Archive for June, 2011

Living A Dangerous Life

June 16th, 2011

Ah, Life.

Life is so dangerous when you live with diabetes. 

It’s so dangerous it’s amazing we make it out of bed.  It’s so dangerous every time we take a shot or prick our fingers we might get an infection.  If we don’t we live in fear of long term complications.  If we need sugar we need it immediately or we could die. 

It’s dangerous.  It’s immediate need just on the other side of our consciousness at all times.

It’s scary.  It’s serious.  It’s a full time job without any breaks.  We count everything.  We don’t eat without thought.  If we do, we are living on the edge.

We need to have emergency supplies of quick sugars, emergency supplies of medication, extra medication in case the original supply gets too hot or too cold or randomly goes bad.  We need to carry emergency syringes in case our pump konks out.  We need to be within an hour of insulin at every moment of every day.

It’s dangerous.

It’s complicated, and it’s quiet. 

Living with danger.


I tell you; just writing the above few sentences exhausted me. 

I don’t deal well with articles or mentions or people who feel a need to highlight the dangers of hypoglycemia or the dangers of hyperglycemia or the dangers of whatever or the struggles we face every day.

I really don’t deal well with it at all.

I’m not saying I ignore any of the above dangers.  Yes, I know what could happen.  I also know what could happen when I cross the street or get on a plane. 

I just don’t agree with highlighting it all the time—we’ve all sat in a medical office and heard the lectures; we’ve read the articles; we’ve answered the questions. Heck; we all get into our cars multiple times every day despite the dangers involved.

When it comes to life with diabetes, we’ve felt most of those dangers, too.

And, amazingly enough, we’ve kept on keeping on

It isn’t the people living with diabetes who highlight those dangers, I don’t think.  It isn’t those of us who have felt what a blood glucose of 27 or 538 feels like.

We don’t need to mention it—we’ve felt it.

And I, for one, continue to keep on keeping on; doing my best every day to live my life.  With and without the danger attached to living with diabetes.  I can’t see it as “dangerous” when it’s my daily reality.

Maybe I should get myself a leather jacket and a Harley—I’m such a thrill seeker. What do you think?

You-Choose Self Improvement

June 15th, 2011

I think we all have a long list of things we’d like to improve on in our lives.  It’s something we discuss every January first and by now have probably long forgotten.  We’ve watched our kids graduate from kindergarten to first grade, from eighth grade to high school, and endured countless (never ending) baseball games and dance recitals along the way.

As life goes on, making these dramatic changes we wanted six months ago now feels like an impossible task.

So here’s a little list of ways to make small achievable goals work for you.

1. Start small.  If you put yourself at the foot of a “lose 50 pounds” mountain and keep your eye on that prize, every day you haven’t lost 50 pounds can feel like a failure.  But if you say to yourself “I’m going to do what I can today to get closer to my goal” and take small steps, you can get there.

2. Be kind.  Of course you can’t change yourself overnight; if we could, we would all do it!  So be very kind to yourself about any and all progress you make—and recognize that a few steps in the other direction doesn’t mean you’ll never reach your goal.  Refocus and be kind to yourself if you want to reach your goal.

3. Stay small. I can’t stress enough how important it is to make little changes before you make big changes.  A big change is stressful; a small change is almost imperceptible.  If I had you lift 20 pound dumbbells on your first day, you probably wouldn’t be able to do it for long.  But if you start small with 5 pound dumbbells and keep at those until they don’t feel as heavy, you may not notice that change to 8 pounds.  Eventually, you’ll be able to use 15s or even 20s if you keep your changes manageable.  

When I say “small goals” I mean a goal like “I’m going to stretch for 8 minutes three days a week.”  (That’s the commercial time for a half hour show if you watch TV in real time!)  Or, “I’m going to treat my lows with juice instead of candy this week.”  It’s all relative, but keeping them small keeps them manageable.

4. Be consistent. Although you will falter along your way, keep your goal in mind: you need to still keep your goal in sight if you want to reach it!  A step to the side or even backwards is fine and not going to derail you—if you stay consistent and don’t let it be the end.

5. Write it down. I think this is the one we all skip.  But if you’re a list-keeper, don’t you feel like you get more accomplished on the days you write a list?  I’ve been known to write things on my list I’ve already accomplished, just to enjoy crossing it off.  But writing a list of where you want to go that includes the small steps along the way will help keep you focused.  It’s worth a piece of paper.

6. Look back.  If you are on that mountain and climbing but feel like you’re lagging or that you’ll never reach your goal, absolutely take some time to think about where you’ve been and what you’ve already accomplished.  You’ll probably amaze yourself—and that may be just the boost you need to keep going.

7. Move forward. In general, movement in any direction is better than standing still.  When it comes to goals, though, moving forward is essential.  Moving at a glacial pace is fine, so long as you keep moving toward your goal.

The bottom line is: you are the one who chooses the goals you set.  You could have no goals and not change at all—but because you want more out of your life, you are going to put in some effort and get where you want to be.

That right there is pretty awesome, if you ask me!

Residents and Fellows and Doctors, Oh My!

June 14th, 2011

So I learned recently (because I never looked it up or remembered before now) that you are a med student, then an intern, then a resident, then a fellow.  I’m sure there are a few more (HA!) steps involved, but super basically that’s it. 

This means that the fellow I saw last week at my doctor’s office has had at least 7 med-school years behind her.  And I must say that if she wants to work with patients with type one diabetes she probably should spend some more time learning before she goes one-on-one with a patient with type one.  She seemed like she had a lot to learn, despite knowing a lot of the calculations and science behind my pump readouts.

As we all know, it’s a lot to learn.  A LOT.  I’m sure for a physician it’s even more to learn than the rest of us!

(That doesn’t sound very fair, and that’s not how I intended that to sound: I don’t have any particular issue with her— but I was glad she isn’t my doctor.) 

For one thing, the fellow kept looking at my doctor for answers to her questions about my diabetes instead of looking and listening to ME. 

Yes, I am the rock star in the room at my own visit!

Which was fine; she hadn’t ever met me before and she was there working to learn from my doctor.  And, my doctor knows a lot about type one diabetes.

But then the two doctors started discussing my sensor.  Saying things like “a representative told me it didn’t work very well with pressure” that they thought would be a help for me to learn.  At that moment it really hit me like a ton of bricks in a crystallized vision I hadn’t seen with such clarity in a while.

They don’t understand what it’s like to live with diabetes

Really, truly, LIVE in the mundane, somewhat silly yet important ways that teach us something with every experience, every day.

Most of us with a sensor who has worn it on their hip and fallen asleep at 200 and woken 30 minutes later to a false “low” alarm knows that it doesn’t work when you’re sleeping directly on your sensor.  Any of us who have worn it underneath tights or (gah!) nylons and have been alerted to a false low can tell you: the sensors don’t like pressure.  (It makes sense, given that the sensor uses measurements from your interstitial fluid, that if your circulation of interstitial fluid is impeded by your body weight or by compressing clothing, that the sensor won’t work as it was designed.)

So the fact that neither of these women had worn a sensor for 3 days (ever, I imagine) seemed off to me.  If I was a physician and I could try something that might give me an insight into my patients’ daily life with their disease, I would like to think I’d try it out

Then again, what’s the point of wearing a sensor if your pancreas works?  They wouldn’t ever get an alarm, much less any of the 13 I got between 9:30pm and 5:00am last night.

Maybe it’s that I want to think my doctors WANT to know what it’s like to live with diabetes… which is kind of strange, as I tend to think I’d never wish diabetes on anyone. 

As we all know, life with diabetes takes a heck of a lot of knowledge and everyday teensy things that end up teaching us more and more. 

No matter how many years of school and training they put in, it’s beyond me why we consider our doctors the “experts” in diabetes.  Sure, they know a heck of a lot and are incredibly skilled and talented in their own right… but I have to consider myself the expert when it comes to my diabetes.

23 years of daily life is longer than any formal medical education, anyway.

1 page of 76

June 13th, 2011

I’m still confused by the fact that exercise is one of the cornerstones of my diabetes management and the topic gets one page out of the typical 76 pages of Diabetes Forecast magazine published by the American Diabetes Association.

I don’t think I’m off the mark to consider exercise a cornerstone of diabetes management for anyone with type one or type two diabetes. 

Several people profiled in 50 Secrets of the Longest Living People with Diabetes agree with me.

The book includes “secrets” on various life and living topics, but exercise is the one “secret” to being successful at living long and well with diabetes that came up the most consistently as one of the top ones regardless of how long people had been living with the disease, according to authors Sheri Colberg PhD and Steven Edelman, MD.

I knew it!

Exercise helps any insulin work better—be it insulin manufactured inside your body (type 2) or outside of it (type 1) and injected in.

Exercise helps food work better—rather than being stored for possible use in the future, exercise helps us use our food as energy now, before it gets to storage.

Exercise helps us manage stress—that daily moment to moment inescapable stress of calculating and figuring and evaluating and checking and projecting and reviewing and anticipating and worrying.

Exercise helps us stay active and mobile to keep us healthy and young as long as possible.  It’s simple—staying active every day helps us achieve our diabetes goals by helping to keep our blood glucose levels in check.

Exercise helps our bodies and hearts stay healthy and helps ward off cardiovascular disease that is one of the leading health complications of type one or type two diabetes.

So why only one page?

It probably isn’t as photogenic as a fruit salad with accompanying recipe.  It probably isn’t as profit-generating as an advertisement for a new (or old) insulin, medication, delivery method, socks, ID bracelet, shoes, lancet, or blood glucose meter.

But it’s a heck of a lot more effective in the fight against an unhappy unhealthy life, if you ask me. 

We all need to re-orient ourselves when it comes to our diabetes management.  Think beyond “food” and “medication” and add in an invaluable tool you have already in your Diabetes Management toolbox: your own body. 

Use it or lose it!

Picking Up Heavy Things & Moving Them Around

June 10th, 2011

I know I’ve mentioned the importance of weight and resistance training before.  I may sound like a broken record and for that I apologize—but I really think this one is important.

I think resistance training often takes a backseat to cardiovascular training because it doesn’t seem as simple as cardiovascular exercise.  Weight training requires weights and some degree of knowing what to do; cardiovascular training merely requires putting one foot in front of the other and repeating for X amount of time.

Yet the fact remains that resistance training is an essential element of fitness.  It helps you stay young and helps your skeletal structure keep healthy and strong. 

And when you perform both cardiovascular or aerobic exercise and resistance training, you can help diminish your risk of cardiovascular disease. 

A review of 34 studies conducted over the past forty years demonstrated significant improvement in hemoglobin A1c levels, blood pressure, cholesterol levels, and overall body composition.  Although the review of the studies was aimed at type two diabetes, the same holds true for improvements for people with type one diabetes and with no diabetes at all.

Looking at how much you would need to pay for drugs to help you manage type two diabetes, lower your high blood pressure, lower high cholesterol, and keep your weight and body fat to healthy levels for even two years is a staggering figure.

We won’t even discuss how great you will feel and look if you work consistently to improve your cardiovascular exercise as well as your strength with resistance training.

So, and I truly do apologize for this one, what are you weighting for??

Contact me with any questions about your own exercise program; we can work together to get you moving in a healthy and fit way and help you manage your health no matter where you are!!

Ah. We Are Still Discussing Diabetic Diets. Hmm.

June 9th, 2011

I can’t believe we still discuss diets.  As in, what we eat, what we should eat, what supplements to take, who makes them, why we need them, why we don’t need them, what we do need, what we never need, what someone on the other side of the planet needs, what someone with green eyes needs, what an apple shape should eat and what a cantaloupe shape should eat and what a dear me pineapple shape should eat.

It’s enough to drive a person crazy.

And, then there is of course the dreaded DIABETIC DIET.  Cookbooks for DIABETICS and DIABETIC CANDY BARS and DIABETIC DRINKS and wow I’m surprised they haven’t come out with DIABETIC EAR CLEANERS by now.

I guess I feel the best when I don’t consider life in terms of “diabetic” and “non-diabetic” because I like to choose when I put on that moniker myself and not give that choice to others. 

It’s my disease, my choice when to be labeled. 

(Hey, I’m not saying I make a lot of sense all the time.)

I think my feathers get the most ruffled when it comes to a DIABETIC DIET.  Type one diabetes has a load in common with type two diabetes, but the advancements in insulin delivery technology over the past 30 years means to me that as a type one I don’t need to avoid much of anything when it comes to food.

(I need to avoid some of it for other reasons like my overall health and size, but that’s not what I’m talking about.)

And then Joslin enters the fray and I feel all hope may be lost.

Joslin, one of the most highly regarded and prolific diabetes knowledge and care centers in the world, and I’m getting miffed when they put up a blog about a DIABETIC DIET.

My prerogative, I guess.  Like I just said, I’m not one to make sense all the time.

Since I have found that the more I shoot for healthy eating the easier things go.  The less I think about “how many grams of protein am I eating” and the more I think about “how many different fruits and veggies can I eat in a day” the better things go.

So when Joslin puts out information with phrases like “ability to prevent or manage diabetes” then I really do request that this preeminent diabetes center be more responsible and specific.  I want them to say, in their own blog written by their own expert, something along the lines of “ability to prevent type two diabetes”. 

I just want those two extra words.  Heck, one of them can even just be a digit.

With news reporters discussing the various types of diets out there and they say things like “prevent or reverse diabetes” it makes my job that much harder.

I didn’t think any of us needed any of this to be MORE difficult.

And, for the record, the top three in the Joslin blog?  Each incorporate HEALTHY EATING and EXERCISE.

Maybe not as marketable, but definitely more effective.

The Plain and Simple Truth About Taking Insulin

June 8th, 2011

I know a lot of people living with type 2 diabetes want nothing to do with taking insulin.  To me, that doesn’t make a lot of sense since from my perspective insulin is the greatest liquid I can think of.

But I digress.

I know a lot of people with type 2 don’t want to take insulin because they feel like some sort of failure if “their sugars get so bad they have to take shots.”


Let’s go through this. 

One. If you are doing all you can with your diabetes management and your body is doing its own crazy thing and your doctor believes that your health will improve if you start taking insulin… may I suggest that you are perhaps risking cutting off your nose to spite your face?

Two. If you need to take insulin, you need to take insulin.  In fact, every single living human needs insulin, so again I ask what you are trying to prove by avoiding it.   (There are a number of different types of insulin and different ways they work; you and your healthcare team will figure all of that out based on what works best for you and your body.) 

Three.  Since you were diagnosed with having type 2 diabetes, has your body ever done what you wanted it to do?  Probably not.  You haven’t been totally in charge for some time, not that you ever were!  So why would you feel like a failure at this point?  I sincerely hope no healthcare professional ever told you that you would 100% be able to avoid taking insulin, or that you would be somehow less of a person or a bad patient if you needed it.  If they did, I suggest you report them to your state medical board.

Four. If you are trying to avoid taking insulin for fear of gaining weight, there are several strategies to help you keep yourself a healthy weight.

First off, when it comes to managing your weight when you take insulin, you simply need to move and grove just like everyone needs to in order to keep fit. 

If you take more insulin than your body needs you will be at a higher risk for low blood sugars and at a higher risk for excess storing of the food you eat.  That’s why simple sugars are such a danger for everyone: they require a big load of insulin to maintain blood sugar levels as they quickly climb.  That big load doesn’t always work efficiently, and it increases your body’s tolerance (and decreases sensitivity) for excess insulin.  With the excess come the added pounds.

Keep yourself active and moving every day, keep your nutrition nutritious, and take as close to the perfect amount of the right insulin for your body and you will do great on insulin.

You and your body need that.

Today’s topic was inspired by Sheri Colberg PhD’s blog.

And Then Sometimes I Don’t Worry About Us

June 7th, 2011

Yesterday I explained how I worry sometimes about most of us.  As I sat down to write this afternoon I picked up the June Diabetes Forecast next to my computer and (for some reason) read the guest editorial.

Maybe if more people were like this associate editor I wouldn’t worry quite as much!

The editor, clinical pharmacist Craig Williams, discussed two patients he and his team saw in the hospital on the same day.  Both had type 2 diabetes, both had lived with diabetes for some time, were physically active and not too overweight.

One of the patients took almost 400 units of insulin a day and needed more while in the hospital.  The other took no insulin and used only a small amount of metformin. 

The insulin user’s A1c was above 9 percent and the metformin user’s A1c was 6.1 percent.

The authors’ point was that as a scientist, he wanted to know why the difference and he was frustrated that we don’t have all the answers.  (Yet.) 

I’m still back there worrying about the patient with an A1c of 9 percent, doing all she can, and still getting less than optimal results.  And I’m fairly certain the one with a 6.1 wasn’t having an easy time of things, either. 

But I also feel for the healthcare providers.  I think patients come to them and expect that the provider than prescribe something for them that, if they do what the doctor orders, will give them the expected result.

Not so when it comes to diabetes!

So I feel a level of sympathy for them because I think for some of them they may feel like they aren’t doing, or can’t do, their job when it comes to each of us and our diabetes.

It’s probably frustrating.

Add in the various forms of denial, anger, fear, frustration, ambivalence, you name it, and the desperate need patients have of their medical team to help with daily life with diabetes and it just has to be a demanding profession any day of the week.

So I really appreciate this author’s laying it on the line and sharing how frustrating the science is for him, from his side.  I almost wish more medical professionals we work with could be as frank with us as we ALL fight the good fight to keep our bodies healthy every day.

With everyone on the same team, it makes me worry a little bit less about each of us– what a great thing!

I Worry About Us

June 6th, 2011

I worry sometimes about most of us.  I worry because I think having diabetes is really difficult and I see people in the “spotlight” that is the internet and I don’t see their struggles as often as I feel my own.

It’s a little hard to describe.

I worry about the people who are lurking around reading blogs and tweets and random snippets of the lives of others with diabetes.  I worry they see the public successes of these few people and feel badly about themselves and their own diabetes.

It’s kind of a mess.

In a lot of ways, I say “congratulations” and “great job” to those people online.  To myself, I often say “oh crap.”

And I’d say I’m one fairly in tune with myself and my disease.  So I extra worry about those who may not be as accepting of the ups and downs of living with diabetes, or even of life in general.

I know people want to point to others as a way to show us we can do it.  Just look at Sue: she’s doing it!  Look at Joe: he’s doing it!  It’s possible!  But sometimes it doesn’t feel like encouragement. 

Sometimes it feels entirely different.

Since diabetes is such a personal disease and it matters who we each are, what we do, when we do it, what insulin or medications we take, what the weather is, how our immune system is working each day, what our hormones are doing, what we eat, etc that it is almost impossible to compare apples to apples

Yet the numbers we deal with (A1cs and regular BGs) are dangerously identical.  Dangerous to us because they promote a very simple comparison between our own numbers and the numbers of complete strangers.

Clearly, I haven’t solved how to tackle this issue in my own life or in the lives of others.  So I do what I can: I recognize it, I think about it, and I do my best for me and my life with diabetes.

And, I worry too.

I hope everyone is able to recognize that a tweet of a number doesn’t tell us a bit of a thing.  It tells us at one moment someone had a certain blood glucose reading.  Or, for one 2-3 month segment of time someone had a certain range. 

It certainly doesn’t tell us who they are or what they are about.

I wouldn’t want to be judged on my numbers alone and I don’t even want to meet anyone who would want to be judged solely on their numbers either.

There is just so much more to us, as people, than a number.

So I’m still going to worry, just for the record.  I’m going to keep worrying about the people who have determined they are either never diabetics or those who have determined they are always diabetics.  I am going to worry for those in denial in either direction, because we each have a lot of living to do and I don’t think anyone can really live when they are busy denying something as big as diabetes. 

I don’t want you to deny your disease, but I don’t want you to be consumed by it either.

We’ve got a whole figurative fruit basket comprising our identities.  Sure, we have apples and oranges, but I’m betting some of us have kumquats and kiwis and dragonfruits and starfruits and pineapples and even a few bananas and peaches, too.

(Or maybe we’re all fruit loops.  I’m not always sure!)

Happy National Donut Day!

June 3rd, 2011

I found out this morning when I checked facebook that today is National Donut Day

Not only is it National Donut Day, but Krispy Kreme is giving away a free donut to every customer.

Yes!  Free.  Donut.  Every.  Person.

Well, that news changed my day quite a bit.  In a good way.

Happy Friday!!

Every time I see a donut I’m about to eat I think about the donuts our Sunday School teacher brought us when I was in confirmation in junior high.  As it was common knowledge I have diabetes, and since everyone knows DIABETICS CAN’T EAT SUGAR, he brought me a muffin each week.

Really quite kind of him if you think about it.

Now, this was back before I had a sliding scale or counted carbs or anything like we do now.  But let me tell you: this muffin was HUGE and it had nothing but pure sugar.  I probably would have been better off just eating a donut!

And then I started thinking (I was well into my third donut by this point- the second paid one) about how many people have commented on what I can and cannot eat in my 23 years of living with type one diabetes.

Add to that the fact I’m a fitness professional and used to weigh about 50 pounds more than I weigh now, and a marathoner, and someone who is just trying to do her best—but  it so often feels like any and every person who knows me has said something about something they’ve seen me put in my mouth.  I’ve stopped eating meals with others sometimes simply because I didn’t want them to evaluate my lunch.

But THEN you have to add in the fact that I don’t want to just tell everyone to leave me alone and scram—I want them to not keep asking or keep wondering.  I want to tell them the truth about eating with type one diabetes.

The truth is, it’s a lot of calculations.  It is a lot of trial and error.  It’s probably more “error” than “trial” really.  And the consequences range from uncomfortable to dire crisis to not being able to feel my legs as I stand 60 years from now.  It’s a lot of guessing and measuring and reading and thinking and trying and feeling like a failure.

It’s a lot of doing my best every day and feeling frustrated that perhaps my best isn’t going to be good enough.

And yet, if someone asks something about what “can” and “should” I eat, or makes a comment about me eating candy… I rarely get to tell them all of that.

I usually settle for saying something like “I can eat anything I want; I just need to count how much sugar is in the food.  It used to be that you had to eat your food to match your insulin, but now I match my insulin to the food I want to eat.”

Still, on a perfect day I wouldn’t need to explain anything—I could just eat—but for now, I guess I’ll stick with my standard response.

And enjoy my donuts.