wellness

Taking a CGM vacation

/ rivagreenberg / 1 Comment

I’ve often been asked why I don’t wear a pump. I do MDI (multiple daily injections), always have. I’m usually asked the pump question by a pump user, who of course extols the benefits of using a pump. And I am sure there are many and it is a wonderful device for many.

Sometimes my pump wearer then tells me they also take pump vacations. It is what it sounds like it is. They take a break from wearing their pump and do injections instead for a while. Wearing a pump, as most (all) devices, has its drawbacks as well as its virtues. In the case of a pump, although if you wear one you’ll know better than me, drawbacks include changing sites, occluded tubing or any other pump failure, carrying tons of supplies, where to wear it for the beach.

Yet, in all the years I’ve heard people talk about taking a pump vacation, I’d never heard, or thought about myself, taking a CGM vacation. Yes, I wear a CGM. Currently Libre 3 Plus. I’d never thought of taking a break until I had reason to do so a week ago.

How’s it going? Remarkably, actually. I’m back to checking my glucose on a meter about 7 days a day. Do I like the finger sticks? Nope, no more than before. But, I’m surprised (amazed) that when I do a check, my numbers are great (I avoid saying ‘good’ as numbers aren’t “good” or “bad”). They are nearly always in range and numbers I like: 83, 101, 98. Huh? How could it be?

I have to guess it’s because of two values I hold. The first is routine. I eat and exercise pretty similarly day to day so I’ve learned my patterns, how my blood sugar reacts. It’s pretty similar day to day. That was the second value by the way, learning my patterns. Which of course came from years of wearing a CGM.

I don’t know how long I’m going to wait before I start up my next sensor. I’m enjoying this vacation. If you’ve never done it, you might like to try. My mind no longer obsesses about my numbers (although it surely did the first day I was CGM-free). That means there’s more space up there and a certain carefreeness. I feel a little more ‘normal,’ and a little less like a person with diabetes. Trust me, I didn’t expect this. But, hey, interesting. (Caveat: I’m no doctor, you need to be comfortable with this decision).

I gave up my CGM last week because I’m experimenting with photobiomodulation (red light therapy). I was going to do a red light therapy treatment on a bed of lights called the Novothor and I didn’t want to risk that the sensor would be affected or shut off. Simple as that.

I’ll write more about photobiomodulation soon. It’s a healing modality that uses certain wavelengths of light with really no side effects. In the short run, it can help heal injuries, lower inflammation, aid blood flow and charge up mitochondria for more energy. In the long run, it may even help people with diabetes avoid what’s come to be called Type 3, brain conditions like dementia and Alzheimers. People with diabetes are at higher risk of such conditions due to the damaging effect of high and low blood sugars on the brain. More to come.

So just a suggestion – next time you feel overwhelmed by your diabetes you might want to take a CGM vacation. See how you feel and what happens.

That said, I know I’ll be putting my sensor on again fairly soon. It’s still an amazing tool and likely, in the long run, I trust it will keep me healthier than without it.

New Barbie doll has type 1 diabetes, and pretty-in-pink medical devices

/ rivagreenberg / Leave a comment
There's A New Barbie Doll In Toyland ...

I’m not quite sure how I feel about this…probably shocked while giggling. Mattel has just launched its latest Barbie doll and she has type 1 diabetes — and very pink medical devices! Her showing up on planet Earth was the result of a collaboration between the toy company and Breakthrough T1D (formerly JDRF), much spearheading by Breakthrough CEO Aaron Kowalski.

Senior VP and head of dolls, Krista Berger says, “”Introducing a Barbie doll with type 1 diabetes marks an important step in our commitment to inclusivity and representation. Barbie helps shape children’s early perceptions of the world, and by reflecting medical conditions like [Type 1 diabetes], we ensure more kids can see themselves in the stories they imagine and the dolls they love.”

Sure, although she doesn’t have any bruising from cannula insertions and how’s she going to manage a day of up and down blood sugars with that constant smile. If it gives little girls comfort that’s fantastic, albeit the Barbie prototype — all legs and no waist — has always been concerning. However, diabetes-wise, the fact that a doll can’t be emotive makes me wonder if perennial optimism feels dismissive of the real frustration, disappointment, and anger when it comes.

Two other dolls of T1D advocates are also being launched. They represent Peloton fitness instructor Robin Arzon and model Lila Moss. Arzon says, “It’s an absolute honor to receive a Barbie doll as a part of the brand’s efforts to grow awareness and representation surrounding type 1 diabetes, so that we can help show kids that all types of challenges give us all the more reason to push forward and achieve our dreams.” Yes there’s a place for pushing forward and achieving your dreams, but Barbie depicts only that, frozen in happy, happy.

Maybe Moss has hit on what I’m really feeling, “To be able to now see Barbie dolls with [Type 1 diabetes], and to receive a Barbie doll that visibly looks like me even wearing her patches, is both surreal and special.” Amen.

The Barbie doll with Type 1 diabetes is available on Mattel Shop and stores across the country.

Blood sugar has a mind of its own

/ rivagreenberg / Leave a comment

One of the things that has the most value for me managing my blood sugar is routine. Like the Virgo I am, I tend to eat the same type of foods, amount, carbs, often the same foods every day — and no I don’t feel deprived. I also tend to exercise similarly day to day. What you see above was me stepping off my routine track and while gleefully wanting to shout, “look ma, no hands!” I took a giant splat, or spike and spill, spike and spill…

The 150 mg/dl around 7 am was just the damn Dawn Effect, and it started before I even awoke. That sometimes happens, other times it waits for me to at least put a foot on the floor from my bed.

But the afternoon spike and spill was walking to a cafe I wanted to try that gets rave reviews for amazing griddle oatmeal pancakes. Now, I next to never eat pancakes. Yes, my low carb lifestyle is my second most effective agent to manage my blood sugar. But today was a gorgeous near 80F, sunny day, perfect for a long walk and an adventure. So I set off for these boasted pancakes, and to indulge in a treat.

When I arrived at the cafe my sensor reported 59 mg/dl, so I watched it and didn’t bolus until I’d finished my meal. I sat on a bench and noticed it was now at 164 mg/dl. Again, I had a 40 minute walk home, so I took one unit leaning toward small errors, small misfortunes. However, the trickery of how many carbs were in those pancakes? Who knows. What would be the effect of the 40 minute walk home? Who knows. How many units of insulin did I really need having waited to inject until after I ate? Who knows?

You know, and I know you know, there’s no rest for the weary.

So I’m happily ready to get back on my routine horse, until a beautiful day, and an impetuous mood, calls me out, very likely to once again get my free ride on this roller coaster.

What a day.

World Adherence Day says you are a machine

/ rivagreenberg / Leave a comment

I’m late to this apparently new day we have now every year, March 27th, called World Adherence Day. And I’m fuming. Started by the World Heart Foundation and supported by the International Diabetes Federation, I find it malicious that healthcare executives from these organizations support adherence – push over pull, hierarchy over collaboration, and medical language over lay language. This poster’s headline announces not just an oxymoron, but these two organizations’ ignorance.

How can ‘adherence’ be a partnership? When I looked up the definition of adherence this is what I got – “In healthcare, “adherence” refers to a patient’s willingness and ability to follow a prescribed treatment plan, including taking medications, attending appointments, and making lifestyle changes as recommended by their healthcare provider.” How can ‘following’ and ‘as recommended by’ be a partnership?

Adherence, for a “patient”, means following a treatment plan created by a clinician. It is absent of partnership, collaboration, choice, context, the complexity of what life throws at us, the complexity of our condition, and our own human foibles managing everyday life and our condition.

Similarly the IDF’s campaign states, “The campaign aims to highlight the importance of following prescribed healthcare plans to manage chronic conditions like diabetes and cardiovascular diseases.” Yes, the bold and underlining is my doing.

Not only is ignorance highlighted in this campaign, but arrogance. Long has the diabetes #languagematters movement shared the words, concepts and behavior offensive and detrimental to people with diabetes’ management. “The Use of Language in Diabetes Care and Education” published in Diabetes Care in December 2017 is explanatory and comprehensive. Have we learned nothing? Yes, we have learned nothing. Below an excerpt from the article:

When will we learn that machine, left-brain hemispheric thinking that values – push, grab, overpower, precision, perfection, narrow focus, heart-less – does not inspire people, emotive beings, to do their best? When will we understand that with all our medicine, treatment plans and glorious devices at our fingertips – hardware and software – it is “heartware,” – connection, compassion, support and safety – always that inspires people to do their best?

Today’s state of industrialized healthcare cannot help but follow its own heavily laden, structured and systemic paradigms and procedures. Such structures are part of the reason the world is in the state it is in today: a narrow focus on getting, grabbing, dehumanizing, power, dominance over.

But things will not change until people reclaim what it means to be human. In healthcare, until health professionals work with their patients with respect, dignity, collaboration and understanding that words like ‘adherence’ imply mechanistic cause and effect, and that anything less than desired is the patient’s fault. And the world will change only when we all treat each other similarly and understand the same.


World Diabetes Day, again, hmmm and again, and again, and again, and again, and again

/ rivagreenberg / 5 Comments

I’ve had type 1 diabetes for 52 years. You may know that. Diagnosed at 18. I was told, like almost anyone diagnosed with type 1 diabetes in any year, “We’ll have a cure in five to ten years.” Well, of course we don’t. Nor do I actually expect one in my lifetime.

That’s not to say I’m not grateful for all the advances we have: better insulins, faster insulins, peak less insulins, smart insulin pens, continuous glucose monitors, insulin pumps now cozy with continuous glucose monitors, looping etc. Most of these advances have come in the past decade. Somehow speed begets speed. Advance begets advance.

Yet, still each year we stand up tall and honor a single day in the year when we attempt to bring awareness to this condition that many of us have lived with a very long time. I’m sure that’s better than not doing so, but it feels like it feeds a complacency. It quiets the masses.

I’d rather we were doing more, if that’s possible, I don’t know. What I do know is, in part, these campaigns promoting diabetes day with blue balloons and roses and the sharing of stories are lovely for the newcomers to our ranks, but this old rank and file member feels these efforts carry a whiff of distraction because we’re still so far from that original promise.

In all honesty, I had no idea when I began writing this post that I’d end up here. I expected to share with you the campaign that Breakthrough T1D (formerly JDRF) is running this laudable day and extend the opportunity to participate. So here it is – ‘What do you want T1D breakthroughs for?’ And, yes, that’s nice.

Yet, wouldn’t it be nicer to no longer have a World Diabetes Day because there’s no reason to recognize an illness that no longer exists.

Three weeks away from a (virtual) conference you should be at

/ rivagreenberg / Leave a comment
ss jacket.png

I’ve spent the past twenty one years speaking to people with diabetes and health professionals around the world, typically about the emotions that come with living with diabetes – and how to flourish.

November 8th and 9th I’m the closing speaker at the Diabetes + Mental Health Virtual Conference. If your mental health is worth $50 you should be there. Health professionals will earn 7 CEUs for attending. As a caregiver, you’ll gain new insights, and tools, how to support your loved one.

This is the third year world experts are gathering online to help us deal with: eating stresses, general and specific fears, perfectionism, stigma, diagnosis trauma, the burden of tech, anxiety, depression, shame, having tough conversations. This is a mecca in the all-but-desert of our diabetes emotional world.

The on-stage experts are too numerous to name, so take a look and also see the agenda. As the closing speaker for the conference, I will share with you what I’ve shared around the world, that we can, and how to, flourish with diabetes. Like ‘Redraw the Frame’ for instance. And, I’m sharing simple calming exercises to stay safe and clear-thinking when you feel overwhelmed.

I don’t recommend things often or lightly but you deserve to live your life less burdened by the ‘scaries’ of diabetes and more knowledgeable and able to manage them when they come.

The Diabetes + Mental Health Conference, November 8th & 9th, 11am-6pm EST. I hope to see you there. Click here to get tickets.

What Yahya saw as a boy that pushed him to become a diabetologist

/ rivagreenberg / 1 Comment

Above Yahya Ur Rehman, final year MBBS student at Liaquat University of Medical and Health Sciences in Pakistan

Yahya wrote to me to share his story and I want to share it with you, below. It’s unique in that this young man, at only twelve years old, not only saw his future, but saw how lacking diabetes treatment is in education and connection.

“In 2013, at age of 12, my life took an unexpected turn. I was diagnosed with type 1 diabetes. The news was overwhelming, but my frequent visits to the diabetologist soon became a part of my routine. It was during one of these visits that I witnessed something that would forever change the course of my life.

A young boy, no older than five, sat in the waiting room with his father. The father was a farmer, appearing bewildered as the doctor explained his son’s condition. The doctor prescribed insulin, but it was clear that the father had no understanding of what diabetes entailed or how to manage it. There was no mention of the importance of carrying sweet products to counteract hypoglycemia or the dangers of hyperglycemia. It struck me that counseling was just as crucial as the prescription itself.

Watching this interaction, I realized the significant gap in healthcare education for people from underprivileged backgrounds. At that moment, I decided that I wanted to make a difference. I resolved to pursue a career in the medical field, driven by a desire to bridge this gap and provide comprehensive care and education to patients.

Determined and focused, I poured my heart into my studies. Six years of relentless hard work paid off when I was accepted into the MBBS program at

Liaquat University of Medical and Health Sciences on merit in 2019. It was a proud moment, but I knew the journey ahead would not be easy.

One day, during my clinical rotations, I encountered a patient who reminded me of the young boy I had seen years ago. This patient, too, was from a rural area and had little understanding of his condition. I took the time to explain everything in detail, ensuring he understood how to manage his diabetes. The gratitude in his eyes was a profound moment of human connection that reaffirmed my purpose.

As I progressed through my medical education, I became increasingly involved in patient counseling during my clinical rotations. I found immense satisfaction in taking the time to educate patients about their conditions, management strategies, and the importance of lifestyle modifications. This hands-on experience deepened my understanding of the challenges faced by individuals with diabetes, especially those from underserved communities.

Throughout my journey, I learned invaluable lessons on the frontlines of healthcare. I discovered the importance of empathy, patience, and the power of education. I also witnessed the transformative potential of innovative treatments and breakthroughs in diabetes management. For instance, I learned about continuous glucose monitors and insulins, which have revolutionized diabetes care and improved the quality of life for many patients.

These experiences reinforced my aspiration to become a diabetologist. I wanted to dedicate my career to helping people manage their diabetes through both medical treatment and comprehensive counseling. I believed that empowering patients with knowledge about their condition was crucial for effective management and better outcomes.

Today, as a final-year MBBS student, I am more committed than ever to this goal. I actively participate in counseling sessions during my clinical rotations, focusing on educating patients about diabetes management, dietary habits, and the importance of regular exercise. I emphasize the significance of understanding the symptoms of hypo- and hyperglycemia and the steps to take in each scenario. Additionally, I encourage patients to maintain open communication with their healthcare providers and to never hesitate to ask questions or seek clarification.

My journey has not been without challenges. Balancing the demands of medical school with my commitment to patient counseling has required meticulous time management and unwavering dedication. However, the rewards have been immeasurable. Every person I help, every life I touch, reinforces my belief in the path I have chosen.

Looking back, my own diagnosis of type 1 diabetes was a life-changing encounter that set me on a path to help others navigate their own health challenges with knowledge and confidence. It has been a journey of personal growth, professional development, and profound human connections. I am grateful for the opportunity to make a difference in the lives of others and to contribute to the field of diabetes care.

As I prepare to complete my medical education and embark on my career as a diabetologist, I remain committed to my mission. I strive to provide not only medical treatment but also the necessary welfare and counseling to my patients. My goal is to ensure that no one leaves my office feeling as lost and confused as that farmer did years ago. I am dedicated to bridging the gap in healthcare education and empowering my patients to take control of their health.

In the years to come, I hope to continue learning and growing as a healthcare professional. I aim to stay abreast of the latest advancements in diabetes care and to integrate innovative treatments into my practice. Most importantly, I aspire to be a source of support, guidance, and inspiration for my patients, helping them lead healthier, more fulfilling lives.”

Diabetes Sisters brings outstanding peer & professional support to women with diabetes

/ rivagreenberg / Leave a comment

Diabetes Sisters has a new look – and a forward looking agenda. They are working to be THE support organization for women and their health, and they’re well on their way.

The photo above documents their offerings. Among them are weekly virtual meet-ups. While a few years ago the groups were run locally face to face, the pandemic brought the groups online where they have stayed. The advantage is now you can attend any group, anywhere, and as many as you like.

I’ve been doing a lot of work with the leads of Diabetes Sisters, Donna Rice, Michele Polz, Shelby Kinnaird and Kristy Farnoly since last November when I wrote an article in their December newsletter that we can’t control blood sugar. I can vouch that these women’s concern is you. To bring you everything in their power to help you thrive.

I can also vouch that flourishing with diabetes lies very much at the foundation of Diabetes Sisters’ new platform. There are regular expert talks on issues that affect women’s health. Some are given by medical experts, others by patient experts. And I kicked off the Expert Series last month with a webinar on flourishing with diabetes.

May 29th I’ll be showcasing live guest Amy Jordan and her amazing triumphal story. Amy lives with type 1 diabetes, blindness, a damaged leg due to being hit by a New York City bus. Yet, she still leads a dance company, her lifelong passion, and has never stopped taking giant-sized bites out of life, with a sense of humor. You can watch Amy’s documentary, Amy’s Victory Dance, and I strongly suggest that you do. Then join us on the 29th for the conversation.

While the organization has put on a new face, much hasn’t changed. Founded by Brandy Barnes in 2008, and then run by her successor, Anna Norton, and including the women who have run the meet-up groups over the past years, everyone has held the same desire – to help women with diabetes not feel alone, not be alone and live their best life.

There’s a lot going on and there’s a warm community waiting for you with open arms.

Tech doesn’t allow you to control blood sugar or diabetes

/ rivagreenberg / 2 Comments

I was a very happy user of the Dexcom G5 and G6 CGM. If you read anything here you likely know I’m not a fan of the G7 – too many lost signals and that atrocious overpatch. So several weeks ago I switched to Abbott’s Libre 3 and frankly it’s working pretty great so far. Yes, there’s an occasional lost signal, but far, far, far fewer, it’s just as accurate for me as Dexcom, so tiny that I forget I’m wearing it, and it uses the smallest amount of adhesive that’s also the strongest. It stays on throughout the entire 14 day wear.

However, while I think the CGM is the best thing to have happened to diabetes after the discovery of insulin, it does not, in any way, shape or form, control it. Or allow you to control it as the ad above indicates. What it does do is expand your ability to influence and navigate, aka manage, your blood sugar: nothing “controls” blood sugar or diabetes because it cannot be controlled.

Thinking we can control blood sugar and our diabetes takes the view that the human body – you – are a machine. As in you can do this and that will happen, precisely. As if I could get a blood sugar of 168 mg/dl down to 100 mg/dl exactly and in a certain time period. As if I could prevent toppling over 140 mg/dl by eating low carb and exercising, which I do, yet I’ve seen my fair share of highs and will continue to.

As a human, with multiple metabolic functions interacting and influencing blood sugar, and as I, and you, daily interact with our often unpredictable world, control is just not possible. So why do we keep telling people to take control as Dexcom assures us you can do with their CGM? I’ve recently written about this in further detail and will post the article here when published.

Meanwhile I’m glad to know “control” has been singled out for phasing out in the #languagematters movement. It’s time we get earnest about it and not continue to set people up for failure giving them the impossible goal of control.