The continued carb debate

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It’s really amazing what a muddle we are in over food these days. It’s on our morning new programs every day, nutritionists telling us, “How to eat, what to eat, what not to eat, what children should eat, how to make pancakes that look and taste like brownies…” Weekly doctors, gurus and alternative healers discourse on Larry King Live about diets, non-diets, trans-fats and why Americans are increasingly obese.

In my last entry I wrote about how my low carb diet has helped control my blood sugars and reduce my insulin requirement. I wondered aloud why everyone doesn’t see the logic in less carbs in = less meds in. But, I must admit, having recently picked up a book that takes this to the extreme — The PH Miracle for Diabetes, The revolutionary diet plan for type 1 and type 2 diabeticsby Robert O. Young — that everything is relative. 

Young says diabetes, largely type 2 but I believe he’s including us type 1s, is caused by our body’s overly acidic PH level (the acidity or alkalinity of our internal fluids). Our over acidity, if I understand him correctly, comes from eating carbs. Carb intake causes the body to flood itself with the ‘fight or flight’ hormones: cortisol, adrenaline and insulin, which cause inflammation. Inflammation, which causes corrosion of our body tissues, prompts a too acidic PH level. Sorry, as you might have guessed, chemistry and physics were not my strong suits. Young says we need to make our PH level less acidic and more alkaline, and the way to do this is through a diet largely of vegetables.

Dr. Andrew Weil, alternative medical guru, says many of today’s diseases and health ailments are caused by inflammation and he advocates ananti-inflammatory diet. Even Gary Taubes author of, Good Calories, Bad Calories, says our over consumption of carbs, trans fats and high fructose corn syrup type additives, trigger a genetic predisposition to haywire our hormonal system and cause unsuspecting citizens to put on weight. Taubes says, it is not our over consumption of calories that is making us fat, but this haywire handling of refined carbs and these other ills in our diet. Seems no one can agree on what makes us fat but these three pundits are speaking a similar language about illness.

So, what to do? Several years ago I vacuumed the refined carbs out of my diet. Admittedly, I felt pretty virtuous doing this. But now Young says I should get rid of: coffee, tea, chocolate, alcohol, grains, dairy and exist almost exclusively on vegetables, fish and what he calls his “green drink” — juiced vegetables with some magic powder in it. Hmmm…I suppose if I was forced to do this, I could, but it really doesn’t sound like a happy life. And, given that he says a positive attitude is an important aspect of his eating plan, I’d fail miserably. Tears shedding all over my clothes and furnishings.

Many times people tell me they’d like better blood sugar control. Yet when I mention reducing their carbs they say, “Hey, I’m human, I want to enjoy what I eat.” Well, for me cutting way back on carbs was not a major hardship and I like the return benefit. I’d already cultivated years of cozying up to veggies and cutting back on butter, muffins, fries and white bread. Then, when I restricted my carbs a little more, like not eating grains too often and eating one piece of whole grain toast with my omelet instead of two, it gave me the kind of control that makes it worth it to me.

But, truly, Dr. Young, I must be weak — I just couldn’t go the distance as you propose. Giving up yogurt, cottage cheese, dark chocolate, wine, manchego and gruyere cheese, the occasional fried dish and friend’s birthday cake would be downright unsocial, not to mention aggravating. So it really is up to each of us where we feel the trade-off is worth the return.

There are plenty of case studies in Young’s book where people proclaim following his diet changed their lives, even to the degree that they don’t need any diabetes medication anymore, including insulin. I imagine that’s type 2s talking. While I understand if I didn’t eat anything that raised my blood sugar, I could probably cut out my bolus insulin entirely, my basal insulin is not optional. We still need insulin for various bodily functions. So if this regimen and its possible benefits appeal to you, check it out. I’m not playing advocate here, just reporting the news.

The debate goes on: carbs in or carbs out?

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Screen Shot 2015-02-08 at 4.09.19 PMTreat carbs like special treats

A friend, and fellow A1c Champion, saw author, Gary Taubes, talk about his new book Good Calories, Bad Calories, a month ago on Good Morning America and sent this email around, “Taubes says that exercise makes us hungry for carbohydrates, not lean, and that carbohydrates cause insulin secretion which creates fat.”  One of her email recipients, who is a Ph.D and medical specialist, wrote back: ‘There is still a lot that we don’t know but for me eating less and moving more has led to my weight reduction. I could have dieted on birthday cake as long as I did not eat more cake calories than I spent.’

It’s a constant debate in this country: What’s the magic formula for losing weight, fast – and easy. The second battle ground, and especially for us d-people, is are carbs good or bad? To me, the answer to both is simple: eat less, move more and since carbs raise your blood sugar, if you want to lower it eat less carbs. Why is that such a difficult notion? Seems crystal clear to me and trust me I’m no rocket scientist.

Around the same time my friend’s email went around, a wicked debate was playing out on DiabetesHealth’s web site. Hope Warshaw, MMSc, RD, CDE, BC-ADM, and diabetes educator, wrote five articles on carbs, Don’t Want to Go Low Carb or Vegan, that garnered more comments than I’ve ever seen in response to an article, and a rebuttal article by Richard D. Feinman, PhD, Professor of Biochemistry and Director of the Nutrition and Metabolism at State University of New York Downstate Medical Center.

In a big nutshell Feinman said, “I’m astonished that experts encourage people with diabetes to eat carbohydrates and then “cover” them with insulin. Why would anyone, (let alone doctors who advocate it every day), recommend a diet that requires more medication?” Are they all in bed with pharma companies? Sorry, that last question is my own.

“It strikes me as odd that what most experts know about metabolism – diabetes is, after all, a metabolic disease,” said Feinman, “they learned in medical school from somebody like me. The first thing we teach medical students is that there is no biological requirement for carbohydrate. It is true that your brain needs glucose, but glucose can be supplied by the process of gluconeogenesis; that is, glucose can be made from other things, notably protein. This is a normal process: when you wake up in the morning, between thirty and seventy percent of your blood glucose comes from gluconeogenesis. There is no requirement for dietary glucose. And, all of the metabolic syndrome ills – high triglycerides, low HDL, hypertension and obesity – are improved by low carbohydrate diets. If we had been describing a drug,” Feinman goes on to say, “everybody would have rushed out to buy stock in our pharmaceutical company.”

I can’t comment on the metabolic workings, but being like most diabetics I can share with you what I experienced when I changed my diet several years ago to low carb. I read Dr. Richard Bernstein’s book, Diabetes Solution, and for the first time read someone advocating getting rid of carbs to control blood sugar. Dr. Bernstein advocates next to no carbs in a diabetic diet.

Himself a diabetic for more than 50 years, Bernstein claims he has reversed many of his early complications and gotten his blood sugar under tight control by virtually eliminating carbs. Less carbs means you’ll be taking less insulin and by taking less insulin, Bernstein claims, your insulin will be better absorbed, there’ll be less variability in its time and efficacy and greater predictability with your blood sugars. Let’s just say after I read his book, I was encouraged and inspired to try his “solution,” so I pretty much vacuumed the carbs out of my diet. “Vacuumed” in the sense that I cut way, way back. I essentially eliminated refined carbs: white bread, white potatoes, rice, pasta, sweets, muffins, starchy veggies. The result? My sugars indeed dropped, were consistently lower, my insulin doses dropped, and maybe best of all I was no longer chasing high blood sugars. You know the ones that come from refined carbs where you just can’t seem to knock them down all day. My Lantus dose went from 20 to 12.5 units and my mealtime Humalog was all but cut in half before each meal. The results were so dramatic and made life so much easier, I have not in five years gone back to my old ways. I do have to add the caveat that we’re all different and your body may not respond the same as mine.

It’s common sense, though, that the less carbs you eat the less your blood sugar will rise and the less medication you’ll need. I don’t understand how anyone can argue the logic in that. If we’re still being given diets with substantial carbs in them it’s probably because the American Diabetes Association (ADA) and powers that be think the average diabetic will never stand for, and won’t be able to, cut the carbs. Not unlike why the ADA’s A1c recommendation is as high as 7 – which correlates with 170 on your meter – even though we’re advised to stay in a target range of 80 – 120. Something sound fishy?

For those interested, here’s my routine that keeps my sugars low. My one carb meal is breakfast. I figure it’s healthy, high fiber, it’s satisfying, and since I walk in the morning, the blood sugar rise gets leveled out. Every morning I make a bowl of slow-cooked, steel cut oatmeal. I know many people who make a batch a week and freeze portions, but I like the morning ritual. I actually eat less than a whole serving and make up the difference with a dollop of low fat plain yogurt or cottage cheese and a tablespoon of peanut or almond butter. Also I add flax seed and cinnamon. For this treat, and like Jerry on Seinfeld I could eat breakfast for any meal, I need 3.5 units of Humalog or 3 if I’m taking my hour walk around my local park. Lunch is generally a spinach salad with feta cheese, tomatoes, beans, left over veggies, or a spinach/feta omelet. For that I need .5 – 1 unit, and dinner is typically fish or chicken, vegetables and beans. If I’m having a glass or two of wine with this dinner I don’t need any insulin – alcohol for most people lowers their blood sugar, unless you’re drinking Strawberry Margaritas and Singapore Slings.

A few months ago I interviewed a fellow type 1 who had had an islet cell transplant, two actually. For 18 months afterward she was insulin-free. Unfortunately, as for most islet cell transplant recipients, if not all, her new cells began to fail and she had to add some insulin back to keep her blood sugars in range. She told me, though, she’s on a very small dose — 14 units total daily. My daily dose is about 18 units and none of my beta cells work. Seems argument enough for me that you can keep your insulin, or meds, at a minimum by sweeping most of the carbs out of your diet.

I should tell you in full disclosure my diet is not carb-free – and alas, I am not perfect. When out to dinner I often nibble on the bread and love it dripping with olive oil. Thank God someone decided that’s healthy. I indulge in an order of fried calamari or crab cakes from time to time, and if dessert comes to the table I’ll stick my fork in like everyone else for a taste. But without question, the less carbs I eat the less insulin I need, and for me the control I get and the way I feel is worth it.

If you’re curious about a lower carb diet, give it a try. First hook up a hoover to your pantry and suck out all the chips, pretzels, rice and muffin mixes. Second, while experimenting, test, test, test. Third, see if your blood sugars and meds don’t drop. Fourth, reward yourself with some high cocoa dark chocolate — Lindt’s 85% Excellence chocolate bar has only 8 carbs per serving! Good luck.

7, a lucky number, even with diabetes

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Screen Shot 2015-02-08 at 4.10.43 PM

 

Remember that ground-breaking management book from Stephen Covey – The 7 Habits of Highly Effective People? Well, Mr. Covey and the American Association of Diabetes Educators (AADE), with support from Bayer Diabetes Care, have released a small pamphlet applying his 7 habits to diabetes care. Covey’s inspiration for the booklet? His wife was diagnosed with diabetes.

I imagine the thinking behind this booklet is to give patients a new tool to manage their diabetes, adding to the typical diet, exercise, meds routine. This tool has the patient draw from a more emotive place: understanding, listening, cooperating and picturing your perfect life. What impresses me is the head-nod to the fact that managing diabetes is not just about medical management, but includes our emotional, mental and spiritual being. Covey’s habits are:

1)   Be Proactive – Choose your actions, and be responsible for them

2)   Begin with the End in Mind – Create a vision for your life based on what is most important to you

3)   Put First Things First – Prioritize tasks based on importance and what one thing can you do regularly that will make a positive difference in your life?

4)   Think Win-Win – Build relationships with others by helping them succeed, too. From this you create the positive energy of cooperation which leads to success in all things in your life, including diabetes management.

5)   Seek First to Understand, Then to Be Understood – It’s about listening. Listen to your health care team to gain the practical skills of self-care

6)   Synergize – Combine guidance from your team and support from friends and family

7)   Sharpen the Saw – Keep everything sharp: your body, mind and spirit

It’s hopeful watching the AADE move in this patient-empowerment direction. In a perfect world, patients’ attention, with the help of their educator, would be on greater quality of life, not so singly focused on diabetes task management, but weaving that into a vivid picture of a happy and healthy life. For a positive vision of our life is truly where our motivation and energy come from — for all things — including managing diabetes. Diabetes educators would exhibit less ‘directorial skills’ and more coaching skills, helping people design a ‘life plan’ with diabetes in it, rather than just a ‘numbers plan’ — blood sugar, blood pressure, lipids, you get the idea. But since we can’t ignore the numbers aspect of diabetes management, at the back of the booklet you’ll find the AADE’s 7 self-care behaviors.

The booklet is a nice start. To get yours – and it’s free – go to: http://http://www.diabetes7.org. What we need now is a well-trained team of educators ready and able to help patients put these habits into play. Well, I guess one can’t ask for the moon, the stars and the sun all at once. But this moonbeam is a small ray of hope. For more information about the AADE, particularly if you’re looking for a diabetes educator in your area, go to: http://www.diabeteseducator.org. 

 

 

Notice your thoughts – it will help you

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I write this blog for several reasons. One, I love sharing my knowledge and helping others. Two, I want you to know that managing diabetes involves emotional resilience not just meds and counting carbs. Three, it keeps my mind checking in on how I regard and manage my diabetes.

Truth be told, my diabetes-life began poorly. My early years were spent in denial and ignorance. Then after developing a few minor complications, I found my way to the top of the learning curve and shifted my vision — from seeing diabetes as a burden to creating a healthy life. And how I deal with my diabetes has given me that. Over the years I’ve maintained a thirty-pound weight loss, I eat sweets only as a treat, I’ve wiped refined carbohydrates out of my diet, I use smaller plates and so eat smaller portions, I’m always taking food home from restaurants (usually it’s mine), I power-walk almost daily and watch my head for incoming negative thoughts. Today diabetes is just part of my routine, and I’m healthier for it. I believe we’re all capable of finding a gift in our diabetes, and for some, it will be better health. Frankly, though, you have to be ready to look for it.

Here’s a Zen sort of exercise that may help you do better: notice your thoughts about diabetes. How do you feel about it?  What do you do to manage it? What don’t you do? Do you resent it? Is it friend or foe? How do you manage it: peacefully or combatively? Do you keep diabetes a secret? Why? Checking in with yourself on these issues may help create some new thinking for yourself, and prompt new actions. How you hold diabetes in your life impacts your entire life.

I’m always curious why we think what we do, do what we do, expect what we do. I’m intrigued by how when individuals face the same issues, we each exhibit different behaviors. And now I’m fascinated by how diabetes shapes our lives: why can some of us deal while so many are so stuck?

Noticing your thoughts can help you see the life you’re constructing every day — your whole life and the role diabetes plays in it. Often I hear my thoughts best when I’m out of the house, walking around the park. My mind seems more free to travel under the open sky. If you let yourself rummage about up there in your head and then capture your thoughts on paper, it’s a great way to glean some new insights and work out frustrations. Both are powerful means for coping with diabetes. 

If you’ve read a few entries here you may think I’m schizophrenic. I report about feeling pride and celebration living with diabetes in one entry and then exhaustion and disgust in another. But, you see, I believe living with diabetes is all these things: the good, the bad, the ugly and the proud. And, our emotions are a significant part of what we need to manage along with our blood sugars.

I hope you find these entries fulfilling in some way. Maybe they validate your own feelings, provide connection with others, expand your learning or peak or satisfy your curiosity. Mostly, I hope they spur you to think about your diabetes-life, and try something new if you need to. I know it helps me to write them. Here’s where  all those thoughts walking around the park go.

You can take a stab at writing your thoughts here too to see them more clearly. You may find you notice something valuable in the process. If so, let me know. Sometimes it’s good for me to test my own theories. 

What if diabetes was just “the new normal?”

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Bayer just started running a new TV campaign for their meter, the Contour. Funny, I rarely think of Bayer in relation to diabetes. I think aspirin, even though a few months ago I participated in a focus group for Bayer’s Contour meter and learned they have a whole division devoted to diabetes care. Still, I think aspirin. But they’re beginning to change my mind. Maybe they’re even beginning to change people’s minds about diabetes with this new campaign, subtle as it is.

While in the focus group I remember reviewing four concepts for the Contour. Two were very positive, and one had a tagline something like, “Yeah, I have diabetes, and, I enjoy my life.” That one must have made it because I heard something like that in their commercial. Remarkably, they’re not talking about the work of diabetes, which actor Wilford Brimley talks about selling diabetes Medicare supplies. They don’t have a combative diva like Patti LaBelle, declaring, “I control diabetes, it doesn’t control me!” And it’s not alarmist, as in the new public awareness campaign for A1cs. It’s just an upbeat lifestyle spot where ordinary people doing ordinary things say to camera, “Life with diabetes? It’s about going for it!” “Life with diabetes? Getting more just got easier.” 

A little trite? Sure. A little simplistic? You bet, but I kinda like it. What I like is it’s not threatening, frightening or bullying. It says ‘I take diabetes on the chin, no biggie.’ While us type 1s know diabetes is no walk in the park, and most type 2s probably feel the same, this may actually help type 2s feel that diabetes is manageable and not the end of life as they knew it. The tone of the pitch, and its upbeat takeaway, actually makes me feel a little more upbeat.

A few weeks ago reading Jill Sklar’s book, The 5 Gifts of Illness, I thought, ‘What if as people grow older, type 2 diabetes was just ‘the new normal?’ I mean, everyone’s getting it, so what if we didn’t look at it as an aberration, but it was expected, as in — you get older, you get wrinkles, and you get diabetes. Truth is, many experts say if you live long enough most people will get diabetes. My 84 year old father has just been diagnosed. But, trust me, that’s another story.

I mean would we look at diabetes differently if it was expected? If it was just “the new normal” at some point in our lives? Of course for type 1s it’s a little different, but still if everyone expected to get diabetes would that change how we view diabetes, and how we live with diabetes? Would people greet it more gracefully and with less alarm and overwhelm? Would people be more accepting of the lifestyle changes diabetes requires? Just as we expect to slow down as we age, maybe if we knew diabetes was a natural part of aging, we might also accept eating less and moving more as what we’re supposed to do when it arrives: the very behaviors that will keep us healthier as we age. Of course, it’s likely some people would deny their diabetes, fight it or fear it I suppose just as they do now. But others would accept it more easily, and still others would embrace it as the impetus to make the last few decades of their lives healthier and more rewarding. I have no answers, but it’s an interesting proposition don’t you think? And, going a step further, if you embrace this notion, you might find you view your diabetes differently.

On a final note, I will tell you about my experience of Bayer’s Contour meter. I was given one last week by a cde. After years of using One Touch meters, I may just prefer the Contour and it took me by surprise. It seems to require half the amount of blood the One Touch does and draw it up twice as fast. Hmmm… it’ll be interesting to watch Bayer as they get into the ring with the big boys.

Coalition of the willing

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I just discovered that there’s a new national public awareness ad campaign sponsored by the American Diabetes Association, American Association of Diabetes Educators, Juvenile Diabetes Research Foundation and the National Council of La Raza (the nation’s largest Hispanic diabetes advocacy group). What’s historic is that all these groups are coming together for the first time. Seems a signal that the powers that be realize that diabetes is the awful epidemic that it is, and are willing to put aside their differences and work together – at least for now. You can catch the campaign here. 

I caught wind of this this morning on the blog, DiabetesMine, which I check frequently. What I found equally interesting is the flood of comments Amy’s (blog writer) article pulled. A third of the respondents seemed to like that the new campaign creates greater awareness of the importance of the A1c value. A third were cynical and jumped on the fact that the commercials don’t explain A1cs in the context of diabetes care, and that this campaign is only to make pharmaceutical companies richer. The last third bemoaned the fact that even though they know A1cs are important, they can’t seem to motivate themselves to better control their blood sugar.

I don’t often leave a comment on Amy’s blog but I did today because I feel strongly whatever we can do to get people more aware of the importance of controlling their blood sugar is good provided the execution is well done. And I think this campaign, as an awareness campaign, is well done. You may want to go check out Amy’s article, and the comments, but I can tell you here what I chimed in with in response to the nay-sayers: 

“I’ve not much to add (to the litany of comments) except maybe this: If you’re cynical, ask yourself why? Our experiences and beliefs color everything we do and say. You’re coming from a point of view before you even see something. Can you suspend your point of view and see something first without an opinion?

For those having trouble putting your awareness that uncontrolled diabetes causes complications into action, take a small step. Change one action for a week, see if you don’t feel better. One week, then a second week, but don’t even entertain the thought of a second week till you get there.  Change happens one step at a time, one day at a time. Five years from now you’ll either be changed — or not. Do nothing and you’ll be the one on the stretcher, but don’t let that scare you, use it as information.

If you think pharmas are only out for profit, you’ll dismiss this campaign before you actually consider that people at pharmas may actually have two sides: wanting to make money and wanting to help people.

Sure, we can say there’s not enough info in the ad, but it will come. Let’s get patients into health care provider offices first. If you think there’s not enough training for most health professionals about diabetes, I agree. If you think there’s not enough attention paid to coping and emotional issues regarding diabetes, I agree, it’s what I write about. But doing something constructive to change this, even if it’s just raising your voice works best when your intent comes from a constructive, rather than destructive, place. Everything is energy and energy affects everything.

If you think this ad campaign should tell you everything in 30 seconds about why you need to know your A1c, likely this is the first in a succession of ads. People can only take away 1-3 messages at any one time. I know, I was in advertising. No point littering, it only creates confusion.

Let’s get patients into doctor’s offices, doctors better trained, up the awareness of how emotions affect chronic illness, and if you agree, choose to be a part of that effort doing something constructive rather than destructive. Anything. This effort really needs as many of us as possible.

Of course Big Dave, one of the many commentators, then commented on my comment. What fun! He said that I’m biased toward pharma companies because I give patient education seminars funded by Sanofi-Aventis and pharmas do not have our interests at heart. Of course, you just know, I had to respond. And so I said, “Big Dave, I wasn’t talking to you particularly, but I will answer your concern. There are four A1c Champion programs: 2 branded, 2 unbranded. I only do the unbranded ones, meaning motivation and education, nothing to sell. And yes, people tell me all the time after I present that they learned something or something in them shifted, usually that they have to be responsible for their care, rather than leaving it up to their doctor. I don’t mind cynicism, I only mind it when it closes minds. I didn’t say pharmas have your best interest at heart, I just said don’t discount it, along with their profit-making.

I have a feeling right now Big Dave is scripting a response to my response. I’ll leave you to check. Just proves, though, that “comment-ing” is a great way to get us all talking and thinking.

Alert: “I’m darn proud of all I handle,” said in garnet and silver

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Screen Shot 2015-02-08 at 4.13.12 PM“Diabetes Pride,” it’s coming. Hear me Madison Avenue?

If you read about my day in the city with Ms. A, “A day trip to Diabetes Land,”  I forgot to mention that I happened to admire a bracelet Ms. Awore. It’s a really nice piece of jewelry and serves as a medic alert bracelet. If you read about my new T-shirt, in“Don’t you love my T-shirt?”, you’ll know I’m starting a new wardrobe featuring messages of diabetes pride. It hasn’t been intentional, but it’s just seemed to have happened lately. Almost as though I’ve an alter-ego taking over my body.

But back to the bracelet. In all my years living with diabetes, thirty-five and a half to be exact, just between you and me, I have never worn a medic alert bracelet. While I’m no Fashionista, I don’t like what they look like, and I don’t like the reference I make in my head — “damaged goods.” Then, too, just to be clear, I’ve never (yet) had an incident where I needed one.

But Ms. A’s bracelet was so nice that after returning home I went directly to the web site where she got it,TAH Handcrafted Jewelry. I clicked ‘Bracelets’ along the left sidebar and scrolled through. There are several designs to chose from. Mine, pictured here, is seventh from the bottom, #9-S. 

I wanted something inscribed, but not one of the expressions I saw on the site, so I called handcrafter, Tim. I asked could he put two words on my bracelet? I wanted it to read, “diabetes” to the left of the center garnet, and “pride” to the right. Just enough to send a message to myself, and anyone who eyes my new bracelet, that not only am I not damaged goods, but I have reason to be proud: a lot of work, as you well know, goes into managing diabetes. It’s something extra we do along with everything else we manage in our lives. Why shouldn’t we be proud? And most people don’t even know we’re working this extra job.

Imagine if all of us who in some way feel “less than” turned it into feeling “more than”? Imagine turning this ugly, old image of diabetes on its head! After all, so much has changed in diabetes today: people are coming out of the closet for one, then there’s dynamic new research, fast-acting insulins, cool pumps, diabetic mountain climbers, triathloners and Olympic swimmers — why shouldn’t we have a new image? I’m imagining that lately —  thus the new wardrobe enhancement. As for my new bracelet, it’s slim, light and bright, and that’s how I feel wearing it. Powerful stuff, me thinks.

You should know 10% of the purchase price of the jewelry on Tim’s site is donated to the foundation of your choice. You get to choose among: Children with Diabetes, Juvenile Diabetes Research Foundation, Diabetes Research Institute and the American Diabetes Association.

Now, if I should ever be found in distress, I think my really nice bracelet will catch some young paramedic’s eye and he’ll see that I have diabetes. He’ll also see I have attitude and extremely good taste in jewelry.

A friend, an injection and lots of laughs

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I’ve interviewed more than 100 people who have diabetes in the past two years. At first I found my subjects just by asking friends if they knew someone with diabetes. Before long, I discovered everyone knows someone with diabetes.

I also went to two support groups for the first time. At Divabetics, here in New York City, I met Phyllis. I liked her right away. As we went around the room giving our two minute introduction she said, “I got juvenile diabetes at 58, now go figure!” I loved  her spunk and sense of humor. 

Yet below the kidding, she was having a tough time. A few years with diabetes, she was confused, carb counting was hard and she was more than annoyed with the difficulty regulating her blood sugar. And Phyllis was working hard at putting all the pieces together: visits to her doctor and educator, reading web sites, talking to others. Sometimes the pieces don’t interlock the way we expect. Case in point: several months ago three of usDiva-betics spent a weekend at Phyllis’s country house. It was an unintended, non-stop, Diabetes 101 workshop. “What’s your blood sugar?” “98,” “You’re kidding, we ate the same lunch how could I be 250!” “You’re kidding, you only need 1/2 a unit for that bowl of cereal?” “Let’s go take a walk, my sugar’s 198 and I want to get it down.” “No way, I think I’m going low. S__t, 45! Where’s the candy?” It was like a version of that old TV show with Beatrice Arthur, Betty White and Rue McClanahan, only ours would be called, ‘The Diabetic Girls.’ Maybe that will be us in our golden years.

But then I think it’s better to enjoy our golden years now, in a stream of golden days. So last week Phyllis and I gathered to celebrate my birthday and her fifth year anniversary living with diabetes. It was she who merrily made the suggestion. Today Phyllis not only talks intelligently about carb counting, Smylin, pumping, etc, she’s one of the women-behind-the-man at Divabetics, and she’s helping others newly diagnosed get their hands around managing diabetes. Next week she’s accompanying a “newbie” to coach her through her doctor visit.

Living with diabetes is a process. You don’t wake up one day and know it all. Gosh knows, I didn’t. But you could wake up one morning and “get it.” In other words, see there is a gift in having diabetes. The road to there though will come with much learning, trial and error, bumping into yourself, your mistakes, lucky accidents, big-headedness, empty-headedness, and all the teachers out there who have proceeded you. Then 1 year later, 5 years, 10 or 20 years later, you’re the veteran helping someone else. You have shed your old skin, transformed into a newer you, and discovered part of the secret living with diabetes is making every day as golden as it can be.

Were we celebrating having diabetes? No. But we can all celebrate having the courage and humor to responsibly make diabetes part of our lives and enjoy the  things, other than the tsouris (stress), that diabetes brings into our lives. Like a new friend with a really wicked tongue.

So that’s the book I gave Phyllis, (photo) a compilation of personal stories from Diabetes Forecast magazine. Just some light reading for the bus. Meanwhile Phyllis gave me two hours of laughs, kinship and our birthday/anniversary lunch.

The thinking person’s disease

/ rivagreenberg / Leave a comment

I seem to keep reading that diabetes is the “Thinking Person’s” disease. Well, yes, I do think a lot, but I couldn’t say that’s why it picked me. Rather, if you are a mental, analytical type, I can imagine diabetes is easier to manage. It’s not hard to understand why. 

Living with diabetes you’re constantly collecting and examining data,  experimenting, judging the results of your experiments, making calculations and making decisions. Hmmm…woke up at 8 A.M. with a blood sugar of 127. Most people would think that’s just fine, but I’ve learned through experience that means my blood sugar is already on the rise, and if I don’t stunt it now it’ll be 145 within an hour. Darn, I should have taken that extra half unit of Humalog before going to sleep, I knew it. But that thought last night was led astray remembering that when I did that three days ago, my morning blood sugar was 55! But now that I am 127, hmmm…let me see …I think I’ll take just a smidge more insulin than usual. But, gee it really looks nice out, I think I’ll take my walk around the park this morning. Hmmm…O.K., now, I have to increase my dose for the 127 and decrease my dose for the walk. “Hey, anyone got a calculator? I’m still a little sleepy, here.” 

You get it. There’s the judging carb grams for every meal, the juggernaut being a restaurant meal, or a friend’s cocktail party where you start eating foods you haven’t eaten since college. There’s the remembering to take your medicine and meter when you leave the house and ordering refills before they run out or you’ll have to call the doctor, who has so many people calling him because every TV ad tells millions of people, “talk to your doctor!” My doctor’s probably so busy talking to everyone, it will surely take him forever to do something as low on the totem pole as write me a prescription. And on, and on, today, tomorrow and forever. 

I often think some of my friends, whom I adore, but would lovingly label as ‘air heads’ could never do this, never in a million years. Hmmm…this could be like the chicken and the egg question? Which came first? Are we thinkers first or do we become better thinkers living with diabetes because we are forced to? Oy, that’s far too much thinking for me.

Except here’s one more thought. Maybe we could use some of these brain cells for thinking about things, other than the every day mechanics of diabetes, that would also help us manage diabetes. Looking so intensely at the minutia of this everyday balancing act, we tend to lose sight of the big picture. In other words — the “why” we’re doing all this work. Isn’t it so that we can live a long and relatively healthy life? Isn’t it to enjoy our friends and our family? To discover our second career, watch the grandkids grow up, create the best vegetable garden on the block? It’s so easy to lose sight of why we’re working so hard to achieve good blood sugar numbers every day. But I think we need to remember it’s to enjoy our lives; to find our mission, contribute our gifts, feel connected, loved, and present in the world. I think we need to find a way to keep that thought ever-present. 

In fact, going further, I think every health care provider, whether it’s your endocrinologist, physician, diabetes educator, podiatrist, opthomologist, social worker, dentist, reiki healer, I think all of them should ask us at every appointment: “What do you love to do?,” “Who in your life gives you pleasure?,” “What’s your dream?” “O.K., great, now let’s create a treatment plan that includes the answers to these questions and act on them. I’m prescribing you do 5 things you love this week, along with get more lancets and test strips.” 

True health is not just about controlling your blood sugar. While that’s important, so is creating a full and happy life and finding your way to integrate diabetes into it. Yes, there is life outside of diabetes. Why else are we bothering? Somewhere in the middle of all the work is a road we need to carve; a life path, that offers a life you’re fully engaged with and that you’re happy to wake up to, along with the responsibility of learning about and managing diabetes.  

That, I think, is where to aim when looking at your diabetes management, and that is truly worthy of all this non-stop thinking.

Don’t you love my T-shirt?

/ rivagreenberg / Leave a comment

IMG_0818diabeteshappens, now that’s attitude!

I do. It’s made by two young type 1s who’ve started a small company calleddiabetes happens to help enhance the lives of young diabetics. Right now, through the sale of their T-shirts, (on their site, look under ‘news’ and send an email) they’re sponsoring a young type 1 girl or boy for a week at Chris Dudley’s Basketball Camp.  They’ll learn how to take better care of their diabetes, and have an incredible week playing ball. Not bad for one’s self-esteem, me thinks. On that note, I think my cool T-shirt is one of the cheekiest, most pride-puffing ways to say, “Yeah, I got diabetes, I got my head on straight, I’m handling it, so what?” Guess I read a lot into a T-shirt.

I saw this T-shirt at the Children with Diabetes conference this July while in the banquet hall eating dinner. A girl, who looked to be about 18, ran past my table wearing it. It was love at first sight; I had to have it. I waited for her to return to the hall, knowing she would pass my table again. When she sprinted back in, I stopped her gayly calling out, “Excuse me, I love your shirt!” She stopped, smiled broadly, and bent down for the question she knew was coming. She told me she’d gotten the shirt in the Exhibition Hall. I thanked her, gave her a thumbs up, and put ‘Exhibition Hall T-shirt’ on my Urgent Vendor Sleuthing List for the next morning.

To my disappointment there were no vendors in the Exhibition Hall selling my beloved T-shirt. Finally I learned they had been there the first day but alas, were gone. All I had to go on now to track down my shirt were two words, ‘diabetes happens.’ But I couldn’t forget those words. They’d been reverberating in my head like a mantra since I’d seen them. A little internet surfing once home, brought up the the information I needed. I emailed Tyler, sent a check, and my shirt arrived shortly thereafter. Only days later I was meeting ‘A’ (see below) in the city and it was the perfect occasion to visibly wear my pride.

I felt happy from the moment the navy cotton slipped over my head. A few pairs of eyes read my chest throughout the day. No declarations from anyone, but I was grinning like a Cheshire cat. “Take that, world,” I thought. “I am one proud diabetic!” If a shirt can have this affect, I’ll have to talk to Tyler about a coat, bed sheets, hmmm………. an umbrella would be nice.