Blood sugar effects of cortisone shots

Just a reminder. If you get a shot of cortisone, like I did for an inflamed nerve in my foot, or perhaps trigger finger, which many people with diabetes get, it will almost surely raise your blood sugar. I got my shot at 6 pm. Luckily at 4 am I woke up, checked my blood sugar, and as you see from my Dexcom, it had risen steadily through the night after midnight to almost 200.



I took a correction shot of rapid acting insulin, stayed up monitoring the drop, took another correction shot at 6 am and my blood sugar came down over the next several hours.



That next morning I increased my basal insulin, Tresiba, by a third and my blood sugar stayed pretty good all day.

The good news is the effect won’t last more than a day or two for most people.

Just be aware to check your blood sugar frequently, check in with your doctor and/or adjust your dose according to your readings.

Lastly, be prepared when the effect of the steroid wears off and you’ve got more insulin in your body than usual, you may experience a low. Correct it and bring your dose back to normal.

Ah, living the diabetes life.



Staging the severity of type 2 diabetes could save millions of lives

…and so would, I believe, changing the name of prediabetes (you don’t have anything) to “stage 1 diabetes”, you certainly do.



This name change for prediabetes, and staging concept, was also imagined by a graduate medical student last year, now physician, Trent Brookshier. Trent conducted research on the idea showing people’s attitudes, perceptions and sense of urgency are significantly different based on what we call this condition of higher than normal blood sugar. A majority of people say they would take action if diagnosed with stage 1 diabetes as opposed to prediabetes. Full post here at IDF Diabetes Voice.

The high cost of priming (insulin pens)


Unknown.jpeg The cost of insulin has skyrocketed in the past several years. But there’s another costly wastage no one is talking about. And that’s the two units of insulin you shoot into the air to prime your insulin pen. More about this below.

Regards the cost of insulin we blame Pharma who blame PBMs Pharmacy Benefits Managers. From what I can make of it they’re the middle men, and women, who are part of the cost determination for drugs and which drugs get on your health insurer’s formulary. If your drug isn’t on it, you’ll pay a significant premium to continue to use it, or be forced to switch from what your doctor recommends to what your health insurance covers.

Making a life and death drug like insulin unaffordable for large groups of people is criminal in my eyes. And then it occurred to me, when I was generously given an inpen, that the priming wastage that occurs using an insulin pen is also criminal.

I was eager to try the inpen because it’s a digital pen that keeps track of a number of dosing markers including when you took your last shot, how much you took and how much insulin you still have onboard. But when I’d prime the pen, sending two units of insulin into the air, poof, gone, for my one unit injection, I couldn’t do it. I used the pen a week and then sacrificed being sure whether I’d taken my meal time shot for conservation. My Jewish, Virgo practicality just couldn’t let me waste more insulin than I was using. And then I got mad.

If you have type 2 diabetes and dose 40, 60, 80 units for a meal or a day, maybe two units/injection doesn’t seem like a big deal. But you’re still being robbed of probably six to ten units a day. If you have type 1 diabetes like me, and eat a low carb diet, you may only be taking five or six units a day. I take one unit typically to cover a low carb meal. Taking five units of mealtime insulin a day would cost me an additional five to ten units for priming (I typically prime with one unit, sometimes I need two).

I use a Tresiba pen for my basal injection. I take six units of Tresiba every morning. Tresiba is only available in a pen so I waste the priming unit or two. I have no choice. For my bolus, either Fiasp or Humalog insulin, I draw my dose up with a syringe from an insulin pen cartridge. No priming involved. I specifically use a pen cartridge not a vial or I’d be throwing two-thirds of a vial of insulin away at the end of every month.

I don’t know if this wastage was purposely built into the design of insulin pens but I find it hard to believe we can’t create an insulin pen, or similar delivery device, where taking our insulin doesn’t cost us more than the insulin we use.

I’m also surprised I’ve never heard anyone talk about this wastage or bring this matter to the attention of pen manufacturers seeking a solution. I’m curious what you think.

Joint collaboration of Lions Clubs International and the IDF recognized at the United Nations


The Lions Clubs International, the largest volunteer, service organization with clubs around the world, held their 41st annual meeting at the United Nations. Throughout the day, they updated members on missions and accomplishments. They have done tremendous work in detecting and treating eye disease in children, in childhood cancer, disaster relief, eradicating hunger and poverty and more.

They have also put a spotlight on diabetes through a joint collaboration with the International Diabetes Federation. An association of 230 diabetes organizations from 160 countries. There is a Memorandum of Understanding between the two organizations to raise awareness of diabetes, make screening more available, as well as education and access to care. It was my honor to be the face and voice of this collaboration, as a member of IDF’s patient advocate group, the Blue Circle Voices.

Highlights: I shared the stats – 425 million people around the world have diabetes. One in three U.S. adults have diabetes or pre-diabetes, and 9 out of 10 people with pre-diabetes don’t know they have it.

Diabetes is not just a matter of insulin resistance (type 2) or not producing insulin (type 1) but also a condition that affects people emotionally: shame, guilt, frustration, fear, stigma.

I shared a service project that took place in Costa Rica last month. A young woman with type 1 diabetes, who’s a psychologist, Daniela Rojas, ran a 3-day adventure camp for children with type 1 diabetes. After every physical feat the kids read an inspirational essay from my book, The ABCs Of Loving Yourself With Diabetes, (Spanish version, El ABC para aprender a quererte teniendo diabetes), that became an open window for them to express and share feelings and fears they never had before. And to realize they are strong outside, and in. This camp is a replicable model of excellence for diabetes camps around the world. I heard throughout the day Lions’ interest in working with diabetes camps.

I received applause when I announced I’ve already applied for my Joslin 50-year medal still three years away, and laughter when I asked if my unruly mane of hair might make me an honorary Lion, well Lioness.

I closed with a story of my father, who when I lay in my hospital bed 47 years ago upon diagnosis, shouted at my cold doctor, “There’s a person in that bed, not just a disease!” Maybe that’s why today I share with health professionals a way to put “Heart-Ware,” the seeing of each other, back into health care.

Above all, I was thrust back into a time when people came together just to do good. Maybe it never left but it’s hard to feel when we are so divided as a nation, as a world. The day was a refreshing and reassuring confirmation that kindness still lives in people’s hearts. And that activism to help one’s neighbor is occurring every day, in small and large communities, through the work of passionate Lions, Leos, Lionesses and Blue Circle Voice members.


My fellow diabetes advocate and friend Christel Marchand Aprigliano was recognized by newly appointed Lions Clubs International President, Gudrun Yngvadottir (from Iceland), for her amazing work influencing diabetes government policy. Rock on Christel! And rock on Gudrun who, having injured herself while skiing a few weeks ago, wasn’t going to miss the auspicious day.


Marking 47 years with type 1 diabetes

riva at 20.jpg

The diagnosis came February 1972 when I was 18. Spent 4 days in the hospital then went back to college, away from home, with insulin vials and syringes. Didn’t know much more than, “Don’t eat candy bars.” That was my diabetic diet. How far we’ve come.

Many call the date of their diagnosis their “Diaversary.” I call it, “Wow, what the f+&k! How amazing I’ve actually gotten this far!” If I had a bedpost, I’d add another nick to my notches for another year gained.

So far I’ve gotten here with few complications – diabetes complications. I have slow-growing cataracts (about 15 years growing), the occasional tingling in my calves (immediately helped by alpha lipoid acid, get it at the health food store), some hearing loss (not usually talked about in diabetes), but nothing much else I can think of. Don’t ask about the everyday decision-making complications. They never end.

I filed for my 50 year Joslin medal five years ago when I wrote this piece for the Hufington Post. The woman who runs the program encouraged me to do so. So, if you’re anywhere near the 50 year mark, why not get your entry in?

I don’t know where the husband is taking me to celebrate in 2022, but I realize this is a big one. Maybe crystal clear water and drinks with umbrellas, and nothing less, should mark this occasion. FIFTY YEARS WITH TYPE 1 DIABETES! Of course I’m thrilled to know Joslin now gives medals for 80 years!

Musing now, I recall something from when it all began. I was in the hospital while they were getting my blood sugar down. My hospital doc was so cold. He told me all the complications I was going to get and gave me two books to read about them. My father, having had enough of his attitude yelled at him, “Don’t you realize there’s a person in that body?” Thank you dad. Thank you dad. Thank you dad. Maybe that’s why 32 years later, I started working in the emotional aspect of living with diabetes.

So look up when you mark another year with diabetes. Stop, take a moment, and congratulate yourself for still being here. Screen Shot 2016-07-16 at 9.09.18 AM.png

The shaming language of diabetes

There’s a movement afoot, that began last year, by the American Diabetes Association, American Association of Diabetes Educators and a number of patient advocates. The aim: to change the shaming, blaming language about people who have diabetes. My friend, warrior CDE, RN, College Prof, Diabetes Educator of the Year, and type 1 herself, is carrying the torch.

Read the full article at ThriveGlobal.


Keto & IF – and no more emotional eating


Unknown.jpeg There’s a lot on the internet about the advantages of eating a high fat, low carb ketogenic diet. Most will say it works best when you’re doing intermittent fasting. I agree. I’ve been doing both for the past month.

I realized in addition to the health, weight loss, reduction of inflammation, metabolic syndrome busting effects, hair growth on your Uncle Larry’s head (sadly not true, but keto does fix a lot) there is a striking advantage I’ve never read about. I experienced it yesterday during my frustrating, miserable day.

I was a sad sack due to an accumulation of things, mostly having to do with a broken toe that still has me barely limping in a surgical shoe. That broken toe has made me a prisoner in my apartment; I’ve been feeling isolated. Not good for happy social hormones. I reviewed all my family members’ problems and felt overwhelmed by the abundance of Medicare papers I have to read. I also watched the Michael Moore movie, Fahrenheit 11/9. That got me entirely depressed. Then let’s not forget there’s always managing blood sugar on top of that. The sky was dark grey and so was my mood.

Yet – and here’s where the revelation comes in – I didn’t get any urge to eat! We’re always told we don’t just eat out of hunger, but when we’re sad, lonely, happy, celebrating, anxious, bored.  I was half those things combined, yet had no craving, no hunger, none of it. And trust me, I was always someone who would reach for food as solace, not lose my appetite to grief.

I realized that ketogenic eating and intermittent fasting doesn’t just stop cravings and lower appetite (because your hunger is satiated from fat, not spiked by carbs and you’ve likely worked your way out of your Leptin Resistance), but those benefits are with you during times of emotional stress too. Woo Hoo!

Disclaimer: I am not a medical professional, dietitian or clairvoyant. I have lived with type 1 diabetes for (47 years in two weeks) dieted for years when I was younger, and have recently been experimenting on myself with high fat/low carb eating and fasting.

“That Sugar Film” – and two ways to stop sweet cravings



I sent my friend, Karen Rose Tank, fellow type 1, The Suppers Programs leader (group cooking skills class and socializing) and health coach, a link to a film I think everyone should see – That Sugar Film.

Produced in Australia by fit and healthy Damon Gameau, Damon takes us with him as he eats anew for 60 days. He leaves behind his healthy low-sugar, low refined carb diet to eat like most of his fellow Aussies – an over the top refined carb, unhealthy fat diet. A diet most Westerners eat.

Damon’s goal was to consume the amount of sugar his mates do – 40 teaspoons a day. To make it more interesting, Damon will get those 40 teaspoons of sugar not from obvious offenders: cake, cookies and ice cream but from foods touted to us as healthy:  breakfast cereals, fruit yogurts, smoothies, granola bars, juice. Foods that say on the front of the package, “Heart Healthy,” “All natural,” “Fortified,” “Low-fat.”

Beside being sick to his stomach the first few days, and feeling euphoric when the sugar hits his bloodstream only to crash a few hours later, all of Damon’s metabolic markers change. He gains significant weight, almost all in the form of dangerous belly fat. In just 60 days he has fatty liver disease. His blood sugar elevates him into the pre-diabetic range and he raises his risk factors for hypertension and cardiovascular disease.

Experiment completed, Damon returns to his former low carb, high healthy fat diet, loses the excess weight and all his disease markers return to normal.

Karen told me the night before I sent her the link to the movie, she’d gone to a conference and been “good as gold.” She ate the sandwich they served without the bread, skipped the cookies for an apple, but….after passing the plate of cookies three times … she took two cookies off the platter. The first was delicious and she enjoyed it, the second she ate even though it tasted sickening. Her blood sugar spiked overnight and the next morning she was beating herself up for eating cookies. As we are all capable of doing.

But the next morning Karen did something. She made the sign at the top of this post and hung it on her refrigerator. The day after, she embellished her sign, not just citing the action she wanted to cease, but affirmations of self-love and actions that keep her relaxed and healthy. That sign is below:


Now, admittedly, you need a fairly tolerant family to let you hang this, but reminders are often helpful. I thank Karen for letting me post these here and in our busy, crazy lives, seeing visual reminders of support are often very helpful.

Replacements are also known to be helpful and that’s where I offer you a second red light for sweet cravings:


When my mind is rummaging for what sweet I can eat, I open the fridge and reach instead for a pickle or olive. Trust me, when that salt hits my tongue, my sweet craving is done.