp class of my day ends at 8am.  It isn’t that I don’t do the run or the workout, but I assure you I’m not as happy about it!

Researchers conducted a study of how postmenopausal women exercised for 18 months.  They found that the participants worked up more of a sweat during the summer!  (Yeah.  Big surprise.)  They made sure to confirm the increased sweat was not only due to higher temperatures. 

They then put some of the study participants on an exercise regimen of 150 minutes of exercise each week and a healthy diet.  I admit I want you to work out for longer than 30 minutes a day.  You deserve an hour a day, most days.  Work up to what you can do, but don’t think you’re automatically done after half an hour. 

The ones who exercised 150 minutes a week ended up with the elevated activity levels throughout the year, even in the bleak and dreary winter months.  That’s a pretty good result! 

Your goal of physical fitness really should be more than fitness during your exercise routine.  It should be an increase in your overall activity level throughout all areas of your life.

So if you have noticed you are more likely to be more active in the lighter longer days of spring and summer, get into an exercise habit that includes at least 150 minutes of exercise each week.  You may just be able to have some of those summertime feelings all year long!

I know you’re attached to your pump; but are you REALLY attached?

May 5th, 2010

I have now seen my new doctor twice and I’m not sure I will get over this one thing they do at the office.  It’s completely threatening to me.

As soon as I arrive to check in, someone I do not know takes my meter.  (LOL, the woman yesterday asked me if I use a glucometer and I just stared at her, blankly, trying to figure out what she was talking about.  First, what on earth is a “glucometer” and second, WHAT DO YOU THINK I DO, DIABETES DOCTOR’S OFFICE.)

Well, deep breath, that’s okay.  I have a lot of meters.  (I guess I mean: I have a lot of ‘meters.)

So I go through the check in process just fine, they check my weight, temperature and blood pressure, and put me in a room.

But then, OMG, then they take my pump.  And they leave the room.  With my pump.  And I’m not going wherever they are going.  I’m in the room.  Without my pump.

And, if you can’t tell, by now I’ve started to mildly hyperventilate a bit.  Because, um, excuse me?  My pump is not attached to me.  My pump.  Not attached.  To me.  And I don’t know where they’re going with it.  In their (I’m sure not) grubby little hands.

And then they take I am not kidding you FIFTEEN MINUTES to do whatever they’re doing before they come back into the room and return my pump.  And it isn’t like I can check my blood glucose on my meter to see how I’m doing…

…probably wise they checked my blood pressure before they stole my pump.

Yesterday my doctor came in while my pump was wherever it was (missing me, I am sure, while downloading all kinds of information my doctor could review with me).  I almost couldn’t talk to her!  She chuckled and said many of us are like that about our pumps.  She pointed out I disconnect every day when I take a shower.  I brilliantly countered that I still have it in the room when I take a shower.  (By this point my brain may have been a little deprived of oxygen as I was still hyperventilating a little.)

Short story long, then I got my pump and meter back and immediately reconnected and checked and was back in my happy place, so my day could continue.

But I’m not sure that I shouldn’t be bothered by my inability to disconnect from my pump and relax. 

With fast acting insulin, if I need to disconnect for more than 45-60 minutes, I need to take insulin to cover the basal insulin I will miss.  This means swimming and spa treatments (who am I kidding I never swim– I’m only talking about the rare trip to the spa or hot tub or even a long bath) will always include for me a quick reconnect and small bolus. 

Yes, I’m always aware of the clock.  The nice part of pump life is that I don’t need to stay connected to a watch to time my insulin shots, but I do need to be aware of the time I spend away from my pump because that is time without insulin delivery. 

And really, that fifteen minutes had zero effect on my blood glucose.  That isn’t what it was about.  It was about me not attached.  (Did I mention I couldn’t even see my pump??)

So you know what?  I’m going to ease up on myself.  I’m okay with the fact I am more comfortable when my pump is around: it has been an amazing tool for my management of my disease and I have to do more work when it’s not connected to me.  I am going to be okay with the fact that when someone else takes an extension of my body into a different room I’m going to be anxious until I get it back. 

But I don’t think I am ever going to call that thing a “glucometer”.  It’s my meter.  My pretty little currently blue meter. 

I think tomorrow I’ll switch to my purple one.  Maybe my green one, for Spring.

Doctor’s Suggestions and Ideas—What a Help!!

May 4th, 2010

(Have I mentioned recently that I am not a doctor and I cannot give medical advice?  If you see a good idea you want to try, check it out with your doctor first.)


I saw my doctor this morning.  I was nervous.  The past two months have been far from stellar for me, in terms of eating, exercise, and keeping my numbers in range.  And last time I saw my doctor, she had many things for me to change (most of the changes have been great).  Granted it was the first time I saw her, but it was not what I’d call a relaxing visit.

So I was nervous about today.

But today, it was almost like she read my post about doctors—she gave me several tips from other patients that I can actually use!!  Amazing!!

Tip One: when my pump factors in the insulin I have on board already with its “active insulin” calculation, it doesn’t recognize any insulin I took from an Easy Bolus!!  Cripes!  I had no idea.  This will undoubtedly save me from some lows.

Tip Two: she wants me to look at (and respond) my pump at least once an hour.   (I really think I must do this; it feels like I am always checking what time it is and what my pump says!)

Tip Three: If my CGM says I’ve got a single up arrow and I’m bolusing for food, she wants me to increase my bolus by 10%.  If I have double ups, increase the food bolus by 15-20%.  I am to reduce the bolus by the same percentages if the arrows are heading down.  I’m not sure how often I bolus for food and my CGM has arrows, but I’ll try to remember these.

Tip Four: if I eat a high and fast carb, take a shot to get it working quickly and avoid the spike, but simultaneously lower my basal for 2-3 hours to avoid going low.  Hadn’t thought about this one, ever.

I am still amazed how much I don’t know about using my pump to my full advantage. 

Make sure when you see your doctor, you share your experiences with your entire medical team—you never know who your ideas and experiences might help!!