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.

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!

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.

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 http://www.behavioraldiabetes.org/ 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.

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)


https://store.foodshouldtastegood.com/catalog

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.

Take Your Mom to the Endocrinologist

I am one of those people who are freakishly close with their mom. I share with her everything that I would share with my best friends. We are attached at the hip on most occasions with one exception: the endocrinologist. I've been seeing my same adorable, wonderful doctor for over two years and no one outside of me has ever met him. So finally, I asked my mom on an endocrinologist date and we took off for Joslin.

While on most occasions I am happy/excited to be hanging out with my mom...this day was different. Since I was diagnosed, I have braved nearly all doctor's appointments alone. I am often times nervous when I go but being alone forces me to rely on my own strength (or so I thought). This day, I was EXTREMELY anxious. In a fit of anxiety, I even tried to convince my mom to skip the appointment for a shopping day instead. After it was all said and done, I had to ask myself...why? I thought about my tendency to do eveything diabetes-related by myself and realized that it is mostly out of my concern for burdening those around me. In everyday life, there is almost always at least a few minutes in my day where I worry or perhaps don't feel right. I would never want my friends, family, boyfriend to spend their time with me worrying because then, I start to feel like a diabetic instead of a 22 year old girl. I realized how detrimental it is to behave this way after my mom came to Joslin. She was not worried or treating me different, she was absolutely amazed at the comradery between myself and my doctor. She had never even seen the resources that Joslin offers its patients. No wonder people worry..they don't know any better because I don't tell them. Lesson learned.

P.S. I am disapointed in my lack of blogging over the summer but life has been hectic and has afforded me little opportunity to reflect about the betes side of things. However, I have good news...I am officially employed and it is in the realm of all things diabetes. I've even found a grad school program which will allow me to expand my career horizons while researching community health and diabetes (now I just have to get in!). So now, I can confidently say that there will be much more blogging and fabulous things to come!