“Hey Doc, my diabetes is stealing my sleep!”

It occurred to me the other morning when my husband woke me at 7:03 AM that diabetes is stealing my sleep.

Celebrate the gift you are

No, not because I worry about complications. Not because I wake in the middle of the night with a low. Not because I wake through the night to pee. No, because I have to wake up early enough to blunt the rise of my blood sugar in the early morning. That pesky “Dawn Phenomena,” where the liver throws sugar into your bloodstream to get you ready for the day, is the bane of my existence. With MDI I have no insulin on board to not rise. My 24-hour long-acting insulin doesn’t go the stretch.

Since I got a CGM, it’s on the hush-hush but “Pinkie”, my beloved Dexcom receiver, doesn’t sleep with me. I know, I know, the whole point of a CGM is to wake me in the middle of the night if my blood sugar goes too low.

But this is what I know after many data collections of what my blood sugar does overnight. It typically drops to 55 mg/dl and then starts coming up. It’s just my pattern. Trust me, I’ve asked several CDEs about this and pretty much get the response, “That’s just what your body does.”

So I don’t need Pinkie to alert me and I don’t want Pinkie disturbing my sleep. So she sleeps in the living room in the top drawer of my tansu in my checkbook box. C’mon, she’s very comfy cozy there and if she peeps, we don’t hear it.

That said, my husband the early riser, has orders to check Pinkie for my number at 7 AM and if she’s barreling up beyond 100 mg/dl, he’s been instructed to wake me so I can take my first shot of rapid acting insulin to blunt the rise.

That’s how I found myself awakened the other day from a deep, deep sleep. Now that I think about it, the dream I was immersed in was about two old friends…hmmm…let’s just say it was just as well I was awakened.

My husband told me it pained him to wake me. He walked into the room, turned on the light, stood over me for minutes with no response on my part and then began lightly stroking my arm.

And so I thought later that day I have an illness that disturbs my sleep and makes my husband sad he has to wake me when we keep hearing that sleep is a health necessity and predictor.

So here’s my happy dream – when longer-acting insulins arrive I’ll be able to make up for years of sleep deprivation.

This is Type 1 diabetes, high and low blood sugars

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This was on Facebook. This is not my Dexcom, but it could be. What struck me is how so many of us are compelled to put our numbers up and share them looking for comfort, camaraderie and someone else who “gets it.” For when it comes to getting it, I believe much of the health care community is in denial. 

We cannot “control” blood sugars in people with diabetes who use insulin. That’s everyone with type 1 and some with type 2. But that frustrates health professionals; after all their job is to cure us, short of that to fix the problem – our up and down blood sugars. 

But that is the very nature of diabetes – fluctuating blood sugars. And even with 24/7 oversight, no matter how hard I work at it, trying to do what a normal functioning pancreas does, I fail. My brain simply cannot replace a normal functioning pancreas.

I wrote about this recently on The Huffington Post in “Type 1 Diabetes Fully Explained.” It went viral in hours. Hundreds of fellow Type 1s wrote to me saying how I had perfectly captured how impossible it is to perfectly control type 1 diabetes. 

It is time for us to agree that the norm of diabetes, intrinsically, its very nature is up and down blood sugars, especially for T1D and insulin-dependent T2s. 

It is time to accept this and stop trying to fight it and control it. I hate that word control. This doesn’t mean that we shouldn’t work at having blood sugars as often as possible in our target range, but let’s agree it’s hard and let’s agree we can’t be perfect at this and let’s sigh a collective sigh of relief. We deserve it.

Furthermore, creating goals is the wrong way to manage diabetes. Goals reinforce the idea that if we only work harder we can lick this beast. But we can’t. Goals reinforce that there is a perfect standard and we just aren’t working hard enough if we haven’t achieved it. 

Rather, what we should learn is what to do with our numbers in the moment, keep breathing, and have the knowledge and no self-blame to do it – and then smile because we did something good for ourselves.

Funny thing, but given that blood sugars fluctuate all day and all night, we are much better off to befriend our efforts, both strong and weak, and behead the doctor who tells us our numbers “should” be better.

I want people with diabetes to hear from their health professional:

“This is tough. You have a condition that requires a lot of work and vigilance. Some days you’ll do better than others. Don’t beat yourself up, instead do your best as often as you can and know that the very nature of diabetes is up and down blood sugars. You cannot do this perfectly because your body will be doing something unpredictable a good deal of the time. Just know this, accept this and keep breathing. I for one honor what you do living with this everyday.” 

Five life lessons turning 60!



I turn 60 tomorrow. How did that happen? My mother’s probably asking herself the same question up in Connecticut. I’d say just putting one foot in front of the other every day. But the occasion does give me pause to think about what I’ve learned so far.

(By the way, this picture was two years ago me shooting up before my meal. My friend P. to my right looks a little startled, but then I’m a teacher and this was a teachable moment.) 

It hasn’t all been easy. I was a shy and quiet kid. People would tease me by saying I was talking too much. Today I speak to all kinds of groups, small and large and love it. No one who knew me then would imagine me now. But my deepest desire always was to help others believe in themselves. Today I do it around diabetes which I could have never predicted.

I couldn’t ask to be in a better place on the eve of my sixtieth birthday. I am married to my true partner in life, in love and in work. My parents are still here. I have a treasure trove of dear friends, and acquaintances who bless me with their fellowship through diabetes. I love where I live, which was a lifelong riddle to solve. And I travel voraciously. To towns large and small across the States, as an A1C Champion, which I love and across the ocean. That’s what you get for marrying a European. How lucky he, and his frequent flier miles, fit right in with my wish list. And growing up a listener serves me well in the work I do today, as a health coach, writing on The Huffington Post, writing books and speaking at conferences and as a peer-mentor.

Turning fifty was a hard one. It was the first time I realized there was more time behind me than in front of me. But even though that’s even more the case now, I’m kinda tickled to be turning sixty. I think of all I’ve accomplished and where I’m so contentedly sitting in my life right now.

So tonight, looking back on six decades – true, I don’t remember the first several years, alright let’s be honest, the first decade – I realize maybe I’ve learned a few things worth passing on to my younger friends and colleagues.

5 Lessons I’ve Learned Along the Way

1. Don’t measure your success against anyone else’sIn my twenties I was jealous of how many people around me were clear about what they wanted to do, were on their path achieving so much. I felt I was floundering. Searching for what work I was meant to do, where, how. What cured me of that was when a friend I envied, got a tumor. Surprisingly, I nursed her through it. But I realized, you don’t know what’s on anyone’s road ahead, including your own, good and bad. Just be on your road.

2. Look for the silver lining. I got type 1 diabetes at 18. I’ve had it 41 and a half years. I was misdiagnosed initially as a type 2; after all only kids get type 1. The first decade I had it there were no meters to test my blood and we knew so little about food, etc. But having been there, I’m so grateful I’m here. And I see what I’ve gained from having diabetes – a commitment to my health. I’m convinced I wouldn’t eat as healthfully as I do, walk as I do or keep myself trim and fit if not for diabetes. And maybe I wouldn’t have fulfilled my need to find purposeful work. Most days I truly look at what I have, not what I don’t.

3. Be kind. If I do one thing passing this way in life I hope it’s that I’m kind. It’s selfish; I like making people feel seen, whether it’s my waiter or the girl who checks out my groceries at the supermarket. At my first job in public broadcasting a colleague taught me this lesson unknowingly. I would watch her make the guy who parked her car feel equally important to the President of the company. She talked to them both with the same regard. 

4. Savor the simple stuff. I think this is something that comes with age. When I’m cooking in the kitchen listening to Sade or Patti Austen, sipping a glass of wine, and my husband is working feet away in the living room (a tiny one bedroom city apartment) I am happy. These are the moments they tell you you will recall in the end. I believe they’re right.

5. Pat yourself on the back more. I think women especially are enormously critical of themselves. We’re not enough, we don’t measure up, if we fail, why did we even think we could do it in the first place? If we succeed, we got lucky. Fuggedaboutit! You are a gem, maybe a diamond in the rough, but a gem. Cherish daily accomplishments, and your efforts. Whoever made us think we were supposed to be perfect at everything?   

When I was 18 and diagnosed with diabetes, it was unreal. One pill a day and “don’t eat candy” kept it unreal for years. As it sunk in, I mourned the complications I would inevitably get and the 15 year shorter lifespan I was told I’d have. 

Hmmm, I haven’t got any complications, and I no longer expect my life to be any shorter than anyone else’s.  

When I was 54 years old my good friend, Deborah O’Hara, died from cancer. She was only 59, and my first good friend to die. Funny, she came from a small town in upstate New York but we met in Asia. She lived in Hong Kong and I lived in Tokyo and our work made our paths cross.  

We don’t know what’s on our path. But when my mother calls me tomorrow and says, “How can I have a 60 year old daughter?” we both know it all goes too fast. You’ll know this as you see more grey hairs. 

You may have to wait before these five lessons mean anything to you, I did. But, I just wanted to share. With that, I’m off to roast some cauliflower and broil the salmon. While listening to Josh Groban and sipping a nice bright white from Spain. 

Phoenix airport syringe disposal and shooting up


It’s kind of a double-edged sword when we get to see something just for us. Nice, and an unfortunate reminder. But I was glad to see this syringe disposal nestled in the bathroom of the Phoenix airport. I didn’t bother to think, whose syringes are they targeting? I just enjoyed the fact that maybe there’s some recognition for those of us using insulin.

I try to take my insulin discretely, meaning I don’t flaunt it in front of anyone. After all, I don’t particularly love watching others inject. But I never try to hide when I need to give myself a shot. And, I often wonder – where are all my fellow insulin users? I never seem to see anyone else “shooting up.” 

But I do it in the open as I like to think of it as a ‘teachable moment.’ So while seated on the plane, waiting for the last few passengers to take their seats, I took out my Lantus Solo star pen trying to inject before the last passenger arrived to take his seat next to me. And there I was, pen in stomach, when my husband leaned over and said, “Are you OK?” I looked up and there was my seat mate standing at our row waiting to take his seat. I finished, extracted pen from body, and in he came without a word, as if he hadn’t just watched this woman take a needle out of her body.

Later, my husband told me he had asked the gentleman if he could just wait a moment while I finished giving myself my insulin injection. The gentleman politely nodded. My husband also remarked that, the stewardess standing not far away, caught my husband’s eye and smiled. Comraderie? Knowingness? Compassion? 

I will never know, but maybe one or two more people were reminded that diabetes exists in the world, as so do those of us who live with it.


Dear Santa, won’t you please take this diabetes away?

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You may have seen this before as I’ve decided I will repost this every Christmas, because, frankly, fun is healing. And if you’re stuck with diabetes, you need as many laughs as you can get!

Dear Santa,

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

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

And, can we talk… I mean the constant figuring out how many carbs are in a ravioli or bread stick or that fried calamari that will be at the company Christmas party. Some days I just want to lie down and shoot myself. Please, please, Santa, would you take this diabetes away?


Dear Riva,

I’m very sorry you’re having a tough time during my favorite season. I only want people to be singing carols and drinking eggnog and feeling good cheer. Unfortunately, it says in my contract that I’m not allowed to interfere with life’s natural occurrences. So here’s my suggestion: although you’ve already opened your holiday gifts, go back and look under your Hanukkah bush for the gift in having diabetes.

You may have to spend a few days looking, so why don’t you schedule it for the week between Christmas and New Year’s while you have some down time? Then you can start the new year fresh.

Best wishes,
Santa and the gang

Dear Santa,

A gift in my diabetes? What are you, crazy? Meshuggah? Thanks, but no thanks!


Dear Rabbi,

I seek your wise counsel. I wrote to Santa to take away my diabetes, but he wasn’t helpful at all. Surely you who have studied the Torah and represent our people who have suffered throughout history can help me with this awful diabetes.

It’s such a strain, Rabbi. I have to test my blood sugar when I really want to be lighting the sabbath candles. I forgot all about the High Holy Days this year because I was so busy counting carbs in the Challah, bagels and honey cake.

Rabbi, please, what solace can you offer me? What words of wisdom? Surely you would tell me to just forget about this diabetes thing and go shopping, right?

Please write soon,

Dear Riva,

Santa and I just returned from the Caribbean, and he told me about your difficulty. He said he told you to look for the gift in your diabetes. I concur with Santa; there are many gifts to be found in diabetes, if you look. For one, my child, you won’t have to drink the traditional Manishewitz holiday wine anymore. The Counsel all agree that it is much too sweet. Bring out the Chardonnay!

When Santa asks you to look for a gift in your diabetes, he is not saying this because you are not Catholic and he is not bringing you anything, although this is true. He is speaking like our brothers the Buddhists, who profess that there is a gift in everything if you look for something positive that it can bring into your life.

Let me tell you a story, my child. My own Aunt Sheila had diabetes, and after she stopped kvetching, she went to a spa and learned how to eat healthfully. She shopped along Rodeo Drive and bought a cute little jogging outfit and started running. On her jog along the ocean she met her fourth husband, Marvin, and they’re very happy. They just moved into a $6 million mansion in Jupiter, Fla. — right next to Burt Reynolds! Everyone’s plotzing! The house was in foreclosure so they have even more money to decorate!

Darling girl, find a gift in your diabetes, because to be honest, since you’re not orthodox, and all I have are these great wigs I got on sale from my cousin Schlomo, I’m not bringing you anything, either. And really, it’s not very pleasant to whine.

Shabbat Shalom
Rabbi, Local Union 107

Dear Rabbi,

I thought about what you and Santa said and have decided to become a Buddhist. I picked up the Dalai Lama’s book, “The Art of Happiness.” He says, “Happiness is a butterfly, which when pursued, is always just beyond your grasp, but which, if you will sit down quietly, may alight upon you.” I told my friend Joe I like butterflies, and I like the robe, so these aren’t bad gifts.

Joe said the quote meant that we are the source of our happiness, that happiness can only come from inside us, regardless of what happens in our lives. Hmm, I said, maybe I need to learn more. So I booked a flight to Tibet.

Now if only I didn’t have to drag all this damn diabetes stuff with me…. ohm… ohm… oy.

Mystery solved: Calorie reduction or exercise for weight loss?


Now that I’ve been off my game, well feet, for the past 3 ½ weeks – graduated from crutches to a soft bootcast and crutches (due to a badly sprained ankle) – I can answer the essential question first hand: which is better for weight loss, reducing your calories or exercise?

Answer: Reducing your calories. And now I know first hand. For the past month my one hour daily walks are gone. Since I hurt myself I’ve been barely walking further than from the living room to the kitchen (and that’s a mere 10 feet), yet I haven’t gained any weight. In fact, I’ve lost a few pounds!

What’s true is I’ve been carefully watching what I eat. Remarkably, not letting boredom, restlessness or frustration plunge me into all day snacking, binging or eating with reckless abandon. Well, except for last Friday.

But after my first week of high blood sugars due both to the stress of my injury and the lack of exercise, I made a conscious decision to keep my food intake healthy and not more than usual, and reduced my carbs  a little more than usual (and I already eat a low carb diet.)

If you’ve read the recent literature it’s all confirmed: When it comes to losing weight, cutting calories is most important. Exercise helps keep the weight off. And, many recommend strength training twice a week to get the most bang for your exercise buck in addition to aerobics like walking, running, swimming and biking. Strength training has you burning calories most of the day.

Of course I had told myself I was going to start doing something to get some upper body strength this fall when I’d finished writing my due-out-in-October-book – Diabetes Do’s & How-To’s.

But, really, I never dreamed it would be dragging my poor body around on a pair of forearm crutches

Are you sowing the seeds for later regrets now?

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I’ve just become aware of a book I’m eager to read but haven’t yet got my hands on. Even so, I thought it worth telling you about it. It’s called, The Top Five Regrets of the Dying by Bronnie WareBronnie became a palliative nurse after doing many other things in her life and spent a lot of time with people who were in their last days. 

I’m not attracted to books like this because I have a ghoulish side, but because I think life is short – easy to do since I’m approaching 60 – and living with diabetes, one wonders will life be even shorter?

I like to know what people value at the end of their lives and what they think they would have done differently given the opportunity to do it all again. Of course, we can never really know if we’d do something differently in the moment without the benefit of hindsight, but still…

So while I haven’t yet read the book, I thought you might enjoy reading the article as I just did. It tells what the top five things are that people regret. 

I won’t spoil the surprise. I’ll just let you know that while I’ve been finishing writing my third book, Diabetes Do’s and How To’s which you will love — it’s just the actions what you need to do to be healthy with diabetes, and how to do them, available this fall–I will tell you I wish I’d made more time for regret number 4. 

Now you see me, now you don’t, diabetes


There’s a strange phenomena that comes with living with diabetes. Perhaps the same as living with any illness or condition that slowly, gradually, over time, progresses. So slowly we don’t see it progressing; I certainly don’t feel it progressing.

It progresses whether we take care of it or not. In the background, slowly during the ordinary days when I get up, work at my computer, meet friends for lunch, walk through the city, laugh through dinner out with my husband.   

If I look back I know exactly when my ophthalmologist told me she saw the first sign of an eye problem – a slow growing cataract when I was 52. The first sign, after 34 years of being so relieved I had no eye problems, now I did.

I remember exactly when I got my first, of the two I’ve had, frozen shoulder. It was the day I got off the plane after living in Tokyo for six years. Day after day my shoulder became more limited in its movement and more painful. 

For a year I went from my endo to my family doctor to an occupational therapist, even a chiropractor while I was visiting friends in San Francisco. But it wasn’t until my mother told me to go to her chiropractor when I came home that my shoulder was properly diagnosed and treated. My second frozen shoulder 15 years later needed an operation. When I asked if this could recur, my ace surgeon said, “Maybe, in about fifteen years.”

I consider myself lucky that after 40 years of living with type 1 diabetes I have relatively little to show for it. Yet, when I sat in the doctor’s office four years ago and was lucky enough to hear I had a significant hearing loss I could only cry and think diabetes. 

When I notice my calves cramping more than usual, as I have the past few weeks, I can only think neuropathy. And while I notice for the first time an odd pulsing in my forearm, like a string being pulled on my nerves, and it subsides, but never really goes away, I think, diabetes? 

Now you see me, now you don’t, diabetes. You are there and not there. I can forget you, but never as long as for a day. While I believe I’m better off to work hard at keeping my diabetes in control and complications at bay, I also know, I cannot control anything, least of all whether complications will creep in in the mist of day, while I’m trying so hard, or during the dark of night, while I’m hoping only to wake up in the morning.  

A 40-year journey with type 1 diabetes

riva at 20

That’s me, of course. Probably in my early twenties, just a few years after getting diabetes at the age of 18. This month is my 40th year with diabetes. I can’t say if I ever thought I’d reach this point: I don’t think I ever really considered it. I did think, however, how in the world will I read the little lines on my syringe when I’m old? Luckily at 58, I still have my eyesight. And better yet, I don’t think I’m old, yet!

I wrote about my journey to here on the Huffington Post. Maybe another reflection when I hit 50 years!

A thriving diabetes community in Portland that welcomed me

Screen Shot 2015-02-07 at 3.51.09 PMIt’s not often in life we meet people whom we feel so in tune with, but when it happens I really, really treasure it. Not surprisingly, many of my diabetes colleagues, friends and acquaintances I meet initially through email. The best is when we actually get to then meet face-to-face – and this week that happened. Two of my email friendships got consummatedshall we say ;-). 

I’d like to introduce you to Heather Clute and Jeff Horacek, tell you what makes them amazing, and share a bit of my week. 

Heather is a wellness counselor and coach and has had type 1 diabetes for 14 years since the age of 27. Jeff is an internist and some roads in his personal life led him to run Portland’s diabetes support group. Jeff is the kind of doctor who credits his patients for his deep understanding of what it’s like to live with diabetes. I know because he’s said it more than once including at his diabetes support group this week.

Both Heather and Jeff also co-host the online radio podcast“Transforming Diabetes” where their interviews with diabetes experts help us transform diabetes from foe to friend. The link above takes you to the program we recorded while I was in studio. We call it ‘getting real with riva’ but it’s really three people sharing what it’s like to live with diabetes and what we’ve all learned along the way. 

I went to Portland to give an A1c Champion presentation to Jeff’s support group and I arrived a few days early to get to know my hosts. And I do mean hosts. Heather hosted me in her home for two days. And besides enjoying her hospitality, and the drive to the second largest waterfall in America, and the walk in the Japanese Garden – which transported me to my days living in Japan – what I also got to see and appreciate is what it’s like to manage type 1 diabetes when you’re also managing three littles ones, two aged 6, one age 8. Cute as buttons they are, yet your time is their time. I saw how many more challenges there are in that setting than my own where I have no one vying for my attention, where diabetes is my only child so to speak. And that’s just the kind of stuff we talked about on our in-studio Transforming Diabetes program.

The evening before my A1c Champion presentation to Jeff’s support group, Heather and Jeff invited two other professionals from the Portland diabetes community to join us for dinner – endocrinologist Elizabeth Stephens and RN, CDE Susanna Reiner. We had a great evening sharing tapas and conversation. I learned from Susanna, who’s heavily pursuing gluten free cooking, about substituting almond meal for flour, which I plan to do in my next batch of chocolate/ginger biscotti which my husband loves. 

The night I delivered my presentation I did something I’ve never done before. Before I began, I led the group through a mindfulness exercise to ground everyone about why they’d come and have them remind themselves what they hoped to get out of the evening, and to be present. I thought to do it because every time I look at Heather or Jeff I think mindfulness – they are working on a program they hope to offer next year that will revolve around mindfulness and diabetes management. 

Maybe this is just my way of saying “thank you” to my hosts. To take a few moments to appreciate how special my time in Portland was and how special it is when people walk into our lives who make us feel validated, important and seen. When you wrap that around diabetes, that’s quite a gift.

In a way there is nothing amazing about Heather and Jeff, they are just two people living their lives and doing what they love. And in the doing they are brightening a little corner of their own, and our, lives. They are, as are so many, the unsung heroes in diabetes, and all our unsung heroes are pretty amazing in my book.