Christel Oerum shares her tips for staying close, and six feet apart, during COVID-19

Christel Oerum above (Check out Christel’s bio and websites at the end of this post) is a diabetes advocate and fitness trainer who’s been mulling social distancing during COVID-19. Below she shares some thoughts.

Given how people with diabetes – both type 1 and type 2 – can be at higher risk for the coronavirus and have worse outcomes if they get it, I, like Christel, am staying safe by socially distancing and not meeting many people.

Christel: Change is certainly the defining feature of 2020 and that includes how we interact with others, whether that’s family and friends, or the strangers we pass on the street, or in the supermarket.

As COVID-19 has swept the world, most of us have had to significantly change our social habits to protect ourselves, as well as those around us, from exposure to the virus.

And while keeping your distance, and limiting social gatherings and interactions is the right thing to do, it can leave you feeling lonely or deprived of human interaction. So what can you do? We can’t change the world we live in, but we can make the most of it!

My First rule…

First of all, I think it’s important that we each individually decide what our boundaries are and what we’re comfortable with. That’s what I call the First Rule.

For me, my First Rule is I don’t meet up in person with anyone who doesn’t adhere to the California (where I live) social distancing and mask-wearing guidelines. 

I have one friend whom I haven’t seen in person since March, since he still goes to parties and doesn’t wear a mask. That’s his choice, but that means we won’t be interacting in person for a while.

I’m not too nervous about contracting COVID, but I’d rather not, and the thought of having to deal with such an aggressive condition, while managing my type 1 diabetes, is somewhat overwhelming. I imagine you feel the same, whether you have type 1 or type 2.

How I’ve sustained my social connections

Once you have your first rule down, you can decide how to actually see people. Because we as humans are social beings, it’s important we somehow continue our human interactions. 

If your first rule is that you don’t leave your home, we’re lucky to live in a time with a lot of virtual resources. We can connect through our Phones or do video calls through Zoom, Skype, Facetime, or other media. 

I am fortunate enough that I have three women in my circle of friends who are all on the same page on social distancing and mask-wearing. Trusting each other is safe, we’ve been meeting up regularly. I call them my “quarantine crew.”

They are women I know and trust, and I know they respect their own health, as well as mine. In the first month of COVID-19, none of us really left our homes. Instead we scheduled Zoom call ‘Happy Hours’ where we’d chat for an hour or two online. I liked best the calls where we all have our cameras turned on, it just adds to the social experience.

As spring came along, and we became more confident in venturing out, we started to meet at our local park. We brought our own food and drinks and sat in the grass and chatted for hours in a big circle, all sitting 6 feet apart. 

We all missed hugging, but in the early days felt that wasn’t safe, so we implemented our own greeting. Instead of a handshake or hug, or even the elbow bump you’ve probably seen, we created our own greeting: we’d touch feet. Right foot to right foot. I have long legs, so in that way we could still maintain an adequate distance and get the feel of physical human contact. If you have some tall friends, you can give it a try, or create your own special greeting.

As we move into winter it might not be so comfortable to just sit outside, but moving outside with others, as in a walk, combines socializing and exercising. Dress appropriately, including a mask and walk the recommended six feet apart.

There are a lot of things I have had to let go of this year, but I’m glad there are still ways to stay close to people, even when we’re separated by a few feet or a screen.

Author Bio:

Christel is a Los Angeles based speaker, writer, diabetes coach, and diabetes advocate. She has been living with type 1 diabetes since 1997 and at an early stage decided that it wasn’t going to slow her down. Her motto is “There is Nothing You Can’t do With Diabetes”. She writes about how to be Fit With Diabeteson DiabetesStrong.com and great food on DiabeticFoodie.com. She also coaches people with diabetes from across the globe, online and in-person, and supports them in meeting their health and fitness goals. 

Facebook: https://www.facebook.com/DiabetesStrong

Instagram: https://www.instagram.com/DiabetesStrong_IG /

My first success restarting a Dexcom G6 sensor

I may have already written about this – restarting your sensor. But admittedly, the first two times I tried to do it, it failed. Once, completely, the second time I only got 2.5 days extra and then it went downhill.

But, I’ve just come off my first successful restart. A full second round of 10 days, with first round accuracy. I believe there are two reasons for my success, and they are also the reasons for my failure. So, if you try this following the video, note:

  1. Take a photo of the code, don’t enter the numbers manually. That means keep the little piece of paper with the code on it when you first put on your sensor.

Actually, I was visiting my mom in Connecticut when I wanted to restart my sensor, and I had kept the paper with the code, but it was back home. My husband took a photo of it and sent me the photo. Feeling very daredevil, I held my phone up to the photo of the code, and wham, it registered it!

2. Wait an hour after your first session ends to start your second session. I don’t know if you have to wait that long, I’ve seen people say wait 15 minutes, but an hour makes me feel safer.

Good luck. I can’t guarantee it will work every time, or any time, but it’s definitely worth a shot.

Latest Freestyle Libre 3, launched in Europe, is smaller & thinner

The FreeStyle Libre 3 has been cleared in Europe for anyone ages four and older. The new continuous glucose monitor is as small as two stacked US pennies, provides real-time readings directly to the mobile app via Bluetooth, and has the same low list price.

There’s no timeline yet for when it will be available in the US. For the fuller story, please see the piece (including video) on diaTribe.

diaTribe is also offering a free webinar open to all on the challenges of stigma and diabetes. October 13th 3 PM Pacific time/6 PM Eastern time. You can click here to register

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Biggest, virtual, free T1D conference from TCOYD

October 3 you can tune in from anywhere in the world, as well as your loved ones. It will be held on the Saturday from 9 am to 5 pm Pacific time, 12 – 8 pm East Coast time. If you’re a health professional, you’ll even earn CME credits.

You’ll find fully-designed conference hall, live Q&A discussions with experts, and real-time networking opportunities, this immersive experience will take you beyond just another webinar. Knowing Steve Edelman is at the helm, there will be a lineup of hilarious sketches and musical performances —all with the goal to educate, motivate and connect the T1D community during these challenging times.

Register at tcoyd.org/one/20

Health education: coming to a small screen near you

Last week my friend drove me west to a studio in New Jersey. As we entered the building we were greeted with a thermometer check to take our temperatures and a bevy of people in masks and face shields. I was there to be taped for a health video that will play in doctor’s waiting rooms. I talk about about my story living with diabetes and give 4 tips (at the end) how people with diabetes can make their visit with their health professionals more successful. It was a blast!

The first stop in the long, low rise building was meeting the stylist. I was in her chair for an hour while she put on my camera make-up. Pots and pots of powders she dipped, brushed and brushed them again onto my face. The highlight was her careful insertion of wisps of eye lashes into my own. Only to be pulled off later that evening sitting outside at a local restaurant to celebrate my tiny stardom with the husband.

Groomed, my friend and I entered the studio where the six person crew awaited. They too were all in masks and face shields and did their utmost, quite admirably, to remain socially distanced from me and each other. I spent an hour reading my script off the teleprompter. It couldn’t be easier: the teleprompter was directly in my line of sight, and I could read at my own pace. The script stopped rolling when I stopped speaking.

After several readings the crew was happy, I practiced sitting and getting up, going off stage and coming back, adjusting my watch and glasses, all for them to frame me within the camera lens. These pictures are the result of my friend’s smarts as she watched off to the side while I was completely unaway she was taking them. Yes it’s hot under those lights. Imagine also being in a mask and face shield!

Once the 3 minute video is ready, (should be mid October,) I’ll post it if allowed. Below were my 4 tips for a successful visit:

1. Come with your “burning” question – and don’t wait til your hand’s on the doorknob to ask it. 

2. After you discuss what you might do better, ask your doctor, “What am I doing well?” Feel good about it, this is hard work and you deserve congratulations.

3. Ask if there are any new medications or devices that can help you.

4. If you haven’t already, don’t leave without a referral for diabetes education classes. That’s 10 free classes, covered by Medicare and most health plans. Sometimes doctors are just too busy to tell us or forget. 

A type 1 diabetes podcast to keep you company

I’ve been remiss at posting lately. I’ll blame it on my general horror and utter fatigue with what’s happening in this country, and the world. The West Coast is on fire, the White House is too, and it’s hard to keep truckin’ at times and not let it affect me. But, prevail we must.

On my walk today I listened to my friend, Valerie, who was interviewed by a lovely UK gentleman, Daniel Newman. Daniel launched The Talking Type 1 Podcast over the past several months and you can tune in for roughly a 40 minute discussion between him and his T1D guest. Daniel also has T1D and a lovely British accent.

Hearing his conversation with Valerie this morning, walking along my local park (thank goodness for the greenery) to my local library, was not only educational but soothing. Valerie and Daniel both exude calm. I learned more about Valerie’s ups and downs with her diabetes against the backdrop of an eating disorder she’s since moved past, what she’s learned and even a dip into health equity and social justice issues, her passion and work.

If you’re looking for people’s stories with type 1 diabetes, like to learn something whie you’re traveling or want to take a break from current events, have a listen. It will make your own journey with diabetes a little bit less bedeviled.

Spoiler alert: Valerie recommended Daniel also feature me on his podcast. That will likely be made available in the next few weeks and when it is I’ll post it here.

Meet Ava Ann, the bunny with type 1 diabetes and chutzpah

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Imagine you’re 13 years old and you have Lyme disease. It’s so bad you spend five weeks in the hospital – and can’t sit up or lie down. Then you spend three years bedridden and in a special wheelchair at home and miss out on school.

Yet somehow your spirit hardly wanes and your resolve to help others increases. So while at college, sick again for a year, you teach yourself to crochet and crochet a line of stuffed animals – that you sell on Etsy – each one of which has a disability.

As Rachel Leland, our young woman with Lyme disease and author of Ava Ann Makes Art: The Story of a Rabbitt With Diabetes, says, “So every kid can have an animal who looks like them.”

So why did Rachel, whose Lyme disease recurs when some small health issue brings it on, create a book about a character with type 1 diabetes? One of Rachel’s closest friends’ siblings both have T1D and that inspired her. It seems also Ava’s cuteness and pretty purple dress, made her both the best selling animal in her line and one of her favorites.

In the book, Ava Ann’s teacher asks her pupils to create an art project about their life. This is the premise for the unfolding of finding your strength living with T1D.

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If you have a child with diabetes, around six to twelve years old, this is a simple, beautiful and profoundly strengthening way for them to see a brighter side of themself and their life with T1D.

When I told Rachel that I thought she has great resilience to have come through what she has, she told me, “Resiliently Rachel” is the name she likes to use online. It reminds her of how grateful she is for all her blessings, including her Lyme disease. I suspect Ava Ann has Rachel’s heart too, as the strength Ava Ann finds in herself is persistence.

Ava Ann Makes Art is available on Amazon in Kindle and paperback.

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Note: Pictures used with permission from the author

 

 

A day without basal insulin is like a day without sunshine – or how I missed my shot and what happened

It’s just not pleasant, no, not at all, when your day is going to be one fretful, fearful mess from the moment you wake up to and through your unconscious sleeping hours. And you know it.

As I moved my Tresiba pen away from my thigh yesterday morning, where I thought I had just injected, I noticed the pen needle was bent – at a 90-degree angle. That’s completely sideways if you are math-challenged like me.

The next sensation, after my subdued panic, was wetness. I felt liquid on my thigh, of course where the insulin should have entered my leg – now it slid down it. And I saw a few droplets shining around the bent pen needle.

Did I get any of my daily six units of Tresiba? Or did they all slide down my leg? Did the pen needle bend before it ever entered my body, or while it was inside my leg or as I was withdrawing it somehow? I had no idea but somehow I just couldn’t imagine the needle bending inside me or after withdrawing it. (In full disclosure, I had used this needle before. It is a NovoFine Plus, and it is thin. Still, this had never happened to me before.)

What to do? Well, first I had to make some kind of assumption to work off of. So I assumed I hadn’t gotten any of my dose, or if any, a treacly unit or two. So I immediately used a syringe to withdraw two units from my Tresiba pen and inject them into my leg. After a few choice expletives of course. That’s a third of my dose, but it’s something. At the worst, I now had 8 units of Tresiba onboard, which seemed highly unlikely. Or the other worst, I only had two units onboard.

My fear of course was Diabetic Ketoacidosis (DKA). I’ve never had DKA so it was all a mystery to me – how would it come, how quickly, when? I told the husband to be prepared in case he had to get me to the hospital.

Okay, battle forces ready, I contacted my inner circle of expert friends. It was 9:30 AM now and while taking my daily hour walk I texted my CDE (now DCES, Diabetes Care and Education Specialist) friend. I explained what had happened. She sounded almost as nervous as me as she wasn’t sure how to advise me on this. But she asked questions and said she’d call me back. She did indeed and we agreed the smartest thing to do was monitor my blood sugar throughout the day and use my mealtime insulin if I needed to kick back any high blood sugar. Two hours later she called me back again and said I could take my next day’s dose of Tresiba at 3 AM. I bargained for midnight.

Two other DCES friends, my endo and an MD friend, who has T1D, were part of my experts. As you can tell, I like a village when I mess up to lift me out of the muck. All interestingly had slightly different opinions. One thought like me that I hadn’t gotten any of my dose from the bent needle and could take 4 units that morning. Another said, maybe take 1 unit of Tresiba before bed because I am highly insulin sensitive, and my endo said depending on where you are after 30-36 hours of the dose you know you got, yesterday’s dose, take 4 units before bed and less the next morning. He also said there were a number of ways to handle this. Amen.

That is what became strikingly apparent to me during all this. There was no one right way to manage the situation. This speaks to the complexity of managing blood sugar, not the cliche of “control” everyone tries to sell you. There were too many unknown variables: there was an unpredictable accident, a bent needle that left me not knowing if, or how much, insulin my body had gotten. How long would Tresiba, which “works up to 42 hours” last in my body? When would my blood sugar start to rise? How much? How fast? In addition of course, to the zillion other variables that affect blood sugar. Forcing myself to stay up till almost midnight, my blood sugar was indeed beginning to rise while I was going in the opposite direction – nodding off in front of my computer.

Conclusion: Luckily, I did just fine and I did it on the shoulders of my brain trust, along with my smarts. As my DCES friend said to me, “You’re smart, you know your body, watch it, use your CGM, keep me posted.” The first time my blood sugar rose was actually only three hours after the event. At 11 AM it was 180 mg/dL! I freaked. Really, can the Tresiba I injected yesterday already not be working? I’d only had a cup of coffee. But as my other DCES friend emailed me, “Most likely that’s your stress response.” And of course, he was right.

Otherwise, my blood sugar stayed mostly level all day and didn’t start to tick upward till just before I went to bed. One last fear, and the biggest one – what would happen overnight knowing I might not have any insulin onboard –  I took one unit of Tresiba to at least add to the two units I’d taken that morning. I also took a half unit of my mealtime insulin to blunt the rise.

I left the husband a note in the bathroom, hanging off the vanity so he couldn’t help but see it. He tends to wake at 3 or 4 in the morning. Please check my Dexcom and wake me if I’m over or rising toward 180. But actually, I woke up – at 2:45 AM – and checked: 85mg/dL. That’s great, but since I knew I’d drop a bit more, which is my pattern, I took a teaspoon of honey, took the note off the vanity, and went back to bed.

This morning, a lovely 114 mg/dL.

Crisis over – that is of course until the next time: that’s type 1 diabetes. Thank you all on my brain trust, and here’s to my fellow PWDs who go through stuff like this every day of every week.

Last night from 9 PM to 7 AM when I woke. My compression low at 3 AM was from lying on my sensor. I know specifically because after I got back into bed I lay on that side where it sits on my arm.

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For me, summer and diabetes don’t mix

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Cartoon by the fabulously talented Haidee Soule Merritt

This is a precautionary tale. Don’t forget, as I did, that the summer heat and humidity can affect your skin, your body temp, your insulin viability, your sanity. For some summer pointers, click here, “How to deal with heat and diabetes.”

For the past two days my blood sugar has been higher than usual. Yesterday, when it went up to 180 mg/dL around 10 am, after waking at 105 mg/dL, and not having anything to eat, only a cup of coffee with cream, I froze. What the f#@k! Granted, my blood sugar rises 20-30 points regardless of no food when I wake from the Dawn Effect, but 75 points was just not right.

My mind began the tedious backtracking. Was my mealtime Humalog bad? Hmmm..maybe, it looks a little cloudy. Was my long-acting Tresiba bad? Maybe, I couldn’t remember when I started it. Were either, or both, spoiled from my hot apartment? Granted the air conditioner is on by the afternoon, but not in the morning or overnight. How hot was it anyway in the kitchen where I keep my Tresiba in a cup on the counter? The Humalog I keep in the fridge.

Quickly I asked the husband if we had a thermometer and if so to bring it into the kitchen. Of course he did. The temperature was 26 degrees. Well, what do you expect when you live with a Dutchman? 26 Celsius. Now I had to go look that up. That’s 77F. Then I had to look up the threshold for temperature and 86F is the magic number, 30 degrees Celcius, before insulin presumably goes bad.

Frankly, I had no idea what caused the rise in my blood sugar that lasted just about til 6 PM, regardless of the fact that I kept taking half units of my mealtime insulin to nudge the number down. It barely budged. Until of course it came crashing down to 70 mg/dL mid-afternoon with my Dexcom arrow pointing downward still. I swallowed three glucose tablets. My blood sugar raced up to 132 mg/dL and then seemed to leave me at 122 mg/dL and stay relatively steady for the rest of the night.

Still, I stayed up past midnight just to make sure my scariest theory – that I had no Tresiba onboard – was untrue and I wouldn’t find my blood sugar climbing to a DKA number. It didn’t.

This morning I woke up with two revelations. The one on my Dexcom was a happy 82 mg/dL. The other was given the heat wave, I haven’t done my daily hour exercise walk for the past several days. I know this daily exercise keeps me more insulin sensitive. So, was that the reason all along? Maybe my insulins are fine, my body is not dehydrated, I just wasn’t insulin-sensitive with the lack of exercise?

I can’t know for sure, but for now I’m going with this theory. While I’m writing this I’m at a pleasant 106 mg/dL so I’m inclined to think it’s a good hypothesis.

All to say, don’t forget the summer heat can play havoc with you and your insulin. This was in my inbox this morning from Hedia, a Danish diabetes app. With its oddly appropriate timing, I thought I’d share – “How to deal with heat and diabetes.”