Monthly Archives: February 2016

Do People With Diabetes obsess too much? Or is it just me?

I was in the grocery store a few weeks back, in the aisle where the boxed juices sit on the shelf.

As I stood there looking at the flavors (because rule #1 for hypo supplies: taste good), I was also checking out the carb count of every single juice box in the aisle.

“Well, this one looks good, but it’s 22g of carbs per box. This one is 12g… how do I count/bolus for that? Each box of this juice is 15g, which I want. But the flavor is… not my favorite”.

After standing in front of these shelves for over five minutes, I asked myself (out loud—good thing I like to shop early in the morning) whether it really mattered if a juice box had exactly 15 grams of carbohydrates per box. I mean, if I’m in the middle of an overnight low, and I need to treat with a juice box, I don’t think an extra 7 grams is going to make a huge difference. So I wound up picking the juice with the flavor I liked (fruit punch), but 22 grams of carbs.
This is just my viewpoint on the subject… I completely understand if you are into exact measurements and precise management of your diabetes to get to, and remain in, a good glucose range all the time. In fact, I admire you for that level of dedication.

But you know, I just wonder if years of exchange diets, A1cs, and carb counting has made me obsessive about a gram of carbohydrate here and a couple of BG points there. It was brought into focus for me about a year or so back when I visited my endocrinologist, she relayed my lowest A1c result ever, and in the next breath wondered herself if I had been obsessing too much. Her very words were “You know, it’s not the end of the world if your meter reads 140 mg/dL before dinner once in a while”.

Plus, and I don’t think this happens to everyone, but it happened to me: As I experienced more success with my A1c results, I became more and more of a micromanager about my numbers. I mean, it’s great when you get good results from it, but I don’t think I can keep it up forever. And mostly, I need to remember that I don’t know everything, or even much, about day to day management of my diabetes. You may disagree with that, but there’s no denying that I could stand to learn a lot more.

The other side to this is what happens if something unexpected happens when your numbers are so tight. And something unexpected is bound to happen once in a while. I’m fond of reminding people that the better your numbers are, the closer you are to hypoglycemia all the time. It’s a lot scarier to go from 100 to 50 than it is to go from 200 to 150.

If I’m obsessing over anything right now, it’s probably my basal rates and my insulin to carb ratio. Over the past two years, I’ve also cut down a lot on my daily caloric intake. So if I can get the basal and insulin to carb ratio numbers right, I think I will be in a good place with my diabetes about 80 percent of the time. And if you told me six or seven years ago that I could be on top of my diabetes 80 percent of the time, I wouldn’t have believed you.

How about you? Are you a control freak about your diabetes? Or are you more of a rounded, but nice, edges Person With Diabetes?

Talking about Cousin Spammy on DSMA tonight.

I’m not sure I can define diabetes spam exactly… but like Supreme Court Justice Potter Stewart once proclaimed regarding pornography, I know it when I see it.

We’re going to be talking diabetes spam on the DSMA Twitter Chat tonight. What does it look like to you? How does it make you feel? How do you handle it? And many more aspects of what spam does to our already overworked eyeballs.
From ridiculous snake oil cures to workout ads that promise to “reduce diabetes” (ummmm… it’s still DIABETES), we’ll be riffing on what really bugs you regarding quack dietary supplements and what your co-worker heard on the TV last night. We’ll talk about what everyone is doing about the stupid e-mails they’re getting, and maybe a little about what we’d like to do about all these snake oil remedies and the people who tout them.

Diabetes spam is kind of like the stoner cousin at the family get-together. Eating all the non-carby good stuff you brought while leaving your aunt Ginny’s undercooked brussels sprouts for you on the buffet. Eyeing your significant other with a little too much gusto. Borrowing a fiver while promising to get it back to you next week, and finishing up with “We gotta hang out more often, cuz!”. Yeah, right. I’m not a kid anymore, cuuuzzz.

So catch up with me on Twitter tonight (all the details are below) and we’ll compare notes, laugh a little, and generally dis’ about cousin Spammy. He’s got it coming… let’s serve it up beginning at 9:00 eastern time in the USA.
Living with diabetes? Living with someone living with diabetes? Join us for talk, support, encouragement, empowerment, and more during the DSMA Twitter Chat every Wednesday night at 9:00 Eastern time (USA). Follow the @DiabetesSocMed Twitter handle and/or the #DSMA hashtag and join the conversation!
I also find this link via tChat helpful.

The DSMA Twitter Chat is sponsored by the Diabetes Community Advocacy Foundation, Cherise Shockley, Founder and CEO.

Universal truths.

I’ve been back on the workout bandwagon for a while now. I’m still finding some time to get on my spin bike at home, and I’ve been getting to the gym so I can run on the track instead of going outside when it’s 20 degrees.

But I’m no different from other People With Diabetes when it comes to working out and fears of hypoglycemia. To combat that, I don’t think of it as managing my diabetes as much as I think of it as managing my insulin. If I can manage my insulin properly, I can avoid the lowest of lows. It seems like I can’t avoid having any lows. I’m not that good at it. But remembering that I might need to tweak basal rates or bolus amounts due to workouts, and doing that properly, is really key. Just about everyone knows that.

Still, working out more often, and the worries of hypoglycemia, coupled with the fact that adding this to my schedule more often, well… it seems like there’s this double-edged sword: Volunteer for something that, in the past, has helped lead to serious hypos; or let the fear create inaction, which is never going to be something that will help me live a good, long life.

Add in knee surgery last year, and worries about how I would come back from that, plus the fact that I really hate how I look right now, and it just seems like a good excuse to either get going or sit right back down and have a drink.

While thinking of all this over the weekend, I came to the realization that there are actually some universal truths that apply to both management of our diabetes and working out. Remembering these truths has helped me embrace working out again, which I have not done for some time due to the reasons stated above.

It’s really hard to get started.
And the older you get, the harder it is to get started. The sooner you get over that, the better you will do. Trust yourself that you will, you can, get started again.

When you’re not on your game on a given day, you feel guilty.
Every day I’m not at the gym, I want to be at the gym. Which means if I don’t go, I feel bad for not going. After every day where I (try to) ignore my diabetes, I feel like I’ve done a disservice to myself and those who care about me. But we live with this disease all the time, right? We need a break (such as it is) once in a while. Which brings me to:

Yesterday is only a benchmark. The future is unwritten.
I’ve written variations of that line a number of times. This past week was when I first realized that it applies to working out as well as living with diabetes. Regardless of what yesterday tells us, there are many chapters left to life, provided we’re still game enough to author them.

Surprises can come at you pretty fast.
Since I started seriously working out again, I’ve had lows in the middle of the night that I didn’t expect, and I’ve had an injury to a toe that I was completely unaware of until my run was over. It helps me to keep in mind that the best planning includes planning for the unexpected. It’s gonna happen.

We are stronger over time than we seem to be an any one moment.
Our lives are not defined by one single day. At least I hope not. With diabetes or with working out, it’s easy to give up when the going gets tough, you’re worn out, and it’s so easy to just say I’m Done. When we don’t do that, well, that’s where champions are made. And People With Diabetes are better at not giving up than any other group of people I’ve ever known.

Maybe the real universal truth is that remaining active is actually part of managing our diabetes. That makes sense, but how often do we think of it that way? I know I don’t… or haven’t… until lately.

Have any other universal truths you’d like to add to the list?

8 Hidden costs of diabetes.

Everybody knows diabetes is expensive. We spend a lot of money on insulin, syringes, infusion sets, sensors, and more.
But there are a lot of hidden costs in diabetes. I found at least eight things that my doctor never told me about at diagnosis, and they cost me a lot.
1. Juice, candy, glucose tabs, and other “in case of lows” supplies.
About every other week, I head to the grocery store for some juice. I also need to make sure I don’t have a shortage of candy for those times when my refrigerator isn’t so close. Supplies in the bedroom in case of overnight lows, juice boxes and crackers in my desk drawer at work, hard candy in my truck. I’ve lost track of how much I’ve spent over the years on stuff like that.

2. Extra doctor visits.
Almost all of us visit our endocrinologist every 90 days or so. But what about all of those visits with our primary doc, even if it’s just when we’re “real people sick”? A podiatrist? An ophthalmologist? A dietician? A Certified Diabetes Educator? My insurance plan’s plan year is only a few months old, but I already have a stack of receipts for co-pays to the other healthcare professionals I see throughout the year. And while we’re at it:

3. Time.
Ever consider the time you spend on your diabetes? Just all those HCP visits take up a lot of time we’d like to spend on other pursuits. Add in blood sugar checks, set changes, and the myriad other tasks we perform on a regular basis, and I figure diabetes is gonna owe me a few extra years at the end. It’s a big, giant cost that bothers me more than I can tell you.

4. Education.
A lot of this is of my own doing, but honestly, I want to know more about diabetes, and more about advances in research and development on drugs, devices, and the mental cost of living with this disease. Often, that means spending money so I can get to where the information is being given. Of course, there is much to be learned via the internet, which is what I’m trying to do when I can’t get away to a conference. But a portion of my budget is now permanently earmarked for diabetes travel.

5. More time.
This is the good part of time spent on my diabetes. That includes spending Wednesday nights on Twitter, communing with my D-homies while doing the question and answer thing during #DSMA. When I’m lucky enough to see my diabetes friends in person, I love just being in the moment and soaking up all the goodness. Life ain’t all bad, right? But then there’s:

6. Extra costs for extra conditions.
Many of us living with diabetes get cursed a second or third time over with another condition like Celiac or high blood pressure or, in my case, an annoying skin condition that I’ve been told will also never go away. My extra isn’t anything that anyone needs to worry about, but it still comes with a cost, and even my dermatologist (another HCP cost) says it might be related to a compromised immune system. Thanks diabetes.

7. FItness.
I’m a believer in trying to stay as fit as I can. I don’t look like it, but I still exercise on a regular basis. Because it helps my body use insulin more efficiently, and because I feel better when I exercise. But it doesn’t come cheap. I will say this though: the cost for my road bike, for my spin bike, for workout wear and even my gym membership has been worth Every.Single.Penny.

8. Worries.
This could come under Time, or More Time, but let’s be honest. This deserves its own category. From fears of a future low, and fears of what a previous low has done to our brain cells, to fears of complications that come with years of diabetes unknowns, the cost of this chronic condition goes far beyond anything anyone should consider reasonable.
This list doesn’t include the money spent supporting my friends and the great causes they work tirelessly for. And it doesn’t count the money I spend on special things for The Great Spousal Unit because she indulges me by letting me write a blog and podcast and go to diabetes events, and oh yeah, she makes it easier sometimes when I’m dealing with a difficult low. No doubt this list could be a lot longer.

There you have it. Next time someone suggests that diabetes is as simple as take insulin and go on with your merry little life, remind them that diabetes comes with a lot of extra costs. And they’re not all covered by insurance.


What is it about diabetes that just knocks us off our game now and then?

Nothing about diabetes is wonderful, unless you count the people you meet who are dealing with the same things, either by living with diabetes themselves, or living with someone who lives with diabetes. The rest of it pretty much sucks.

Still, sometimes we put on airs of “I’m a tough hombre” because we deal with everything this disease throws at us, and yet we get through it… we’re strong enough to suffer the slings and arrows that diabetes sends in our direction, and often we emerge from the battle stronger than ever. How many people with completely healthy bodies do you know who can put up with what we put up with on a regular basis?

I can’t say that’s how I was feeling the other night when I went to bed. But it had been a long time since I’d experienced an overnight low, and nothing about that Thursday night was any different from a thousand Thursday nights before it.

Insert diabetes… begin chaos.

I woke up around 1:30 a.m., feeling sweaty, and a little irritable. If I’m sweaty at this point, it means my blood glucose level has already sunk pretty low. Normally, when this happens, I just need to get up, go downstairs, get the juice from the fridge… I’m good. This night, I didn’t, couldn’t, get to the fridge. Instead, I sucked down a juice box sitting next to the bed. Then another. Then a package of peanut butter crackers. Then some candy. Then some peanut butter. Another juice box. In all, it took around half an hour for me to actually feel like myself again. Like I could even stop to check my BG. Prior to that, it was all about feeling well enough to remain upright.

Therein lies the problem with feeling like you’ve nearly nailed your management of diabetes. You get surprised when you least expect it. It’s also the point where a lot of People With Diabetes feel a lot of guilt. I was a little guilty in this instance. I had a snack that evening that I probably over-bolused for. It happens. It happened Thursday night. But unless I make a habit of it, I’m not going to feel bad about it. That kind of thing doesn’t work for me. And while I don’t want to tell you what to do, I think you should consider what I’m saying here.

This might sound a bit harsh, but when it comes to diabetes, guilt is for suckers.

It’s not that we’re perfect… no way are we perfect. But what’s done is done, and feeling any guilt about anything that happens to you because of a disease that you did nothing to contract is like blaming your parents for your eyes being brown. Sure, your parents had a lot to do with it, but your eyes are still brown. After the moment passes, we still have diabetes.

So Friday came, I went to work (tired and hungover and a little afraid of my next bolus), and I continued living. That’s the final victory.

If you want, think of it this way: our imperfections are only a trivial botched play in the middle of an otherwise victorious game. If we live, we win. I want to improve my game so I’ll be successful more often. But I’m also going to realize that sometimes, a botched play is going to happen anyway, and the best way to deal with a botched play is to make it trivial by making the rest of the game spectacular.

I’d rather concentrate on the spectacular.

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