Archive for June, 2011

Is Diabetes Getting the Best of You?

June 30th, 2011

Watching some of the “You Can Do This” videos this morning, someone said “diabetes isn’t going to get the best of me.”

And, although I understood what they meant, when I heard him say that I thought: MINE WILL.

I deserve my diabetes receiving the best of me as often as I can.

My best effort.

My best enthusiasm.

My best intelligence.

My best patience.

My best forgiveness.

My best discipline.

My best physical body.

The best technological tools.

The best medical professionals.

The best insulin for my body.

The best understanding and supportive friends.

My diabetes deserves MY BEST EFFORT.  It deserves that because I deserve that.

Doesn’t yours?

If you are concerned that you aren’t giving your diabetes the best you deserve, reach out and ask for help.  I’m here; and you are not alone with this.

Keep Your Body Guessing (And It Will Keep You Guessing!)

June 29th, 2011

One could say that we are all, at our core, lazy creatures.  One could also say that we are simply incredibly efficient creatures.

Same difference, I guess.

Our bodies are so much smarter than we give them credit for being.  As we push the constraints of our current fitness level, our body adapts and learns to live at that fitness level, until we push beyond that one.

It is gloriously without end.

As I run more, the act of running does not cause such a crisis in my body.  I have to run farther or faster or on challenging terrain in order to create that same “crisis” response.

One of my favorite experts, Jason Karp, PhD, describes it as threatening your body with what it considers near-death experiences.

If you aren’t saying “woah” or “wow” at any point in any of your workouts, you aren’t at that crisis point.  Your body is yawning while you are telling yourself you’re working “hard enough”.

It’s the same with lifting weights: you need to challenge yourself and your body.  If you don’t challenge yourself, you aren’t going to change your body.  You won’t increase your fitness level without change.

I know there was a time in my life that if I had to run a block, I would go low.  My body was being threatened by that run and it recruited everything it needed to accomplish my goal… including glucose.  Now, it takes a lot more than running a block in order to create that same crisis.  My body learned how to run… and it learned how to run efficiently.  I can run several miles now before a low becomes likely.

But, of course (and this is one of the great parts), if my body is busy learning how to do one thing very efficiently, if I do something else that my body isn’t used to, I’m back to creating a new threat.  If I rowed 100 meters this afternoon, I think I’d need to watch my glucose levels very closely!

As another example, I changed from an endurance weight training “maintenance” kind of routine for myself and began a heavier weight training routine this week.  I’ve been doing about a half hour each night before dinner of various dumbbell and barbell exercises.

And for the last three nights, I’ve been low at 3am. 

Changing things up with the number of repetitions, the speed of the move, the weight lifted, distance travelled, or any number of typical ways to increase intensity of an exercise will affect your blood glucose levels.  It will happen every time your body perceives a threat to its survival.

It’s pretty incredible, when you think about it.  Be it efficient or be it laziness, it’s an amazingly intelligent system—even if its pancreas has some issues.

Educate Educate Educate

June 28th, 2011

There is a lot of education required to live well with any diabetes diagnosis, from pre-diabetes to type one diabetes. 

I tried to explain what life is like to a group of nursing students yesterday in an hour and a half.  You can imagine how little I was able to explain! 

Beyond our own diabetes, we need to educate others about our disease.  I think it helps cut down on misunderstandings, eradicate myths, and hopefully increase support.

Yet, in a quick conversation about diabetes I rarely get beyond explaining there are two types with different pathology and management.

So when Joslin blogged today about the SEVERAL known types of diabetes that exist today I thought I would share the information.  I think it’s useful for a lot of us to know, in light of news articles about cures and treatments that surface nearly every day and our friends and family send our way. 

If you don’t have time to read the entire article, I’ll give you the six broad types they include:

–          Gestational

–          Type 1 (autoimmune)

–          Type 2 (not autoimmune)

–          LADA (latent autoimmune diabetes in adults)

–          MODY (maturity onset diabetes of the young)

–          NDM (neonatal diabetes mellitus)

I find this information fascinating; like I said, I’m not going to explain it to someone in an elevator as we travel together for a few moments, but it helps me figure out some of the wacky information I’ve seen and heard through the years.

Maybe you’ll find it useful too.



This is a question that we get asked regularly.

If we asked this question to the general population twenty years ago, a majority probably wouldn’t have any idea.  But today, unfortunately, so many people have diabetes that everyone seems to at least have heard of  type 1 and type 2.

And—due to the rising rate of obesity in pregnant women—the public is becoming much more familiar with gestational diabetes.

However, when you get to the details of this complex disease, things get less and less clear cut—not only how many types of diabetes there are, but also how they’re characterized.

For example, type 1 is an autoimmune disease, and people require insulin at diagnosis. Usually the diagnosis is in childhood, adolescence or early adulthood, but not always (people can be diagnosed with type 1 at any age).

Type 2 isn’t autoimmune,  and it may take years before a person requires insulin, if at all—and patients are usually older and often overweight, but again this is a generality, particularly as the number of people who are obese grows and gets younger.

Gestational diabetes occurs during pregnancy and blood glucose returns to normal after delivery, but often it doesn’t.

In addition, researchers have discovered another category of diabetes called latent autoimmune diabetes in adults (LADA). Think of LADA as a slowly progressing version of type 1 with some of the characteristics of type 2.  In fact, some people call it type 1.5.

People with LADA have antibodies to the disease like those with type 1 but they don’t need insulin right away.  Their blood glucose can be controlled on lifestyle or oral agents for months or sometimes years.

There’s more.  Type 1, 2, gestational diabetes and LADA are polygenic—this means that it takes the involvement of many genes to cause the disease.  But there are other, much rarer forms of diabetes that are monogenic, meaning a change in only one gene is responsible for the condition. There are two types of conditions in this category: Maturity Onset Diabetes of the Young  (MODY) and Neonatal Diabetes Mellitus (NDM).


Between 1 and 5% of people diagnosed with diabetes are thought to have MODY.

MODY usually presents in childhood or adolescence but because its symptoms are often mild, many are not diagnosed until much later.  Unlike those with type 2, people with MODY are usually of normal weight and don’t have high blood pressure or high cholesterol levels.

Physicians may start to consider a diagnosis of MODY and do genetic testing if there is a history of diabetes in successive generations in the family—grandparent, parent and child.  Most often people with MODY can be treated with lifestyle or oral agents.


Type 1 diabetes is diagnosed after 6 months of age.  But there is a rare condition called neonatal diabetes mellitus that can occur from birth to 6 months.  Unlike other forms of diabetes, about half of the cases of NDM are temporary.  This type of diabetes will disappear in infancy, although it may come back in adulthood.  The other half of the cases will continue to have diabetes throughout their lives.

Double Dipsea Report

June 27th, 2011

I’m only giving a report on this one because I gave you one from the practice last week.  It isn’t the most exciting report… in fact, it will probably read a heck of a lot like the one from last Monday.

Kinda like the run.  It felt incredibly familiar.

I’ll start off by saying that we started from the ocean side and ran inland 7ish miles before we turned around and went back to the ocean.

I hadn’t looked at the time the run started, but I thought we would get out around 8:00.  (Did I mention we kind of did this one on the fly?) So I set my basal rate for that start time.

We started at 9:00.  Ooops.

I was very glad to know, this time, just what I had ahead of me.  I mean that I was glad to know when it came to my eating and insulin… not that my mind was happy to take my body up and down those hills again!  I knew my first three miles had only climbs… and stairs.  The stairs were very steep and tall; I wished I was taller so my hips wouldn’t hurt with the angles. 

Oh well.  Not the first time I’ve wished I were taller!

I think I started in the 170s with my BG.  I can’t recall, since I was purposefully NOT thinking about what it was going to be like out on the trail and that meant I kind of tuned out some stuff.  I know we got to the second aid station before I realized I should probably eat something, and check.  I was 105 at that point, which should tell you (again!) how steep that climb was.

I had 25 grams of gu and kept on trekking.  My next check was 108, maybe a half hour after the first stop.  I ate something at the rest of the aid stops along the course: a few pretzels, some gummy bears, more pretzels, etc.  I didn’t want to grab too much, as I don’t generally eat anything other than gu when I run.  So I played it safe.  I think I was 150 by the end of the four hours we were out there.

(Speaking of playing it safe, my friend didn’t have her trail-running shoes on and I swear she stubbed a toe on every third rock and nearly tripped three hundred times.  I was so scared she was going to fly off the trail and head down the side of the mountain.  I am SO GLAD she remained vertical most of the time, and didn’t have any lasting injuries.)

We were fairly smart about the whole thing, this time around.  We decided we weren’t going to try to run up any of the 4,500 feet of trails.  We hiked/walked uphill and ran the few feet of flat and few hundred feet of downhills. 

We beat last week’s time by 15 minutes.

The part I liked the best, and my friend agreed, was that although we didn’t go very fast (530 people finished before we did… and about 30 people finished after we crossed the line) we still did it, with smiles on our faces.  Some people run that thing all the time since they live nearby, and some train and plan for months to complete the course.

We found out about it about three weeks before we ran it on Saturday. 

And that is what we are so happy about: we knew we could do it.  We never doubted ourselves.  I had the knowledge about my running and my insulin and food requirements and I just took care of what needed taking care of.  We kept going the whole time, we worked hard, and we had fun out there together.

Why else would anyone want to do the Double Dipsea?

We All Deal So Differently

June 24th, 2011

Living life with type one or type two diabetes requires a lot of work.  It’s amazing how we all deal so differently with that workload.

Some people stay in denial and don’t do a thing: don’t take their medication, don’t change their habits after diagnosis, do precisely what they know is damaging to their bodies, or fight every day to not acknowledge what living with diabetes takes.

Some people immediately take their doctor’s instructions to heart, learn all there is to learn, do everything precisely “right” and are probably their doctor’s star patient.

Some people learn quickly that routine is their best friend, and never vary from day to day: breakfast is food X, drink Y at time Z with insulin A at the same time every day.  Any variance is a threat.

Some people think “I just have to do this until…” and some people think “I will be able to get off medication” and some people think “It’s no big deal.”

Some people change everything.  Some change nothing.

Some people fight for their child: 504 plans, Americans with Disabilities ride passes at Disneyland, attendance at every JDRF event imaginable: Let’s Get Rid of This Horrible Disease.

Some people participate in clinical trials, some people see a physician once a year to get their insulin prescription renewed. 

Some people live with diabetes, others are diabetics, some are persons with diabetes.  Some are patients, some are advocates.


Some people tell everyone.  Some people tell no one.

Some people see their diabetes as the hardest thing they’ve ever dealt with.  Some people struggle every day.

Some people ask why me? Some people don’t care.  Some only ask in the dark.

Some people won’t go to the grocery store without their meter.  Some people don’t know where their meter is right now.

Some people can recite their past three years’ of A1cs.  Some couldn’t tell you what the last one was, nor when it was taken.

Some people make charts and graphs.  Some people don’t.

Some people go by how they feel.  Some people can’t recognize a low.

Some people love their doctor.  Some love their Diabetes Educator.  Some can’t stand any part of a medical visit.

There are of course a lot of extremes and most of us probably wander between the extremes through the years of life with diabetes.  Certain times of our lives will prompt greater focus on our disease, and some periods will necessitate greater distance in favor of a different focus.

It’s always there, always a part of us, no matter what we do.

It’s our diabetes.


June 23rd, 2011

Have you fallen out of your exercise routine?  Do you need a figurative shot in the arm when it comes to your workouts?  Are you afraid of getting your hopes up and then dropping out of a new class or new plan?

You aren’t the only one.

In fact, you are so completely NOT alone that people write about it in nearly every fitness magazine out there.  They write about it because it’s a fact of fitness life: our minds can work against us.

Runner’s World included a tip list in their May 2011 issue from runner Kara Goucher about how to get started and stay strong when it comes to running.  I of course know not all of you are runners, so I’ll include the tips I think are multi-disciplinary in their approach(Did you forget I’m a lawyer?) 

Talk It Through

New runners think it’s not “real” running unless you’re gasping for breath.  Not true.  If you can’t talk, slow down.

AG: I say, if you’re working hard, you’re exercising.  Try to go faster on some days and always push yourself, but don’t worry about actual speed and try to keep at least 80% of your workout where you could have a conversation of at least 5 words at a time.

Take Pride

A lot of people think they look slow, or fat, or sweaty.  Don’t let any of that stop you.  Among runners, you are golden.

AG: How true how true.  Do you care what someone else looks like when YOU are exercising?  Didn’t think so.  Get out there and be kind to yourself and the work you are doing!!

Have a Key Word

Use your key word when things get tough during a run.  Or use it before your run if you don’t feel like heading out.  Say it to yourself, mantra-like.  A word I used during a really tough time in my career was fighter.  That was what resonated for me, and it worked. 

AG: Have a phrase or way to encourage yourself and keep your mind strong during any workout.  Anything encouraging will work.  I have used “keep going” “you can do this” and always smile at “suck it up Buttercup.”  (Like I said, anything encouraging will work.)

Focus on Yourself

If you think about other runners, you’ll end up thinking, She looks faster than me. Keep things inner directed.  Be aware of others, but keep yourself front and center.

AG: You aren’t exercising for the person on the stationary bike next to you.  You aren’t exercising for the person with the locker next to yours.  You aren’t exercising for anyone else’s body: keep yourself and your goals front and centerYou are there for YOU.

It’s easy to let what others are doing get to you.  It’s easy to compare your blood glucose or A1c to that of your friend’s.  It’s easy, and it’s potentially damaging when something your body does or needs differs than what someone else does or needs.

Take the high road on this one, challenge yourself, be kind, and reap the rewards of your efforts.

You can do it, Buttercups!

When It’s Crazy Hot

June 22nd, 2011

We are having a bit of a heat wave in my area. I personally love the heat, but it definitely requires a different strategy for exercise.

My friend and I tried to beat the heat yesterday and we went out for a run at 7:20am after bootcamp. We planned a good, difficult 8.8 miles… and we thought we could beat the heat.

We were sorry to be wrong. We cut our route short and added in a load more walking than we intended.

Sometimes heat will do that to you!

It was the kind of heat where I had 30 grams before I started running, lowered my basal lower than I usually do for a run, checked 30 minutes in and was 98. I had a 25 gram gu, ran another 15 minutes, checked again and was 99. Normally, I would have maybe had 20 grams that entire run, and a more normal temp basal for my run.

I’m telling you, it was HOT.

(When we got back, I needed an immediate nap. I slept for 90 minutes! My friend told me she still feels wiped out today—normally that route would have been no big deal for either of us.)

So what can you do when it’s a zillion degrees out, shade is nearly nonexistent, you are sweating as soon as you open your door, but you still want to get in a workout??

Many runners suggest starting a run as early in the day as possible to avoid the heat. I think tomorrow I may try a before-bootcamp run, if I can get to bed early enough tonight. Some say wear a hat to protect your head from the sun. Everyone says to keep hydrated by drinking a lot of water and electrolytes during the day.

But what if getting outside is simply not feasible for you and you still want to work out??

Here’s my latest suggestion. Try something new INSIDE when it’s crazy hot. Check out a workout via Netflix Instant.

If you have air conditioning and you have space, any regular cardio workout is great. If you don’t have A/C, try the coolest spot you can find and go for a short stretch or yoga workout.

It’s fun to keep things interesting and try new things despite the weather.

You’ll find the Netflix workouts in the “Sports & Fitness” genre, Workouts. You can try an Ab, Glutes, & More workout, a Yoga, Low Impact or even Qigong!

The 10 minute Solution workouts are nice because, well, if you don’t like them, you’ve only got 9 minutes left. (Although I’ve also just stopped and tried another option.) I’ve also heard good things about the Crunch Candlelight Yoga workout. What’s the risk involved in trying it out on your instant queue?

I’d try Yoga Booty Ballet or Yoga Zone workout if I were willing to wait for a DVD. I’ve done some of the Yoga Zone workouts and they are okay. I also like Rodney Yee, and always appreciate the blissful beaches where they film.

Read the member reviews and check out the star ratings—you never know what will work for you and what won’t work as well. Remember if it is a new activity for you, your insulin needs will probably be lower than normal even for exercise, and on hot days you may need more or less overall; be smart about what you’re doing with your insulin and keep some juice nearby. Always have water within reach and be sure to stay hydrated as you work, A/C or no A/C.

Close the drapes and ban others from the room (if they aren’t joining you) and then just bust a move. It’s fun, and safer on crazy hot days!

Amazing Benefits of Exercise

June 21st, 2011

You feel better when you exercise.  It helps you manage your diabetes.  It helps you lose weight or keep your weight in check.  It helps you fit in your clothes.  It helps your heart stay strong.  It helps your blood fat levels get to and stay in a healthy range.  It keeps your bones strong.  It helps you manage stress.

AND it helps you stay young.

I’m telling you, exercise is an amazing thing.

I think I blog more about cardiovascular exercise than I do resistance training, mainly because what I do for my cardio exercise is more interesting and exciting to write about.  (I mean, did you see yesterday’s blog?!)

When it comes to resistance exercise, however, I’m a huge fan and wish I were able to devote more time to it (marathons have taken precedence for the past two years).  Resistance training to help me stave off muscle loss as I age is crucial.  I also have one body so it’s hard to do everything I want to all the time. 

I’m sure you understand.

So you can imagine how fun it is for me to spread the word about TELOMERES

Telomeres are little pieces at the end of our cells’ DNA.  With every cell division, a tiny bit at the end of that telomere is lost. 

You can imagine how this story ends up.  If you can’t, look at your grandparents.

With every cell division snipping off a teensy piece of DNA, we are on a limited time budget.

The 2009 Nobel Prize in Medicine was awarded to three scientists whose work showed that telomeres are vital to protect our cells’ DNA.  Not only did their work show that the longer our telomeres the biologically younger we are, but they showed that the telomeres of middle-aged people who exercised regularly were only marginally shorter than those telomeres of people half their age who didn’t exercise regularly.

Gotta love scientific proof that regular exercise (and of course good sound nutrition) help our bodies significantly slow the aging process.

Just add it to the list of the amazing benefits of exercise.

How Do You Take Insulin For THAT?!

June 20th, 2011

I ran one of the oldest and most famous trail run routes on Saturday.  It didn’t feel like a lot of running—it felt like a lot of huffing and puffing and “omg how am I supposed to get THERE from HERE?!

I’m doing it again on Saturday.

It’s the Dipsea Course in Marin, north of San Francisco.  I ran the “Double Dipsea.”  It’s beautiful and varied and generally amazing.

And then you realize you have only gone 0.8 miles and there are 13.2 more miles to go…and you start to wonder.

When I do this next weekend for the official event, I’ll start at the ocean and run inland—the biggest dip at the center of this elevation map is where we begin on Saturday, so my map after that one will be a wacky cut-in-half mirror image.

It will be GIANT hill, huge hill, huge hill, GIANT hill.  Not the other way around. 

So let me begin by saying, in case you aren’t familiar with the way trail runs go for the mere mortals like me who just go out and try and have zero hope or expectation of coming close to being the fastest out there, that over the course of the 14 miles I probably only ran maybe about 7 miles, in the traditional sense of the word “run.”  The 14 miles that should take me less than 2½ hours to complete on a road will take me closer to 5 hours on Saturday’s terrain. 


It’s a lot of hiking, a lot of climbing, a lot of little strides and a lot of cautious steps and fingers crossed that you won’t miss a step or turn an ankle on a root or stone.

I’m telling you, it’s fun.  (In its own special way.)  But it isn’t easy.

If you go into this without experience, you might think “run” and know “less insulin” and go from there.  But you can probably see from this elevation map that my insulin needs vary along with the course.  I need less insulin/more fuel for the inclines and less for the declines.  The slower I go, generally the more insulin I need… but not when I’m climbing. The faster I go, generally the less insulin I want… but not when I’m barrelling down a hill.

It’s a lot of trial and error, and a lot of learning, and a lot of being prepared for whatever happens.

I mean, I got stung in the shoulder blade by a bee through my shirt on a trail run half marathon once.  Wacky random stuff happens out there, and the best we can do is prepare for what we do—and do not—expect.

So because I know I will face the giant hill first (with names like “steep ravine” and “insult hill” and with my favorite section just like the Ewok village of Return of the Jedi) I will make sure I have enough fuel and an inadequate amount of insulin (I’m thinking 20-30% of my normal, as 40% was too much the first time) to help me reach the crest.  I’ll need to fuel up again midway down the giant hill in order to prepare for the huge hill.  Since I won’t have much time between reaching the bottom of the steps at the bottom of the huge hill and literally turning around and heading back up all 671 of them, I’ll need to be checking and continuously aware what my blood glucose is doing so that if I need to eat I’ll be able to do that when I won’t endanger other runners who aren’t thinking I’ll stop on a step. 

It gets complicated, of course.

But it’s an amazing adventure.

Fun Fitness Friday!

June 17th, 2011

Happy Friday!!  Let’s make today “Fun Fitness Friday”.  Walk at lunch, walk after dinner, play some backyard soccer while the veggies are roasting on the grill.  It doesn’t take much to make it Fun Fitness Friday… just a little imagination and a carefree attitude!!

Want to play some catch?  What about heading to your neighborhood park and snagging a stray tennis ball a player couldn’t find and start lobbing it against a wall or backboard?  If you’ve got a buddy, you throw they catch…

Want to breathe in some summer evening air?  Head out on a little bike ride around the neighborhood.  Take a look at a map before you go and try to make your route look like a star.

You know those houses in the ritzy neighborhood?  Take a quick trip to that neck of the woods and head out for a walk and check out the yards and houses.  Which one would you move into if you won the lottery?

Feeling overheated?  Head to the closest pool and see how long you can tread water… or how many times you can push yourself out of the pool and sit on the edge (turn right just as many times as you turn left to switch from your front to back sides).  If you’re a diver, have someone toss some coins to the bottom and clock how quickly you can gather them all.

Too hot to head outside?  (Is there such a temperature??) Take care of some active chores (Clean the bathroom! Vacuum! Laundry!) for 15 minutes and then spend 3 minutes on each: pushups, squats, sit ups or crunches, planks, and a wall sit.  Go for as long as you can, take a little rest, and get back to it within that 3 minute window.  (If you’re anything like me, the less I want to do something the more important that timer is.)

I’m not the best with fun ideas so please tell me what you think would be fun, and what you’re up to today!  Post it as a comment here or on facebook so we can inspire each other!

Play mini golf.  Go bowling.  Toss a Frisbee or football around.  Head out for a little hike.  No matter what you do, HAVE SOME FUN. 

It’s Friday, after all.  Fridays were made for fun!