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.