Archive for September, 2011

Whoomp There It Is

September 30th, 2011

We’ve got new cardiovascular recommendations, Ladies and Gents.  The American Heart Association wants us all, by 2020, to improve our cardiovascular health by 20% and reduce deaths from cardiovascular diseases and stroke by 20%.

That seems like a lot to accomplish in eight years.


Taken from the IDEA Health and Fitness Association’s September newsletter, the goals set by the task force assigned to make this all come down to 4 Health Behaviors and 3 Health Factors:

The new Impact Goals document declares that as men and women raise their levels of physical activity by increasing the intensity, frequency and/or duration of that activity, they experience much healthier lives. Moreover, coinciding with the release of the new AHA goals, new evidence suggests that low cardiorespiratory fitness (CRF) is as strong a predictor of cardiovascular disease (CVD) and other health causes of mortality (referred to as all-cause mortality) as are well-established risk factors such as smoking, obesity, hypertension and diabetes (Lee et al. 2010).

Confronted with how to define and measure ideal cardiovascular health, the task force identified four health behaviors and three health factors:

4 Health Behaviors

  • nonsmoking
  • body mass index < 25 kg/m2
  • physical activity (150 minutes per week of moderate-intensity exercise or 75 minutes per week of vigorous-intensity exercise, or a combination of these two)
  • consumption of a diet that promotes cardiovascular health (emphasis on a low glycemic load, high fiber, high marine omega-3 fatty acids, high polyunsaturated to saturated fat ratio, and low trans fat content)

3 Health Factors

  • total cholesterol < 200 milligrams per deciliter (mg/dL)
  • fasting blood glucose < 100 mg/dL
  • blood pressure < 120/80 mm Hg

Clearly those of us with diabetes have missed the Avoid Diabetes Boat (some of us by a long shot).  However, we still can do so much to reach fantastic levels of cardiorespiratory fitness we are missing another bigger boat if we don’t do our best to keep up with the other recommendations.

Let’s get after it.


On Your Own (?)

September 29th, 2011

It’s sometimes the things someone says when they don’t even realize they’ve said something.  I met a woman at my recent talk on Diabetes and Exercise, and she said something in a way that made me instantly know I will never ever forget her.

She probably didn’t even hear what she said, but it struck me and has been on the edge of my consciousness ever since.

She said she has to do her diabetes all by herself.

(Realistically, I understand that I just got a bunch of readers who said in their heads something along the line of “of course!” or in some way agreed with that.  And, depending on how your day is going, you may feel various ways about that, and there are probably about three hundred different ways to say “of course!” But keep reading because this is important.)

But here’s the thing.  I think she’s wrong.  I don’t think she has to do her diabetes all by herself.

For one thing, her boyfriend was attached by her side the entire two hours she was at the event.

For another thing, I think she is pretty damn brave for showing up when she’s feeling like her diabetes life is not where she wants it.  She was in a room full of people who know E.X.A.C.T.L.Y. how that feels.  I’m proud of her for getting herself to that chair.  I’m proud of her for speaking to me when I plopped myself down next to her because I hadn’t seen her say a thing to anyone in the entire room and felt compelled to introduce myself.  (Seriously; what IS that?! I find myself do irritating sometimes.  But, in all, it was important and I’m glad I elbowed my way into her world for that brief time.)

I’m thrilled she knew enough to ask for help.  I’m honored she felt I could be a good resource for her.

I was thinking later about other people I have known whose actions tell me they feel the same as this woman: doing diabetes all alone.

One person hid her diabetes from everyone and didn’t let anyone else have a chance to share the burden.

One person kept his diabetes to himself but went low often enough that his entire office knew what to do for his lows, and they called in a nearby doctor when it was necessary.

That doesn’t sound to me like he was alone with his diabetes.

One person asked for help from some smart people, received it, and has since spent most days speaking, explaining, educating, and venting to friends, acquaintances, and maybe the entire internet about diabetes and how it is to live with the disease.

Oh, wait; that’s me.

Life with diabetes is not meant to be a solo enterprise.  It simply doesn’t work in any significant, long-term way to keep it that way.  But you do have to recognize that you are responsible for sharing your diabetes burden if you want to feel not alone.  You do have a responsibility to yourself to check your blood glucose levels, and deal with them however best you and your doctor have decided, and to keep living your life.

You have a responsibility to speak to the people you share your life with.  You aren’t getting rid of your diabetes any time soon, and like it or not, your diabetes is a huge part of that life.  So share some of your diabetes.

Teach your best friend to count carbs.  Teach your girlfriend how to deal with you when your blood glucose is 50 and getting to the fridge for juice on your own is too much.  Teach your kids what you’re doing and why it matters.  Invite your boyfriend with you to your next visit with your CDE.  Show up at a diabetes event.

Be brave.  YOU CAN DO IT. Diabetes gets a hell of a lot lighter off your back when you share it.  If you aren’t getting the response you want or need, try again.  If the people still aren’t willing to help, ask someone else.  Ask your CDE.  Ask your counselor.  Ask me.  Ask someone you met at that diabetes thing you went to three years ago.  Whomever you share something with will then be helping you do your diabetes.  Not alone.


You Either Do, or You Don’t

September 28th, 2011

Some of these studies have just such goofy titles I have to blame the editors.  I mean, you have to think about the researchers who came up with the study idea in the first place: they probably already suspected the answer, but wanted proof so they came up with the study to prove/disprove the theory.

In any case, the study that brought this up for me is called: Does Blood Glucose Monitoring Increase Prior to Clinic Visits in Children With Type 1 Diabetes?

If you have ever BEEN a child with type one diabetes, you probably have already answered the question.  Assuming you are anything like me, the answer is most assuredly Y.E.S. (with a twist)

I sort of think that’s why they make us come in every 3 months, and why my endo in high school made me come in more often than that.  (She is an entirely different story and one not quite appropriate for me to discuss here.)

But this study is I’d say completely accurate when it says, essentially, that those who already checked a lot increased the checks the month before the visit but those who didn’t check in the first place weren’t likely to check any more often just because a visit loomed.

I can just hear the thoughts of those unlikely to check: “I’m not afraid of you, doc.”

I can hear them because I’ve said and thought them.

(The twist comes in when I say that downloadable meters haven’t always been available so I used to have a pending visit and drag out a couple different pens and pencils and make up a “realistic-looking” blood sugar log book before the visit.  So in that way, I did increase my activity related to BG checks… they just weren’t in any way BG checks.)

The goal, of course, is to use the doctor as a tool just like any other we have at our disposal for managing our disease.  If you’re smart, you write down your questions in the weeks before you go in, and check often so that you can discuss periods of your day or specific issues you’re dealing with.  (They are supposed to be great at that kind of detective work.)

If you have a funky chirping or whirring noise when you drive your car, you try and see how you can replicate the noise for the mechanic.  I don’t see checking blood glucose much differently than that.  If it’s an issue with something that only happens when your car is cold, write down when it happens and leave it with the mechanic overnight so they can hear it, too, and then trouble shoot and hopefully fix whatever is weird in your car.

Same here, in my world.  If you’re smart about it.

Having been on the other side of things, I agree with the results as they seem realistic.  If you aren’t responsible enough to check your blood glucose levels on your own for yourself, you aren’t likely to check them for a doctor visit either.

Growing up with diabetes is tough stuff.

Really tough.

‘Fess Up

September 27th, 2011

How many of you have already gotten sick since school started back up?

Did you know that people who exercise five or more days a week spend 46% fewer days laid up with a cold or respiratory virus compared to those who work out only once a week or not at all?

I am starting to think we should get UNSICK pay. Sheesh.

The study found that aerobic exercise was best to fight the common cold because it activates the immune system and increases the activity of white blood cells and antibodies whose job it is to fight off infection.

How great is this information?!

The boost in immunity lasted for a while after the aerobic exercise ended… much like an elevated heart rate, I imagine.  You stay armed and ready for the next bout.

Of course, too much can be a bad thing and if you’re overtraining you end up having the opposite effect.  My rule of thumb when it comes to overtraining?  If you wonder “am I overtraining?” the answer is YES. 

We sometimes don’t do a very good job at listening to ourselves.  If something someplace happened in your body and you thought, even hours or days later, that you might be overtraining, what’s the harm in taking it easy for an extra day?

This is the type of place I think those of us with diabetes can excel over our non-glucose-checking counterparts.  Listening and respecting and responding to our bodies’ little teensy questions and signals and tweaks and blips really comes into play when it comes to taking care of ourselves.

Diabetes mandates that attention and respect.  We are trained for it already.

So when it comes to warding off an attack of a tuffy node, do yourself a favor in advance: Get out there and move yourself.

Ahh and Omm

September 26th, 2011

“Yoga: It’s not just for Sissies” was my other title.  But then I started to think about who I’ve ever met who actually thought yoga was for sissies.  And I can’t come up with anyone.

So why does yoga sometimes get a bad rap?

Yoga is actually pretty difficult, and you get some nice strength benefits and some crazy great flexibility benefits and different types can improve your cardiovascular fitness as well.  That right there is the fitness trifecta: cardiovascular training, strength and muscle work, and flexibility.  Woop; there it is!

Not to mention improvements in your physical balance and for some, mental balance as well. (Bonus!)

Researchers (love those researchers) in India took a look at a group of 123 type 2 patients.  They divided the 123 into four groups, according to those with microvascuar complications, with macrovascular complications, with peripheral neuropathy and without complications.  They then subdivided the groups into those who received standard care and those who received standard care plus yoga for three months.  They then compared the health of those in the care + yoga group with the standard care group. (Not sure what “standard care” is for type 2s in India but I’ll assume it isn’t much different than in the US.)

The point they were trying to study was whether or not performing yoga reduced oxidative stress on the body in type 2 individuals.  (I looked for a good definition of “oxidative stress” and found: Oxidative stress is the total burden placed on organisms by the constant production of free radicals in the normal course of metabolism plus whatever other pressures the environment brings to bear (natural and artificial radiation, toxins in air, food and water; and miscellaneous sources of oxidizing activity, such as tobacco smoke). I like it.)

Since oxidative stress is in a lot of ways how damage occurs in our bodies, it’s good to see that we have options to fight it! Of course, eating well and not smoking are key here, but so is exercise.

Back to the study: they found that the groups performing yoga for three months in addition to receiving standard care for their type 2 diabetes had a significant reduction in their BMI (they lost weight), glycemic control was better (exercise=better BG management), and they had increases in vitamin C and other critical antioxidants that typically decrease with age.

So if you’re struggling with your diabetes, I would say be it type 2 or type 1 or any one of the other types, give some yoga a try.  You just might like it, and you’re sure to love the side effects!

Here’s How I Figure It

September 20th, 2011

Being a fitness professional, I know more than the average bear about what aging can do to a body.  Being a type one professional (in training and education for longer than any other professional schooling, I see myself as a type one professional… aren’t you?) I know more than the average bear about what my diabetes can do to my body.

So here’s how I see it.

  1. We need cardiovascular health.
  2. We need muscular strength and endurance.
  3. We need great management of our blood glucose levels.
  4. We need to be happy and healthy as many days as we can, for as long as possible.

I think only #3 on that list makes me different than any non-diabetic.

I think it’s critical for my cardiovascular system that I engage in challenging
regular cardiovascular workouts
.  I want to increase my body’s ability to handle stress and one of the best ways I can do that is to train it to work under some extreme conditions.  Every time I do, my body reacts by building a few more bone cells or making a few more mitochondria.  Thank you, Body; I will need those!

I think it’s essential for my skeleton and my muscles and my wellbeing overall to challenge myself with resistance training a few times a week, every week.  We all begin losing muscle mass by the age of 30—and the only way to fight that is to pick up something heavyHeavier.  And heavier still, as our muscles grow and we get stronger.  You need to lift  something heavier than you thought you could lift last week, or hold it longer, or move it  faster or slower to always work against a challenge.

If you’re bored, you aren’t challenged.

My blood glucose levels are always going to be a challenge for me, and I need to keep my head on straight about those.  I need to work with all sorts of health care professionals who are my allies on this.  Life is too short to be stressed out when I see a doctor or dietician.  I don’t want to carry anxiety about working with someone around with me.  I want to check as often as necessary and not have any part of me afraid to see that little screen.

Life just has so much more crammed into it that is so much more important than spending time afraid or anxious.

And on that note, if I can manage those items #1-3 I think that #4 will kind of take care of itself.  Work hard, work smart, and keep everything in perspective.

Go to it!

Crunch That.

September 19th, 2011

Over the past few years, I’ve stopped doing the 10 minutes of abdominal work at the end of every bootcamp hour that I was taught to lead when I started years ago.  Here’s why:

crunches don’t get you much.

Core strength is important, of course. But you’ll strengthen your core anyway when you are doing other exercises with proper form!

(I think everybody loves crunches during bootcamp since that’s a time I’ll let them lie on their backs!)

I’m pasting in a portion of a discussion below, taken from a continuing education provider that has given me loads of great information.  The article points to several studies that
were published in the New York Times last monthIt’s worth a gander if you care about your core strength!

Are Crunches Worth the Effort?

When researches at Indiana State University began research on strength of core muscles vs athletic performance, the results were not what they expected. The thinking was that those with sturdy cores would perform better on physical performance tests. However, the results showed otherwise. But don’t give up on those core exercises yet.

While Indiana States results were not expected, other studies have shown novice runners do benefit from stronger cores. Those with better core strength were able to
reduce their 5K running time.

While studies vary across the spectrum on whether strong cores help with performance, what is known is if you train for your sport, the core strength will come. So what
does this mean for us? Avoid performing dozens of crunches. In fact, 6-8 good quality crunches a few times per week are best. Perform them correctly by maintaining the natural curve of the spine and lift only enough to feel the first bit of contraction. And remember, we all have a “6-pack,” but some of us need to reduce the body fat.

Unlocking Medical Mysteries

September 16th, 2011

I don’t think seeing a doctor should involve emotional discomfort.  I know it absolutely does, but that doesn’t mean I don’t want to fight that.

Yes, I think that’s at least a quadruple negative right there.

Yesterday I saw my family practice doctor and we were talking about a few things and I realized how uncomfortable I was.

Uncomfortable, as I sat fully clothed on a crackly piece of paper on a table I had to climb up onto and she sat two feet below me and typed on her computer.

So I interrupted myself and asked if she minded that I sit in the chair instead.

Her response was the best: Yes of course; this is a conversation.

See; she gets it.  She understands that when it comes to my health, I am the expert and she is a consultant.  Not to undermine her education or experience or knowledge in any way at all… but not to undermine my education, experience or knowledge either.  We were having a conversation.

It was a good thing, and I’m glad I was able to say and do what I said and did. 

I’m on a writing roll here today aren’t I.

(Green underline there since I didn’t put a question mark!)

Anyway, while she was out of the room I made my obligatory tour of the surfaces of the room.  (What can I say.)  I found a sheet of paper that had some information that I don’t know if you will recognize.

On the off chance you don’t, I’m listing them here.  The medical world isn’t meant to be so confusing; it is just big (huge) and they use codes and you can end up feeling lost before you even are allowed through the door.

I think we all deserve better than that.

So here are diagnosis codes your doctor uses when they see you.  They need to use at least one diagnosis code (called an ICD-9 code) for any medical procedure code (called a CPT code) they use to (hopefully) get paid by your insurance company. There are big books of codes that change every year, so doctors usually have one sheet of paper that includes their most typical codes to make things faster as they zoom from room to room and patient to patient.

For diabetes:

250.0… type 2 diabetes, non-insulin dependent, not stated as uncontrolled

250.1… type 1 diabetes, insulin-dependent, not stated as uncontrolled

250.2… type 2 diabetes, non-insulin dependent, uncontrolled

250.3… type 1 diabetes, insulin-dependent, uncontrolled

And then there are more!  Each specific complication has its own code, or way of coding.

250.5x(0-3 above) and 362.01 is diabetes with retinopathy

250.6x and 337.1 is diabetes and neuropathy

250.7x and 440.20 is diabetes and peripheral vascular disease

250.4x and 583.81 is diabetes and nephropathy

250.8x and 405.99 is diabetes and hypertension

250.8x and 272.4 is hyperlipidemia

Some codes have 5 digits and some have 4.  Usually the 4 digit codes are for the general diagnosis with the fifth digit getting more and more specific.

It’s pretty interesting from a coding point of view (which may be about the most boring thing ever if you don’t care about it) but I think anyone with a chronic disease like diabetes really should know the basics of this stuff.

It’s a way to take charge.  As my Dr. Joe would say, it’s your time!!

Real People, Real Life, and CDES

September 15th, 2011

My talk to the CDEs (Certified Diabetes Educators) yesterday about Diabetes & Exercise was kind of interesting.  I mean, I spent a long time talking about myself so of course it was the most riveting talk anyone has ever attended.  (HA!)

What I found interesting was how many people there were (1) used to discussing type 2 diabetes and very excited to switch over to a discussion of type 1 and (2) had no idea how exercise works in real life when it comes to diabetes.

Real life.

Yep.  Hard to escape it!

One lady started asking me my background as I was setting up; she assumed I was another CDE and seemed surprised I am not.  I assured her I was plenty qualified to discuss diabetes—24 years of constant experience will do that!

As we got into it, I got some great questions from the group.  Some wanted to know if I eat before I work out. (not really)  Some couldn’t figure out how I can check as I run. (very carefully, or I’ll walk)  Some wondered if I take my meter with me on every run.  (nope)

Real life.

I ended up checking during the talk, as I was standing at the front of the room.  I didn’t notice I don’t think that I was checking so much, but omg one of them apparently timed me from start to finish (I did take a correction bolus).  She was
excited that it took me 40 seconds to do it all.  (I was a little weirded out that someone timed me.)

I am now that person that she’s going to tell a future patient about.  She’ll be sitting with someone complaining about how much time diabetes takes and she’s going to say “no; it takes 40 seconds.”  (Sorry about that one, if you’re the patient on that one!  That seems so annoying when others do it to me and I truly apologize.)

They all seemed flabbergasted that I could check and continue with my activities simultaneously.

Um, I do it all the time.

Real life.

When they were warmed up, they started firing questions at me about more specific types of exercise.  It was fun to fire questions right back at them about other factors I involve in my decisions before/during/after I work out: heat, workout intensity, food today, food yesterday, elevation changes, insulin on board, temporary basals, etc.  Then I’d tell them what I would do and I’d tell them about what I would expect.

Real life.

I told them about one of my clients whose blood glucose wasn’t what I expected at the end of a workout.  (I expected 110  and she was 155.)  I asked her if she had set the temp basal for 30 minutes like we had discussed.  She said she had set it instead for an hour.

Timing affects a lot.

These are the kinds of things it takes a lot of experience to manage.  It takes that constant vigilance.  It takes a lot of trial and error and a load of strips.

But the funny thing is, it is all so worth it for what you get in return.

Real life.  LIVING with diabetes.  Life.



September 14th, 2011

I think I had maybe two phrases that carried me from about age 2 to age maybe 16 (when I promptly added the obligatory third phrase involving driving):

ONE: if my sister can do it why can’t I do it too [because she’s older than me]


I’ve never gotten over either one of them, quite frankly.

But this study would have made me even more preposterous on that second issue.  (The dog issue.)  Every time my parents wanted me to go out and stop irritating them or otherwise entertain myself I could have shown them the results of this study, and explained to them how important exercise is for kids.

It would have been AWESOME.

Researchers studied 618 pairs of adolescents (12.5-17.5 years old) and parents for about 18 months to get the data.  They looked at how active the kids were on a daily and weekly basis.

The families with dogs in their homes and lives were much more active, and correspondingly I presume healthy, than those without a pet in their home.  (The study mentions dogs in particular and pets in general so I do too.)


It wasn’t necessarily that the kids were in charge of walking the dog (I mean for real how often does THAT happen).  It was the fact that the dog was around that got people off the couch to feed, water, clean up, open the door, close the door, find the ball in the backyard, throw the ball, hide the leash, bend down to pet, bend down to scoop and bag, kneel to hug, crouch to defend against love attacks, dry off with a towel after the sprinklers went on at the new time, and on and on and on.

I’m telling you:  We all, every single one of us living with and those living without diabetes need to be as active every single moment of every single day as we can manage.

If we get a bunch of CRAZY FUZZY LOVE at the same time, we score bigger than a rock star.  No joke.

So who’s going to adopt a new fitness friend?!  Let’s go, Mom and Dad!!  I’m ready!!

She doesn't look like she would make me more active... but she does!! (on one of her white mats!)

(I also must be completely fair and say that my cats get me off the couch just as much as I think a dog would.

They chase each other and crash into things and I need to go check what broke.  They want dinner.  They want breakfast.  They want to see who is doing something outside and they look so curious that makes ME curious too.  Gracie will see us coming and race to a white mat and expect to be petted on that mat.
George will jump onto the bed and want to be brushed.  Yes, we cater to them.  Yes, they have us convinced we wouldn’t have it any other way.

We are so lucky!)