Friday, April 27, 2012

So you had a bad day.

Lately, I’ve been reflecting on sources of strength – where do you turn or what do you turn to in difficult times? Or in more simple terms, how do I make it through days where diabetes is forcing me to have a terrible, no good, very bad day? Like the days where my body plays tricks on me and I feel low but in fact, I’m just a normal gal (according to my blood sugars anyway). There are days where I don’t feel well and I just plain and simple don’t have a choice but to deal with it. There are days when technology fails at the most inconvenient times and I am one sad, stressed out robot. I have to admit it’s these days that I truly feel the burden of living with diabetes and I loathe all of my pancreases even the plastic, wireless one that I usually find so nifty. So, how do you pull yourself up by the boot straps and get through the days, weeks, months, years? Survival mode to me is like a retroactive time machine – so what does that mean?

Often coping means checking-in with my team of experts: me, myself and I. I think to myself, how can I better this bad situation and calm my anxieties? How have I dealt with this in the past? I call this (as of 30 seconds ago) the “Destiny’s Child” method because it is intended to be powerful – imagine that your brain is dressed up in camouflage dancing beside Beyonce in the “Survivor” video and tell me that doesn’t empower you to get through a crap day. Yes – I can call, text, email or visit with friends and family but I’ve learned that while that coping mechanism gives me the “warm and fuzzies”– it is uber rewarding to pull from deep down in your guts and find inner strength to cope and then enjoy the sense of pride for what you’ve accomplished. Even if you didn’t really “accomplish” anything in the traditional sense, sometimes the feeling that you survived is enough to make you smile. And when that doesn’t work, there’s always malbec and cute animal videos on youtube.

Tuesday, April 24, 2012

The Anxiety Monster

Panic and anxiety are the grown-up versions of the monsters that lived under your bed when you were a little kid. They are menacing and core-shaking just like those craaazy monsters your parents had to kick out of your room each night. And just like the aftermath of surviving a midnight monster attack – you often realize how silly your thought-process actually was during that so-called terrifying event.

Like my fear of monsters – my anxiety is fairly irrational and certainly not based on facts or historical evidence. Often my hysteria is based on spooky stories passed through generations of other people with diabetes, their families, the media and complete strangers who feel it necessary to scare the living bejesus out of me. As I’ve dealt with my anxiety and attempted to wrangle my panic attacks – I realize that this takes a heck of a lot of compromise mentally, physically, emotionally. Living with diabetes means envisioning the worst and always being prepared for what highs and lows are thrown your way. It is difficult to stray from focusing on the negative and to continue learning from the days when anxiety wins and I lose. When I look at the positive, it’s clear that what feels like giant failure is actually a testament to how strong I actually am and how much stronger I’ll become. It’s like waking up and realizing that your army of stuffed animals clearly scared the monsters away for good except in my case, it’s slaying the low-blood sugar dragon and then realizing it wasn’t the catastrophe you were sure would happen in your mental picture.

Focusing on learned lessons has become a coping mechanism for anxiety and panic, by keeping a mental list of times where you’ve survived some serious shiz and didn’t lose your marbles in the process. Even now, I find it difficult to wrap my sometimes silly, sometimes anxious head around how I even got to this point and all the things I’ve accomplished/survived/thrived through since I was diagnosed. The biggest step to regaining control is accepting that just like the monsters – anxiety is a big friggen’ deal but not such that a little perspective, some family, some friends and maybe a few stuffed animals can’t cure.

Tuesday, April 10, 2012

The Mary Poppins of Diabetes

If you are a chick with T-1 – I’ll bet a million dollars that your purse is so large that it resembles carry-on luggage. If you happen to be a family member or friend of mine – chances are I’ve asked you to hold my purse so that I could test, bolus or check my CGM and you are most likely still in physical therapy for the muscle strain that occurred. My bad for not telling you to lift with your knees instead of your back!

When I leave my apartment, I generally do a checklist in my head of all the possible diabetes situations that could occur while I am out in the wild. Do I have enough juice and glucose tabs in case I have multiple lows? What if my pod malfunctions? Did I remember to even put my g-damn pod in my purse? Do I have test strips? Where is my CGM? Is it charged? Should I bring snacks in case I morph into a hungry/cranky diabetic? The list goes on and on…and by the time I actually get out the door I have a very heavy arsenal of supplies in my purse. I see girls carrying small wristlets and clutches as their ONLY bag and laugh at how I fit at least two of those in my purse everyday just to keep my diabetes schtuff organized. I have a magical purse similar to Mary Poppins – sometimes I worry about falling in it and never being able to find my way out.

Since I am the MacGyver of diabetes – I decided for this post I would do a fun(ny) inventory of what is currently in my bag. Surprisingly, today was not too strange of a day in the world of purse contents. The contents include: my wallet (which is actually a wristlet and therefore contains entirely too many coupons/membership cards), 5 pods in two different pockets, 5 lipglosses, 1 jar of glucose tabs, 2 juice boxes, a vial of Novolog, a book of stamps, my checkbook, approx. 50 used test strips that have fallen to the bottom of my purse, a smushed granola bar, a wristlet containing my OmniPod, Test Strips and Lancet, a glucagon pen, a moleskin notebook, sparkly gel pen, a few sets of keys that I'm not sure who/where they belong to, my cell phone, my DexCom, sunglasses, post-it notes to myself, a pack of sugar-free gum, Advil, car keys and finally about 10 bobby pins/ hair ties in every pocket.

So now that you think I’m a hoarder who lives in my purse – I will leave you with this:

At least I don’t carry pictures of my cat. The End.

Friday, April 6, 2012

Social Dieting

I learned in graduate school how social networks affect your health – studies have proven that who you hang around with influences your ability to make long-lasting changes to your health and lifestyle. It has been shown that many people are overweight and stay overweight because of their environment and the people that surround them. I read a review for the new book “The Social Network Diet” by Miriam Nelson and Jennifer Ackerman – who hopes are to inspire a “ripple effect” of healthy lifestyles through their diet. The idea is very simple – remove the negative and add in a lot of positive. This includes people. And while the focus of this diet like millions of others is weight-loss and reducing obesity rates – it made me begin to think about this concept as it applies to my life with T1.

After 10 years with diabetes, I have to constantly inventory the “negative” influences over my diabetes and replace them with positive cues. For example, leaving my yoga mat in plain sight next to the couch so that is practically screams at me to get my lazy bum up and use it. Or, not buying chips at the grocery store because I am a snacking monster. But, how does this apply to people? I’ve certainly had a number of horrible health professionals that I’ve given the axe – including the biotch that told me I should carry a scale and a carbohydrate book to the dining hall at college for every meal. That would have been a foolproof plan for me to make ANY friends my freshman year. For the record, this “health professional” then went on to show me pictures of her pugs in costumes, enough said. “The Social Network Diet” influences people to be the epicenter of change in their network of friends, family, co-workers, etc. I think this is something people with diabetes deal with more than most. Every time we meet a new person, there is an internal gauge for how much that person needs or wants to know about your life with diabetes. Sometimes this is a forced and uncomfortable encounter and other times it’s wonderful to share. It can be a difficult to navigate social networks with a chronic disease – and to decide how much is too much when it comes to sharing about your health and not making people feel like they have to act differently around you. I’m sure it’s similar with weight loss – how many food items in the pantry can you throw out before your family stages an intervention and takes over the grocery shopping? How many times can you harass your friends to join your boot camp class before they stop answering your calls?

I might have to buy this book just to see what solutions they offer for the backlash that comes from being the “agent of change” in your social groups. This could be a mad social scientist experiment in the making – so beware friends, if you suddenly get a barrage of texts, emails and calls from me asking if you want to cleanse our pantries together please don’t ignore, I’m only trying to change the world one enriched flour item at a time.

Monday, April 2, 2012

The Domino Effect

Morning time is not my strong suite. I don't function before 7am unless I happen to be waking up for a shopping spree or a beach vacation. I require gallons of coffee before I am aware that I'm actually awake. A special thanks must be given to Keurig for making every work day possible. Besides my cup o' joe, there is one other morning activity that makes me spring out of bed with a smile on my face. Every morning after I turn off my succession of obnoxious alarms - the first thing I do is check my Dexcom to determine the fate of my morning. Today, I woke up to 93 with a beautiful straight arrow and a graph line showing that my BG had been around 100 for the last 6+ hours. GORGEOUS! 

Night time BG's tend to be fabulous for me and this has begun to translate into fabulous mornings. So why the heck did I title this post The Domino Effect? Well, here's my latest idea that's sure to knock your socks off. I tend to be hyper-focused on the points of my day where my BG's tend to be crappy. I recently printed my Dexcom results and noticed that from about noon until dinner - I had a lot fewer normal range BG's than after dinner through the night. So I got to thinking, what if I focus on really fine-tuning my evening and nighttime BG's? This would be much less frustrating than tackling an already annoying part of the day AND it would likely cause a domino effect of great BG's leading into my afternoon sky-rockets in flight (minus the delight).

The ironic part about this idea is that once I put it down on paper - I had a succession of 3 mornings where the "dawn phenomenon" kicked my bleepin' arse. If I wake up in normal range - my dawn phenomemnon spike doesn't usually make too big a difference. BUT on the late night/early mornings where I spike around 3am and never come down - I am frankenstein even after my cup of coffee.

P.S. The title of this post was also inspired by a Sex & the City episode. I have got to stop being such a gosh darn stereotype of a girly girl.

Monday, March 19, 2012

Public Health Rave

Before you get excited - there's no glowsticks involved in this rave. Rather, this is actually a rant disguised as a rave about how ah-mazing public health is. Recently, I've explored what it takes to become a certified diabetes educator (CDE) - my public health experience has influenced my curiosity in exploring what it takes to combine my two loves: public health and diabetes advocacy. It's proving to be much more difficult than I anticipated due to the fact that you cannot sit for the licensing exam with an MPH (master's in public health) but rather you must already possess a clinical degree, a license such as an RD or an MSW (master's in social work). Part of me totally gets why this is the case.  It makes sense that you need to have one-on-one patient/client interaction experience. However, I feel like perhaps these eligibility requirements are slightly antiquated given the recent skyrocketing numbers of people with diabetes. It is so important now more than ever to not only prevent diabetes but also the expensive and painful complications associated with it. I believe that many health professionals who do "public health" work are more than qualified to become CDE's (I swear I'm not patting myself on the back while writing this!). Public Health represents a shift in how we approach health and wellness - it takes into account social, economic, environment and other factors that acute care does not. So as someone who addresses health at a community-level in their job - no, I don't have patient interactions but I do understand that preventing and caring for type 2 diabetes involves a lot more than diet, exercise and medication. And my lack of "clinical" experience is nothing professional training and education couldn't cure. If prevention is the new focus in U.S. healthcare, then public health and clinical care will certainly be marrying and becoming one big, healthy family.  I'm just hoping I'm invited to the wedding!

Thursday, March 15, 2012

Super Freak

So remember on Sex & the City when Carrie talks about “single-self behaviors” that you do when your significant other isn’t around. Well, I realized this morning that I have some “diabetic-self behaviors” that could potentially be viewed as weird and perhaps a little gross. For example, I am not the type to carry around gauze or alcohol wipes for my fingers after I prick them to test. Although I realize I am not and never will be a vampire or a character on True Blood, I find it’s much more convenient to just lick the blood off my finger and keep movin’ with my day.

I also discovered while changing my pod what I would like to call “doing the nerve.” Hitting a nerve while changing your pump site feels like a lovely combination of being punched in the stomach while having a bee sting you – my response is a dance that is a combination of foot stomping and shimmying my shoulders. It’s all quite graceful I can assure you.

I think everyone has secret behaviors that make them tick – but some of mine that are particular to how I deal with the everyday management of my diabetes are especially laughable because they are my ways of “cutting corners” so to speak. Like how I let my diabetes bag fill with used test strips because it’s a lazy habit that’s easier than always finding a trash can (and without fail, it always dumps out in the bottom of my purse). Or how I undoubtedly throw/drop/lose the plastic straw wrapper from my juicy juice when I’m low and find millions of them in my office/car/apartment/purse/bed/kitchen. Even better is waking up with fruit snacks or granola bar in your hair or under your pillow from a middle-of-the-night low BG.

I laugh at myself when I go to the supermarket and buy small bottles of juice rather than juice boxes. Why you ask? Well, because I think it looks much more grown-up and sophisticated to drink a mini-bottle of juicy-juice rather than slurping through a straw. Duh.

Wednesday, March 7, 2012

Judgment Day

Diabetes is judgmental. Someone recently shared with me the brilliant insight that diabetes is the disease that is most publically judged. By publically, I mean that pretty much everyone considers themselves a diabetes expert. How many times have you tested your blood sugar and had a friend, family member or complete stranger (my personal favorite) say “what is it supposed to be?” or “is that normal?” And as soon as this nosey (but lovable) person gets all up in your business - you shamefully realize that your meter is flashing a number that is NOT in the “supposed to be” range. Consider this: if you met a person with cancer – would you recommend treatments to them if you weren’t a cancer patient yourself? Or, if they told you they were a cancer patient would you respond by saying “Oh, my grandmother/father/aunt/uncle/mother died from that.” Fingers crossed, your answer is no. I am not discouraging people from inquiring about my diabetes – I love sharing with those who care to be interested. Knowing that my friends, family, etc. want to learn goes a long way especially since it can be mentally and emotionally exhausting to share so much.

One of my doctors at Joslin shared with me a hysterical little pamphlet called “diabetes etiquette for people who don’t have diabetes.” I have compiled enough material to write a novel filled with funny stories about the questions and reactions people with diabetes get on a daily basis when we share our diabetes with the real world. No matter how long you’ve had diabetes – there is something in this pamphlet for everyone. For example, Don’t #1 -“Don’t offer unsolicited advice about my eating or other aspects of my diabetes.” If you’ve ever attended a social function of any kind – I guarantee you ate or drank something that prompted someone to say “can you have that?” Or maybe you didn’t even get to eat it before someone looked at you as if you kicked a puppy because whatever you were about to enjoy resembled frosting with sprinkles on top.

The reason why my doctor shared the etiquette do’s and don’ts with me is because we were discussing the internal anger, guilt and disappointment that people with diabetes feel about their blood sugars when they are not “normal”. One can’t help but feel like a loser when your A1C is not in the “recommended” range and every diabetes pamphlet in the world says you should be able to achieve this through exercise, medication and diet. We all know it’s not that simple but it still feels pretty crappy. It’s hard not to feel disappointed when you think you did a kick-ass job bolusing for a meal only to find a few hours later that your blood sugar is 250.

This “bummer, dude” feeling can be influenced by external sources or it can be a strictly internalized emotion. Either way, it certainly takes a toll. I find that in these situations – laughter comes highly recommended. Visit to download the diabetes etiquette booklet and have a good laugh at someone else’s expense – just don’t tell them I told you to do it.

Monday, March 5, 2012

Is g-free the way to be?

Are gluten-free products a waste for those without Celiac's?

A few years back (before it was the cool thing to do), I cut wheat and gluten from my diet. At the time, there was not a rapidly expanding selection of wheat and gluten free foods and it was challenging to find yummy, not outrageously expensive foods to eat. I chose to eat this way because I found I felt better on a multitude of levels – including how it affects my diabetes care. I am a huge fan of mixing gluten-free choices into my diet – especially because I am a bread-a-holic.

I have never had a sweet tooth – cookies, cupcakes, ice cream and brownies make my stomach churn before I even take the first bite. We’ll skip the conversation about how ironic this is given I was diagnosed with T-1 and save those jokes for later. However, I’ve been known to stage grocery store interventions to treat my addiction to all things bread. I literally stand in the aisle and silently compromise with myself while trying not to freak out the other customers in the bread section. Forget chocoholicism, an egg sandwich on a bagel or a slice of pizza is bliss (could I be more of a New Yorker?!). And according to the latest news, maybe there are no actual benefits to my choosing to eat gluten-free breads, granola bars & chips but I certainly feel better than I do when I choose the alternative. Maybe it’s the placebo effect – where I’ve trained my mind and therefore my body into believing that gluten-free is the solution to my bodily function woes. Don’t get me wrong – my g-free, healthy diet is often undermined by that tiny, restaurant devil that stands on my shoulder and shouts “me want gluten!” And I am lucky enough at this point that I don’t have to monitor every little morsel that goes into my mouth – I have T-1 friends with celiac’s and I give them so much credit for managing the two.

Essentially, I feel lighter, less lethargic and in better control of my blood sugars when I eat g-free. Apparently, it’s also really in vogue according to diet trends – I was so ahead of my time, who knew? So maybe its guilt or I’m just a complete whack job – but I feel healthier when I make the conscious choice to buy Food Should Taste Good® Jalapeno Chips instead of the numerous other naughty alternatives.

P.S. I should get a job, start a fan club or buy stock in Food Should Taste Good® because I am actually infatuated with all of their products. Buy them here, you will not regret it (And if you do, send them to my office or house and I will help you resolve the issue)

Thursday, March 1, 2012

Dexcom - I love you, I'm just not that into you.

There is no doubt my Dexcom CGM has significantly improved my quality of life. Sometimes I forget what it was like to NOT know what my blood sugar is all the time - testing myself 8 times a day seems SO antiquated and prehistoric in comparison to how I am able to monitor my blood sugar now. Between my Omnipod and my Dexcom, I feel like a hip diabetes robot that is wireless, tubeless and in the know 24/7. However, as someone who has dealt with diabetes-related anxiety for some time now, I'm beginning to wonder if I'm suffering from what I'd like to call "plastic-pancreas hyperawareness syndrome."

There are points in my day where perhaps I would like a little less information about the misbehaviors of my pancreas. For example, on days when I'm feeling particularly anxious or even having a panic attack - the double-down arrows of doom accompanied by vibrations and beeps alerting me that my blood sugar is plummeting are a bit dramatic. I went so far as to disable the alarm for when my blood sugar rises above 200 because I found that I would overreact, over-bolus and therefore, end up low and very crabby.

And while I love the security of my Dexcom relationship - we have some trust issues. I find it difficult to trust that my juice box or glucose tabs will raise my blood sugar when there is a lag in how the CGM reports progress. 5 minutes can seem like an eternity when you are low and that little upward arrow of hope has yet to provide IMMENSE relief to my hypo-anxiety.

When I feel frusterated with the Dexcom and my anxiety, I will often take a vacation from the CGM and go back to the old-fashioned way of monitoring my blood sugar. This "vacation" never fails to provide the epiphany necessary for me to stick that CGM back on my belly where it belongs. Diabetes requires constant learning - I've learned that sometimes it will be difficult for me to process all the information that my CGM provides. In the end, the security and comfort I feel when I look at trending normal blood sugars on that little screen could make it all worthwhile.

So Dexcom, its not you - it's me. But don't worry - I will still faithfully read your screen to the point of obsession whether we're having a good day or thinking about taking a vacation from each other.