Archive for October, 2010

Doctors and Motivation

October 29th, 2010

I got a notice from the ADA the other day that someone did a study to see how weight loss changed based on how medical advice/recommendations was offered by physicians. 

Gee, go figure: cajoling‚ coaxing‚ scolding‚ and reproach have all been found ineffective [for weight loss].

It’s almost like some of the physicians had never tried to get anyone to do anything in their lives!  If you’ve ever even babysat you know that people don’t respond well to scolding or reproach.  (I’m sure some bosses at all sorts of jobs could stand to learn the same thing.)

The study found that the more effective method of counseling was what they called “motivational interviewing.”  Motivational interviewing enlists patients’ own desire for change‚ emphasizing that change cannot come from the doctor‚ but places doctor and patient in a collaborative effort. The study‚ published in the October issue of The American Journal of Preventive Medicine, noted that motivational interviewing has already been found effective for reducing alcohol use and smoking‚ and could hold promise in weight loss. 

I wonder how many doctors have thought about some of this; I’m sure quite a few have.  I hope everyone who is reading this blog finds a doctor who thinks about and uses motivational interviewing.

It’s worth it.  YOU are worth it!

Walking for Exercise

October 28th, 2010

I sometimes think you would like to read a blog entirely about my diabetic life.  And then I think, I don’t really HAVE a diabetic life… I have MY life!  So just like my life, my posts have a lot to do with diabetes but they have a lot to do with other things, too, like exercise and how I think physical movement and exercise impact my diabetes and the rest of my life.  And how having diabetes affects my thinking.  And on and on and on!

I ran an errand on my way home from bootcamp this morning and passed by the high school after the students had started class.  This meant I drove past the track as the students were in P.E.


Now, I know for a fact that not all high schoolers like physical activity.  I know for a fact that not all high schoolers like, um, well, ANYTHING. 

But they DESERVE something more than a saunter in circles for their P.E. class: yikes.

And not one of them looked or acted like their heart rates were elevated.  At all.

Not one.

This is what concerns me about telling people to take a walk.  “Walk” can simply mean almost anything to anyone, so let’s lay some ground rules for walking.

  1. Walking at any speed is preferable for our health to most other modes of transportation.
  2. Walking for transportation is different than walking for exercise.
  3. One cannot walk for exercise AND hold a cup of coffee.  (Sorry.)
  4. One should sweat and be out of breath during and after walking for exercise.
  5. One cannot walk for exercise AND hold a cell phone.  (Still sorry.)
  6. I’ve seen friends walk for exercise and it turns into a stroll-and-chat.  Good, but not the “moderate exercise” so recommended for everyone’s health.  If you are going to walk for exercise with a friend or family member, speak together before you go out and discuss the goals: is it to walk quickly and raise your heart rate and keep it elevated, or is it a stroll-and-chat?  You will slow down if you aren’t both on the same page.
  7. One cannot walk for exercise AND carry a shopping bag.  (Sorry again.)
  8. Walking for exercise is free.
  9. Walking for exercise can be performed in almost any weather.  (Really.)
  10. Walking for exercise gets you outside in the fresh air.
  11. Walking for exercise is easy to do.  Just… walk.

So what are we waiting for??

It’s Lower-Carb Than “An Apple A Day!

October 27th, 2010

I used to get sick all the time.  When I was in school, I’d have a cold several times per year!  When I was in high school and even college, I was okay with missing a day or two (sometimes up to a week) but as I grew up and had more responsibilities getting sick became more and more of an inconvenience.

Not only that, I didn’t feel good!

But now I can count on one hand the number of times I’ve been sick in the last six years. 

Pretty cool.

I guess my immune system is doing its job fairly well!  I credit my exercise habit for the positive change.

Since I have been fairly active for years and exercise 5-6 days per week, I can credit my healthy immune system because of the fact that during moderate exercise immune cells circulate through the body more quickly and are better able to kill bacteria and viruses.


But just like nearly everything, moderation is key.  Exercise is fabulous for warding off sickness, but overdoing it can cause the opposite effect. 

Cortisol and adrenaline, known as the stress hormones, raise blood pressure and cholesterol levels and suppress the immune system. This effect has been linked to the increased susceptibility to infection in endurance athletes after extreme exercise (such as marathon running or Ironman-distance triathlon training).

I do need to keep in mind that with the marathon coming up on Sunday I need to pay extra attention to my recovery after the several-hour event. 

After several months of training and slowly increasing mileage and hours running, this Sunday’s event will culminate in 26.2 miles run in hopefully less than 5 hours.  This mental cut-off is only a time I set for myself; if something goes wrong, I’ll need to change the plan.  One thing I’ve most definitely trained is my ability to be flexible as I run: I never know how I’ll feel that day, what my numbers will do, what the weather will do, how my mind will be.  I’ve trained and learned as much as possible to be adaptable in as many circumstances as I can; time will tell how that goes!

For me, this means I get to take it easy after I cross that finish line.  I don’t have plans for Sunday evening other than lying horizontal and having my husband man the Halloween door.  I’m not sure I’ll be up for the constant flow of trick or treaters!   

Maybe I’ll get a massage, too.  I’ll be trying to avoid getting sick, you know… ;)

Vision Training

October 26th, 2010

With the World Series about to start, I have decked myself out in SF Giants orange and black.  I have orange nail polish on, and orange and black tights ready to wear tomorrow.  My husband has planned which nights we’re going to the neighborhood hot dog stand to grab a dog before we watch the game.

Which is to say, I’m getting excited. 

I have had a less than fond relationship with baseball for several years because rather than being a football widow, I am a baseball widow.  (Do you know how many baseball games there are each year??) 

But, after twelve years, I’ve begun to take more interest in the game.  I’ve started watching more games on TV.  I have favorite players. 

(I still read a book while the game is on, but at least I’m on the same couch.)

But when the Giants games changed to being broadcast on Fox, I was unnerved.  It wasn’t my favorite announcers.  The same graphics weren’t on the screen.  Everything was different!  I hate change!

But one Fox graphic is pretty cool.  I’m sure it isn’t just Fox that uses it, but the graphic that shows where each pitch went is pretty cool.

Since I still can’t watch quickly enough to tell most balls from most strikes.

So what I should do, if I’m interested in being able to distinguish one from another at the blazing speeds at which those baseballs fly, is to train my vision.

Sports vision is a growing field that could have an impact on how we play and move.  Vision training includes visual exercises designed to help athletes improve vision speed, depth perception and peripheral vision; develop proper eye posture; track objects; and improve focus.   Basically, vision training works to improve the eye-brain connection.



Now, sports vision is supposed to help most in dynamic sports that require a high level of visual dexterity and spatial orientation.  (Think outfielders.)  This includes baseball, football, basketball, skiing, tennis, auto racing, and golf. 

Not long distance running.

So there are a number of ways that I could train my vision, if I wanted to.  (I bet it’d make me a more confident nighttime driver, too.)  I could juggle tennis balls with numbers written on them, and call out the numbers as I juggle.  I could have someone stand 4 feet away and gently toss playing cards in my direction and try to call out the suit and catch the card simultaneously.  I could get a soccer ball and write different letters on the white spots and work on heading the ball as I say the letter.

Seriously; there are a million ways to train my vision.

For now, I’ll work on listing all the ways I could do it; I don’t think I’m ready to start trying to head a soccer ball anytime soon.

Those World Series players don’t seem quite so overpaid when I think about their abilities to do some of these drills…


(Thanks to the ACE FitnessMatters May/June 2006 issue for the interesting article on Sports Vision!)

Get Outside Your Boxes!!

October 25th, 2010

I looked at the article about the causes of diabetes I found in the October issue of Diabetes Forecast.  I didn’t want to sit and read the whole article, because I don’t want to get caught up in the “why” at this point… the help I think I need  these days is more of the “how” than “why”.  At least for now.

I read one paragraph that was about causes for type 2 and a few paragraphs about type 1.  The type 2 paragraph caught my eye:

Finally, modern society should probably shoulder at least some of the blame for the type 2 diabetes epidemic.  Access to cheap, calorie-laden foods may even influence type 2 risk beyond simply their effects on body weight; the stuff that is in processed foods, like high-fructose corn syrup, could alter the body’s chemistry or gut microbes in a way that affects health.  Add to that the fact that most Americans are sedentary, spending their time sitting in cubicles, driving in cars, playing video games, or watching television.    The lack of exercise, plus the abundance of unhealthy foods, cultivates a fertile breeding ground for diabetes.

I think that if I had written this article, I maybe wouldn’t say “finally”… I think modern society has stacked the deck against healthy living in a lot of ways!

It reminded me of a trainer I worked out with at a fitness convention once: she said we are all about BOXES these days.  We lie on a box, stand up, shower in a box, sit at a box and read a box while we eat, get into a box, drive in our box to sit at another box and stare at a computer box for hours before we climb back into the box, drive to our big box and sit on a box and stare at a box before we go lie down on our box for the night.

A little sad when one thinks about it.

I’m glad I can eliminate a couple of my boxes, or at least minimize my box time.  I’m glad I am outside for 2-3 hours every day, and more when I run outside.  I’m thrilled when I have time to walk to the grocery store instead of driving there. 

Of course, I’m staring at a box right now and typing on more boxes, but aside from that, I’m about to go for a run.  Outside a box.

Maybe I’ll see the sidewalk squares a bit differently today.  ;)

Enjoy the time you spend outside the box!!

Cheesey Popcorn

October 22nd, 2010

This one is neither here nor there but it’s the kind of thing I think people with diabetes understand and maybe medical professionals and people who live with people with diabetes may not quite “get” so I’ll write about it.

First step: I know this is not textbook diabetes management.  I can’t say I’ve ever really been one to think textbook diabetes management is possible for the life I lead, so this is not surprising.  Please do what works for you and don’t think I’m recommending any of this for anyone.  Just recording my own experience.

Second step: I do my best, and this is an example of me doing my best.

Third step: here’s the story:

I went to a 10 am meeting this morning with my husband.  Prior to the meeting I had a bagel for breakfast and a latte.  That is unusual; usually I have tea and oatmeal.  So today’s breakfast was a heavy carb load.  (Someone asked me if I could eat bagels… uh, yeah.  I just usually don’t choose to because of the carb count and the way they hit my blood stream is somewhat difficult to manage so I treat them as a treat.  But since my marathon is in omg nine days, I decided a bagel was what I wanted for breakfast this morning.  Nine days before a marathon, I eat what I want.  I’ll use it somehow!)

I thought the 10 am meeting would last an hour, but it went two hours instead.  I got home at 12:30.  I had checked at 11 during the meeting and made a minor correction for a high, but no big deal. 

I was ravenous when I got home.  Truly, starving. 

So I grabbed a bag of cheesey popcorn I had been saving for a post-run treat and started in on the bag.  I was a few handfuls in when I realized maybe I was low.  I couldn’t really think of a good reason to be so hungry!  (For the record, cheesey popcorn has carbohydrates but it isn’t a great treatment for low blood sugar because it is not quickly metabolized- the fat and fiber slow down absorption- unlike juice or candy that can get into the bloodstream relatively quickly.)

Yet I was sitting there, stuffing my face and getting my fingers cheesey, thinking as long as I didn’t bolus I wouldn’t do much damage if I was indeed low.  If I wasn’t low, I’d bolus later when I got up and found my meter.   (This is the part I imagine parents of type one kids may question.)

So I kept sitting and stuffing for a little while, and didn’t get up and find my meter or really do anything.  A good textbook diabetic  would I am sure get up, check, treat with juice or glucose tabs if low, or bolus if high and bolus for the popcorn carbs.

But I’m not always that textbook diabetic.  Today, I didn’t have on a CGM or anything to help me figure out if I was low or I was simply hungry as a result of the simple carbs I ate for breakfast.   So I ate and sat.

I thought about writing my blog right then, but facebook distracted me.  (Well, facebook and Angry Birds.)  I only got up when my phone battery started to drain and I needed to charge it.

That’s when I found my meter and checked: 115.  So I probably was low, but maybe the popcorn hasn’t hit yet.  I’m not sure.

Sometimes, that’s okay.  I’ll check again soon and bolus if I’m heading higher or eat more if I’m heading lower.  Because that’s what I do.

Me, the non-textbook yet real life diabetic. 

(And the soon to be Angry Birds Champion of My Couch, as soon as I can get my husband to leave the couch since he’s really good at the game.)

JDRF isn’t for me

October 21st, 2010

On my facebook pages, an ad for the JDRF comes up all the time.  Seeing the ad makes me want to smack it.

Type 1 diabetes is a chronic, debilitating disease affecting every organ system that can strike suddenly. Are you T1D Aware?


Well, yes, I would say that I am T1D aware.  And given my experience, type one did not strike suddenly—it made me pretty darn sick for a long time before I was diagnosed.  (I see my school picture from fifth grade, taken in September, and I don’t look like myself in any of the other years.  I wasn’t diagnosed until March.  That isn’t sudden.)

Chronic, yes.  Unending, yes.  It’s my life.

Debilitating?  DEBILITATING?!  (I’ll get back to this one after I count to 10 and take some deep breaths.)

Affecting every organ system?  Yeah, can’t help that.  Every part of my body is connected to every other part.  I’ve got a major flaw since I have no beta cells to monitor the glucose in my body.

So this is one of the reasons I’m not a big supporter of the JDRF.  For one, I think the need to find a cure is too easy for people to focus on rather than learning to deal with their disease, or their child’s disease.  (How happy with yourself and at peace can you really truly be if you are always asking for a cure to take away your diabetes?  What are you teaching your child when you walk for a cure?  Most likely, they don’t need a cure as much as they need your support and acceptance of their disease RIGHT NOW.)

This other reason comes back to the “debilitating” portrayal of type one diabetes.  Seriously; a foundation built upon the notion of supporting people living with type one diabetes is the one out there using the term “debilitating” and all the connotations of weakness or “less than” that goes with it simply misses the mark entirely for me.

I don’t need a cure.  I don’t need to be associated with an organization that refers to my diabetes as something that debilitates me.  I don’t think my diabetes de-anythings me!  I understand they are trying to play up a sympathy card with these dramatic words and dramatic imagery, but it offends me.

JDRF, take a good look at the type ones around living and loving and learning and really embracing their lives.  Take a good look at ME. 

I guess I really should say: enjoy the taste of my dust.

What to do with a nonresponsive pump company?

October 20th, 2010

 (Got this question on facebook yesterday and decided I had enough to say in response I might as well blog about it.  Thanks for asking, and I hope something here helps you out somehow!!)

What do you do when your insulin pump company fails you and won’t send you supplies?

My first reaction when I read this question was to question “How does a pump company fail anyone?  What promises does someone think they made to you?”

But I do recognize that I have been disappointed in MiniMed for several years; after Medtronic purchased MiniMed I felt their service levels changed.  I now spend a minimum of 30 minutes on hold before I can speak to anyone.  That disappoints and frustrates me.

And that wasn’t really the question.  Seems to me the question was based on a current crisis.  Even if it isn’t a real crisis (maybe you still have 3 weeks of supplies), it most assuredly feels like a crisis!  I do hate that—as if we don’t have enough to think about, we spend time worrying if we will get our supplies in time.

But really, a pump company will hold up supplies usually for two reasons.  One, there is a problem with your prescription for supplies.  Perhaps it was unclear, perhaps it expired.  Either way, they won’t send you a thing until your doctor okays it.  Two, there is a problem with your account.  Maybe they missed recording your last payment, maybe your insurance changed, or maybe there is some wacky hold on there for some reason.

But the bottom line is you need to take care of this as soon as possible.  If that means calling from work, that’s what it means.  If it means calling your doctor’s office and asking them to call the pump company to straighten out what they need, that’s what it means.  It simply will not get resolved without your repeated efforts to get a response from the pump company.

And yes, this is one of those things that just completely bugs me about having diabetes.  Seriously.  We all deal every day with everything we EAT, everything we DO, everything we THINK ABOUT, and we pause our lives several times a day to check our blood sugar levels.  And this is what bugs me: having to stay on top of the administration of my disease. 

But that’s the truth: no one else is going to care as much about your own health as you do.  No one else is going to stay awake worrying if you will get your supplies on time or not.  (I imagine they are busy worrying about their own health.)  So it really is up to you to take care of the administrative side of your disease.  (Maybe a spouse can help, but even that can get complicated these days with HIPAA.) 

My suggestion and response, then, is to 1) recognize that the pump company is a company and not someone who owes you anything or can fail you on a personal level; 2) recognize that any problem you face with getting your supplies probably has a simple root hidden amidst the tangled mess you see now, and 3) recognize that no one else has the same motivation you have to get resolution.  Ask for help from your doctor’s office; ask for help from the customer service people at the pump company; ask for help from anyone you can think of! 

Good luck getting a resolution and more importantly, getting the supplies you need!

Mix Things Up! The More the Better

October 19th, 2010

Yet another study has found that the more different types of activities you do, the better your results. 

The most recent announcement  from the ADA deals with Type 2 Adults who were separated into four different exercise groups and their A1cs were monitored.  Go figure: the group that combined aerobic exercise and weight training had a better result than the groups that did only one type of exercise.

I have seen much better results in exercisers who use both aerobic and resistance training; what has been your experience?

Adults with type 2 diabetes who participate in aerobic exercise can experience improvements in HbA1c levels‚ body composition‚ and overall fitness.

The best improvements can be observed when the exercise involves a combination of aerobic and resistance training‚ according to the HART–D study‚ which included 262 men and women with type 2 diabetes. Researchers randomly assigned participants to one of four exercise regimens: supervised aerobic training only; supervised resistance training only; supervised aerobic plus resistance training; or self–directed exercise‚ which was the control group. In each exercise program‚ participants completed at least 150 minutes of training per week‚ with the researchers observing the effects of each training program for nine months. Participants assigned to aerobic plus resistance training experienced a 0.20 percent improvement in HbA1c‚ and those assigned to aerobic training alone experienced a 0.16 percent improvement‚ compared with a 0.24 percent increase in the control group. The resistance–training group experienced a nonsignificant improvement of 0.08 percent. Fat mass was significantly reduced by 0.6 kg to 1.4 kg‚ and waist circumference reduced by 1.7 cm to 2.5 cm in each exercise group when compared with the control group. The findings were presented at the Obesity Society 2010 28th Annual Scientific Meeting in San Diego.

Endocrine Today (10/12/10)

What Can A Family Do?

October 18th, 2010

I’ve been reading comments about various things I’ve posted on Facebook and I’ve seen a theme among some people: they wish their family did something or didn’t do something or helped in some way, and they are frustrated by their family’s response to their disease.

I can understand that.

I always kind of assume my family knows what I think about when it comes to food.  I learned the hard way how wrong that assumption was when I sat down to a family meal a few years ago and asked my mom how much sugar she had put into some dish.  She told me and I calculated the appropriate bolus.

Ten minutes later, I took my first bite and turned to her and asked her the question again.  I pressed and said “real sugar?” and she then said “yes, well, Splenda!”


I have a number of these same types of stories and I’m sure you do too.  It does seem to weaken my trust in my immediate family members when I realize they just don’t even think about what I have to think about all the time every day. 

But on the other side, I’m not sure they need to think about all of the ins and outs.  I already need to think about my disease continually in order to preserve my own health; I’m not sure why I should need them to do it as well.   

I’ve used each of these surprises with each person as an opportunity to teach my family members what they missed—was it that I can’t be without my insulin pump for more than 30-45 minutes?  Or that I need to know accurate carbohydrate counts so that I cover the carbs with my insulin?  Or that I can’t take a surprise hike after dinner to an unknown destination up a hill 4 miles away with only 5 glucose tabs? 

Does it mean having to explain to a family member that the comfort you once found in cookies now carries a heavy burden instead of the comfort they intended to offer?  Does it mean you have to teach them about what happens to your body when you have a high blood sugar, or a low blood sugar?  Does it mean they need to learn from you how you want them to treat you, all over again?

It most assuredly does.

You are in charge of your diabetes.  You are in charge of how you see your disease, and how you see yourself with it.  You are in charge of how you handle yourself when it comes to your family’s reaction to your disease. 

Are you going to stay quiet, internalize and complain later?  Forever?  Are you going to get through whatever crisis it is, and come back the next time with a different attitude to explain what it felt like when they didn’t recognize your constant fight with your blood sugar levels?  Does it mean you invite them to your next doctor’s appointment so they can hear what you hear every few months?

Maybe so.  Because I promise you they are never going to understand if you don’t take the time to explain.  And explain.  And explain again.  They already love you and want to support you as best they can, so what do you have to lose?