No to resolutions, yes to more laughter

I never make new years resolutions. What I want to do I’ll do, what I don’t I won’t. Why set yourself up for failure. Although I did tell my husband let’s resolve to laugh more this year. And that appeals to both of us.

So, in keeping with my non-resolution, here’s all you need to have a good laugh. You may have heard of the marshmallow experiment. Researchers took a number of four year olds and gave them each 1 marshmallow. They were told if they waited until the researcher returned to eat it, they would get a second marshmallow.

Next time you’re dying for that cookie or piece of cake and wresting with yourself whether or not to have it, remember the look on these kids’ faces and the stalwart winner at the end!

No urgency in Emergency

Lying in bed at 6 A.M. a few weeks ago I felt a sting and when I brushed my hand against my wrist, felt something fuzzy there. I didn’t know it but I had just brushed off a hornet or wasp or bee that had stung me. I jumped out of bed, ran to the kitchen to inspect my throbbing wrist, ran back to the bedroom (mind you these runs are only 10 feet long) to wake my husband. We turned on the light and there was my attacker on the wall near the lamp on my dresser. I began to freak out.


While I expected my husband to nurse me in some way, he sat down with his computer on his lap, his typical early morning work routine. I was flabbergasted until he began reading off a web site what to do for bee stings. As he read the anaphylaxic (allergic reaction) life-threatening symptoms: throat closing, light-headed, dizziness, weakness etc, I was having them all. I was so weak I had to sit on the kitchen floor, my head spinning and my legs falling out from beneath me. Then through my fog I heard my husband’s voice, “Check your blood sugar, check your blood sugar, check your blood sugar.” With shaky hands I did and it was 57, most likely the cause of my weakness and shaky symptoms — along with a good dose of panic.


After I gobbled some glucose bits, my blood sugar returned to normal but my panic was only slightly abated. I’ve never been stung by a bee. How serious is this? My Aunt is allergic, if she gets stung I know she can die. Is there a stinger in my wrist we have to get out? We followed all the steps advised on the web site should there be an embedded stinger and then I said uncharacteristically, “Let’s go to the ER.” It was Saturday and I knew I couldn’t reach my doctor.


We walked the six blocks to the hospital, and as we walked I questioned whether I really needed to go. But I was worried and wanted someone to tell me it was O.K. so we kept walking. 


Entering the ER was nothing like on TV.


We arrived at 7:15 A.M. Only two people were in the waiting room and I thought this is great, I’ll get seen soon. Then the drunk showed up strolling the room and talking aloud to no one and then the woman who’d been sitting there quietly started yelling and every 10 minutes went to the public phone nearby to yell to someone how much pain she was in and no one was paying attention to her. More like she was off her meds. I saw they paid attention to her when security finally came to calm her down. What a freakish scene I found myself in, on an early Saturday morning, in a place I’ve never been, hoping for quick medical attention.


When we had first entered the receptionist asked me a bunch of questions, only one having to do with my bee sting, and typed my answers into her computer barely looking at me. A half hour later I was called up to another desk where the woman asked me the same questions and typed my answers into her computer. As I tried to engage in at least some conversation, we spent more time talking about her failed diet than my bee sting. 


When I finally saw a physician’s assistant, 3.5 hours after arriving, including the one hour wait after being called into the inner sanctum of the E.R. where I was utterly ignored, she told me all looked fine, go home and take some pain reliever. 


In truth, I was relieved to hear a medical person say, don’t worry, it’s O.K. I guess that’s what I came for. And I surely understand that if there were people arriving on stretchers then my bee sting could wait. But having one simple nurse up front could have sent me home in less than a half hour and receiving one simple smile could have ameliorated the cold, fearful wait. 


As I left I thought let me never come back here again unless it’s through the back door on a stretcher. 



Ready to torch my blood sugar log



For the first time in I don’t know how long I’m keeping a log of blood sugars. No kidding, it has the blood smears throughout to prove it. 


The reason? Two weeks ago I started with a new endo whose main task has been adjusting my insulin dose and when I take my Lantus so I have less lows. Personally, I wasn’t particularly concerned about my once or twice a week low, and I particularly liked that my A1cs are in the 5’s, but endo said the fluctuations in blood sugar irritates the blood vessels and it would be healthier to be mainlining more around 100 and up to 140 two hours after a meal. 


That meant two changes: 1) Cutting down from 14 of Lantus to 10 units and 2) Switching my Lantus from before breakfast to before bed.  Switching to before bed was to override the morning highs (dawn phenomenon). My sugar was rising so fast in the morning it was thought my Lantus wasn’t lasting 24 hours and by moving it to before bed I’d have better coverage for the morning. I’d been taking a first dose of Apidra by 7 AM to blunt my blood sugar rise and then a second dose for breakfast. The cutting down on the amount of Lantus I was taking was because endo thought I had too much Lantus in my system overall the 20 or so hours it is working, and it may be contributing to my lows. 


But cutting back to 10 units, the immediate result was HIGH blood sugars. I was freaking out. And, I had such unpredictability with my numbers that I  was unexpectedly at a loss how to deal with my rapid-acting mealtime Apidra. I had had my routine sooooo down pat before this all started that this lack of control was, and is, driving me insane. So we upped my Lantus to 12 units which seems to be working a little better except for the 261 I had out of the blue after lunch the other day and the 30 that awoke me at 2 AM with my heart beating out of my chest. 


I’m not liking this new routine much. Can you tell? The unpredictability is driving me nuts, did I say that already? If so, it’s worth repeating. But, I have to commend my endo for checking in with me weekly to discuss my numbers and for listening to my frustration. That can’t be fun. I’m giving endo another half point.


And I’m going to give this new regimen, which now includes dosing my Apidra for dinner higher since those evening hours may be when my Lantus is wearing off now, another week to see if things settle down, which I tell myself daily, hourly they will. And while I wanted to jump ship this morning and go back to my old ways, endo said let’s give it another few days and I know endo is right. I know I am biting at the chomp to cut the process short because I’m so impatient to be back in control. However, this morning endo revealed another reason to try and get my sugars to be more consistent: lows can lead to insulin resistance. Oy!  


One thing I can say from all this stomping around in my sugars is I see a clearer case, personally, for using a pump. To have as I’ve always described it, “more elegant control” – greater flexibility in the moment and to be able to preprogram for more and less insulin as the body needs it at various times of day. Personally, I was waiting for the pump to get small enough that it wouldn’t feel like an intrusion on my body, and it seems to have done just that with the soon-appearing-near-you Solo MicroPump


So while I’m still futzing around with my calculations I can offer you some advice from two diabetes educators I checked in with about what the ratio should be between your Lantus and rapid acting mealtime insulin if you use both. 


How much to dose: “Historically/Mathematically the total daily dose of insulin (both Lantus and Apidra or Novolog or Humalog) would be divided in half, Lantus being half and the prandial (mealtime) insulin being the other half which is then divided further by 3 to give the dose before each meal. This usually coincides with eating a minimum of 30 – 45 carbs/meal. Not everyone’s body, however, matches what can be figured out mathematically. But it’s a place to start and then you tweak it just like you are doing.”


My other educator added that since I eat a low carb diet, maybe 15 grams of carb/meal at most, except for breakfast, that I shouldn’t expect my Lantus/ Apidra ratio to be 1:1 but more like 2:1.


General rule for where your sugars should be: 80-100 before meals, 125-140 post meals and 120-140 before bed. 


My advice: Find the best match between your medicine and your blood sugars even if it takes some doing. Make it a priority – both for your diabetes health and your peace of mind.  



A crowded corner in diabetes-land, Lonelyville

Bryant park - 1

I live very near a coffee shop called, “Lonelyville.” I pass it on my morning walk. I always think what an odd name it is for a coffee shop. After all, the people sitting there chatting in groups of two and three and the ones on their own bent over their laptops are all there precisely to leave their lonely selves out the door, and feel unalone. 

When diabetes patients are surveyed about the challenges of living with diabetes, loneliness is always at or near the top of the list. Living with chronic illness is a lonely affair, whereas short term illness not so much. For instance, break your arm and it will mend in a few weeks or months: You know the experience will end. That allows you to get lost in, and commune about, your poor arm: “Hey there, buddy, what happened to you?” people ask and you get to tell your tale of woe or anecdote. You can show off your cast, people sign it with endearments, and you complain about how itchy your arm is and people commiserate, “Oh, poor baby.” And even if you feel lonely for a while, it will end and your arm will mend.

Diabetes doesn’t end. And for most of us there’s no outward appearance of it, nor how hard you work at managing it. I was out to dinner this week two nights in a row. The first night my husband and I were meeting an acquaintance of his and his new girlfriend. When the conversation turned to my work, she said brightly, “My brother in law has diabetes!” Deducing he had type 1 and had gotten it recently, I asked, “How’s he doing?” She said, “He’s doing really great.” Her enthusiasm let me know that she really had no idea what he’s living with. My husband must have felt similarly for he began to tell them what my typical day looks like: Pricking my finger up to ten times a day, calculating carbs at each meal, constant injections, all the daily planning and organization and on and on, and on. Their eyes widened just getting this small insight. And, I thought listening to my guy, Wow, look at how much I do in addition to my “normal” life! Yet I can’t allow myself to think of it as more than “normal life” or it would be too overwhelming, or make me feel sorry for myself, and that would impede my every effort. 

The next night we dined with a friend and met her beau. When she and I both took out our Apidra to shoot up for dinner, hers was in a pen and mine in a vial. The beau looked mystified and asked about the difference. A little more conversation told me he didn’t know much at all about managing diabetes. Whether my friend chooses not to share much with him or he’s not that interested, I don’t know, but I wondered, isn’t that a lonely place for her?  

At some level diabetes just is a lonely place some of the time. I’m sure this is true of any long-term illness or grief experience. But I’m not drawing any comparisons here, only remarking on an essential reality of living with diabetes. And, even though I work in diabetes, know a multitude of patients and diabetes educators, have an unimaginably supportive husband, diabetesjust is often a lonely affair. My loneliness lessens in those moments when I talk with my friends who have diabetes because diabetes is always part of our conversation, even when it’s just sitting there beside us unspoken.

So really, all those blog posts that went out from the diabetes bloggers at the Roche social summit after we returned (a few posts ago), all those shouts while we were on site of, “Gosh, it’s so great to finally meet you!” or “We ought to do this on a regular basis!” or “I couldn’t wait to get here!” All the uncontained joy and bonding and merely sharing the same air and recognizing this complex dance we do every day with all its machinations and emotions, well, it was all about for a few moments not feeling so alone.

Oops, no insulin on board

For the first time since I don’t remember when I left my apartment and went around the corner to my local pub restaurant, and forgot to bring my insulin. 


Wow, it didn’t even dawn on me until still seated at the bar after a glass of wine and an appetizer, the entree came and my husband said, “Aren’t you going to shoot up?” Oh, my gosh, I thought, not in a bad way, no, sort of a tickled how could I be so mindless way, “I forgot to bring it.” I answered the look of concern on his face with, “That’s OK, the wine will drop me and I’ll shoot up as soon as we get home.” Home only being two blocks away.


Then I sat back and enjoyed the absolute freedom that “normal” people experience every day, actually several times a day. No calculating carbs, no pulling out the syringe and vial, no turning away to give myself an injection, no wondering if I just took the right amount of insulin. No afterthought that I’d have to check my blood sugar two hours later to see. No making a mental note when two hours later would be. No, I just sat back and enjoyed the utter, overwhelming freedom, and the incredible wiener schnitzel in front of us in this super Austrian pub. 


I don’t know what caused me to forget my insulin, although I can guess. I was doing a million things before I left the apartment, my mind was equally in a million places, forward and backward, and I had just had an upsetting phone call with a friend. In part, that’s what prompted the last minute desire to go out for dinner; I needed to get out of this tiny apartment and change the view and my head. 


But whatever the reason, it’s amazing that forgetting my insulin doesn’t happen more often, like once a day or once a week, really, and so I have to give myself credit for the 99 times out of 100 that I remember to bring my insulin with me. 


So even my mistake gives me justifiable cause to pat myself on the back for all the times I succeed. OK, here’s the part where you laugh with me. 

In the air and on the road with diabetes

Relaxation, except for managing my diabetes


A cycling beast who knows better now


Every night a swan party


I just returned from two weeks holiday in London and Holland visiting friends and family. It was truly a fabulous trip, rich in every way, unfortunately also including the almost constant and frustrating lack of control I had over my blood sugar. 

I have decided perhaps there are five basics to managing diabetes: food, activity, medicine, stress-management and routine.

Here at home what I eat, including my carb load, and when I eat doesn’t vary very much, including an hour walk I usually take in the morning. Checking my blood sugar at home, usually four or five times a day, I pretty much get the blood glucose numbers I expect.

But, whoosh, get on an airplane and everything goes out the window. Just how do you manage your blood sugar when confronted with the following: 

– Airplane food, and I use the term “food” loosely. Coming home they called something oozing from its little box, “quiche” 

– Losing five hours in your day

– Jet lag that mucks up your mind

– Breakfasting on a cheese sandwich on country slabs of thick dense bread (delicious but awful for my blood sugar). There’s no way to know how many carbs it contains and I won’t be caught dead paying 30 euro ($47.40) for a hotel breakfast. I’ve also discovered the muesli I love that comes in bags with no carb count, or at the breakfast buffet where breakfast is included in the cost of your room, requires three times the insulin my at home oatmeal breakfast requires.  

– A two hour bicycle ride through eye-popping rural Holland that exhausted my blood glucose bank for two whole days causing constant lows

Well, you get the idea. Getting blood sugar numbers I did expect, checking pre and post every meal, was the exception, no longer the rule. I was under- or over-guessing my insulin with so few clues to go on. How do you shoot up for bread fresh baked next door at the bakery rather than bread at home that comes as a plastic-wrapped loaf from our over-refining processing factories? 

I have no great wisdom to share how to do this better for I don’t know. An abundance of restaurant meals and lack of routine will always be my Achilles heel and my only recourse currently is to test frequently and correct. Further, as much as long- acting and short-acting insulins have released most of us from having to eat at a certain hour, guessing the match between insulin andnot your usual foods, for me is a Herculean mental task. 

Then, admittedly, when cows, sheep, ducks, pastures and canals beckon me to turn to my sister in law after 75 minutes of cycling and say, “Let’s go just another 45 minutes,” I now know better. That will require less insulin for the next 24-48 hours. Boom, those were mighty drops! Six years ago I stopped cycling when I removed my bicycle from my closet as my husband’s clothes moved in (there’s nowhere to put a bicycle in a tiny city apartment). And I realized riding around New York City was just as likely to get me killed as well toned.

So, I’m home now and while a piece of my heart is still in Europe, the piece of my head that’s going to make my morning oatmeal, spinach salad for lunch and fish and veggies for dinner is feeling so relaxed by merely not being on vacation. 



Everybody’s got a story: here’s mine


thoughtful riva

I always wonder how people get to where they are in their lives. Best I can figure my curiosity began when I was nine. At the diner my family went to for the occasional dinner out, I would scan the room and notice others laughing, animated in conversation, or a couple with not even a word passing between them.  Who are these people, I wondered? What do they really think and feel? 


It’s not surprising that as I grew up I wanted to write the human interest features column for a newspaper, or that over the past few years I’ve interviewed more than 135 people with diabetes: I am fascinated by people’s “stories.” So here I share mine over the last several years since moving into this work. I hope it may offer you some clarity, or inspiration.


Warning: It’s lengthy. Perhaps think of it as a chapter in a book if it helps, definitely not a tweet. We know I’m not much good at that. 


Modified from a contest entry for “Second Acts,” that More magazine was running about changing one’s life after forty. 


My Second Act


I was 48 years old, planning my wedding, (my first thank you) and going into the hospital for diabetic frozen shoulder surgery. As if that wasn’t enough excitement, I fretted whether I’d still have my health insurance coverage for the surgery. This was seven years ago and the I worked for was bankrupt; every month scores of people were being laid off. I was to be one of them—luckily it would happen two weeks after my surgery. 


On the cusp of fifty, I had lost my job, was going to physical therapy three times a week and the rehabilitation chair that moved into my small apartment, which I had to use to raise and lower my arm an hour a day, gave me a time-out: What did I really want to do with my life? I was in what my friend Pat refers to as “The Void.” I didn’t know what I wanted to do for a living anymore. In my heart I didn’t want to continue in marketing communications, I’d always wanted to be in a helping profession. Yet, I didn’t want to go back to school for four or six years to earn a degree for the profession I’d toyed with – psychologist. While I wanted to help people, I wasn’t convinced that listening to their problems was an effective means for helping them change their lives.


At this same time something else happened that set me along the path that would become my new work– this work. I went to a diabetes educator. I have had type 1 diabetes since the age of 18, thirty years at the time, yet never had I been to a diabetes educator before, someone trained specifically to help people with diabetes manage their illness. After my first visit with the educator, I contemplated becoming a diabetes educator myself. I assumed it would be a six-month course. But this was not the case. I needed to first have a Master’s degree in pharmacology, nursing or social work. Then it was a two-year program and I’d have to practice 1,000 hours before I could become certified. So, I began looking for a copywriter job again. It was what I knew. Trouble was I also knew I didn’t want to do it anymore.


A year later in the midst of doing some freelance work, going on exploratory interviews and reading the famed career book, “What Color Is Your Parachute?” for the third time, my husband said, “You’re a writer and you’d like to help others who have diabetes, why don’t you write about what it’s like to live with diabetes?” I looked at him sweetly, rolled my eyes and said, “Honey, who’s going to buy a book about what I think about living with diabetes?!?” But five years later that’s exactly what’s about to happen. This July, my book, “50 Diabetes Myths That Can Ruin Your Life: And the 50 Diabetes Truths That Can Save It”will be published. And included along with knowledge and advice from diabetes experts and fellow patients is my own.


The road to here began with a roadmap. It wasn’t the first, I’d been drawing them most of my life, but this one was more specific. After I lost my job my husband and I sat on a bench one balmy afternoon and wrote down my vision: To help educate and motivate others with diabetes to better manage their condition. That vision sat in the center of a large blank, daunting white sheet of paper. Then we drew colored lines coming out going in all directions: these were to be the steps to my dream: 1) Write a column for a diabetes magazine, which I do now. One day after reviewing the four major diabetes magazines, I called the editor of Diabetes Health, the magazine that felt like it best matched my voice. I told her I wanted to write a column and led her to my web site to see the work I was doing. Presto—she called me back and said, “Looks great, what would you like to write about?” If it hadn’t happened, I would have told you, not possible. 2) Write and illustrate a bookthat would help people with the emotional management of diabetes. I did that in 2007 and self-published it. It was in the bookstore at the annual conference of the American Association of Diabetes Educators last year. This year it will be there again along with its Spanish translation. 3) Give talks to patients, and medical staff. I do that now across the country through an organization called Patient Mentor Institute (PMI). When I first heard about PMI, I immediately called but they told me they hadn’t yet scheduled their next training. Six calls, one every month, put me in the next training session six months later. Having my roadmap in place, and my heart, mind and body in sync with what I wanted to do, created the foundation I needed to keep putting one foot in front of the other. 


At the beginning of this road, when my husband first suggested that I write a book (and I felt that cold fear like a steel blade pierce my heart!) it didn’t hurt that a week later we met with my friend who worked as a copywriter at an advertising agency. She told us how miserable she was there. The next morning my husband said, “I couldn’t sleep all night thinking about you going back to that kind of work. Why don’t you interview other people with diabetes and write a book that shares many peoples’ experiences.” So that became my first real step: To interview others was so right it reverberated in my bones. I could capture a myriad of stories that would create a shared community and lessons learned. 


For two years I interviewed people. I still interview people. It’s usually a phone call, sometimes a coffee in their house or a coffee shop. I bring a little tape recorder and they bring their story. All I have to do is ask, “How did you discover you had diabetes?” and a lifetime pours out of them. My very first interview I practiced with a good friend. My first “real” interview was with a couple who discovered that their three year old son had diabetes, and they will never forget the date, September 10, 2001. While in the hospital the following day experiencing their personal world collapsing, the World Trade Center towers were doing the same a few short miles downtown, the smoke visible from the hospital hallway windows. The gravity of this interview was a sign to me to keep going. I branched out to interview acquaintances I knew who had diabetes and asked them who they knew. My circle of fellow patients grew quickly as did a community of diabetes educators, nurses and psychologists. In capturing peoples’ stories I have amassed a research library of sorts, collected a wealth of learning and understanding, and also a network of people I now know with diabetes, and in diabetes. 


But this book of interviews was not the book I would end up getting published, for I learned a lesson about publishing two years after beginning the interviews. While you may have what you think is a great idea, a publisher may not. I couldn’t sell the interview book. But the woman who was to become my book agent (whom I was introduced to having met her friend while on a train going to my brother’s house in Connecticut for Thanksgiving—trust me, that’s a whole ‘nother story) said let’s look for an idea you can sell. I shelved the interviews for the time being and we spent three months writing a new book proposal for my diabetes myths book and after shopping it to twenty publishers we had a deal—and I began all over again. As it would turn out, numerous nuggets from my interviews are featured in the book–so while we may hit detours in life, I know nothing is a waste. It’s been seven years now since I lost my job and embarked on this journey and five of those I’ve been avidly working in diabetes. I stopped freelancing two years into this venture because I knew if I didn’t jump in fully, I might never jump in at all. 


If you’ve been on this web site before, you may be acquainted with what I’ve been doing, if not, this blog began about two years ago and all my posts are archived here. I contribute regularly to Diabetes Healthmagazine. I’ve just been featured in Diabetic Living magazine. I’ve been invited to speak at the Mayo Clinic this September both about diabetes, and about my books. “Patient-expert” is a title I wear proudly now and I have earned it by putting one foot in front of the other and following my heart. I could not have told you with assurance that I would end up here, only that when I began I felt trying was worth the effort.


One of my messages has become that you can create an exceptional life–notdespite having diabetes–but because of it. That it can be a catalyst to greater health, happiness, meaning and purpose. What’s required is knowing how to medically take care of yourself and having the emotional resilience to weather the ups and downs. I don’t mean that you become a “Pollyanna,” but once you deal with the stages of shock and grieving, (and mind you they will re-visit you from time to time) that you will reach a crossroads that invites you to answer the question, “How am I going to live from here?” You will be better served if you can recognize that “What is, is,” and choose to honor your life by managing this sometimes-beast as best you can, and embracing more spiritual qualities like appreciation, joy and giving back. This is where, after decades, I have arrived. It wasn’t a quick trip, but I hope I can now shorten the passage for others.  


I knew in my late forties, as sure as I breathe, that it was time for me to finally nosedive into my dream of making a difference and create my singular road that would lead me there. With my husband’s financial support I could take a break from earning a living. With his emotional support I was loved and encouraged to keep going. The biggest challenge looking back was social: I missed having people to go to lunch with, and, admittedly, deadlines someone else gave me. What helped, however, and still helps, is having a routine: Taking a yoga class, my daily walk around the park and meeting my interviewees face-to-face as often as possible. And now seeing the early fruits of my labor. 


I say all the time now, “The universe keeps dropping gifts at my feet.” My husband says, “Don’t discount all the hard work you’ve done.” And I don’t. Yet I’m convinced that being on the right track, leading with your heart and following with your feet opens more doors than you can possibly imagine. Don’t be discouraged if you can only pry the door ajar slightly now. Keep tugging at it. One day it will open.


Today I associate most closely with something Mahatma Gandhi said: “Happiness is when what you think, what you say, and what you do are in harmony.” From the very first bench meeting my husband and I had to when he recently told me enthusiastically, “We’re only two degrees of separation from Oprah!” it amazes me where I’ve arrived. We joke that one day I’ll be sitting on the Oprah show and she’ll be holding up my book saying, “And everyone is going home with a copy of Riva’s book today!” 


You may laugh, most days I do too, but dreams have a way of turning into reality when you hold them fast and keep putting one foot in front of the other. 

A Taste of Mississippi Livin’

Screen Shot 2015-02-08 at 12.51.58 PM

I just returned from spending a week in Mississippi. It was a great trip: relaxing, lots of laughs, I’ve learned a few new great expressions and have come away with a much better understanding of why diabetes is an epidemic in America–to a great degree it’s the ubiquitous fry up.

I was touring Mississippi with three  girlfriends. A kind of “Ya Ya Sisterhood” on insulin. When my New York friends asked before I left, “Why on earth are you going to Mississippi?,” I told them, “Because I can.” I have always wanted to see part of the South with a Southerner. One of our Ya Yas grew up in Mississippi, so that was it: four diabetic women in a car soaking up the local life, comparing blood sugars every few hours, noticing how differently we all react to food and exercise, and in-between being charmed by the South’s hospitality and shocked, by how difficult it is to find healthy food. I didn’t realize, but Mississippi has been ranked “fattest state” for three consecutive years.

Now hearing “Yes, maam,” repeatedly is admittedly some compensation for the lack of health-friendly food. Trust me, you will never hear it in New York. And my favorite new expression, “Bless your heart…” I’ve learned is extremely useful when you’re bad-mouthing someone but want to maintain a polite demeanor. And, yes, the pleasantries unrolled like an unfurling flag, and this troupe of women were lovingly and graciously hosted to lunches and toured through town after town. Tana, a fabulous cook, whipped up an incredible melange: cream of spring soup, shrimp Louie, southern mayonnaise biscuits with home-grown herbed butter and chocolate pots ‘specially for this Yankee, and actually welcomed me with my own signboard, boa and special guest, Marilyn Monroe.

While I didn’t know (or care) what we would do in Mississippi, other than soak up local life, I found our tours revolved around visiting university campuses and churches. Initially, I kept looking for downtown and charming stores to poke my head into, being the New Yorker that I am, and it took me the first several days to realize depressed downtowns were not where life was any longer. It was on college campuses and at church. 

I experienced my first Baptist service, complete with a children’s choir, baptisms in what looked like the bell tower, singing, singing, singing and your requisite fervent preacher. Walking through a Presbyterian church, we lucked into hearing an amazing organist, and left with his CD gifted to us. We toured several antebellum houses learning about the history of the families that owned them and plantation life. Admittedly, when I walked into anyone’s house afterward I expected a tour. 

I was introduced to the very funny and bawdy series of books, The Sweet Potato Queens by Jackson, Mississippi author, Jill Conner Browne. Our Tennessee gal-pal, Ann, read passages to us in her rich Southern drawl, with tears of laughter streaming down her cheeks, as we drove past tractors and catfish ponds. I ate one of the best meals ever at J. Broussard in Colombus, pecan-crusted catfish and a nutty buddy (you figure it out!). I sampled thirty different types of pecans (peecaaahhns) in a pecan (peecaaaahhn) store in Indianola, which was all of three streets long but seemed to be experiencing rush hour traffic while we were there. 

The friends and family of my native Mississipian asked me what I found surprising about Misissippi and I told them. It’s much more rural and green than I expected…people are very friendly and welcoming…many have been to New York — and love New York.. everyone goes to church, and the food, outside of a few truly fabulous restaurants, is growing our increasing population of diabetics. 

I, in fact, had a very earnest conversation about this with the President of Jones college in Laurel, Mississippi, Jesse Smith. Jesse Smith is a sort of President Obama–young and vital and making tremendous changes to the university to expand students’ potential and opportunities, and that includes healthier meals on campus. But throughout our trip my companions and I had to work really hard to eat healthy. Fried in Mississippi is a food group: fried chicken, fried steak, fried green tomatoes, fried pickles, fried okra, fried crawfish and on and on. If it was edible, it was fried. Then of course there are the staples: biscuits n’ gravy, chicken n’ dumplings, overcooked vegetables in lard and sweet tea, 1/2 cup of sugar in 1/2 a gallon of tea. 

My eyes were open widest looking at the aisles in the little superettes at each gas station where we stopped. Aisle upon aisle of chips, crackers, fried pork rinds, soda, fried meats, and, perturbingly nothing else. Except in one, which harbored a stand of books. “Bible Cure for Diabetes” intrigued me enough to buy it but also made me think: Would we really need a bible cure for diabetes if there were more fruits and salads available?

So what will I remember from my trip? Outstretched hands and open hearts and the knowledge that all the segments I hear on the morning news about healthier food choices aren’t going to happen where it’s so hard to find them. As Dr. Smith explained to me, there was a time when the livelihood of Mississippi was based on people working the land. That required a lot of calories and a lot were burned off in their labor. Today, however, few people labor in the fields, yet the foods have not changed. Further, education about food and its consequence on health doesn’t seem to have reached many people, including the young people I saw working in the gas station superettes. 

On the last day of our trip we talked about how much opportunity there is to bring education to areas like this where it’s so vitally needed: A grass roots movement to teach people about the benefits of healthy eating like Governor Mike Huckabee is doing for Arkansas. So if anyone wants some wise women to consult on this, please do let me know, and, really, bless your heart.

Even diabetes gods have occasional hoofs of clay

So there I was at the Norfolk, Virginia airport having just gone through security and Starbucks (aren’t they both required?) when I feel my  heart beating rapidly, my hands shaking and I know that it’s not the caffeine: I’m entering low blood sugar land. The airport is relatively empty so I drop my rolling case where I am, not far from my gate, fish for my key, unlock my case, then open the zipper of my packed knapsack and rustle out my meter. 

What must I have been thinking, (or not), when I packed my meter inside my knapsack and locked it inside my small suitcase that would get handed to the baggage guy just outside the plane door as I board? I had flown down from New York to Virginia to speak at a health fair to fellow patients about developing healthier habits for living with diabetes — admittedly this isn’t one of them! Was I unconsciously packing away my diabetes now that my job was done and taking the day off? Going incognito so to speak?

My meter on top of my case now proves my suspicion correct: 51 mg/dl, and while I don’t have a CGM I clearly know I’m going down. I close up my case and wheel it, and me, to my gate so if anything should happen there will be others around. I sit not far from a grandmotherly looking passenger in the waiting area and unpeel the tangerine I also packed in my locked case. Well, at least I was smart enough to bring a sugary food in case this should happen. So somewhere at base camp riva I wasn’t going to let anything too drastic happen. (Yes, I had my SweeTarts with me but wanted to use up that tangerine already, and knew I had the low blood sugar window open enough to do so.) I actually brought that tangerine down with me from Brookyn two days earlier. Now it was doing its job. Peel, munch, ask grandma where she’s going like I’m perfectly in my body, peel, munch, “Really, on a cruise you say, around Asia? How nice.”

Fifteen minutes or so later, another low handled and danger averted. As my collective brain cells kick in I revisit why I didn’t have my meter easily accessible and was willing to have it in cargo during the flight. After all I was in the perfect situation to have a low: traveling, off my routine, and while I ordered from room service that morning my usual hot oatmeal, the hotel didn’t know the secret “riva receipe:” a dollop of low fat yogurt and cottage cheese on top for stabilizing protein, bits of apple and berries for more rapid glucose, and a tablespoon of peanut butter for fat to sustain and level my blood sugar rise. 

Best I can figure, on some unconscious level there are just times I want to be an ordinary jane (I’d say ordinary cow, see photo, but it doesn’t sound very nice even in a frilly pink dress) and I yearn to put me, riva, before my diabetes. Judging from results I guess I’m willing to walk the line at times between being fully at the ready and knowing I can pull out my Super-Diabetic cape at any moment and save the day. 

I’m sure that confidence comes from knowing that cape is with me wherever I go: All my knowledge, learning and experience, and so maybe that’s why at times I pack it rather than wear it. For all of us who recognize this scenario, yesterday was just another day in funky-town, one for rebooting and reflecting and with that, maybe I’ll see if that cape can drape over these cow shoulders if I do want to wear it next time. 

Diabetes gets tiring on the road

It had to happen. Three weeks on the road, or more apt, in the mountains of Queenstown, New Zealand and the harbor of Sydney, my lack of being able to control my blood sugar as well as I’d like is driving me mad. Translation: being out of my routine, not taking my daily hour walk due to San Francisco-like hills, and finding constant surprises at lunch like a chicken and avocado sandwich that comes on doubly thick slabs of sourdough bread with mayo or a  thimble-full of quiche that comes in a carb-laden pastry shell is wearing me down. 

Then foolish me, I underpacked my Lantus SoloStar insulin pen needles. I had several sample packs of “click-on” needles and misread the 8 mm size as 8 needles in a pack. Unfortunately I have discovered there are only 3 needles in  a pack. So now I have five more needles to get me through 20 more days on the road. Now, tis true, I don’t change the needle every single day, but every two to three days and this won’t get me through. Luckily, I have experimented and I if I stick a syringe in the rubber stopper of the SoloStar as far as it will go, I can withdraw the Lantus as if from a vial.

I just said to my husband, “I’d like to be home now for one day.” He looked at me as though I were mad, here in the midst of white sandy beaches and honeysuckle. But I’d like to watch the morning news, sit at my computer, poke my nose into my neighborhood shops, and with that put on my sneakers for my walk around the park and reach into my refrigerator and cupboard for my usual foods. I don’t really think I’m yearning for snow and frigid temperatures but the comfort that my routine gives me managing my blood sugar. While my crankiness will lift, right now as the Brits would say, diabetes is just “a little up my arse” after 17 days on the road.