All aboard: Amtracking through Pennsylvania with diabetes

coloredpullmanportercar

These last two weeks I’ve been “Amtracking” up and down the East Coast: From New York to Cambridge, MA two weeks ago and  last week to Harrisburg, PA and then back from Philadelphia to speak to patients and nurses. This work I do has to my surprise led to seeing a lot of the country.

Not having ridden Amtrack for probably a decade it was a delightful surprise – almost stepping back into a more genteel era. The seats are wide, comfy and provide plenty of leg room, unlike those I’ve grown used to now in airplanes’ economy class. The conductors are pleasant, “Hello, how are you doing today?” While stepping aboard on one leg of my journey, the high steps made it difficult to lift my wheeling case. Not a problem, the conductor had it in tow before I even thought how was I going to manage it.

Amtrack also has a “Quiet Zone.” A car where no cell phone use or loud conversation is allowed. What a delight. Between the gentle rolling of the train and the silence I fell off to sleep for an hour. Moreover, two restrooms in every car, never a line! I am forever changed. Next time I go somewhere Amtrack goes and the trip is not more than a few hours I will opt for the age-old comfort and civility of train-ing over plane-ing. Moreover, it allows you to bypass going through airport security where a hand search reveals syringes and begs questions, an insulin pen raises a red flag and one is supposed to (I rarely do) extricate one’s self from seat, climb over two fellow passengers and scuttle off to the restroom to take a shot. 

I was train-ing to speak to two groups of patients and nurses amid the rolling hills of rural Pennsylvania. My train stop was Harrisburg, where I was picked up by Betsy Wargo, a dedicated diabetes educator who serves the nearby area through Wellspan, and had invited me to be the key speaker for their annual diabetes health fair. The fair was held at Gettysburg Hospital in historic Gettysburg, home of one of the major battles of the Civil War and Abraham Lincoln’s famous address. At the hospital I had the pleasure of addressing about 70 patients as an author and fellow patient. I shared my personal story of getting diabetes at 18 and what it’s been like to live with, dispelled many of the diabetes myths that confuse most people and explained the power of tapping into our positive emotions to better manage diabetes. These of course are the topics of my two books.

Focusing on what we want (happy, healthy life) rather than what we don’t want (complications) and putting more energy into our positive emotions, for instance appreciating what we have, forgiving ourselves when we muck up, patting ourselves on the back for all we do and taking pride in our efforts – helps us do better. Oprah often says, “When you know better, you do better.” What’s also true is, “When you feel better, you do better.” Afterward Betsy and I toasted the successful evening over a drink at the famed bar inside the hotel and talked passionately about how to help patients improve their self management.

The next day I was picked up and driven to Springfield, a town just outside of Philadelphia, where I presented my Taking Control program to another 70 patients. I followed an endocrinologist in the line-up and when I finished my talk numerous people told me how much they got out of what I said. It doesn’t hurt to have a powerful story to share or to follow a doctor who has just pummeled your audience with target numbers, facts and figures.

Then it was back on the train home to the Big Apple where I, for one, was riding on a high. As we approach Thanksgiving, more and more for me it is not an annual event. Throughout the year I give thanks for how fortunate I am to be doing this work and how grateful I am for all who make it possible. 

Saturday is World Diabetes Day

UnknownGlobal symbol for diabetes

This Saturday, November 14th, is World Diabetes Day (WDD). The day people around the world will mark in various ways to involve the local community, engage the media, and raise awareness of key diabetes issues among decision-makers and the public. In 2008 over 1.2 billion people were reached through campaign messages.

 

One of the most stirring and public displays of WDD will be the 1107 monuments lit in blue around the world, from Sydney to San Francisco, from New York City’s Empire State Building and United Nations building to the Obelisque in Paris.

 

November 14th marks the birthday of Dr. Frederick Banting. Born November 14, 1891, Dr. Banting, along with Dr. Charles Best, discovered life-saving insulin in 1921 in Canada. 

 

Learn more about World Diabetes Day and how you can get involved. As a simple show of support, think of doing something “blue” this Saturday like lighting a blue candle in your home or workplace or wearing a WDD pinThe blue represents the sky and the circle unity across the globe in this effort. The icon also represents support for the United National Resolution on diabetes which was led by the International Diabetes Federation.

 

As for me, I’ll be in Springfield, Pennsylvania addressing 75 fellow PWDs and nurses about healthy diabetes habits proudly wearing my pin. You can be sure I’m going to ask how many people know what it stands for. And everyone will by time I leave.

7 diabetics sittin’ ’round talkin’

Yesterday I had the rare good fortune to do one of my favorite things. Shoot the breeze with other PWDs (people with diabetes if we’re being politically correct). Miriam Tucker, medical journalist, was in town and invited a bunch of us to brunch. At the table were also Dan Hurley, whose new book, Diabetes Rising, is due out this January, Joy Pape, cde and author, Lee Ann Thill, blogger of The Butter Compartment – don’t you just love it – and art therapist, and two of my fellow peer-mentors, Ruth Charne and Ann Gann. 

 

We assembled at 12:30 and didn’t leave till 3 PM. That gives you an idea of the spirited and passionate conversation we were having, that I would venture to say, always erupts when you fill a table with opinionated PWDs – oops that’s redundant. 

 

When we left I said how much fun it had been because I always learn something. The first thing I learned was no one knew any better than me how many units of insulin it takes to cover a galette as you see above – the house specialty of the French bistro where we were dining. Their galette arrived as a thin buckwheat pancake with an egg on top and spinach inside. (Yes, I was deviating from my typical low-carb meals, but it was their speciality…) 

 

As I peered at it in front of me I asked my table-mates how many carbs do you think this is? Everyone leaned across the table to inspect and then perplexed faces looked back at me. Each guess ventured was obviously and apologetically offered as a guess. And while it didn’t help my dosing any, I warmed and basked in the knowledge that I’m not the only one who’s guessing at my dose a good deal of the time – and even here among such a highly educated group! Of course this led to the timeless debate about low-carb diets, adherence, what does it mean to be “good” or “bad” and as Miriam looked at her pump, unsure it was working, the value of wearing an insulin pump. At the table three did, two didn’t, one had and one’s beginning. I’m waiting on the Solo Micropump to throw my hat in the ring.

 

We wondered whether pharmas are really invested in curing diabetes. Well, it seemed not many of us really wonder. We talked about what defines “screwing-up” in diabetes – is it just getting a bad number or consciously eating something you “shouldn’t.” That led to should there be “shouldn’ts?Which led to talk about “compliance” and “non-compliance”: Are these appropriate terms for diabetes? The general consensus was they work well for doctors, who are used to thinking in terms of tasks done and not done, but not patients who are living busy and complex lives where doing or not doing a diabetes task is never about one thing. We chatted about why do we feel guilty, even after living with diabetes for more than 30 years and knowing full well our numbers are sometimes not a reflection of our actions, why do we still feel guilty or ashamed with a number like 300? 

 

You should have been there, you would have loved it. If you have a bunch of PWDs in your area why not invite them all to lunch? I promise you it will be educational and entertaining. 

 

For those who wonder, turns out I guessed really well for my galette. With an insulin to carb ratio of 1:17, 2 1/2 units of Apidra left me at a perfect 91 before dinner. Truly it was the gods coming together saying, “riva, today we’re going to give you a break.”

 

My sincerest thanks to Miriam for arranging brunch and to all who came. And Katie you were missed. There’s little I find more delicious than having food with those who really get it – simply because they really got it.

The hours my head lives in diabetes-land

Summer 2005 - 40 copyIf I think about it, most mornings when the weather isn’t obvious, I stand at my living room window while my oatmeal is simmering on the stove, squinting through the trees outside to see if it’s raining or not. When the TV news, on in the background, announces the weather, I pay attention. Well, sort of. It seems to go in one ear and out the other as I’m up and down, in and out of the kitchen stirring, testing my blood sugar, shooting up my long-acting and rapid-acting insulin, trying to think back if I already took one unit of my rapid-acting insulin to blunt the dawn phenomena (rapidly rising early morning blood sugar) and cleaning up the little blood splatter that’s trickled off the used strip onto the counter and cabinets. (I omitted that I’m lately careful to open the lid of the strips canister slowly and quietly after my husband said one day, “Every time I hear that snapping sound it makes me feel horrible knowing you’re going to hurt yourself again.”) Judging the weather for the course of the day is all about when I will take my daily walk, which is a big determinant of how much insulin I’ll inject for breakfast. 

 

Some version of this goes on throughout a fair part of the day: Hmm…maybe I should move my 9:30 AM walk to around 11 AM and walk to a subway station further away from my home that’ll take me into the city where I’m meeting friends for lunch. Wonder what’ll be on the menu for lunch? Better remember to take my insulin. Hmm..should I put it in my bag now?…But, the weather guy said “chance of showers” this morning…hmm…do I remember what time? 

 

Of course at the restaurant I spend time studying the menu trying to chose something that isn’t a lot of carbs, then spend time analyzing what’s on my plate when it arrives so I can take my best guess how much insulin I need to cover it. Done. Probably should check in a few hours, though, to know how well I guessed. After lunch it’s finally bright sunshine so I decide now (not when I took my bolus for lunch) that I really want to walk the 23 blocks downtown where I’ll grab a subway back home. Damn! I didn’t plan for this but I can’t resist walking in the city on a beautiful day. The heck with it, I’ll just have to deal with it when the low comes. Hmm…will it come? If I took just a little less insulin than I actually needed for lunch then the walk will balance my blood sugar out. Hmm…

 

Guess not. Almost at the train station I feel my heart beating rapidly, I’m a little sweatier than I would be normally…Can I hold on till I’m down on the train platform or do I have to stop now and break my stride and handle this? Jeez, the third time this week! When am I going to get better at judging all this? Should I stop? Shouldn’t I? Should I stop? Shouldn’t I? Wow, why can’t I figure this out. Oh… I… get… it… I’m …really… low. Beettteer …stop! 

 

I eat a roll of SweeTarts and 10 or so minutes later my body’s back to normal. But my head is still calculating: Where/how could I have avoided this? CouldI have avoided this? 

 

It’s only 3 or 4 PM on a typical day and look how much of my time, energy, moments I’ve devoted to my diabetes. Oh, yeah, I forgot, this morning three people sent me emails telling me that I should get the H1N1 flu shot. Should I? I’ve never gotten a flu shot before. I know this flu is supposed to be really bad and diabetics are on the critical list. Should I ask my doctor? Do more research on the web? Just do it? Just not do it? Hmm…will have to give this more thought.

 

Granted, some of my friends think I’m obsessive – you probably do too now, but probably not if you live with insulin-dependent diabetes. In full disclosure it did take me 37 years to decide to get a medic alert bracelet (admittedly I wasn’t thinking about it ALL the time.) And I have been thinking about getting a pump for the last five years, although not ALL the time. 

 

Everyone talks about how diabetes tasks are a lot to handle. But I’m not talking about those time-grabbers like: Calling to make a doctor’s appointment (GP, endo, podiatrist, cde, dietitian, ophthalmologist) getting there and hanging out in the waiting room. Or checking how much synthroid, apidra, lantus I have left and judging when I have to call my health insurance company to refill my prescriptions. I’m not talking about the time spent calling my health insurance company to get more test strips or going to the lab for my blood tests, or thinking through all the extra medicines, syringes, testing supplies and back-ups I have to take when packing, or what/how much food to pack if I’m getting on a plane or a long train ride and making sure I get to the supermarket to get something healthy. I’m not even talking about the on-going supportive phone calls with my diabetic friends or the short quarterly crying jags from being tired of all this. 

 

No, I’m talking about how many moments of every day my energy is stolen by needing to analyze, calculate, plan, prep, correct, stuff pockets with glucose tablets and ‘just-in-case-cash’, make light of (so as not to burden anyone), solving and resolving all the stuff that happens because of my diabetes, or all the stuff I’m trying to avoid happening because of my diabetes. Call me crazy – but my A1Cs are in the 5’s because of all I do, and that’s where I plan to keep them. Also, I’ve never been unable to treat a low blood sugar myself.  I do what I do so that to the best of my ability I’ll never be in that position and so that I will have the longest, best run possible. 

 

At the International Diabetes Federation conference two weeks ago, Michael Weiss, Past President of the ADA, gave a presentation about what living with diabetes has been like for him. From his half hour talk I remember two things:

 

1) Even when he got cancer and was petrified and went through a year of chemo, now that he’s five years cancer free it no longer occupies him. Yet diabetes still does every day. He said so. He also said when he had cancer, “All I had to do was follow my doctor’s instructions. It was easy. With diabetes I have to make all the decisions every single day. It’s never-ending.”

 

2) How much of his thinking is monopolized by diabetes

 

I’d never thought how much of my time/energy/thoughts are monopolized with diabetes until Michael said it – and then, bling, I realized how true it was, and felt oddly validated by hearing someone else say it. Maybe it’s the curse of an overly responsible type 1, or being on insulin no matter what type you have, but today I want everyone in the world to know that when I say you can find a gift in your diabetes, I mean it. And when I say managing diabetes is a second job, I mean it.

My diabetes-head is growing just slightly larger

UnknownThe global symbol for diabetes day: blue for the sky under which we all stand, a circle for unity

Having made the acquaintance of so many remarkable fellow diabetes bloggers a few months ago at the Roche social summit, I’ve had the wonderful opportunity to share some of my thoughts and experiences on several web sites. So, for a few posts you won’t see here as well as posts from fellow bloggers, jump onto theWorld Diabetes Day blog. You’ll find a lot of posts to inspire you. Here are mine:

Diabetes Day: Wouldn’t It Be Nice Not to Need One?

Riva’s Story: The Diabetes Express

What Diabetes Is – and Isn’t

Then check out all of World Diabetes Day which was created by Manny Hernandez, founder of TuDiabetes and David Edelman, founder ofDiabetes Daily. You’ll find an amazing songbook of educational information, patient stories, blog posts, doings about Diabetes Month and Diabetes Day and how you can pick up the gauntlet in your community. 

I’m honored to be in such fine company.

2,000 amazing book signings

All smiles

With little fanfare, my husband turned to me about two months ago and said, “Wouldn’t it be something if we gave away your books to the speakers and member nations who’ll be at the International Diabetes Conference this year? After I rolled my eyes I said laughingly, “It sure would.” And, I’m here to tell you it was!

1,000 copies of “50 Diabetes Myths That Can Ruin Your Life and the 50 Diabetes Truths That Can Save It” and 1,000 copies of “The ABCs of Loving Yourself with Diabetes” made their way to Montreal where they were on display last week in the Exhibition Hall of the IDF as my gift to all those who work to make life better for people with diabetes. The books were accompanied by thisletter that expresses my appreciation.

By noon the second day of the conference all the books had been handed out and are now heading back to libraries, clinics, hospitals and patients as far away as China, South Africa, the Philippines, Russia and most everywhere in between. The IDF has more than 200 member countries around the world.

For an author who rarely sees the impact of her work, chatting with those who surrounded me, seeing their delight in the colorful and unique pages of the ABC book, hearing them agree how we only talk about negative emotions in diabetes rather than strength, joy, appreciation and pride, was thrilling. Seeing their smiles glance over the playful cover of the 50 diabetes myths book that dispels a huge myth right on its cover was also a thrill.

So much so in fact that when the books were gone by 11:30 AM the second day I felt bereft. It had been so fulfilling to talk to so many who are working tirelessly every day in diabetes that I wished I had brought another 2,000 books! 

I did spend a fair amount of time at the many behavioral sessions offered at the conference where I heard confirmed the value of story-telling in helping patients in their healing process and that most behaviorists in the field are currently advocating motivational interviewing and patient-centric methodologies. I actually find both a step in the right direction but at the same time not quite the right step. Motivational interviewing is a directive approach where the HCP largely directs the conversation and intent rather than without prejudice openly exploring  the patient’s ideas for options, and as pointed out in one presentation, the HCP can bring his or her own prejudices to the process and a number of other blocks. Also, while most HCPs need to become more patient-aware, making the patient/doctor interaction patient-centered, too heavily weights the interaction on the shoulders of the patient and minimizes the HCP’s contribution. I am well aware of these approaches and working on a behavioral intervention that moves patients further and will be unique to the diabetes world.

Back to the conference, while it was a chore to leap out of bed early the first morning and walk a half hour in the cold to the conference center for the 8:30 AM session, it was the session that resonated most deeply with me and was most akin to the work I’m developing. 

It was given by Dr. Jean-Philippe Assal who spoke with the knowledge of a physician, the understanding of an educator and the eloquence and wisdom of someone who has evolved in his study of patient/physician interaction and human nature to understand that treating patients with diabetes is as much art as science.  

Dr. Assal also presented a remarkable video about gondoliers developing their skills to maneuver the waterways in Venice and comparing the development of those skills to how we develop the skills needed to live successfully with diabetes. An incredible metaphor and one that can only be recognized by those who look beyond the traditional care model.

The second day of the conference my husband and I found ourselves to our good fortune lunching with Dr. Assal, his wife, Tiziana, an education specialist, and their assistant, Benedetta Barabino, a biologist who is working in stage directing to help patients and physicians work through blocks and barriers. Needless to say it was a stimulating lunch centered around how the patient must be regarded as an equal expert to the provider as he/she is the expert on his/her life, and that working together the best outcomes can be achieved. 

One outcome that was immediately achieved over lunch is the husband and I have an invitation to visit the Assals at their Geneva home. Hmmm…I wonder how long it takes to get to Geneva from Brooklyn?

20th World Diabetes Congress

Just landed home from two weeks in the U.K. where I’m collaborating with an expert in behavioral intervention to help patients better manage diabetes. This promises to be exciting new work in the coming months and something I’ll be writing more about. 

Off again tomorrow morning to theInternational Diabetes Federationconference taking place this year in Montreal. The conference brings together the top researchers in diabetes from around the world. It begins this Sunday, the 18th and finishes on the 22nd. I’ve never been to the IDF conference so it promises to be enlightening. 

If you happen to be there check out the display area where my books will be available. 

Now that I’m still on U.K. time which means I’ve been up forever and the room is beginning to spin, I’m going to say come back next week when my travels will be limited to my walk around the park and shlepping groceries home from the local market

Revving up for Diabetes Day, November 14

L1030211Learn and Do on Diabetes Day

This is my last post for a few weeks and so I wanted to leave you with some interesting things to check out and do while I’m gone. And, remind you to come back the end of this month to hear about where I’ve been and what I’ve been doing. Meanwhile,  as we rev up to November’s Diabetes Month, here are some great ways to start your learning curve now.

 

1. Check out World Diabetes Day, the new web site Manny Hernandez, founder of TuDiabetesand David Edelman, co-founder with his wife of Diabetes Daily, have created. The site brings greater awareness to diabetes in general and things you can do to be a part of diabetes day, November 14, and spread the word. You’ll find lots of news and lots to read, including blogsfrom an assortment of bloggers, including three from me that will show up throughout the month. 

 

2. If you’re new to my blog or come sporadically, you might want to read some past posts. Most are timeless since you may have noticed I tend to write about the emotional experience of living with diabetes and how to reframe diabetes, using it as a catalyst to create more health and happiness. 

 

3. You can listen to my recent podcast on the Diabetes PowerShow. A lively discussion between me and the show’s four passionate hosts about diabetes myths and the emotional resilience needed to live with diabetes, and how to create it. Also available on iTunes.

 

4. Do your homework, but I promise I won’t collect it. Pay attention over this next month to what you do well in your diabetes care and appreciate your efforts in some tangible way, whether buying yourself a little something or just giving yourself a pat on the back. Also, pay attention to what you could do better and figure out one simple step you are willing and able to take that will help you do better. Take it, look for improvement and write down your improvement. Then go back and buy yourself a little something or give yourself a pat on the back to commend your efforts. 

 

I’ll see you in late October after I return from the International Diabetes Federation conference in Montreal. Hopefully I’ll be a little more educated and so will you.

The Diabetes Resource web site

What’s a blogger to do when she’s going to be away for a few weeks and can’t post except from home? Well, one thing is I’m working on solving that problem, but not in time for the next three weeks I’ll be away. So, I will leave you with this post and the next that give you something to do. Of course, you have to promise to come back the end of the month.

Take some time to check out my fellow blogger, Gina Capone’s, fabulous new web site, The Diabetes Resource. This one-stop, convenient and easy to navigate site covers everything related to diabetes; from camps to monitors…professionals to articles and chats, and it is updated daily. Remarkably, this is the only site that puts the whole spectrum of diabetes resources in one place. 

Check out:

1. A directory of everything under the sun related to diabetes, i.e. magazines, pregnancy, celiac disease, dieting, diabetes drug companies, home delivery services and on and on and on and on…………..

2. Events happening in your neighborhood and around the country

3. A chat room every Wednesday night

4. Great articles 

5. Advertising

“I developed The Diabetes Resource to take the hassle out of searching the web and navigating site after site to get the critical information you need when you need it,” said Gina, herself a type 1 since the age of 25. “I tried to think of everything I could that related to diabetes and then brought those resources together at one location, one web site.”

“The Diabetes Resource is the first web site dedicated solely to consolidating and bringing organization to all of this information and I welcome that,” said Kitty Castellini, Founder and President of Diabetes Living Today™, a popular radio program dedicated to discussing issues pertaining to diabetes.  

So, take a look. It should keep you busy and allow me to feel less guilty.

Life is diabetes and diabetes is life

P-U Bring the Stars Out to PlayThe answers are inside you

A lifetime ago, well literally half my life ago when I was in my twenties, I quit my advertising copywriting job to design and write inspirational greeting cards. I was taking some personal growth trainings at the time and wanted to share my newfound key insights with the world. I actually did create the cards, get them printed, get them sold and four years later, still a starving artist, get a “real” job. 

But what I wanted to teach others has never gone away. What I learned during that time of training and years of reading are life principles that affect the quality of our lives, and as Oprah says, “When we know better we do better.” So, here is what I know for sure:

1. There’s a pay-off to everything we do. You may not think so when you’re miserable but whatever you’re doing, crying in your beer, moaning on someone’s shoulder, letting guilt fill your day, playing the victim with diabetes, it’s comforting to you in some way. 

2. You will tend to get what you expect. If you want more, raise your expectations. If fear of failure is paralyzing you, lower your expectations.

3. “Act as if.” When you don’t feel it, act as if you do: happy, confident, strong, whatever. Who’s to know that’s not really you? Certainly you’ve been these things at various times before. By pretending you feel a certain way, you will begin to. The world then responds to you in kind, as it does all the time, actually.

4. What is, is. You may not like what is, but it’s what you’ve got in your deck to play with. All you can control is how you play your cards. You can always add to your deck of course.

I am coaching a young woman in her early twenties who has type 1 diabetes. She has had diabetes for about 10 years and is going through an emotional storm:  a bad break up with her boyfriend, a death in the family, financial strife and more. The immediate ramifications for her have been a loss of interest in her studies and future, which she was so enthusiastic about previously and out of control blood sugars. Due to months of stress her blood sugars have been consistently high causing her to lose 20 pounds with no effort – her body is not absorbing the calories she eats. Her emotional storm has unmoored her from her good diabetes habits – she is eating erratically, missing meals and not covering her snacks or correcting her high blood sugars, all of which she used to do.

During our coaching session my job is to ask her questions to spark her thinking in a way other than she has been thinking. When we are stuck in a problem it’s very hard to think outside our usual box. And, as much as I want to give her the answers I think I see for her, they are not her answers. She needs to delve down and come up with what will work for her. Trust me, this is hard work. Both for her and for me. Real thinking takes time and effort. Much of her thinking will actually happen after she leaves me because I have stimulated it and it will continue. Holding my tongue while she searches for her own answers is hard work for me. But I know that she must remember what she already knows, reflect back on what she’s done in the past that’s worked and determine what she truly believes she’s capable of doing and willing to do. In short, only she knows what will work for her in her life. In this scenario she is the expert, I am only a tool.  

At the end of our time, however, I do, with her permission, share a few of my own thoughts and suggestions. And as I look back now on what I told her, I see it is very much based on the four principles above. 

I pointed out to her that while it’s hard to see it, there’s a pay-off for this unbearable sadness she is nursing. Maybe it reinforces her sense of herself as not being a very good person and it is always comforting to be right about what we believe. As for expectations, she is already talking about likely failing this semester as she is not paying attention in class. I reminded her that the expectations she plants she will likely create. Alternatively, I suggested she “Act as if” she is fine, her old self, confident, an interested student, for instance, while in class. At least for the periods of time she can sustain it. They will grow longer.   

I suggested she spend up to 30-60 minutes a day obsessing about her worries. And when blue thoughts roll in, in as they will, save them for that period when she will indulge them. Sometimes you just have to cut off non-constructive behavior. The rest of the time I suggested she be as fully present as possible wherever she is and employ the “act as if” principle. Lastly, I reinforced that she move forward with the small steps she identified that she could take to move in the direction of the life she once dreamed of and still wants. Covering her emotional eating with insulin is a step she identified that she can and will take. The results of this will likely be a little better blood sugars, a little less stress, a little more ease and a little light streaming into her world that now looks so dark. Each step we take creates a ripple effect: one positive step puts you in a more positive upward spiral.

It’s not rocket science, but when the world is on tilt it’s hard to see where you stand. I learn a lot when I coach someone. I learn to listen harder and more openly. I learn myself to be more present in the moment and not finish someone else’s sentences, not even in my mind. I learn we each see the world differently, operate in the world differently and prioritize differently. And, her emotional storm has reminded me just how dependent good diabetes care is on how the rest of our life is going. So along with the four principles I’d like to add this one specific to diabetes: Don’t just tend to your diabetes, also tend to your life. And don’t just tend to your life, also tend to your diabetes. They are intertwined.