Archive for April, 2011

Meeting Other Diabetics

April 29th, 2011

I am super excited to be a part of the Diabetic Youth Foundation’s Bay Area Walk FUNraiser this weekend.  I am excited not only because I feel good helping such a fantastic organization doing amazing work year-round, but I’m also excited because I get to meet more people just like me who are living with diabetes.

I haven’t always felt that way.

I promise.

I remember going to my first ADA walk with my mom shortly after I was diagnosed.  It wasn’t exciting at all.  I was still trying to figure out what was going on with my own diabetes; I don’t think I spoke with any other person at the event.

I stopped attending a lot of the diabetes-oriented events after that, and after a few “support group” meetings that were nothing but bitter complaint sessions in smelly hospital meeting rooms.

No fun.  At all.

I do know I met another type one when I was in high school; she was pretty normal and she was the first person who told me about wearing an insulin pump.  She also actually liked her doctor—a new idea for me.  We never really socialized since she was older than me, but it somehow made something better for me to know she was out there at my school.

(The only other person I knew with type one went to my grade school and she was very shy and no fun so I never really knew what to do with her.  I knew her before I was diagnosed myself so all I really remember was her sad face when someone had a birthday at school and brought cupcakes to class.)

It wasn’t until I (for some odd reason, considering how I felt about others I had met) signed up to work at the DYF’s Bearskin Meadow Camp that I really had to interact with other type ones—interact with them as PEOPLE, AND as fellow type ones.

I think it was the PEOPLE part that has made all the difference for me.

If you have had the same experience meeting other diabetics that are “just like you” in only one area, but completely not like you in the rest of their non-diabetic lives, then you’re just like I was for the first 10 years I lived with the disease.

Since I have come to learn that everyone living with (at least type one, I can’t speak for type twos on this) diabetes is, in fact, EXACTLY LIKE ME.  Not one of us cares to be defined by the disease.  Each one of us has dreams and hopes and plans that really don’t have one iota to do with what our blood glucose levels decide to be at any given moment.  Not one of us cares to be slowed down by diabetes, and each of us have pretty full lives ASIDE from what we do to care for our bodies.

It’s important to get to know others with diabetes, if only to reinforce for yourself that others out there are just like you and doing what they choose to do, diabetes or not.

Feet & Toes What’s A T1 Girl To Do

April 28th, 2011

One of my biggest healthcare pet peeves is The Foot Issue I have to deal with as a 23 year veteran of life with type one diabetes.

People have been checking my feet for 23 years. 

Every time I want to kick them.

It’s not about my feet!!

I can reach my feet. 

I can physically feel my toes from the outside and from the inside. 

I only have cold toes when I’m standing around in 40 degree weather. 

I’m more ticklish than anyone else I’ve ever met.  I can feel a feather on the tops and on the bottoms of my feet.

Leave my feet alone.

Check instead for whether I have infections at the sites of my pump catheters or continuous glucose monitor sensors. 

Now there’s an idea!!

Ask me if I ever get lumps under the skin from a painful site.  Ask me if I’m using the right catheter for me, and if I’m rotating my sites to prevent buildup of scar tissue

Stop going down your list and LOOK AT ME, the person/patient in front of you.

Listen to what fills my daily life. 

Ask me if I do yoga in bare feet, if you want to check the health of my tootsies. 

BUT, please don’t ask me if I can put on a pair of those Vibram five-finger shoes.  Because the answer to that question, sadly, is: not so much!

I kept putting toe #2 in slot #3 and then I'd get a bunch of toes all squished into one slot. I don't think that's due to my diabetes!

Stop Using Pain As An Excuse to Avoid Exercise!

April 27th, 2011

I hear the “I can’t” excuse sometimes from clients when I ask them to do various moves.  Some of their fear is warranted, and I can understand some of it for a week or two, but there comes a point when the “I can’t” really does sound a lot like “I won’t.” 

I read this today and thought it was so good I wanted to share.  The author is, by the way, an orthopedic surgeon.

Don’t Use Pain As an Excuse

by AOSSM April 20, 2011

By Dr. David Geier, AOSSM

One of the most common reasons patients give for not exercising is an injury or pain. People often use knee or shoulder pain or some other limitation as an excuse for not playing sports or being physically active. And while certainly musculoskeletal injuries can affect participation, rarely should these injuries keep people on the sidelines permanently.

Joint pain is unfortunately a fairly common affliction among the United States population. According to the Centers for Disease Control and Prevention, in 2006 approximately 30% of adults reported that they experienced some sort of joint pain in the previous 30 days. Musculoskeletal injuries are rarely completely incapacitating, however. While many weekend warriors cite old knee or shoulder injuries as reasons that they can’t exercise now, with so many options available, even people with real injuries should be able to modify their routines and still get in a good workout.

For example, a female with early knee arthritis can still perform cardiovascular-enhancing exercise. She might not be able to run long distances six or seven days a week, but she might be able to run two days a week and swim or ride a bicycle the other days to decrease the repetitive impact on her knees. A male with rotator cuff impingement from overuse at work or in the yard might have to back off from tennis or baseball, which might aggravate his shoulder, but he could play soccer or another non-throwing sport. And for athletes who enjoy lifting weights, simply adjusting a few of the exercises might be enough to exercise in spite of a current injury.

For those who fear that they are making an injury worse, they should see a sports medicine physician. Most injuries do not need surgery, and often there are simple initial treatments, such as physical therapy, home exercises, taping, or anti-inflammatory medications. And while patients are often reluctant to go to the doctor for fear of being completely shut down from a sport or activity, sports medicine physicians usually try to encourage treatments and rehabilitation that get people back to sports and exercise as quickly as possible.

Finally, even if the activity is potentially detrimental to a joint, it might not always be that bad. Someone with near bone-on-bone knee arthritis is possibly making his knee worse running every day. Having said that, if he wants to keep running, the benefits of his overall health might outweigh the risks to his knee. Daily exercise can provide multiple medical benefits, including improved cardiovascular function, lower blood pressure, and weight loss, as well as improved sleep and mood. Even if he needs a knee replacement in the future, the medical upside to exercise is significant.

While aches and pains can be an obstacle to physical activity, they shouldn’t be permanent barriers to all exercise. If you are worried about injuries or exercise modification discuss it with a doctor [or speak with a trained fitness professional!] and know that being physically active is possible despite these pains.

As always, contact me if you need help finding a way to stay active and pain-free.

H is for Happy

April 26th, 2011

Hey!  Remember how I’m not a doctor?  Me, too!  If you have specific questions about any of this, please ask your doctor about it—I’m just presenting my understanding of this study.

If you have either type 1 or type 2 diabetes, you know cardiovascular (heart) disease is a major risk.  You may also know that my personal approach to dealing with that looming unknown is to keep myself fit and active every day to take care of my heart.

You may know the common positive risk factors that signify a higher risk for developing cardiovascular disease: smoking, poor diet, inactivity, and (ut oh) diabetes.

You should probably know, whether you have diabetes or not, what your cholesterol situation is.  You need to know this so that you can understand how at risk you are of developing coronary heart disease. 

We should each want to do all we can to decrease our risk.  One way to do this is to look at negative risk factors for cardiovascular disease. 

High-density lipoprotein (HDL) cholesterol can be a negative risk factor for developing cardiovascular disease.  This is because HDL’s main role in metabolism is to transfer cholesterol from plaque deposits in our blood vessels to the liver for excretion. 

So the HDL cholesterol actually functions to remove cholesterol.  (Tell me THAT makes sense, calling them both cholesterol.)  The more HDL we have, the better off we are.

H is for HAPPY!

Want to raise your HDL?  A recent study suggests a four-pronged approach: (1) aerobic exercise; (2) diet; (3) moderate alcohol intake; and (4) stop smoking already!

Since I’m a trainer and exercise is my specialty, that’s the one I’ll discuss.  (You can Google the others.) 

The greater your aerobic capacity, the greater the association with elevated HDL levels.  Sweet! 

At minimum, get 120 minutes a week of aerobic exercise and you are doing yourself a world of good.  Happy-HDL levels-protecting-your-heart kind of good!

You want to have a great volume of blood pumped by your heart per beat, and you want the amount of oxygen travelling through your blood into your muscles at high levels while simultaneously having a high amount of oxygen-poor blood travelling back from the muscles to your heart.  (V02 max)  The higher each of these is, the higher your aerobic capacity.

You want to challenge your cardiovascular system so that it improves in response.  To improve your aerobic capacity during those 120 minimum minutes per week, yes, you’ve guess it: INTERVAL TRAINING. 

Work as hard as you can for 3-5 minutes, then recover for 1-2 minutes.  Recovering isn’t sitting down, though.  Stay moving during your recovery and get back to the hard work ASAP!!

Makes me HAPPY just to think about all the great things we are doing for our hearts.

Why Don’t I Weigh Less?

April 25th, 2011

As my Memorial Day marathon approaches, I’ve gotten the same question from my boot campers a few times. 

I don’t keep my mileage on my long runs (Saturdays most often, this week I woke at 4am to get it done) a secret.  I doubt anyone would, when they get up crazy early and run 17 miles before most wake up for their weekend!

So when a bootcamper asks on Monday how far I went this weekend, sometimes they ask more questions.  The past few weeks, someone has asked me why I don’t lose weight when I run so much.

(Fortunately, I haven’t yet been offended by a weight-related question from a bootcamper.  I figure they ask because they’re comfortable with me, and as a trainer, my body is at issue for my clients.  So why not.)

But back to the question: Amy, why don’t you lose weight when you’re running 17 miles at a time??

Well, there are several reasons I maintain my weight regardless of the number of miles I run.  Two reasons in particular.

Most importantly, I maintain my weight because I eat more as I run more.  It’s just how it works.  I also eat WHILE I run to maintain my blood glucose levels and my energy. 

I also don’t run off that many calories, all things considered.  I burn maybe 80 calories per mile, so really, it isn’t that much weight.  (I’m a pretty small creature compared to most and have been running for a long time.)  If I eat 200 calories while I’m running, and if I ran 17 miles at 80 calories per mile, that’s a net calorie loss of 1160.  Spread out over a few hours, and discounting the amount of calories I would have used sitting at my computer or sleeping, and it simply doesn’t end up a huge calorie toll.  (I’d have to do those 17 miles four times to come close to burning off a pound.)

The other part is much more complicated and one I think is often too complicated for a bootcamp discussion: remember—they are at bootcamp to exercise, not to talk!  (I heard that snicker, Bootcampers!)

One of the other reasons I maintain my weight regardless of the number of miles I run has to do, I think, with my diabetes.  My daily insulin requirements aren’t much different from the months I run and the months I don’t run.  Sure, the basal rates are different (lower when I run more), but the amount of insulin I take to cover the increased carbohydrates I eat ends up evening things out when I compare it to the higher basal rate I need to take when I’m not doing the aerobic work and don’t eat as many carbohydrates to fuel the work. 

Since the amount of insulin I take affects storage of body fat and my weight, if I take the same average amount of insulin then I won’t really change my weight much at all.

The third reason is that I’m not trying to lose weight.  If I were trying to lose weight, I’d eat less food and take less insulin and keep up my exercise regimen… but I wouldn’t run marathons at the same time.  Those two objectives (losing weight and running a marathon) place competing, intense, high-powered demands on my body and I don’t want to ever place that much stress on my body—I need it to last me the rest of my life!!

If you want help making your way through any distance or achieving a weight goal, I’m here to help!! Contact me at

Earth Day with Diabetes (Vegans, beware!)

April 22nd, 2011

I’m always frustrated that I can’t recycle my pump supply packaging, nor can I recycle my strip vials.  I know there is some sort of sterile reason for this, but knowing that doesn’t help so much on a day like today: Earth Day.

Happy Earth Day!

Earth Day is a day to focus on our impact on our environment.  I was reading an article about how much of an impact eating meat and dairy has on the environment, in a substantially negative way.  One of my reactions as I read was “do you want to take protein away, too?”

I think living with diabetes makes me feel like my carbohydrate choices are somewhat limited, and I’m curious if you can relate.  I don’t mean to say my choices ARE limited, and I certainly cannot keep up my fitness and running without some serious carbohydrate support, but it’s more of a mental thing than literal.

I have to watch my carbs.  Literally: I need to count every gram I eat!  But I don’t do that with my grams of protein in the same way.

(Sure, I have counted all of my foods in various ways for various reasons, most notably counting Weight Watchers Points for a few years as I worked to get myself to a healthy weight.  It’s an important skill to have, but it isn’t something I enjoy doing all the time.  If I think too much about the food I’m eating and if I try to micromanage the eating experience more than I have to, I’ve noticed my life becomes generally less enjoyable.)

I appreciate having some things on my plate I don’t have to care about, or count.  It used to be vegetables for a long time, until one CDE said to me once a very long time ago “I don’t recommend diabetics eat carrots on their own as a snack” and that shifted the way I see vegetables a little.  (It was a sad day.)

But so far, lean protein has remained a respite from my food counting, and I appreciate it if only for that reason.  I like eating a stick of low fat string cheese and not touching my pump for that.  I like snagging a few almonds and not touching my pump.  I like grabbing a hardboiled egg and only bolusing for the fruit or toast I have with it.

So, while I am happy to applaud efforts to minimize our carbon footprints, I’m happier still if I can minimize any counting when it comes to animal protein. 

I may take this idea into consideration, though, as it isn’t like I really enjoy eating a lot of meat:

Substitute a vegetable protein source for an animal protein just one day per week, and over the course of a year, you’ll shave off the equivalent of driving 1,160 miles per year.  If every American did this, we would save 1.7 billion gallons of fuel annually.*

As long as I can still have something on my plate that I don’t need to count, I’ll be happy.

What about you?

Happy Earth Day!

*Go Green Get Lean by Kate Geagan (Rodale 2009)

Who’s Afraid of the Big Bad Low?

April 21st, 2011

I used to not mind being low, at all.  I mean, it used to be a fantastic opportunity to drink a Coke or eat candy.  A license to eat?!  YES!

I’ve noticed over the past 10 years or so that going low just isn’t’ as FUN as it used to be.  That’s a little sad.  I’ve spent lows feeling just fine, and I’ve spent lows feeling like I cannot see or hear or some other loss of sensation that is discombobulating to say the least.

I’ve met people who feel pain when they are low, I’ve met people who have passed out with a BG of 70.  I’ve met people who, like me, always experience a low just a bit differently each time.

I’m not sure I’d say that I’m AFRAID of being low, really, but they do seem to take more out of me with each passing year.

Then again, I don’t like the flip side, of running higher than I need to in order to avoid being low!

I find it interesting that someone did a study of 777 adults with type 1 diabetes about their fears of going low.  (I’ve never been able to say hypoglycemia very well; it’s “low” to me.)  Many of the subjects had experienced a “severe” low in the past year and a half before the study.  I don’t think I’ve had a “severe” low too many times… but then again, maybe I have.  (Have I mentioned being low isn’t any fun anymore and it seems to take a lot out of me?)

In terms of study results, it isn’t surprising that those who had experienced a severe low were more likely to be afraid of going low.

It’s a curious thing to me these days.  I wonder how I’ll feel in another few years.  Then again, maybe I’ll have a D4D by then and being low (without an awesome helper to help signal to me) will seem like a thing of the past! 

How do you feel about your lows?

Those Precious 23 Inches

April 20th, 2011

I think I’ve mentioned that I’m working towards getting help with my diabetes… in all forms.  I always feel great when I can help someone else, and it’s usually such a small effort for such a great reward, I don’t feel like I’m burdening someone else with my disease.  I’m just asking for a little bit of help sometimes when I need it!

That said, you know as well as I do just how much work life with diabetes can be.

So, I’m making an effort to get help from my husband.

Which, not surprisingly, involves teaching him how to use my pump.

As a little background here, I met my husband almost thirteen years ago.  My husband has always been very good at the carbohydrate side of things (I absolutely love that I can eat a meal—usually at a restaurant—and then ask him how many carbs he thinks I just ate!  He’s really pretty good at the estimation, based only on what he saw my plate looked like before and after a meal.  Crazy great!!)

But I’ve determined it would be a great thing if he knew how to work my pump, too.  My CGM sometimes keeps me from getting a good night’s sleep and it would be lovely if, before he goes to bed, he can check my blood glucose and tell my pump and deliver insulin without me being involved or having to wake up.

Maybe it’s a pipe dream, but I’m willing to give it a try.  (And, most gratefully, so is my husband.)

It’s going to be weird.  He’s going to completely invade my personal space… those precious 23 inches between me and my pump… I’m about to start sharing that space.

Talk about trust!!

Wish us luck.

High Impact versus Low Impact

April 19th, 2011

I do a lot of high-impact exercise and I’ve paid a price for it already when I developed a stress fracture in my lower leg as a result of too much running too quickly seven years ago.  It meant I had to do NO impact for a few months and ease my way back into impact slowly to build strength for the long haul.

I’ve learned to mix up my high impact exercise days with low impact exercise days so that I can treat my body to strong bones and healthy joints. 

So what’s the difference between low impact and high impact?  I’ll steal from an expert to explain it:


The Differences between High Impact and Low Impact Exercise

High impact exercise is when both feet come off of the ground at the same time. Good examples of high impact exercises are jumping jacks, jumping rope, running or jogging on a treadmill (or outdoors), and performing plyometric exercises. High impact activities also include exercise classes which involve jumping, leaping or jogging in place. Doing high impact exercise puts you at greater risk of injury, especially if you’re just starting out.

Comparatively, low impact exercise is when one foot is on the ground at all times. Walking is a great example and also one of the most popular forms of low impact activity.  Unlike running or jogging, when you walk, you always have one foot touching the ground.  Other examples of low impact exercise are working out on an elliptical machine, cycling, swimming, low impact aerobics and using a rowing machine.  It’s important to realize that low impact doesn’t mean low intensity ( unless purposely designed to be so) because you can still get an intense workout keeping both feet on the ground.

What Are the Advantages and Disadvantages of Each Type of Exercise?

Both high impact and low impact workouts have their advantages and disadvantages.  One of the best advantages of high impact workouts is the benefit it has for bone health. High impact exercise helps to increase bone mineral density more than low impact exercise does. This means high impact is better for preventing osteoporosis.  High impact activities also usually allow you to raise your heart rate faster. This is a great advantage if you don’t want to spend a lot of time exercising.

The disadvantage of high impact activity is that it increases the risk of injuries and overuse syndromes, especially if you don’t allow your body adequate time to recover between workouts. The risk of stress fractures and tendonitis is greater with high impact exercise.

Low impact workouts are ideal if you are overweight, have joint problems or injuries that may be aggravated by running or jumping. This is because low impact exercises like walking or cycling place significantly less force on the body than high impact workouts like running or plyometrics.  Low impact activities are also ideal for someone new to working out.  The less jarring exercises are kinder to the unconditioned frame of a beginner.


We could all stand to mix things up a bit when it comes to our exercise habits… especially if it means creating an exercise habit! 

Keep the amount of impact your body can handle in mind as you search for and find and enjoy the perfect fitness challenge for yourself!!

The Yearly “Fun” Side of Life With Type One Diabetes

April 18th, 2011

My husband started a new job a few months ago, which is fantastic in general, but also a sort of a pain for me a couple months after he starts.

It’s time to choose a health insurance plan.

Which again I should say is a blessing to have a husband who works for a large company that has fairly good health insurance coverage.  (This company “is so good” this one will even provide pet insurance, if you pay for it.)

But the fancy colored brochure and the guy who came to explain the plans to the employees and all of the fancypants HR people employed to help us decide what plan will work best for us don’t really mean much, as they aren’t really helping.

Do you know what I mean?

Sure, I can figure out that if I took Drug X every day and that didn’t change and I saw my doctor once a year and had labwork it would be better for me to sign up for Plan A instead of Plan C.  That would be easy. 

I can even sign into my account at the medical clinic and look up what visits I had, and add up those copays and see how much a pair of glasses or contacts costs and see how much I should set aside in a flexible benefits plan.  I can estimate based on my records and prior year’s expenses just like anyone else. 

But life with diabetes isn’t that easy.

The thing I can’t figure out, mainly because it isn’t in the brochure, is how much they cover for Durable Medical Equipment, or if they cover test strips and how much I pay for either of those.

And, not to ignore the fact I’m an attorney and I did medical billing for eleven years so it isn’t like I don’t know how to read the book.

So I read the brochure and it says “for any other questions contact your HR department”.  I show it to my husband, who dutifully heads to his HR department and asks.  (He asked the guy who came to explain the plans and that guy didn’t know nor has he gotten back to my husband as promised.)

They don’t know.  So, they (which I think is nice) call up the main insurer, who suggests they call the plan administrator, who says it’s different whether it’s prescribed by my doctor or if it isn’t prescribed by my doctor.

Gee, thanks for the help.  (And FYI, I can’t get pump infusion sets without a prescription.  But that shouldn’t change the allowed amount for payment of the code.)

So now I have to go through my records and find the codes for my pump supplies, and find the codes for my CGM, and my husband has to go ask for the specific code payments/classifications. 

I’m serious.  This is what he’s spending his day at work doing today.

Two years ago, I just did what I think most people do, and looked at the prescription coverage and saw it was identical for each option, and I looked at what I actually see doctors for, and I made my best decision at the time.  I didn’t go into the code-by-code analysis.  I tried to simplify things and not treat myself like I needed special treatment.

THAT was a bad decision!  We ended up with some hefty medical bills that year.

It just frustrates me sometimes.  I am a rather healthy and fit person, were it not for this one little thing, also known as 250.01