riva greenberg
in your power to create health
Recent posts on The Huffington Post
My goal is to help you improve your diabetes management. Here you'll find: observations, reflections, current events, something I've learned, an interview I've done, interesting books I've read or something else that I hope offers you value. Then enjoy my books: 50 Diabetes Myths That Can Ruin Your Life and the 50 Diabetes Truths That Can Save It and The ABCs of Loving Yourself with Diabetes.
I seem to recall in my twenties either a psychic or my Aunt, (whom my mother always called the "witch") not because she had a bad temperament, but for her psychic abilities, told me my mid-fifties would be fraught with an assault of health problems. Not necessarily diabetes-related, not alarming, but annoying.
At 56, having just returned from a sports orthopedist with my hand in this very lovely, restrictive brace, I tend to think that was a correct diagnosis. The hand brace is not due to some fabulous sp orts inju ry, that would at least recognize m y athleticism, but tendonitis.
Some months ago I was in a boot cast fro 12 weeks because of a fall and straining my ankle. That was diagnosed as anke tendonopathy. When i look inm y closet I notice a wardrbe of braces.
All to sa y, I may not be posting as freqnetly as usualllllllllll for as you've probably noticed t yping in this thing doesn't work very well. Sorry, I got too tired to correct all themistares after the first pa ragrph. My blood sugar testing andinjecting will also prove a bit more challenging I suspect.
I will continue to post, however, on The Huffington Post, well, a girl's gotta see her name somewhere. You can still follow those articles here.
I've just finished a book of stories I learned so much from. Particularly how medical training wipes the humanity out of our health care providers. You may not be surprised, except for how strategic and intentional it is.
Kitchen Table Wisdom by Rachel Naomi Remen is full of small stories that include her own experiences as a physician for more than 30 years and observations of fellow physicians, and, as a patient suffering with Crohn's disease since her teenage years.
Her stories illustrate how most medical training depletes physicians of their humanity by actually outlawing any show of emotion or authentic aspect of themselves. Physicians are judged weak to by these standards and strong if they share nothing but their medical expertise; no heart, no humanity. Her stories also reflect the courage and grace as patients find their courage to live, and often die, with illness.
You cannot come away from these stories without having a new understanding of our medical system. And the healing power of being with patients in a sacred space that does not judge, but allows frailties to just be. You will better understand why most doctors treat us like interchangeable parts and how far we have to go till this changes. Especially treating chronic illness.
Today, though, maybe there is a movement afoot. I just read Amy's post over on DiabetesMine about a new ideal for treating the whole patient with a dedicated team. Perhaps it is happening, somewhere. Perhaps it will happen, someday.
In the meantime, pick up a copy of Kitchen Table Wisdom. Your soul will thank you.
I have one of those 3" x 6" plastic mood-visuals hanging on my refrigerator. It comes with a little red cut out square that you place over the face that illustrates the mood you're feeling.
One thing I've noticed about this little mood chart is that out of the 30 moods on offer, 25 are negative and only 5 are positive. What does that say about us?
Here's a sample of the negative choices
Exhausted
Confused
Guilty
Angry
Hysterical
Frustrated
Sad
Embarrassed
Disgusted
Frightened
Enraged
Anxious
Lonely
Jealous
Overwhelmed
Here are the five positive choices
Happy
Ecstatic
Confident
Lovestruck
Hopeful
I have two thoughts about this and I'm going to share both with you.
1) We are so ingrained to see the fly in the ointment. Is it so hard for us to name positive emotions that they only gave us five? Do we spend so little time feeling positive that the words don't come more quickly to us?
2) I can go through each of these negative emotions and tie it to diabetes. For instance:
Exhausted - After 1 billion blood sugar tests it gets a little tiring!
Confused - This isn't the number I usually get when I eat that!
Guilty - A night of eating everything I love that just gets away from me
Angry - Stopped by security at the airport because of my insulin pen!
Hysterical - Stopped by security at the airport because of my insulin pen!
Frustrated - Having to eat just because I'm low. Damn!
Sad - I may really not make it to 80
Embarrassed - Shooting up in front of people I don't know
Disgusted - Leaving blood trails on my newly renovated white kitchen cabinets
Frightened - What will they find in my lab tests this time?
Enraged - This disease costs a shit-load of money
Anxious - Left the house without testing and have no idea where my sugar is
Lonely - No one else knows what this is like!
Jealous - Of everyone else's freedom
Overwhelmed - I feel lousy yet I still have to get up to test my blood sugar, see if I have to refill my meds, god, I got it wrong again?
That said, I can go through each of the positive emotions and also relate it to diabetes:
Happy - I'm in great shape overall and better shape than if I didn't have diabetes
Ecstatic - Just started blogging for the Huffington Post as a patient-expert
Confident - I'm generally on top of things
Lovestruck - My partner couldn't be more supportive
Hopeful - This will continue to get easier to live with
But I'd add a few more positives to my mood meter:
Peaceful - Just had my labs done, everything's OK
Contented - Overall, I love my life
Excited - Going to the AADE to present this August
Joyful - I've found my passion and am in my 'element' as Ken Robinson says
Grateful - For everything I have: partner, home, work, friends, family, chocolate
Delighted - Lovely surprises come on a regular basis these days
Proud - While I thank my lucky stars, I did a lot to get here
The truth is we can look down and we can look up. I rarely change where my square hangs - it's usually on "happy". For even when I'm not happy, I've noticed that glancing at my happy square, makes me feel happier and think of something to be happy about.
Just an observation, make of it what you will.
A fellow type 1 friend of mine was trying to get a CGM to better control her blood sugar.
She's had diabetes for more than two decades. Her blood sugar bounces from high to low often enough that her doctor felt a CGM would be extremely helpful, even though her A1C is just below the American Diabetes Association recommended 7%.
Of course the A1C is an average of your last two to three month's worth of blood sugars. That means you can have lots of blood sugars around 250 mg/dl and lots around 50 mg/dl, and average out at 150 mg/dl - just below an A1C of 7%.
While this averaging game is nothing new to me, what was new to me is that her insurance company would not cover a CGM because the liaison between the insurance company and the CGM company said my friend's diabetes was cured. Why? Her A1C is under 7%.
My friend's doctor told her he's seen this coming ever since companies decided to diagnose type 2 diabetes with the A1C test. The American Diabetes Association has recently recommended this along with an international committee from several other diabetes organizations including the International Diabetes Federation and the European Association for the Study of Diabetes.
One main advantage they cite for using the A1C test to diagnose diabetes is that it can be taken any time of day, and without fasting.
Yet, at what cost does this come? If an A1C of 7% or above will mean you have diabetes then will insurance companies say a well-controlled diabetic, who has an A1C under 7%, does not have diabetes? If that's the case then I've been cured for years and didn't know it. Funny, though I still experience hypos and highs no non-diabetic gets.
Will patients lose having tools that could help them better manage their diabetes with this diagnosing criteria? I know one who already has.
If you missed it, Oprah did a show on diabetes ten days ago where Dr. Oz confused and scared a lot of people about diabetes with misinformation. As one diabetes educator said to me, "Dr Oz is a SURGEON.!!! Diabetes is NOT in his area of expertise!!!!!!" Read my post on the Huffington Post.
Now I ask you to join me in letting Dr. Oz know that we are worthy of accurate information to help us manage our diabetes, not myths and fear, and that if he truly wants to help patients he should correct the misinformation he's put out there.
Spread the word, tweet, twitter, leave a comment on the HuffPost and let's send the message that the diabetes community deserves the respect it's so often denied.
Eight years ago, when I first started thinking of myself as someone who works in diabetes, I attended a Taking Control of Your Diabetes (TCOYD) event in San Diego. I was covering it for Kelly Close of Close Concerns.
Wandering around the exhibition hall I started chatting with a gentleman who was eager to answer my questions. He told me he was a peer- mentor and that he speaks to patients around the country helping them manage their diabetes, in part by sharing his story.
He neglected to tell me he was a former physics professor at M.I.T. Thank goodness I didn't know, I might have been intimidated. But that's not Robert Kolenkow's way to intimidate anyone.
Because of Bob, I've been a peer-mentor for the past three years and it's one of the most rewarding things I do.
I told Bob about a year ago that he's one of my mentors because he led me to this work, and he welled up with tears. You can meet Bob in his recent article in The New York Times. He epitomizes the saying that "a life examined is a life worth living."
O.K., let’s declare a moratorium on fretting over what your significant other is going to get you for Valentine’s Day. Or whether he or she will, or what it will mean.
The best Valentine’s Day gift you’re ever
going to get is the one only you can
give to yourself. That doesn’t mean you still wouldn’t mind a dozen red roses
and chocolate truffles.
But it does mean that it’s time to start keeping different company with actually something, not someone, you hold most dear — your emotions.
It’s time to
cuddle up with more of your inspiring, positive emotions and less with your
nagging, negative ones. How? By simply asking yourself a few questions that get you
focused on the good news in your life. For instance:
·
What do I appreciate in my life?
·
Who am I grateful for in my life?
·
What did I learn this week from a mistake I made?
·
What do I truly love about myself?
·
What can I do today for someone to make them feel good?
·
What am I most proud of?
Now, isn’t this a Valentine’s Day gift truly worthy of
you?
Typically any discussion of
emotions around diabetes are always negative ones: Depression, denial, guilt, shame, worry
and fear. I’ve watched this conversation lead people straight into their
“unhappy place” where they yearn for pity or consolation.
But one Valentine’s Day, standing on the brink of such
an event, I conducted an experiment. I was at a monthly diabetes support group
meeting (Divabetic). I’d been invited to discuss the power of positive emotions,
the basis of my book, The
ABCs Of Loving Yourself With Diabetes. That evening, instead of the women there introducing themselves by
telling everyone what they were struggling with, I asked them to say one thing
they love about themselves and one positive thing diabetes has given them. I since use this in workshops.
Here are some of the answers I got:
“Even though I’ve lost some of my vision from diabetes,
I have so much more compassion for other people with a disability.”
“I feel very humble. I know I could have something much
worse.”
“I got
diabetes at ten and really like how it’s made me strong and responsible”
“I feel really valuable and worthwhile being able to
help my family members who have diabetes”
“I eat healthier now and have lost almost fifteen
pounds!”
“I love the friends I’ve made in this group.”
Each remark brightened the energy in the room. They
laughed and smiled, they reached out hands to each other, not to console but to
connect, and to celebrate the good news they heard ‘round the room. Only two of
the women had to search for an answer, but even their search was an opening for something positive to fly in that wouldn’t have been there otherwise.
It’s a universal law, we tend to attract what we focus
on. Spend more time with your positive emotions like joy, hope, curiosity, passion, kindness, forgiveness and
pride, and you will have more of these in your life.
Barbara Fredrickson, positivity
expert and author, along with many positive psychologists like Martin Seligman,
has conducted
research that reveals positive emotions open
our hearts and our minds making us more creative, flexible and resilient. They
broaden our outlook, helping us to see more options. When engaged in positive
emotions, our thoughts and actions surface more spontaneously, and we forgive
our mistakes and let things roll off our shoulders more easily. Above all, they
make us happier and healthier.
Sounds like an ideal prescription for managing diabetes, and life. Now if only we could get doctors to prescribe it!
That Valentine's Day, when 27 women and I spent a few
moments together loving ourselves (nothing kinky mind you), was one of the best
Valentine's Day gifts I've ever given or gotten, and I suspect my Valentinas
would say the same.
Today, indulge yourself in a few of your own positive emotions, alongside anything else. Ask yourself one or two questions like: “What am I doing in my life that I like?” and “Who can I thank for what they mean to me?”
Then every day let this be more of the company you keep.
Because there were so many comments made on so many blogs in the diabetes community in reaction to Oprah's show last week, "Diabetes: America's Silent Killer," while my intent was not to critique Oprah’s show in my first blog post for The Huffington Post, I felt a responsibility to do so. And so I have.
My second post for HuffPost, An Open Letter To Oprah Winfrey and Gayle King, was accepted within 2 hours and is in the Entertainment Section. I sure do hope someone shows it to Oprah and Gayle.
If you'd like to know when I post on The Huffington Post, just sign up as a fan or get the RSS feed. Meanwhile, thank you for the encouragement, warmth and support you have given me to reach this vantage point just by stopping by.
Voices around the diabetes community
Oprah Does Diabetes, Kerri Sparling
Oprah Does Diabetes, But the Diagnosis? Fair to Poor, Hope Warshaw
Dear Oprah & Dr. Oz - The Diabetes Show - Major FAIL, Kelly Kunik
At 2:33 PM yesterday I pushed the "Send" button on the backstage posting area of The Huffington Post and my first blog post was launched: A review of Oprah's show, Diabetes: America's Silent Killer, and why most patients don't manage their diabetes the way they should, and how they could.
A few weeks ago I attended a seminar given by Amylin Pharmaceutical, manufacturer of Byetta and Symlin, in of all places Carnegie Hall. I have no complaints, it included lunch and a tour - and an important education.
Amylin's seminar, "New Approach to type 2 Diabetes Management" had five prestigious presenters at the helm: Dr. Louis Aronne, Clinical Professor of Medicine, Weill Cornell Medical College and obesity expert; Dr. Robert Chilton, Cardiovascular surgeon, University of Texas Health Science Center; Dr. Donna Ryan, Obesity expert, Pennington Biomedical Research Center; MEd Molly Gee, Dietician, Baylor College of Medicine; Dr. Matthew Wintle, UK, Director of R&D, Amylin.
The new approach proposes that the same attention on glucose control for type 2s must be given to cardiovascular risks. We heard from the presenters that type 2 diabetes is a cardiovascular disease. As Dr. Chilton warned, people with type 2 diabetes have a two-to-four-fold increase in risk of stroke and coronary heart disease and a two-to-five-fold increase in risk of heart failure, and will likely die due to cardiovascular disease. Cardiovascular risks: obesity, blood pressure, cholesterol, triglycerides and inflammation, (also known as metabolic syndrome) typically accompany type 2 diabetes. If we don't control these health ailments, cardiovascular events will occur in greater numbers as the tide of type 2 diabetes rises.
In all disclosure, Amylin is working on a drug that will help control cardiovascular disease risks as well as glucose, and not produce weight gain. The catch-22 of course is that weight gain contributes to cardiovascular risk and some diabetes medications cause weight gain.
I came away from the Amylin seminar thinking unmanaged type 2 diabetes is a time bomb, and for the first time I understood why the American Diabetes Association has long advocated a low fat/high carb diet; obesity prompts the hormonal imbalances that create metabolic syndrome. I won't get into healthy fats vs. unhealthy fats or that unused carbs also turn into fat. Suffice to say, if you have type 2 diabetes, get your vitals checked and ask about your heart health.
As February is American Heart Month it's a good time to learn more about your heart health and risk for heart disease. Cardiovascular disease is America's number 1 killer - every 25 seconds someone experiences a cardiovascular event and every minute someone dies. It is time, I agree, to think 'heart' as well as 'sugar' if you have type 2 diabetes.
I've long heard that people with type 2 diabetes have as much chance of having a heart attack as people who've already had one. Somehow it doesn't sink in unless you've had a heart attack or until you see, as I did, the stunning pictures of what clogged arteries look like.
To show support for heart month, this Friday you're encouraged to wear red. I'd also ask you to show support for your heart: Take a walk and make that doctor's appointment to check out your heart-health. Then you can toast your heart-healthy actions with a glass of heart-healthy red wine.
The CGM iPro sensor I wore for five days (see post below) came off Monday morning in a hurricane. Not exactly what you think, but I like the drama. My walk from the subway station to the hospital to see my CDE was in a rainstorm at high gale winds we rarely see here in New York - umbrellas discarded on the streets, puddles knee-high. Were it not for the fact that my iPro site was itching like mad for two nights from the sticky tape over it I'm not sure I would have braved the storm at all.
By the time I arrived at the hospital the entire front of my jeans was soaked so that I was wringing water out of the cuffs. I was eternally grateful that not only did I brave the storm, but that my CDE did as well. Moments later the CGM came off, a lot more easily than it went in thank goodness, and we downloaded the results. Luckily the battery lasted for as long as I wore it, just over five days. That's not always the case, but it was here. Hallelujah!
Then we stared at pages of graphs, charts and numbers of my blood sugar numbers as picked up by the sensor every five minutes and I got to see my patterns throughout the day, and night.
Since I was doing finger sticks at least four times a day along with wearing the sensor, my daytime numbers were not surprising, and, my daytime numbers are typically understandable to me. When I'm a little high it's usually because I didn't calculate the carbs in a meal or snack correctly. When I'm a little low it's usually for the same reason, or my powerwalk lowered me slightly more than I expected. Being insulin-sensitive, as many type 1s are, a half unit of my rapid-acting insulin has an impact.
During this five day period I also went high after a birthday lunch for my mom who turned 80 - a poor calculation on the calamari and spring rolls! But mom, you're worth it. And I discovered just as routine is my savior, so is my experience. Since I was logging my numbers, I used the carb counts on packages more than usual and that led me more astray than the educated guesses I typically make based on years of testing. Perhaps it's because food manufacturers are allowed a 20% margin on the carb counts listed on their packages, so beware.
But what I really wanted to know from this experiment is what my numbers do overnight, and that was the reveal. Around midnight they start sliding downward hour after hour. Around 5 AM they are at their lowest, in the high 50's/low 60's, and then they begin to gradually come up between 5:30 and 6:30 AM and then rise more swiftly. If I wake up and test my blood sugar around 6:30 AM the number's usually around 75 or 80, a half hour later they're 90 or 100. A half hour after that they're climbing over 100. This is without doing anything or eating anything.
"This is perfectly normal," said my CDE and nothing to worry about. In the morning your liver is pumping out glucose-raising hormones to get you ready for the day (dawn phenomenon). Even if you're a little over 100 before you take your injection, it's fine." O.K., I'm relieved about that since my boundaries are admittedly narrow.
"Can I prevent the overnight slide or morning rise?," I asked. "Not really, this is your body and you're doing fine. The only thing that might reduce the overnight low is cutting back on your Lantus one unit, but I don't think you need to do that. You don't go that low at 5 AM and then you come back up. "Would a pump level this out?," I asked. "Yes, and that's when most of my patients change to a pump, when multiple injections just can't do more for them."
So what I know is I'm working the MDI (multiple daily injections) system as best I can. I keep my blood sugar between 120 and 140 before I go to sleep, on the higher end of that range if I've had wine with dinner since that creates a slightly greater drop overnight. Then I blunt the morning rise with one unit of my rapid-acting insulin as soon as I wake up and take the rest of my breakfast dose just before or during my morning meal.
My concern that I drop so low overnight, like to 30 or 40 mg/dl, that my liver shoots out glucagon to save me from dying turned out to be false. That is a relief. Also, while I don't log my numbers ordinarily, I'm already obsessive enough, if you log your numbers - and for most people this is an invaluable exercise - make sure you also note what you eat and any exercise. Most log books don't give you space for this. So log your numbers on a simple sheet of paper. A bunch of numbers without these references is an incomplete picture.
I highly recommend if you have access to wearing a trial CGM for a few days to see your pattern that you do so. This kind of information can lead to an important change or modification in your treatment plan. I know I'll be sleeping better from now on.
Note: Our bodies are different. Don't base any of your own treatment decisions on my results. Check with your health care provider to be safe.
Noticing I was becoming a sugar-testing junkie recently, I opted to get hooked up to a CGM for a 5 day trial period, save some finger skin and see if I could learn something.
My recent addiction to knowing where my numbers are, beside a proclivity to perfection, is largely because my blood sugars rise sooo rapidly in the morning. Can I shut the barn door more quickly so I don't have to do two boluses before breakfast? The first to merely blunt the rise.
My new CDE put this on me in her office and what should have been a rather simple affair turned out to be quite a painful one. I wasn't prepared for the tugging, gripping and sensation of tearing skin when this thing went in. In fact you'll see quite a bit of redness around it which is my blood. My CDE told me it is not uncommon to bleed and not a problem. OK, but it didn't exactly lift my spirits and it did make me utter, "Diabetes is not exactly a pain-free disease!"
When I left my CDE's office, newly bionic, I walked about 20 blocks to meet a friend for lunch. Each footfall, I was overly aware of this gizmo dug into my side and the very fact that my walking was impacting my blood sugar. A weird thing for your brain to be so focused on an automatic body function. When I sat down to lunch I copped the banquette seat feeling vulnerable and exposed to any passer by who might ram into my poor abdomen. Well, it's not really on my abdomen, but I don't know what you'd call this side area.
Leaving the restaurant I began to experience my plastic gizmo differently. I felt somehow as though it was now my helpmate. As though I was not in this all alone anymore. I found this quite comforting and recognized it as a wholly new feeling.
Now, two days in, I'm used to my CGM, it doesn't hurt but the five inches of sticky tape that's holding it in place grips and pulls as I twist and turn. And while my plastic companion is (hopefully) tracking my numbers, so am I four times a day in a log book, along with carb counts and activities, just in case anything goes awry.
I will keep you posted next week when gizmo comes off. It would be dandy to have learned something more than which pants slide easily over gizmo and which ones don't.
Remember that popular Beatles' song, "When I'm 64?" The refrain goes, "Will you still need me, will you still feed me, when I'm 64?" I often wonder how I’ll be able to manage my diabetes when I’m old. Granted I’m 56 and many would say I’m already old, but let's not go there.
But 'tis true, my memory isn’t what it used to
be. Sometimes in the morning, since I take three injections, I can lose sight
of which I've taken and which I haven't. I begin with an initial unit of Apidra
(rapid-acting insulin) when I first wake up to blunt my rising blood sugar
(dawn phenomena). I take my breakfast bolus once my bowl of oatmeal is already
in my lap – sorry, small one bedroom apartment means my dining table supports
my computer, not my meals.
I try to take my Lantus (long-acting insulin)
around 8:30 AM, but sometimes I’m just not entirely sure whether Lantus made it
into the mix, in-between the testing my blood sugar, throwing the oats in the
pot, stirring, checking the weather, sifting through my new emails, deciding
what to where and when to shower.
The way I can usually remember whether I took my
Lantus is to try and find the red mark on my body where I injected. Is it on my
thigh, near my navel, on my upper arm? If I can remember where I injected, then
I know whether I’ve injected. Hmmm…doesn’t inspire great confidence, does it?
What will happen as my eyesight worsens? I’ve
worn glasses since the age of eleven, but what if it gets worse? Will I be able
to see the notches on the syringe? True, by then I’ll be bionic sporting a
pump, CGM, artificial pancreas, the whole nine yards, and likely the cataract
surgery I’ll need soon may even restore my eyesight. OK, forget that one.
But what about Alzheimer’s? How do people with
Alzheimer’s and diabetes remember to take their medicine? Order their refills?
Schedule doctor visits? How do people with Parkinson's and diabetes keep from
trembling during an injection or pump bolus? Really, how?
Managing diabetes as a fairly healthy adult who
works at home and so can tailor her day around her diabetes needs is laborious,
but entirely doable. What will it be like, however, in ten or twenty years when
my knees are shot so I can't stand well and reach my insulin in the fridge, my
memory's gone so I haven't a clue if I shot up or even what I take anymore, the
dribbling starts and I slip in the tub...yikes!
All this makes me ruminate that this is not an
illness for the aged and yet of course it’s mostly seniors who get diabetes. I
don’t know the answers to how I'll manage this when I'm 84 (at least I'm
thinking that far out) so I choose not to spend much time in the question. And
I do expect by time I’m “old” so much will have changed to manage diabetes that
there'll be hardly much at all to do.
Doesn’t hurt to dream, does it?
The recent earthquake in Haiti reminds us that when danger strikes, people with diabetes are doubly hit - not being able to do without their medicine and testing supplies.
Insulin for Life is sending insulin, strips, meters, lancets, pens, pen needles and syringes to Haiti and can use your donation. Their operation will need funds to be able to continue sending supplies. You'll see a 'Donate' button on the left bar of their web site in orange.
You can also check out Manny Hernandez' post about his exchange with Insulin for Life's president Ron Raab.
From time to time I see a book worth mentioning and my latest little thrill is Michael Pollan's, "Food Rules." Pollan, author of Omnivore's Dilemma, seems poised to be another Michael Moore, aiming his sword at our food giants' factory floors and over populated animal pens.
The American food system, according to Pollan, sets us up for obesity and ill health as 90% of what's in our supermarkets and is easily accessible, affordable and available isn't real food but food-like substances. Chemicals mess with our metabolism and overly sweet and salty foods leave us craving more of the same. I happen to agree with him wholeheartedly.
Pollan says doctors encouraged him to write the book because they don't have time to give patients the food lecture and what they'd like is a pamphlet they can hand patients with some rules for eating wisely. In Pollan's article on the Huffington Post, "Food Rules": A Completely Different Way to Fix the Health Care Crisis," a cardiologist remarks, "You can't imagine what I see on the insides of people these days wrecked by eating food products instead of food."
After spending years trying to answer the supposedly incredibly complicated question of how we should eat in order to be maximally healthy, Pollan discovered the answer was shockingly simple: eat real food, not too much of it, and more plants than meat. Or, put another way, get off the modern western diet, with its abundance of processed food, refined grains and sugars, and its sore lack of vegetables, whole grains and fruit. Again, he gets my thumbs up. This is, by the way, how I've been eating the last several years and maintaining both my weight and my A1Cs in the 5's.
"Food Rules" weaves humor and real life practicality into simple, straightforward rules for making healthy food choices. You can read it in an hour and be a lifetime wiser.
As this new year begins I have not made any New Year's resolutions. Actually I never do. Not since turning old enough to realize they're a cruel joke we play on ourselves. If I don't keep them I'll feel like a failure and if there's something I really want to do, I'll do it.
One thing I have been doing these past few weeks, however, is re-reading the slew of posts that I've now written here over the last two years. Truth be told, I would barely change a word. What a nice feeling that's been, and so has re-reading my own lessons been, which, yes, I benefit from as well as anyone.
Here's one that struck my fancy again especially because it reminds me to look for the good and believe in myself especially starting a new year.
Posted November 18, 2008
What if we had to purchase happiness and self esteem the way we purchase most things? Would you value it more? Would you feel it more? Would you recognize it as a tangible commodity you owned? Would our lives be happier, easier, more joyful overall? It's an interesting notion I think.
Somehow it seems negative emotions: anger, fear, guilt, worry get more of our attention and feel more at home in our lives than positive emotions like happiness, hope, pride and success. Is it just fear of failure or something else at work? I don't know, but if you had to pay for simple pleasures - a sunny day and a clear blue sky, a field of flowers, to have the loved ones in your life that you do, the satisfaction of a job well done, a fun dinner with friends, coming home after an arduous trip, having your kids put an arm around you - would you enjoy these things more?
I try these days, as too many of my contemporaries are getting ill and passing away, to recognize how fortunate I am and cherish the day and all it brings.
Time passes much faster than it used to so I'm trying more and more to follow the words of a very wise man, "Be the change you want to see in the world." These were Ghandi's words. So, if you want to have love, be love. If you want to enjoy peace, be peace. If you want to find joy, be joy. If you want to see yourself live well with diabetes, live well with diabetes.
And I think the way to appreciating things more is while not necessarily easy, pretty much as simple as what Christopher Robin said to Pooh: "You must remember this: You're braver than you believe, and stronger than you seem, and smarter than you think." Hmmm...that's a lot to take in, and yet, some pretty good stuff to live by.
So as I start this new year and it stretches in front of me now pretty much a blank canvas, I'm going to try and remember my own words and those of Christopher Robin. After all, one of my true blessings is the company I keep - around the corner, virtually and in storybook form.
Donation to JDRF
I just sent a check for $350 to the Juvenile Diabetes Research Foundation (JDRF). This is part of my commitment - to donate part of the proceeds from the sale of my book, "The ABCs of Loving Yourself with Diabetes," to an organization making life better for those with diabetes. If you purchased a book this year this donation was possible because of you.
Last year your purchase funded a similar donation to Diabetes Research Institute, another premier institute searching for a cure for diabetes.
Every year I'll make a donation to a diabetes organization from the sale of "The ABCs of Loving Yourself with Diabetes." So buy a book and do yourself and others a good deed.
TuDiabetes
Like JDRF, started by a few families with type 1 kids wanting to raise awareness, TuDiabetes, one, if not the world's largest diabetes social networking site, is making a similarly dramatic difference in the life of people with diabetes. TuDiabetes, the dream and vision of Manny Hernandez, is a place where almost 10,000 PWDs across the planet come together to share their stories, information, hopes, fears and inspire one another. Manny's mission is that no one with diabetes feel alone.
Manny's Diabetes Hands Foundation, from which TuDiabetes was born, is constantly active raising diabetes awareness through projects they both initiate and support. Think about lending your support as you watch Manny's video. From every dollar you donate TuDiabetes and diabetes awareness grows. I've had the pleasure to get to know Manny a bit this year and I can tell you no one has a truer heart.
Sometimes I think it's easy for all of us in this diabetes-blogging world to forget that we actually affect something or someone out there, speaking and listening virtually as we do. But as I look back on my year I know that we do.
I've written enough posts to share my personal ups and downs with diabetes and get it out of my system, for the moment that is. I've written several articles for various diabetes magazines and been advisor for a few diabetes organizations. I've seen my second book, "50 Diabetes Myths That Can Ruin Your Life and the 50 Diabetes Truths That Can Save It" hit bookstores and receive praise from reviewers and thumbs up from readers. I've been invited to Roche pharmaceuticals' first diabetes bloggers social summit. I gave away 2,000 of my books at the International Diabetes Federation conference that are now in libraries, clinics and practitioners' and patients' hands around the world. I've traveled across the states educating and inspiring fellow patients. I've flown to England to become a more skilled health coach and been taught by two Harvard professors to enhance my skills even further. One of my aims next year is to be part of the solution helping patients improve their self-management.
Of course this all came at a cost: I traveled far and wide, met wonderful new people, made some incredible new friends and made my husband very proud. Here's to a great new year for all of us.
I posted this two years ago, and in truth, my letter to Santa hasn't changed any.
Dear Santa,
All I'd like this Christmas is for you to take this diabetes away. I'm so tired of it already. All these finger sticks and guessing when my blood sugar’s high or low. Now that I'm in menopause I can barely tell if I'm sweating because I'm losing estrogen or my blood sugar's crashing at 50! And, can we talk...I mean the constant figuring out how many carbs are in a ravioli or bread stick or that fried calamari that will be at the company Christmas party. Some days I just want to lay down and shoot myself. Please, please Santa, would you take this diabetes away?
Sincerely,
riva
Dear Riva,
I'm very sorry you're having a tough time during my favorite season. I only want people to be singing carols and drinking eggnog and feeling good cheer. Unfortunately, it says in my contract, that I'm not allowed to interfere with life's natural occurrences. So here's my suggestion, after you open your holiday gifts, look under your Hanukah bush for the gift in having diabetes. You may have to spend a few days looking so why don't you schedule it for the week between Christmas and New Years while you have some down time? Then you can start the new year fresh.
Best wishes,
Santa and the gang
Dear Santa,
A gift in my diabetes? What are you crazy? Meshuggah? Thanks, but no thanks!
riva
Dear Rabbi,
I seek your wise counsel. I wrote to Santa to take away my diabetes but he wasn't helpful at all. Surely you who have studied so much and represent our people who have suffered throughout history can help me with this awful diabetes. It's such a strain, Rabbi. I have to test my blood sugar when I really want to be lighting the sabbath candles. I forgot all about the High Holy days this year because I was so busy counting carbs in the Challah, bagels and honey cake. Rabbi, please, what solace can you offer me? What words of wisdom? Surely you would tell me to just forget about this diabetes thing and study the Torah, right?
Please write soon,
riva
Dear riva,
Santa and I just returned from the Caribbean and he told me about your difficulty. He said he told you you should look for the gift in your diabetes. I concur with Santa, there are many gifts to be found in diabetes if you look. For one, my child, you won't have to drink the traditional Manishewitz holiday wine anymore. The Counsel all agree it is much too sweet. Bring out the Chardonnay!
When Santa asks you to look for a gift in your diabetes, he is not saying this because you are not Catholic and he is not bringing you anything, although this is true. He is speaking like our brothers the Buddhists, who profess there is a gift in everything if you look for something positive it can bring into your life.
Let me tell you a story my child. My own Aunt Sheila had diabetes and after she stopped kvetching, she went to a spa and learned how to eat healthy. She shopped along Rodeo Drive and bought a cute little jogging outfit and started running. On her jog along the ocean she met her fourth husband, Marvin, and they're very happy. They just moved into a $6,000,000 mansion in Jupiter, Florida -- right next to Burt Reynolds! Everyone’s plotzing! Darling girl, find a gift in your diabetes, because to be honest, since you're not orthodox, and all I have are these great wigs I got on sale from my cousin Schlomo, I'm not bringing you anything either. And really, it's not very pleasant to whine.
Shabbat Shalom
Rabbi, Local Union 107
Dear Rabbi,
I thought about what you and Santa said and have decided to become a Buddhist. I picked up the Dalai Lama's book, The Art of Happiness. He says, "Happiness is a butterfly, which when pursued, is always just beyond your grasp, but which, if you will sit down quietly, may alight upon you." I told my friend, Joe, I like butterflies and I like the robe, so these aren't bad gifts. Joe said the quotation meant that we are the source of our happiness, that happiness can only come from inside us regardless of what happens in our lives. Hmmm, I said, maybe I need to learn more. So I booked a flight to Tibet. Now if only I didn't have to drag all this damn diabetes stuff with me....ohm...ohm...oy. riva
"Sisterhood of the Traveling Pants" is a sweet friendship tale of four teenage girls, lifelong friends, who will be spending their first summer apart. On the eve of their separation, they find a pair of jeans that magically fits all of them perfectly, even though they're all different shapes and sizes. They decide they will share the pants over the summer as a way of staying together while they are apart.
I have a similar story only it involves a computer bag, someone I'd never met before and less than sweet emotions.
I spied this burgundy computer bag on the second day of the International Diabetes Federation conference I attended this October in Montreal. Scads of people (true different sizes and shapes all) were walking around the lecture rooms and exhibition halls with this bag on their different-sized shoulders. Magically, it fit them all and I knew it would fit my shoulders as well. And I wanted one, badly.
Frankly, I don't lug around my computer. And I didn't want this bag because I thought it was such an amazing bag, although I do love burgundy and did get married in a gorgeous cut velvet burgundy dress... but that's another story.
No, this bag had an emotional tug on me from the moment I saw it. Having this bag over my shoulder would proclaim to the world just as it says, "I am traveling to change diabetes." It would prove membership in the club of those who work in diabetes, and be validation that I am making a difference.
This bag was my visible, tangible confirmation that these posts and my books and talking to fellow patients contributes something. With no congenial office to go to, no lunches with colleagues, drinks after work, boring meetings where everyone rolls their eyes in solidarity at the boss's obtuseness, no annual Christmas party, this bag symbolized to me below my conscious radar, acknowledgement for what I do. It was a purely immature and selfish urge to want, and to get, this bag. I also noticed that the more I saw the bag around the conference, the more my amygdala (fear-based center of the brain) was controlling me beyond all reason.
I asked at the Novo Nordisk booth if I could get a bag and was told they were only given to people who'd attended their seminar the first day of the conference. Disappointment clouded every other booth from my view.
Miraculously, the second day of the conference I attended a small party given by one of the vendors I knew whereupon one of the guests said to me, "I know Pia at the Novo booth, give her my name and tell her I said if she has any bags left to give you one. Pia's great, if it can happen, she'll make it happen." Excitement flushed my cheeks, or was it the wine?
The next day I found Pia and she said the last day of the conference they would give out their remaining bags. She wrote my name in her little red book adding each of the beautifully scribed letters to the list of the select few (trust me this is as close to VIP as I get) who would be given this treasure. "Come back anytime after 10 AM on Thursday," Pia said, "to get your bag."
I told my husband, "You see persistence pays off!" all puffed up with how pleased I was with myself. Thursday morning at 10:30, my hands hanging awkwardly by my side feeling their emptiness soon to be filled, I walked over to the Novo booth. I didn't see Pia so I asked the woman there, "Hi, my name is in the book to get one of your burgundy bags." "I'm sorry," she said, "they're all gone."
"They're all gone?" I said dumbfounded. How is this possible? My name is in the book. I'm here as I was told to be. "Are you sure?" I almost whispered, "My name's in the book." "I'm sorry, they're all gone," she said and turned away.
I could barely keep the disappointment out of my voice when someone I'd befriended at the conference addressed me minutes afterward. (Yes, I know you're saying to yourself my goodness all this fuss over a bag?! But you have to imagine this was the world diabetes conference, 12,000 people, and every time I turned crowds of them were parading by in my burgundy bag.)
My husband didn't know what to say to make me feel better. Then by accident at 2:09 PM, not that I remember, I saw Pia. "Hi, I came by earlier but was told there are no bags left?" "Yes, I'm sorry," she said, "they started handing them out early this morning by mistake and they all went in no time." After a long pause she said, "I still have one left in my office in Copenhagen. If you give me your address I'll send it to you when I get back."
Without a moment's hesitation I gave her my card and thanked her, stupidly, I'm sure I was rambling. Only as I walked away did I think the chances of her really sending me a bag from Copenhagen were slim. After all, it would be so easy to lose my card on the way home. She'd be swamped with work when she returned and this would go forgotten. Someone would have already taken that last bag from her office, or she would look at it upon her return and think it's too much effort.
But still, I waited. Hope is its own salve. I watched the mail and waited. I thought if it comes it will be in three weeks time. Certainly Pia needs some time to catch up on her work after attending this conference and it is an international package. After three weeks and no bag I kept moving my timeline out. Each day I approached my front door hesitantly, expectantly, hoping to see a package but I knew after four weeks I would never see that bag again.
Just when I truly forgot about it I came back from my morning walk and my husband said, "You got a package and pointed to the FedEx box on the floor." I looked at it and said as I sat down at my computer, "I'll open it later." My husband, having looked at the post mark knew what lay in the box and said, "Are you sure you don't want to open this? It's going to make you very happy." Not thinking about the bag at all, it took two more of his attempts for me to get up and look at the box whereupon I saw that it was from Copenhagen.
Inside was the burgundy bag and a note from Pia hoping I would enjoy the bag. Little did she know. I wrote Pia a thank you letter and sent her my books in return, yet I'm sure she still doesn't know how much this bag and the fact that she took the time and trouble to send it to me means. The fact that there are still people in this world as good as their word. The fact that what seems like a small act of kindness can be richly rewarding to another. When I give presentations now I put my materials in this bag and on its first flight out at JFK waiting to board a plane to Cleveland, the woman sitting next to me seeing my bag smiled and asked me about what I do.
Yes, it's crazy, but I proudly sport this bag as my declaration to the world that this is the work I do. That I am a member of this club. Inwardly, it's a cue to myself that what I do matters and that I belong right where I am.
On second thought maybe this tale bears less resemblance to "Sisterhood of the Traveling Pants" and more to the film, "The Red Violin," where a perfect violin is admired for its red color and passes through many lives playing a significant role. Maybe my bag's adventures from Copenhagen to Brooklyn to Cleveland, where it has yet to travel, stories it will yet engender and lives it will yet touch, is the true gift and meaning of this bag.
Hmmm...let me see, it must be at least a few posts since I last reminded you about this fantastic book I wrote that was released this summer, "50 Diabetes Myths That Can Ruin Your Life and The 50 Diabetes Truths That Can Save It." Nice thing is people keep discovering it.
I wouldn't bring it up again (well, maybe) except this morning Catherine Price not only reviews the book but also includes in her review my answers to some really great questions she asked me like: "What 3 things would you tell people about diabetes?" "What kind of policy changes do we have to make to help stop the spread of diabetes?" and "How do I personally stay positive managing my diabetes?" among other questions.
You may remember Catherine - who among her many writer hats blogs on A Sweet Life, a great savvy and diverse site that brings you news, expert advice, tips, recipes and blogs - wrote a great piece in the NY Times recently.
If you don't know "50 Diabetes Myths That Can Ruin Your Life" also has its very own web site. Now there's just no reason to let myths ruin your life.
If you haven't seen this video, Pink Glove Dance, that's gone viral, take a look. It's for breast cancer awareness and it will grab ahold of your heart.
It upends our typical view of hospitals and everything we associate with them, and the music is a foot-stomper.
You'll find yourself smiling (even if you watch it more than once as I have) or find a tear or two has crept into your eyes as they have mine, as it reminds us just by its joyfulness of our connection, and the humanity we all share.
Medline, the manufacturer of pink examination gloves, is making a significant contribution to the Providence St. Vincent Medical Center at the Portland hospital where the video was shot and offering free mammograms to the community when the video gets 1 million hits. Nice to see a company think outside the box.
The video's already gotten almost 5 million hits, but that's no reason not to add yours. Now we need one of these for diabetes awareness, don't ya think?
I truly think type 1 and type 2 diabetes should have completely different names. Yes, they both have "insulin inefficiency" and wacked out blood sugars in common, but their causes and related health conditions are different, and equally significant, managing the two are generally far from the same thing, and our lives with diabetes are far from the same.
I know this well, I don't need confirmation, yet yesterday while on the phone with three of my closest friends with diabetes I was surprised by how acute and visceral this knowledge is becoming for my type 2 friend who is learning to use an insulin pump. “That freakin’ daily log I have to keep now” she said. “I’ve worn my hands out! And, I’ve never been so attached to glucose tabs before! If I’m out gardening I’m going low. Last night I was 71 before going to bed. What do I do?!” Ah, welcome my type 2 to my type 1 world.
We four met as A1C Champions: We travel around the country giving educational presentations to fellow patients, sharing our personal story of living with diabetes hoping to inspire our audiences to better manage their diabetes. Most of the Champions have type 2 diabetes, yet not surprisingly of these four friends, three of us have type 1. Not surprising because for type 1s there is an intrinsic bond as pervasive and invisible as our condition; we see our mutual struggle in each other, we know intimately the burden we manage every day, and, that no one else sees it. That said, we three type 1s adore our type 2 friend. She is one of the most open, caring, curious and both emotionally and diabetes-intelligent people I know.
So, we were all on the phone yesterday at the request of our type 2 friend who was seeking our type 1 counsel about her pump. Her blood sugar control is far better overall, but “lows” are more frequent. “Before (15 years worth) I rarely went below 85 or 90,” she said with tempered evenness. “Now about every third day I'm going low! Even shopping can make me go low!! TWENTY MINUTES IN WALMART AND I'M REACHING FOR THE GLUCOSE TABLETS!!!
This will straighten out. She is working with her endocrinologist to refine her basal calculation (the amount of insulin the pump delivers throughout the day). Also, since her blood sugars now hover at a lower level than they used to, she's paying more attention so that they don't go too low.
My friend has discovered through this pump experience a new understanding and respect for what type 1s live with every day, pump or no pump. And I was made more aware through our conversation of just how truly unknowing others are of what we deal with everyday, even those with type 2 diabetes.
So there we were, three type 1s throwing out ideas to help our type 2 friend with her pump until she sees her diabetes educator again. “Eat the same three meals, and only three, every day for a week to figure out your basal rate.” “Get a book on pumping by John Walsh or Gary Scheiner and devour it cover to cover.” “Make sure you’re using multiple basal programs for different hours of the day and night when you need varying amounts of insulin.” “Don't just eat glucose tablets if you're low, they don't last that long. Make sure you eat some protein too." "Well it's a toss up whether to detach from the pump when you're going low to stop the insulin drip or eat a snack. Of course that could lead to weight gain." And finally, "Accept that even if you do the same thing every day your body will not act the same way every day." The true mantra of type 1.
I don't write this to discourage you if you're a type 2 thinking of a pump. My type 2 friend is definitely benefitting. Her blood sugars are lower overall, she is taking less insulin, this is allowing her to lose some weight and when not worrying about lows, which will rectify themselves once her program is worked out, she feels better and more motivated to do better seeing her numbers improve. Also, she has a real awareness now that her actions affect her results. “It’s a real eye-opener to see on paper that what I do affects everything,” she told us. “It’s made me more judicious about what I eat. I see so clearly now that I’ll have to add more insulin if I eat that. It’s made me see my management all quite differently.” That's indeed good news.
An insulin pump, I've been reading in preparation to go on one myself next year, typically reduces the amount of insulin one needs. Something about how it saturates your cells with insulin and mimics the normal functioning of a healthy pancreas. For Type 2’s the insulin requirement can drop by a third or nearly half. My friend used to give herself 4 units of Apidra (rapid-acting insulin to cover meals and make corrections) to come down 80 points, now it's more often 1 unit.
Depending upon the day, my mood, who I'm with, the conversation, whether or not my oatmeal burned that morning, my feelings about living with diabetes vary. Some days are almost a breeze, other days I'm exhaustedly fed up with all it takes and soooooo annoyed no one really gets it.
With that, I wanted to spotlight these diabetes musings that reflect only two of the many sides of living with diabetes. One is a page from my book, "The ABCs of Loving Yourself With Diabetes," which coaches you to more often engage your positive emotions - like kindness, forgiveness, strength, courage and appreciation - to manage your diabetes, and your life, with greater ease and happiness. It's featured in the current newsletter from TCOYD (Taking Control of Your Diabetes.) TCOYD, headed by Dr. Steven Edelman, who has type 1 diabetes and was named Educator of the Year this year by the American Diabetes Association, brings informative and inspirational one day health fairs and conferences across the country to people with diabetes.
Then two weeks ago, Catherine Price, a blogger over at A Sweet Life, shared her story of living with diabetes in the New York Times, "Thinking About Diabetes With Every Bite" and it was as if she was telling my own tale: The constant rigor, calculations, analysis and invisibility of living with diabetes, particularly type 1 diabetes where you must inject insulin and test blood sugars several times a day, every day, to manage it.
For me, both sitting in the positive and dealing with the sometimes grinding daily tasks co-exist - sometimes simultaneously, sometimes in parallel and sometimes at unsettling right angles depending upon the day. But always like a chronic condition they are there, the many sides of diabetes rising and falling, ebbing and flowing, expanding and contracting as we learn, move, grow, expand, collapse, relapse and press on again.
I want to tell you something it took my mother roughly 70 years to learn: Fear and worry can be giant stalkers and thieves. I grew up with a mom whose two primary emotions were fear and worry. Admittedly, there are times these can save a life. But usually they steal from your life. Fear and worry for decades have colored how my mother sees and interacts with the world, "Take a hat or you'll get sick!," "Let's go now (2 hours early), there'll be traffic!," "No, I'm not going. They only invited me because they were being polite." These are not life-savers, they are life-stealers.
My mother's automatic response to most situations is: "You shouldn't X, because Y will happen and Y will be terrible!" Fear and worry affect her decisions and expectations of others and the world. It is a heavy load to bear when fear and worry are what you hold most close, simultaneously creating comfort, distress and so much limitation.
I've pointed this out to my mother for years, since I was a teenager actually. She is wholly aware and agrees, but knowing and doing something to change are two different things. When she imposes her fear and worry on me, I stop her as quickly as I can. Sometimes graciously, sometimes not so much. She has learned at these times to back off. It is self-protection for me: I don't want to absorb her negativity. I love my mother and I know after years of trying, I will not change her and I don't want her outlook to change me. Funny thing is if you met my mother you would think she is lovely, warm and personable, and perfectly normal, all of which she is. And she harbors these demons.
I have seen these emotions narrow my mother's world and opportunities, like the friends not made because "They don't really want me" and the job offered not taken because, "I won't do it properly" when hands down she would do it better than anyone. I've been ruminating about this because I recently read a quote that captured these thoughts so well and reminded me how easy it is to nurture fear and worry living with diabetes:
"Worry does not empty tomorrow of its sorrow, it empties today of its strength." Cornelia (Corrie) ten Boom
So succinct, so profound, so true. I shared this quote with a group of patients I presented to a few weeks ago in Gettysburg, Pennsylvania. If you spend time worrying about the future, complications or premature death, you will not change anything except probably feel worse than you already do. However, if you take that same investment of time and energy to do something productive and useful - like learning how to and eating healthier, being more active, going to the doctor and spending more time doing what you enjoy, you will change everything.
Corrie Boom was an interesting woman - the first licensed female watchmaker in The Netherlands who after WWII became a preacher traveling the world preaching forgiveness. During the war Corrie worked with the Dutch underground recusing Jews, until in 1944 her entire family was arrested and sent to Ravensbruck concentration camp. When released from the camp - due to a clerical error, otherwise she would have died there like her sister - Corrie returned to the Netherlands and opened rehabilitation centers. Soon after she went back to Germany where she began preaching, bringing her Christian beliefs about the power of forgiveness to over 60 countries. In her post-war experience talking with other Nazi victims, she discovered that those who were able to forgive were best able to rebuild their lives.
There is more and more literature coming out about the power of positive emotions, which I believe just as strongly as I believe negative emotions are disempowering. While fear and worry provide the comfort of feeling like you're doing something, in actuality all you're doing is using up time and energy that can be put to actually improving something.
My mother's turning 80 this January and in many ways she is recapturing much of the life she gave away. While fear and worry are still fond friends, she has found a way to turn her head away a good deal more often now and see them as the thieves that they are.
Copyright ©riva greenberg 2007. All rights reserved.
