It's a celebration
Did you know that on this date -- October 30 in 1920, Frederick Banting woke from his sleep and wrote down the method to isolate insulin? Don't worry, I didn't know either. A friend, who is an M.D., just sent this salutation to me in an email and it gave me a moment's pause. Banting's dreamed method was so on the mark that in January of 1922 he treated the first patient with type 1 diabetes successfully! In that regard I am very happy to wish you a fabulous insulin day.
Think today how lucky you are. Millions died from diabetes before insulin was discovered and had to subsist on starvation diets before their grizzly end. So, maybe on Happy Insulin Day we should all celebrate by indulging in a favorite food -- pizza, Drake's coffee cakes, cherry pie, mocha fudge ice cream (oops, my fantasies) -- because we know we can manage it with insulin. And, yes, tomorrow is another day.
It's really amazing what a muddle we are in over food these days. It's on our morning new programs every day, nutritionists telling us, "How to eat, what to eat, what not to eat, what children should eat, how to make pancakes that look and taste like brownies..." Weekly doctors, gurus and alternative healers discourse on Larry King Live about diets, non-diets, trans-fats and why Americans are increasingly obese.
In my last entry I wrote about how my low carb diet has helped control my blood sugars and reduce my insulin requirement. I wondered aloud why everyone doesn't see the logic in less carbs in = less meds in. But, I must admit, having recently picked up a book that takes this to the extreme -- The PH Miracle for Diabetes, The revolutionary diet plan for type 1 and type 2 diabetics by Robert O. Young -- that everything is relative.
Young says diabetes, largely type 2 but I believe he's including us type 1s, is caused by our body's overly acidic PH level (the acidity or alkalinity of our internal fluids). Our over acidity, if I understand him correctly, comes from eating carbs. Carb intake causes the body to flood itself with the 'fight or flight' hormones: cortisol, adrenaline and insulin, which cause inflammation. Inflammation, which causes corrosion of our body tissues, prompts a too acidic PH level. Sorry, as you might have guessed, chemistry and physics were not my strong suits. Young says we need to make our PH level less acidic and more alkaline, and the way to do this is through a diet largely of vegetables.
Dr. Andrew Weil, alternative medical guru, says many of today's diseases and health ailments are caused by inflammation and he advocates ananti-inflammatory diet. Even Gary Taubes author of, Good Calories, Bad Calories, says our over consumption of carbs, trans fats and high fructose corn syrup type additives, trigger a genetic predisposition to haywire our hormonal system and cause unsuspecting citizens to put on weight. Taubes says, it is not our over consumption of calories that is making us fat, but this haywire handling of refined carbs and these other ills in our diet. Seems no one can agree on what makes us fat but these three pundits are speaking a similar language about illness.
So, what to do? Several years ago I vacuumed the refined carbs out of my diet. Admittedly, I felt pretty virtuous doing this. But now Young says I should get rid of: coffee, tea, chocolate, alcohol, grains, dairy and exist almost exclusively on vegetables, fish and what he calls his "green drink" -- juiced vegetables with some magic powder in it. Hmmm...I suppose if I was forced to do this, I could, but it really doesn't sound like a happy life. And, given that he says a positive attitude is an important aspect of his eating plan, I'd fail miserably. Tears shedding all over my clothes and furnishings.
Many times people tell me they'd like better blood sugar control. Yet when I mention reducing their carbs they say, "Hey, I'm human, I want to enjoy what I eat." Well, for me cutting way back on carbs was not a major hardship and I like the return benefit. I'd already cultivated years of cozying up to veggies and cutting back on butter, muffins, fries and white bread. Then, when I restricted my carbs a little more, like not eating grains too often and eating one piece of whole grain toast with my omelet instead of two, it gave me the kind of control that makes it worth it to me.
But, truly, Dr. Young, I must be weak -- I just couldn't go the distance as you propose. Giving up yogurt, cottage cheese, dark chocolate, wine, manchego and gruyere cheese, the occasional fried dish and friend's birthday cake would be downright unsocial, not to mention aggravating. So it really is up to each of us where we feel the trade-off is worth the return.
There are plenty of case studies in Young's book where people proclaim following his diet changed their lives, even to the degree that they don't need any diabetes medication anymore, including insulin. I imagine that's type 2s talking. While I understand if I didn't eat anything that raised my blood sugar, I could probably cut out my bolus insulin entirely, my basal insulin is not optional. We still need insulin for various bodily functions. So if this regimen and its possible benefits appeal to you, check it out. I'm not playing advocate here, just reporting the news.
A friend, and fellow A1c Champion, saw author, Gary Taubes, talk about his new book Good Calories, Bad Calories, a month ago on Good Morning America and sent this email around, "Taubes says that exercise makes us hungry for carbohydrates, not lean, and that carbohydrates cause insulin secretion which creates fat." One of her email recipients, who is a Ph.D and medical specialist, wrote back: 'There is still a lot that we don't know but for me eating less and moving more has led to my weight reduction. I could have dieted on birthday cake as long as I did not eat more cake calories than I spent.'
It’s a constant debate in this country: What’s the magic formula for losing weight, fast – and easy. The second battle ground, and especially for us d-people, is are carbs good or bad? To me, the answer to both is simple: eat less, move more and since carbs raise your blood sugar, if you want to lower it eat less carbs. Why is that such a difficult notion? Seems crystal clear to me and trust me I'm no rocket scientist.
Around the same time my friend's email went around, a wicked debate was playing out on DiabetesHealth’s web site. Hope Warshaw, MMSc, RD, CDE, BC-ADM, and diabetes educator, wrote five articles on carbs, Don't Want to Go Low Carb or Vegan, that garnered more comments than I've ever seen in response to an article, and a rebuttal article by Richard D. Feinman, PhD, Professor of Biochemistry and Director of the Nutrition and Metabolism at State University of New York Downstate Medical Center.
In a big nutshell Feinman said, “I'm astonished that experts encourage people with diabetes to eat carbohydrates and then "cover" them with insulin. Why would anyone, (let alone doctors who advocate it every day), recommend a diet that requires more medication?" Are they all in bed with pharma companies? Sorry, that last question is my own.
“It strikes me as odd that what most experts know about metabolism - diabetes is, after all, a metabolic disease," said Feinman, "they learned in medical school from somebody like me. The first thing we teach medical students is that there is no biological requirement for carbohydrate. It is true that your brain needs glucose, but glucose can be supplied by the process of gluconeogenesis; that is, glucose can be made from other things, notably protein. This is a normal process: when you wake up in the morning, between thirty and seventy percent of your blood glucose comes from gluconeogenesis. There is no requirement for dietary glucose. And, all of the metabolic syndrome ills - high triglycerides, low HDL, hypertension and obesity - are improved by low carbohydrate diets. If we had been describing a drug," Feinman goes on to say, "everybody would have rushed out to buy stock in our pharmaceutical company."
I can’t comment on the metabolic workings, but being like most diabetics I can share with you what I experienced when I changed my diet several years ago to low carb. I read Dr. Richard Bernstein's book, Diabetes Solution, and for the first time read someone advocating getting rid of carbs to control blood sugar. Dr. Bernstein advocates next to no carbs in a diabetic diet.
Himself a diabetic for more than 50 years, Bernstein claims he has reversed many of his early complications and gotten his blood sugar under tight control by virtually eliminating carbs. Less carbs means you'll be taking less insulin and by taking less insulin, Bernstein claims, your insulin will be better absorbed, there'll be less variability in its time and efficacy and greater predictability with your blood sugars. Let’s just say after I read his book, I was encouraged and inspired to try his "solution," so I pretty much vacuumed the carbs out of my diet. "Vacuumed" in the sense that I cut way, way back. I essentially eliminated refined carbs: white bread, white potatoes, rice, pasta, sweets, muffins, starchy veggies. The result? My sugars indeed dropped, were consistently lower, my insulin doses dropped, and maybe best of all I was no longer chasing high blood sugars. You know the ones that come from refined carbs where you just can't seem to knock them down all day. My Lantus dose went from 20 to 12.5 units and my mealtime Humalog was all but cut in half before each meal. The results were so dramatic and made life so much easier, I have not in five years gone back to my old ways. I do have to add the caveat that we're all different and your body may not respond the same as mine.
It's common sense, though, that the less carbs you eat the less your blood sugar will rise and the less medication you'll need. I don't understand how anyone can argue the logic in that. If we’re still being given diets with substantial carbs in them it’s probably because the American Diabetes Association (ADA) and powers that be think the average diabetic will never stand for, and won’t be able to, cut the carbs. Not unlike why the ADA's A1c recommendation is as high as 7 – which correlates with 170 on your meter - even though we’re advised to stay in a target range of 80 – 120. Something sound fishy?
For those interested, here’s my routine that keeps my sugars low. My one carb meal is breakfast. I figure it's healthy, high fiber, it's satisfying, and since I walk in the morning, the blood sugar rise gets leveled out. Every morning I make a bowl of slow-cooked, steel cut oatmeal. I know many people who make a batch a week and freeze portions, but I like the morning ritual. I actually eat less than a whole serving and make up the difference with a dollop of low fat plain yogurt or cottage cheese and a tablespoon of peanut or almond butter. Also I add flax seed and cinnamon. For this treat, and like Jerry on Seinfeld I could eat breakfast for any meal, I need 3.5 units of Humalog or 3 if I’m taking my hour walk around my local park. Lunch is generally a spinach salad with feta cheese, tomatoes, beans, left over veggies, or a spinach/feta omelet. For that I need .5 - 1 unit, and dinner is typically fish or chicken, vegetables and beans. If I’m having a glass or two of wine with this dinner I don’t need any insulin - alcohol for most people lowers their blood sugar, unless you're drinking Strawberry Margaritas and Singapore Slings.
A few months ago I interviewed a fellow type 1 who had had an islet cell transplant, two actually. For 18 months afterward she was insulin-free. Unfortunately, as for most islet cell transplant recipients, if not all, her new cells began to fail and she had to add some insulin back to keep her blood sugars in range. She told me, though, she's on a very small dose -- 14 units total daily. My daily dose is about 18 units and none of my beta cells work. Seems argument enough for me that you can keep your insulin, or meds, at a minimum by sweeping most of the carbs out of your diet.
I should tell you in full disclosure my diet is not carb-free - and alas, I am not perfect. When out to dinner I often nibble on the bread and love it dripping with olive oil. Thank God someone decided that's healthy. I indulge in an order of fried calamari or crab cakes from time to time, and if dessert comes to the table I’ll stick my fork in like everyone else for a taste. But without question, the less carbs I eat the less insulin I need, and for me the control I get and the way I feel is worth it.
If you're curious about a lower carb diet, give it a try. First hook up a hoover to your pantry and suck out all the chips, pretzels, rice and muffin mixes. Second, while experimenting, test, test, test. Third, see if your blood sugars and meds don't drop. Fourth, reward yourself with some high cocoa dark chocolate -- Lindt's 85% Excellence chocolate bar has only 8 carbs per serving! Good luck.
Create a picture of your life
Remember that ground-breaking management book from Stephen Covey – The 7 Habits of Highly Effective People? Well, Mr. Covey and the American Association of Diabetes Educators (AADE), with support from Bayer Diabetes Care, have released a small pamphlet applying his 7 habits to diabetes care. Covey's inspiration for the booklet? His wife was diagnosed with diabetes.
I imagine the thinking behind this booklet is to give patients a new tool to manage their diabetes, adding to the typical diet, exercise, meds routine. This tool has the patient draw from a more emotive place: understanding, listening, cooperating and picturing your perfect life. What impresses me is the head-nod to the fact that managing diabetes is not just about medical management, but includes our emotional, mental and spiritual being. Covey’s habits are:
1) Be Proactive - Choose your actions, and be responsible for them
2) Begin with the End in Mind - Create a vision for your life based on what is most important to you
3) Put First Things First - Prioritize tasks based on importance and what one thing can you do regularly that will make a positive difference in your life?
4) Think Win-Win - Build relationships with others by helping them succeed, too. From this you create the positive energy of cooperation which leads to success in all things in your life, including diabetes management.
5) Seek First to Understand, Then to Be Understood - It's about listening. Listen to your health care team to gain the practical skills of self-care
6) Synergize - Combine guidance from your team and support from friends and family
7) Sharpen the Saw - Keep everything sharp: your body, mind and spirit
It's hopeful watching the AADE move in this patient-empowerment direction. In a perfect world, patients’ attention, with the help of their educator, would be on greater quality of life, not so singly focused on diabetes task management, but weaving that into a vivid picture of a happy and healthy life. For a positive vision of our life is truly where our motivation and energy come from -- for all things -- including managing diabetes. Diabetes educators would exhibit less ‘directorial skills’ and more coaching skills, helping people design a ‘life plan’ with diabetes in it, rather than just a ‘numbers plan’ -- blood sugar, blood pressure, lipids, you get the idea. But since we can't ignore the numbers aspect of diabetes management, at the back of the booklet you'll find the AADE's 7 self-care behaviors.
The booklet is a nice start. To get yours - and it's free - go to: http://www.diabetes7.org. What we need now is a well-trained team of educators ready and able to help patients put these habits into play. Well, I guess one can’t ask for the moon, the stars and the sun all at once. But this moonbeam is a small ray of hope. For more information about the AADE, particularly if you’re looking for a diabetes educator in your area, go to: http://www.diabeteseducator.org.
I spoke in front of 60 people twice in the last two weeks at the American Diabetes Association Health Expos -- first at the Jacob Javitz Convention Center in New York City, and yesterday at the Convention Center in Tampa. I was a key-note speaker on the Main Stage of the Exhibition Halls sharing healthy tips and my personal tricks managing diabetes. It’s enormously rewarding for me to give these presentations: I love to help, to share my experience and, I guess, be on stage. What few people know, although at times I bring it into my talk about controlling blood sugar, is that my blood sugar often spikes just before I start from pre-stage jitters. Ah, the price of fame.
But that is not the nut of this story. Rather, yesterday at the Tampa Expo after my presentation, I sat in on a CDE’s workshop about ‘Everyday Dealings with Diabetes.’ During the break, I talked with another participant about “burn out.” She is a teacher whose days are so fragmented that she can't seem to eat and do her exercise as well as she'd like. She also recently had gastric bypass surgery and lost a huge amount of weight. While she generally eats much healthier than she use to, and her need for medication has disappeared, she still has to carefully watch her weight, her diet and her activity, or the benefits could all go away, and her diabetes will return. “I’m constantly “fighting” my diabetes,” she said, exasperated.
My antennae went up immediately. If she’s “fighting” her diabetes, if that’s her attitude, focus and feeling, then she’s going to experience burn-out on a fairly regular basis. Doing battle is exhausting. Further, we typically see a fight as having a winner and a loser. From all she said, I imagined she casts herself as the loser. More tiring still.
“Can you change your attitude?” I asked. “Don’t think of fighting your diabetes. Think, instead of what diabetes has given you. It’s caused you to lose a lot of weight, eat better, start walking and now you have this trim, energetic body. You may not do your best all the time, but you're doing much better than you ever did before."
Her blue eyes flashed with surprise and understanding as she got it. She said, “Wow, you’re absolutely right! I’m so glad you said this. Thank you.”
So often we forget in all the work diabetes takes why we’re doing the work, or what we’ve gained by doing the work.
A few hours later while going through security at Tampa airport, I was still wearing my speaker’s badge from the Expo. If I’m honest, it was intentional: I was curious to see if anyone would approach me and start talking about diabetes. I thought maybe I could help someone, even outside the Exhibition Hall.
Well, who noticed my badge but the TSA security officer! As my suitcase made its way through the screening machine, the operator noticed something suspicious. So Bob, according to his name plate, politely asked if he could open my bag. As he did so he noticed my badge. Now, I thought, I’m dog meat! He’ll look for my syringes and this will start a whole episode. Bob said, “So, you were a speaker at the ADA Health Expo?” “Yes,” I said, not wanting to engage. “Hmm… “ he said, “Interesting.” “Why?” I queried, forgetting my disengagement strategy. “Well,” said Bob smiling, I have diabetes.” And so it began. As his white-gloved hand found the menacing granola bar in my case, Bob told me about his A1c, his diet, and how he’s still gotta lose a few pounds but he's working on it.We chatted for a good five minutes off the line, and I was smiling all the while thinking here I was helping the TSA security officer! Who woulda thought? I also realized, as I walked to my gate, with Bob wishing me a safe flight, that when you stay alert and open and in a space of gratitude, you can help anyone, anytime, anywhere -- particularly if you wear a sign saying, 'Diabetes Speaker!'