I don’t know if the expression “management-rage” exists, but it should

Last night on my way home while riding on the subway, the husband texted me, “How about meeting at Giovanni for an early dinner?” Giovanni is one of our three neighborhood watering holes. “I’m not very hungry,” I replied, “but sure,” since the husband rarely makes requests, and I have given him my solemn oath that when he does I will listen. Yes, you read that right, not necessarily agree or acquiesce, but listen.

Not too hungry, I ordered pasta. I rarely eat pasta because of the carb rise but I have – and want to know if you’ve discovered the same – discovered that homemade pasta does not raise my blood sugar nearly as much as packaged.

So I ordered the restaurant’s homemade Tagliatelle alla Genovese (braised short ribs, carrots, celery, fresh herbs & white wine, finished with shaved pecorino cheese.) Low carb ingredients, not even tomato sauce to add to the rise, just pasta a smattering of meat and vegetables. Yes, it was delicious.

My blood sugar was already on the low side before eating so I devoured a piece of bread to raise it a bit. I dosed 1.5 units of Humalog in total for my meal – for the bread, a shared appetizer of grilled vegetables and two-thirds of my smallish pasta dish. By time we walked the 8 minutes home my blood sugar was in the 50s. While I obviously didn’t think 1.5 units would knock me back to 57 mg/dl, or was too much for a piece of bread and pasta, even lower carb homemade pasta, it was. (YDMV: Your diabetes may vary)

Here’s the part where the “management-rage” comes in. Earlier in the day, not that you think me anything but a low carber, which I am 95% of the time, or a dilettante, I had also eaten lunch out. I wouldn’t normally also go out for dinner, but the husband stated his preference and it’s been a while since he had).

My lunch friend coaxed me (yes, I’m giving up full responsibility) to share an order of something she’d coveted every time she’d been where we were now having lunch: lemon ricotta pancakes.

Pancakes! I never order pancakes, but heck, we were celebrating getting together on the first beautiful, sunny, warm day in a while. We ordered the pancakes to share. And of course a spinach salad to balance the scales. The pancake dish was only two pancakes, but large. I ate three quarters of my one pancake, being so unused to knowing how to dose for this particular food item.

Bam! Walking twenty blocks to the subway after lunch, my blood sugar was letting me know I had overdosed. I corrected with the glucose tabs I carry. So just hours later, my blood sugar falling, falling once again, I couldn’t bring myself to eat more glucose tabs. Management-rage took over with a vengeance. My inner monologue, “I’m so tired of this diabetes, the constant calculating, the constant tracking of bites of food, guessing, eating when I don’t want to, starting the whole mess all over again every day… waa, waa, waa…” If you’re interested, I’ve had this sucker 51 years.

I lay on the couch watching my blood sugar go from 64 to 57 mg/dl and I ate a piece of 85% chocolate and a keto coconut cookie. I KNEW it wouldn’t do much, but I simply couldn’t bring myself to eat more glucose tablets. “Fuc# it!” I also asked the husband to watch my blood sugar on his Apple Watch, as I didn’t even want to look. That lasted about 10 minutes.

A half hour goes by, my blood sugar’s just sitting at 57 mg/dl and I was getting kinda hungry so I ate a Cauliflower Slim (3 grams carb) with a little avocado. Still not willing to give in to my blood sugar or my rage. I hung out at 57 for about an hour before I ate more chocolate and another keto cookie, and slowly, slowly it started going up. Did I feel my low? Yes, and no. Yes, but not enough to make me do anything intelligent. Was I suffering from hypo-fog, absolutely not! I was experiencing management-rage: resentment about the current conditions my diabetes was causing and (safely) unwilling to do anything about it.

Before I went to bed I was a lovely 95 mg/dl, but I knew, like a thief knows not to knock over the ming vase entering the house he’s going to rob, that it wasn’t going to stay at 95. That chocolate was going to keep my blood sugar rising for hours. To check my theory I got out of bed 15 minutes later and I was 113. I took half a unit of Humalog knowing 113 wasn’t the top of my rise. Overnight I went up to 162 mg/dl. When I woke at 4:15 am (I know, tell me about it) I was 138 mg/dl and I took half a unit of Humalog. At 7 am I was 95.

My management-rage last night was real. A temporary, albeit real burnout, breakdown on a day I was just damn tired of dealing with diabetes. I’ve had them before, I’ll have them again. I’m not irresponsible and I am not advising you to be irresponsible. If I’d gone lower than 55 mg/dl, or felt I was in any danger, I would have eaten the glucose tabs. I kept eyes on my blood sugar all night.

There is no avoiding the highs and lows. We are not machines and blood sugar is unpredictable. We will forever be guessing, calculating, judging, recalculating…but it has lifted my spirits to think of last nights episode as “management-rage.” Maybe because I don’t own a car, so I get to have my own little corner of rage. Feel free to use it the next time you’re having such a day.

Note: Pictured above are my co-conspirators last night and three favorite chocolate bars. They used to all be available at Trader Joe’s, but the Montezuma no longer is, at least not at mine. I brought 12 bars home from London, where they’re manufactured, recently. You can find the Cauliflower Slims at Trader Joe’s.

Sanofi is the last to lower insulin prices starting January 1, 2024

Well, it didn’t take long for Sanofi to follow Eli Lilly and Novo Nordisk to cut its insulin prices. Yesterday it announced starting next year, Lantus, its most popular insulin will.come down 78%, with a monthly cap of $35 for people with private insurance.

It’s also lowering the price of its short-acting insulin, Apridra, 70%.

Sanofi already has in place a $35 monthly cap for uninsured people with diabetes.

These three companies control over 90% of the global insulin market, and finally, with the threat of government pressure, they’re lowering their inflated prices that have tripled over the past decade. It still amazes me each of the CEO’s say we’re doing it because it’s time. Really? Seems like it’s been time for a very long time.

For more details, click here.

Once again, what we know validated – People with diabetes live longer on lower carb, plant based diet

I really have to scratch my head when I read headlines and articles like this one published yesterday in USA Today. Is there anyone in the diabetes community who doesn’t know this? And how many people, not in this community, who have diabetes don’t know this? I hate to admit it, but probably enough to make this headline seem like news.

I know that from the ten years I spent criss-crossing the country as a peer mentor speaking to groups of PWDs largely at their support group meeting. But then I say, shame on their health practitioners for not communicating or making sure their patients understood this.

So the bullet point is a new study from the Harvard T.H. Chan School of Public Health found that if we avoid high-carb, highly processed animal products we’ll live longer and have a reduced risk for cardiovascular disease and cancer.

Cost of a vial of Humalog will drop from $274.70 to $66.40 end of year

Eli Lilly is radically changing course after years of inflated prices and come the fourth quarter of this year, making their Humalog and Humulin, their state-of-the-art analog insulins, available for $35/month to those with private health insurance.

We saw this happen earlier this year when Congress passed a bill capping monthly insulin at $35/month for those who have Medicare.

Yet, those who didn’t were left in the dust. Now Eli Lilly CEO David Ricks says, “We are doing this completely voluntarily because it’s time and it’s the right thing to do.” Well, we might argue the same was true years ago, but that said, this really is a big loosening of the stranglehold Eli Lilly has had on the pricing of insulin, a drug as you well know, millions of people will die without access to.

One can only hope the two other giant Pharma insulin manufacturers — Sanofi and Novo Nordisk — follow suit.

For the full article, click here.

A podcast that looks at diabetes from different angles

Yup, I know, in my last post I shared a recent podcast and said it was well worth listening to. How embarrassing, now to post a second podcast and yes, even though I am humble and shy, tell you it’s a really great conversation.

On this Salience Podcast, salience meaning things that are particularly noteworthy, my host and friend Zhen Goh, sociologist, cultural and complexity researcher and a student of the Dao and I dive into a great deal surrounding diabetes and its management that you rarely hear about including the relationship we have with health professionals and they with us, and how it affects our lives.

Here’s the brief: Today on the Salience Podcast, we discuss the issues around industrialised healthcare’s culture of control, and how we can move from a more pathogenic culture of seeking to “control” chronic diseases, to one that recognises the variability of patient lives, and encourages salutogenesis – or, the sense of coherence that patients can seek by cultivating their ability to understand their own condition, manage and respond appropriately, and to also create meaning around their experience.

Here’s the episode: https://podcasts.apple.com/us/podcast/episode-7-riva-greenberg/id1627648038?i=1000599818092

Thanks for listening.

A diabetes podcast worth listening to, Embracing Diabetes

You may think me biased because February 3 I was a guest on the Embracing Diabetes podcast, available on Apple and Spotify. But there’s something about a podcast on diabetes led by a woman who has lived with type 1 diabetes more than 25 years and another PWD who is also an endocrinologist. What these two women, respectively Amy Stockwell and Liz Stephens, diabetes advocates and educators, bring to the party, is exactly the Embracing Diabetes tagline — compassion, community and creativity.

Funnily enough, I’ve met both Amy and Liz in the flesh. I met Amy years ago at a Diabetes Sisters conference and felt a kinship immediately, and had dinner with Liz years and years ago in Portland, Oregon when a mutual friend, who also has type 1, brought us all together for scrumptious, Northwest healthy/hippie cuisine.

Normally, I hate listening to myself, but I actually enjoyed listening to my own podcast and others I’ve heard on the channel. I share my own history of course, stories and experiences, and wisdom about “the life” and our interaction with our health professionals. So pour a cup of tea, or lace up your sneakers, and tune in.


Putting an Eversense sensor into Dr. E

You likely know I’m a big fan of endocrinologist Steven Edelman (founder of TCOYD) and his recent plunge into stand up diabetes comedy along with his sidekick endocrinologist Jeremy Pettus.

This video just crossed my email box and I thought it worth sharing. I myself cannot yet see using the Eversense CGM (why cut into my body if I don’t have to?), but if you’re contemplating it this may be of interest.

The Platinum Rule asks clinicians to look at their values

(Forgive the stock photo above)

You may be familiar with what’s known in the diabetes and medical community as #languagematters. It began as a global advocacy movement and now has a lot of research and recommendations behind it. As you might imagine, it reminds health professionals that the language they use with people who have diabetes should not be judging and negative but realistic and supportive. That this affects outcomes.

Similarly, this morning I read in the Scientific American, “Beyond the Gold Rule: Clinicians need to understand patients’ values, not apply their own.” That what also makes a difference in how we tend to people is values. Physicians, largely, of course not all, tend to swim in the sea of their values mostly ignorant of their patients’.

As the author, science journalist Claudia Wallis, points out, “We have to acknowledge the ways in which our own personal biases can shape the way we perceive and respond to patients.”

Here’s a brief excerpt from the article:

“In the arena of medicine, the stakes for making or influencing choices for others can be especially high. Such choices impact people’s quality of life and even their chances of survival. As health care becomes less paternalistic and more individualized, the time seems right for a new ethical guideline. Enter the “platinum rule,” proposed by Harvey Max Chochinov, a professor of psychiatry at Canada’s University of Manitoba: do unto others as they would want done unto themselves.

Chochinov, an expert on palliative care, eloquently describes this principle in his essay “Seeing Ellen and the Platinum Rule,” published last year in JAMA Neurology. He begins with a story about a health crisis affecting his late sister Ellen, who was severely disabled by cerebral palsy…”

How refreshing it is to remind all of us that we all see the world according to our unique experiences, conditioning and values. The whole article is worth reading.

Medicare’s $35 cap on insulin now in effect

Starting this past January 1 if you are on Medicare insulin will cost you no more than $35 per script per month. For people with type 1 diabetes, like myself who are not on a pump, that’s more like $70 per month, as we use two different insulins a day, both a rapid and long-acting insulin.

You do not have to first meet a deductible and the cost is intended to be applied at point of sale, like when you buy your insulin at the pharmacy, but some Medicare Plan Ds (Pharma) will not have their payment systems updated until the end of March.

For more details, here’s an article in today’s Wall Street Journal, “How the New $35 Cap on Insulin Costs Will Work.