The joys of yogurt as part of keto

After years of avoiding dairy, I think only because everyone seemed to be and we always heard how fattening it was, cheese and yogurt have come zooming back into my life. Eating Keto, these higher fat foods are back on the menu, and I’m loving them. So it was with some nostalgia I read Catherine Newman’s article in this week’s diaTribe about yogurt.

Yes, I well remember the days when Dannon was the only yogurt on the shelf. I even remember when I worked for a few months during college at my neighborhood Waldbaums as a supermarket cashier, I was privy to grabbing a yogurt out of the refrigerator section for my lunch break. Dannon cherry and coffee were always in my hands.

These days I only eat plain, whole milk yogurt. I want the fuller fat and don’t want the extra carbs. It’s part of eating keto and delicious. I’m enjoying various brands including Brown Cow (very fresh with cream on top) Fage 5% (thick Greek yogurt with more fat than their other yogurts), Icelandic Provisions (thick, thick, thick) and my latest pick up, Organic Valley Grassmilk. Also cream on top and 100% from grass fed cows. It’s produced by a consortium of farmers in Wisconsin whose mission is to create healthy products. I have learned, from a little investigation, that when a label says “Grassfed” the cows are not necessarily only eating grass, they can be ruminating on grass and being fed grain back in the feedlot.

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Whatever your preference, today there are so many different yogurts to try and each has its own uniqueness. Eating keto, I’m especially grateful full fat products like whole milk yogurt is available. When the husband first came over to live here from Holland almost twenty years ago he couldn’t believe everything in the supermarket was low fat.

As Newman says in her article, check the carb count on any yogurt you pick up, and you’re better off adding your own toppings than getting yogurt with fruit and add-ons already in it.

My simple yogurt bowl is a few heaping spoonfuls of yogurt with tahini and almond butter. When I want more of a cereal concoction, I add flax and chia seeds, roasted nuts, coconut flakes, salt, stevia, cinnamon, tahini and almond milk.

And like Jerry Steinfeld, there are many days I’d rather eat this breakfast cereal for dinner than dinner. 😉

 

The absolute joy of eating a sandwich!

Mock me not. I cannot tell you the absolute joy eating something, anything between two slices of bread has brought me. No, I’m not crazy, I’m a person with type 1 diabetes who has been happily eating low carb for at least a decade. That means I don’t eat bread. Well, hardly ever. Perhaps only if I’m out to dinner and the waiter brings killer bread to the table.

Even when I found this Keto bread recipe (uses almond flour rather than white or wheat flour for minimal carbs) I didn’t fashion it into a sandwich. A sandwich was such a dreamlike remote memory to me. Instead I would toast half a keto roll and have the single slice with my lunchtime soup. It sat on the rim of the bowl sad and alone.

No, I would not make myself a sandwich, not even when I made it for the husband. Somehow I just couldn’t make the leap that I can eat this bread in sandwich form, until one day last week I did. And now the simple, humble two-slice, not Danish open-face, sandwich is back on my menu. Now that’s worth celebrating, maybe with a glass of wine 😉

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Should you be curious today’s filling is melted Swiss Raclette cheese, artichoke, avocado and pesto with a side of half sour pickle.

Diabetes education program for mental health professionals

 

carousel-ada-apa-diabetes_tcm7-217577.jpgIf you’re a mental health professional interested in better understanding the emotional impact of diabetes, and being better skilled at working with people who have diabetes, you can take a two part course to do so and earn credit.

The American Diabetes Association (ADA) and American Psychological Association (APA) have partnered to offer up to 12.0 CEUs for licensed mental health professionals interested in providing mental health care to people with diabetes.

The program takes place in two parts – a 7-hour in person program followed by a 5-hour online course. The upcoming sessions for this year take place in San Francisco at the ADA 79th Annual Scientific Sessions and in Chicago at the APA Annual Convention.

The cost of the program is $300. It includes the live program (7 CE), the online program (5 CE), listing in the directory and 1 year membership to the American Diabetes Association. Credit from the American Psychological Association and the National Association of Social Workers is provided through the American Diabetes Association.

ADA hopes to expand the amount of providers who can help people with diabetes manage the emotional weight of living with diabetes by understanding how diabetes affects mental health, not just the everyday tasks of managing blood sugar.

For any questions, please contact ADA staff at mentalhealthprogram@diabetes.org

Chronic illness is not only about individual responsibility

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We like to think, especially in America, that it’s all about the individual. Everyone can “pull themselves up by their boot straps,” and if you’re failing, you’re not pulling hard enough. It’s not true.

This was a fascinating article about how some of us living with diabetes are impacted, uplifted and held down by “the system,” with a lens on how the U.S. policy on immigration has helped manufacture and worsen disease.

Excerpts from article in italics:

“Within a few years, the disease would rage out of control, causing her kidneys to fail, her leg to be amputated, and, within a decade, her death. Lacking any known genetic predisposition to diabetes, MarĂ­a and her mother saw the disease as a product of their estrangement.”

We constantly dismiss societal impacts on illness – How is our food grown and brought to market? What’s affordable and what isn’t? How and where do people grow up and settle?

“Blaming personal behavior is just a convenient evasion. The mismatch between “bad” foods that move freely—and people who cannot—is the real culprit behind a global health crisis.”

What resources or supports are in your community? What challenges do you live with? What financial resources do you have?

“Weathering”—the way the body responds to cumulative disadvantage and discrimination—takes a toll, affecting endocrinological, metabolic, and immune systems, and accelerating the onset and progression of disease.”

Chronic illness is a combination of self-efficacy, what you can do and social-efficacy, what society has put in place.

“Globalization has brought industrialized food to all, while undermining people’s livelihoods. These disruptions to local food and economic systems are, we believe, some of the biggest drivers of noncommunicable chronic diseases.”

For not only does society contribute to illness, sometimes it’s the leading cause.

 

 

 

 

 

Diabetes Patient Advocacy Coalition helping to make insulin affordable

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I am so proud to call this woman, Christel Marchand Aprigliano my friend. Christel is an amazing advocate in the diabetes community. She created her coalition to get more favorable governmental policies for medicines and education passed in Washington for people with diabetes.

Now, with the spotlight and pressure on the obscenely high cost of insulin, on what appears to be outright greed on the part of insulin manufacturers and PBMs, pharmacy benefits managers – who are doing anything but benefitting patients – and with people skipping doses of insulin because they are uninsured or underinsured, Christel appeared on C-Span to discuss the issues. If you’re confused about what’s happening, it’s a good interview to watch.

While I’m sure Christel has a team of people behind her, don’t ever forget what one person can do, what you can do. Getting involved is as easy as hopping over to DPAC and adding your voice. Don’t fear, you’ll be guided through the process. While each one of us makes a difference, a chorus of voices is hard to ignore, as we’re seeing now in the fight to make insulin affordable.

 

Free online diabetes summit to help you thrive

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Mark your calendar for five days (May 1-5) of talks given by more than 25 outstanding people in the diabetes community. Their wise counsel, knowledge and positive experiences comprise the third Diabetes Empowerment Summit organized, arranged and passion-driven into existence by Daniele Hargenrader. Daniele is a diabetes coach, personal fitness trainer, author and advocate who’s using her early difficulties with diabetes, diagnosed at age 7, to share with us how she, and we, can go from lemons to lemonade.

Click here to register for the summit, see the schedule of speakers and take advantage of special bonus gifts.

The summit will share education, practices, tools and an entire community of tips and wisdom from PWDs, coaches, authors,  doctors and caregivers who understand what living with diabetes is like – and how to do your best. DiabetesMine today posted a short interview with Daniele about the summit.

Twelve years ago, when I published my first of three books, The ABCs of Loving Yourself With Diabetes, few people gave thought to how vital it is to address emotional health living with diabetes. Today, I help people with diabetes live a flourishing life and share with health professionals globally a way to work with PWDs that engages and fosters their patients’ potential for flourishing.

Two months ago my ABC book was used as a tool at diabetes camp in Costa Rica to allow 70 kids for the first time to express and share their fears and feelings about living with diabetes – and to discover their inner strengths, gain confidence and build resilience. Still, the book is being read by their families, opening up conversations and understanding for the whole family that their child, brother or sister, can live well with diabetes minding it, managing it and respecting it.

Such is available to all of us and I’m thrilled to see our diabetes community of patient advocates broadening resources for everyone like this summit.

I love the expression, “Each one must teach one.” Even better, when each one can teach so many. Hats off to you Daniele!

 

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.

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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.

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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.

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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.

 

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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.