As much as I know about diabetes, I really wasn’t sure how to deal with the blood sugar rise from cortisone shots. And yes, I’ve had cortisone shots before – one for my trigger thumb last year, one some time ago for another sticky finger, and most recently shots for a tailbone that decided to grow a bone spur, or at least make me aware one was there.

I got the cortisone shot Friday afternoon around 2:30 pm and within a few hours I was already watching my blood sugar rise, and rise, and rise (on my Dexcom CGM). And even though I was injecting half unit, after unit, after half unit, it was like I was treating with water. I really got the visceral experience of being insulin resistant, which I am not. I was fearful, frustrated and fretting.

Of course the fear is of taking too much insulin and when it will all kick in, particularly while sleeping overnight. Through the evening my blood sugar rose to just over 180 mg/dl and then came down to about 167 and hovered there all night. That afternoon and evening, all I did was keep dousing myself with extra insulin, and watching the numbers on my CGM.

The next day I googled what to do about this. Surprisingly, this did not occur to me the first day, fool that I was. The best article that I found was on Healthline, “Yes, Steroids Spike Blood Sugars – So Beware.” The bottom line is, as diabetes educator extraordinaire Gary Scheiner, actually had emailed me the last time I had a cortisone shot:

– most people need to raise their basal insulin by 50% starting about 6 hrs post injection, then double their basal on days 2 and 3, then taper down.  Some need to triple their basal.  The humalog doses can remain as-is (correct any highs and cover meals as usual); the extra basal takes care of the insulin resistance caused by the steroid.  

So that’s exactly what I did. I took my Tresiba dose of 6 units/day up to 9 units for days two and three, and watched it. Today, day 4 I’ve dropped it down to 7 units and tomorrow anticipate going back to 6. Watching my blood sugar today, it looks like it’s back to normal.

This simple tip has worked like a dream. Still, it’s scary when you normally take a small amount of insulin and merely think of doubling or tripling it let alone do it! Terrifying actually. But unfortunately that’s what’s required for most of us when we get a cortisone shot.

I hope this offers some help next time you get a cortisone-induced rise in your blood sugar. I’m confident you’ll sleep a whole lot easier. I know I have.

I was going to write a sort of year end wrap up and post it last night, but perhaps it was fortuitous that I was at my mother’s house and so could not access my blog. Perhaps it is better that I just post today an email I got in the last few days with a sentiment I so appreciate, a way to go forward into 2022.

The email was an email blast from a site/podcast called Sounds True. Sounds True was founded by Tami Simon and she’s the interviewer on the podcast. I have enjoyed many of the “new age,” spiritual interviews I’ve listened to. I also notice that during this time of incredible distress for the world and us, pockets of spirituality are sprouting everywhere. So I’m going to share this email with you on this, New Year’s Day.

Dear Riva,

I was on a solitary retreat in the Colorado mountains when I discovered how a very small action can make a huge impact. 

I had been meditating for several days as part of a 10-day solo retreat. And I had gotten in the habit of taking a walk each day toward the sunset hour when it felt like it was definitely time to stretch my legs and get outside.

On one of these walks, I saw a person in the distance headed toward me. I hadn’t seen a human being for several days, and I felt a strange adrenaline rise as I noticed him in the distance walking in my direction. This person I didn’t know continued to approach, and when we were about 10 feet away from each other, this stranger smiled at me with a genuine sweetness … and kept on walking.  

That was it; that was the small action. 

And for whatever reason (maybe because I had been meditating all by myself for several days), this human act of softly reaching out to me with a gesture of connection broke my heart right open.

Your words matter. Your phone calls matter. Your emails matter. Your genuine smile matters. The way you hold space for another matters. With the smallest of gestures, we lift each other up. 

Here on the last day of 2021, I want to remind us all that we matter … to each other. My sense is that we have no idea how many people we touch in small ways with huge impacts. Thank you for every act of compassion you share. I feel grateful to be in connection with you.

I’m committed to bring more kindness into ordinary days. Little feels more important right now. As Simon says, “With the smallest of gestures, we lift each other up.” As I have often said, even with diabetes, look up and see your possibilities.

Happy New Year

I’ve posted this six previous times on this blog, the first being in 2009 best I can tell. Hey, when something’s good, enjoy it again. Merry, merry, happy holidays.

Dear Santa,

All I’d like this Christmas is for you to take this diabetes away. I’m so tired of it already. All the time stabbing my fingers for blood and guessing when my sugar’s too high or too low.

Now that I’m in menopause I can barely tell whether I’m sweating because I’m losing estrogen or because my blood sugar’s crashing at 50 mg/dl!

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 lie 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: although you’ve already opened your holiday gifts, go back and look under your Hanukkah 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 Year’s 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 the Torah 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 go shopping, 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 to 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 that 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 that there is a gift in everything if you look for something positive that 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 healthfully. 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 million mansion in Jupiter, Fla. — right next to Burt Reynolds! Everyone’s plotzing! The house was in foreclosure so they have even more money to decorate!

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 quote meant that we are the source of our happiness, that happiness can only come from inside us, regardless of what happens in our lives. Hmm, 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.

I am not one of those people who enjoys drinking my meals. So when my friend told me that for the past few months she’d been making and enjoying a protein shake for lunch, I thought, yuck not me. But, I am now among the converted.

I tried it largely because many days I do a version of intermittent fasting. I make a cup of coffee when I first wake up. Yes, tis true, I put cream in it, but I sort of don’t register this as breaking my fast. Some will argue, but so be it. That cup of coffee with cream around 8 am fills me up until around 10:30 or 11 am. And here’s something interesting: It’s not that I’m trying not to eat, I’m literally just not indulging in the habit of breakfast, and so find I’m not hungry those first few hours of the day.

So, most days I eat my breakfast – yogurt, a half slice of cinnamon coffee bread (I make myself), a spoonful of almond butter and two spoonfuls of tahini – around 11 am. That means I’m once again not hungry at the proverbial lunch hour. Instead around 2 pm I have an edge of appetite and make myself a protein shake. It’s just perfect to fill that little hole in my stomach with something filling, nourishing and tasty. There are a zillion protein shake recipes online. Take a look.

My shakes (only been doing it a few weeks) are a variation on a theme. Typically, I use a third of a banana, to keep the carbs low and add some berries, which are already low in carbs. I add a few spoonfuls of plain greek yogurt, a cup of almond milk, the green in the picture above was made green by adding some red Swiss chard, (you can add any green veg that doesn’t have a strong taste, many use spinach), then, while the serving size appears to be one scoop, I’m using half a scoop (after all, I am not protein deficient) of my Plant Fusion vanilla protein powder, 4 ice cubes (the ice cubes add heft) and I blend it all in a blender my mother likely gave me when I moved into my first apartment after college.

There are a lot of protein powders out there. I bought this one I’m using above in Whole Foods but I see they also sell it on Amazon, which is the link I included above. I bought PlantFusion because I read all the nutrition labels of all the choice, and this one seemed to hit the trifecta of low carb, healthy ingredients and price.

When I told my friend I was making using that old blender my mom gave me, she said, “Why don’t you get a Nutribullet?” Whereupon I replied, “Why should I? This is doing all I need!” The defense rests.

So if you’re tired of what you’re eating for lunch, or you’re experimenting with different ways of eating, you might consider trying a protein shake for your breakfast or lunch, whatever suits you. My prejudice of not wanting to drink a meal has disappeared. It’s so tasty, satisfying, filling and nutritionally sound. It’s been a wonderful discovery for me, and I don’t see that stopping anytime soon.

As the year winds down, good and bad, I wanted to post this poem. When it was first sent to me, it spoke to me. I found it beautiful and true. No matter what we do, actions great and small, I do believe the world speaks to us if we can be quiet enough to listen.

I have talked a lot over these past 20 years. How many words I’ve uttered on stages, and from behind lecterns, around the world in an attempt to uplift others with diabetes, and the health professionals who tend us. All the words I’ve written that look back at me in three books and hundreds of articles. It’s all good and I am proud.

Still, greeting this moment, this ever present, every changing moment, I wait quietly as the song that is my life falls down into my cupped hands. This is particularly poignant for me as I reflect upon the current stream of my life with the passing of this year.

Why is it at least 50% of the time I put on a new Dexcom G6 sensor, I get this message? I follow the instructions, yet this pops up way too often. What’s happening? And beyond whatever is happening, this not knowing whether or not my sensor will work, I notice increases my stress level. As if type 1 diabetes did not already require 24/7 hyper vigilance.

Of all the things people hope the G7 will be – that the sensor is smaller, thinner, more accurate and gives you a farther range, I’m hoping this screenshot above will be history.

I took this photo in front of a Pilates studio in my neighborhood because I thought it was funny. It wasn’t quite as funny when it became true.

At 2:45 am, the morning of Thanksgiving, I awoke with low blood sugar. I was in my mother’s home. I padded out of bed to rummage around the refrigerator looking for juice or fruit or something to raise my blood sugar. Yes, I could have taken a glucose tablet, but when my blood sugar isn’t dangerously low, I’d rather imbibe something nutritious.

No juice to be found, dried fruit would take too long, a jar of raspberry preserves went by unnoticed, I reached for some pomegranate seeds and began munching. Oops, I felt one get stuck in my teeth. Upon closer inspection, there was no seed there, and there was even less of a tooth there. I had cracked my molar and now a piece of it was missing. For the next four days my tongue kept returning to the emptiness where once there was enamel, and getting scraped in the process.

Thanksgiving at my mother’s friend’s home with a broken tooth meant a bit of turkey, roasted sweet potato and something I haven’t eaten in likely three decades for blood sugar reasons, white mashed potatoes. Boy, they were good!

Since it was Thanksgiving weekend, I couldn’t call my dentist until today, and now I’m booked in to see him tomorrow at 9 am. The good news is my tongue has gotten used to the new tooth terrain and is getting scraped far less often. Bad news? That remains to be seen. Still, I’m thankful, there are other teeth in my head standing in for their wounded comrade.

So while my mouth undergoes some redecorating, I am still enjoying my favorite of all seasons, the fall, as the leaves are still golden around here and I smile as the lights begin to come on for Christmas.

I received a mass email this morning from the American Diabetes Association (ADA). In short, the U.S. House of Representatives passed the ‘Build Back Better Act’ that has a national $35 insulin co-pay cap, and allows Medicare to negotiate the price of insulin. This was, in part, aided by the thousands of letters and emails, from us, urging our representatives to support this.

Yet, the bill isn’t a done deal yet, so the ADA is requesting continued support. It’s easy with this form to press this through, it’s mostly written for us.

Let’s keep on them and get insulin down to an affordable price. For the first time I feel it’s within reach.

• 

The husband’s first flight since COVID began was truly memorable. Read on.

Today is World Diabetes Day, the day recognized around the world by a United Nations’ resolution. And this year marks the 100-year celebration of insulin, it was discovered in 1921. You may know it was discovered by Canadian surgeon and medical scientist, Frederick Banting and Charles Best. You may not know Banting and Best sold the patent for insulin to the University of Toronto for US $1.00 – so that no one would ever have to go without insulin. 

Well, we know how that worked out. The last time I walked into a pharmacy to ask how much insulin would cost if I didn’t have insurance, I learned three insulin pens cost $750.

I do have insurance, I have Medicare. Still, the one box of Tresiba pens (five come in a box) that I got a few months ago cost me almost $500 because I had not reached my deductible. That’s $100 per pen. I was told after reaching my deductible, a box would cost around $225. That’s still $45 a pen – with insurance. Plus if you’re on Medicare you cannot take advantage of pharmaceutical patient assistance programs.

Last Wednesday, the husband took his first flight since COVID. Of all places, he went to Toronto, to facilitate a leadership workshop. Having insulin on the brain, I researched how he could purchase insulin for me, while in Canada, knowing it would be cheaper there than here.

I reached out to a few friends and colleagues, they then widened the circle of comrades, and I read numerous articles online. This was a great story. In Canada you don’t need a script to purchase insulin. 

From what I learned, it is legal to order insulin from a Canadian pharmacy and have it shipped to you in the States, but it is illegal to buy it there and bring it home. Grrrr… However, all I talked to who have done it, and each article I read (like the one above) said, if the TSA finds the insulin, they won’t arrest you and they won’t take it away from you. Okay, non-risk-takers that we are, we decided to gamble on this.

The husband’s client for whom he went to Canada is actually in the business of making medicines, so the Chief Medical Officer put the husband in touch with his local pharmacist (thank you, thank you). Yes, the husband could get two boxes of Tresiba from them and they would deliver it to his hotel on ice. For free.

Those two boxes, each with five pens, cost US $218 total. That’s $21.80 a pen! With no insurance! The husband went through US customs on the Canadian side with one box in his vest and one in his carry-on. Both items went through the X-ray machine with no alarms being set off and no police appearing with cuffs. The husband collected his vest and carry-on and walked briskly to the gate whisking his little charges to freedom. 

Of course my two lovely boxes of Tresiba, posing above, were the first thing out of his bag when he walked into the house Friday night. Still, my mind keeps twirling this unbelievable fact/feat around, just like when your tongue can’t stop running over something stuck in between your teeth.

Insulin has always been my drug of choice, but now I have a new dealer, Canada. Thank you Banting, thank you Best, thank you Toronto. Should the husband need to go back again, I might just go with him to thank the nation myself for their sanctity for life – and of course to get some more insulin.

Note of appreciation to Elizabeth, James, Allie, Karlynn, Chris, Michael, Ahmad and, of course, the husband 

• 

Yes, I’m welcoming you a week late, but if you’ve been scrolling around you’re probably aware this is the month dedicated to raising awareness of diabetes. And November 14th is World Diabetes Day. It’s actually a United National resolution put forth by the International Diabetes Federation.

In honor of diabetes month, I’m participating in a Sanofi sales call tomorrow to talk about the importance of helping more people better understand what diabetes is and the toll it takes.

But this is what I want to share, something just between you and me. It’s a message I’ve long wrote about and often speak about. It flies in the face of what doctors will tell you. And yet it is true.

YOU CANNOT CONTROL DIABETES, OR YOUR BLOOD SUGAR. Statement of fact. So let yourself off the hook when you get numbers you don’t expect. When you do everything right and everything goes wrong.

There are just too many factors that impact our blood sugar. Just to name a few – stress, being sick, temperature, menstrual cramps, lack of sleep, counting carbs, meter readings, how much you exercised yesterday, lacking two other hormones that manage blood sugar as well as insulin… If you’re not familiar, take a look at Adam Brown’s 42 Factors chart. And trust me, there are more.

How could you possibly manually do what your body does automatically? I would like every health professional to experience diabetes for a week and tell me I can control my blood sugar and my diabetes.

Okay, enough said. Whew, it felt good to let that out. So let yourself off the hook. Perfectionism doesn’t work here, or anywhere frankly. Instead, learn how different foods and exercise tend to impact your blood sugar, Learn how to respond to any number to nudge your blood sugar back into range. And then acknowledge that that, just that, is success.

That’s my message for diabetes month. Feel free to share it.