exercise

We Interrupt This Irregularly Scheduled Diabetes

I’ve been running high lately, and I don’t know why.

BG 220

That’s a lie. I know why. I eat too much, too often, and too late. Or I don’t eat, and then I go low or get super hungry, and then I eat all the things. Dang those holiday treats!

I haven’t been working out, exercising, or bringing sexy back. I have a gym membership, so accessibility to a place to exercise certainly isn’t the problem. I always find some seemingly good excuse for not getting there. First I was busy trying to find a new place to live. Then I was busy moving. Then I hurt both hands during the move.

Hurt Hands

Then I got even busier than usual at work creating something that I am extremely excited about. We are starting a new diabetes journal, available to all, and we’re now accepting research and volunteers to be peer reviewers. Check out The PLAID Journal. You can see a couple of videos and news articles about the The PLAID Journal on the Announcements page. Also, the Facebook page for PLAID. (Lots more to come on PLAID, so stay tuned.)

Then the knee that I hurt while cycling several years ago flared up again. Add to all of that an ever-growing to-do list, and there is always something that keeps me focused on something other than me.

I hate it. I hate the feeling of my blood sugar being high. I hate that I can’t get my BG to stay where I want it. I hate when I prick my finger and see a number that is dramatically higher than I feel because my body is getting used to it. I hate being thirsty. I hate waking up in the middle of the night to go pee. I hate thinking about it. All. The. Time.

I also hate being overweight. I hate feeling like I am the overweight that I am. I know that we’re in an age where we are supposed to accept our bodies and all that jazz, but this is not normal. I can’t just accept this. I don’t feel like me at this size. I feel like I’m stuck in a heavy fat suit, and everything I do is just that much harder because of it.

But for whatever reasons, I can’t seem to change it.

Before April of this year, I was on Weight Watchers, and I was doing pretty well with it. I had lost over 10 pounds in three or four months, and was feeling pretty good. I was on track to get back to a weight and size that I wanted to be. And stronger. And back to a more human shaped geometry, instead of just round.

Martin and Amanda on Bicycles

Today, I’m the heaviest that I’ve every been. Almost 207 whopping pounds. I put that out there for no other real purpose than to make it real. I should be about 170, in an ideal world. And I’ve seen a human skeleton. Short of an anatomical anomaly, there is no such thing as “big boned.” I’m just plain old overweight right now.

As joyous as April started out with Amanda and I tying the knot in beautiful Key West, it ended in tragedy with the loss of our precious little cat Squirt, and I know that losing her has played a role in where I am now. To some it may sound silly (she was so much more than “just a cat”), but she was a part of my life every single day for nearly 14 years. It feels like the loss of an immediate family member, because that is exactly what it is. I think dealing with that loss, on top of everything else already mentioned, has made me do things like eat my emotions and talk myself out of doing fun active things.

Working out and exercising has always been like therapy to me. Be it gym, walking, running, or cycling, it’s a safe place for me to get out all of my stress, frustration, anger, aggression, sadness, and any other negative emotions that I’m dealing with. Some days I only need 30 minutes or so. Other days I might need a couple of hours. It also makes sure that I have a few minutes during normal human hours of the day that are just for me, Martin Wood, where I’m not making sure that the needs of everyone else are being met.

It’s my career choice to help people, and it is a major part of who I am, and I love it, but sometimes in order to help people we have to make the time to help ourselves. I haven’t been doing enough of that. Now that we are in a neighborhood where there is less chance of going for a walk or run and interrupting a drug deal, I finally feel that spark of motivation to get out of the house and move around.

I also enjoy doing other things, like reading, video games, movies, and basically anything that doesn’t involve repairing yet another kitchen appliance in my house. Sometimes it’s hard to make room for those things, but we have to. Down time is as necessary to life as to-do lists and full calendars. A friend said recently that “cancelling a holiday commitment is like heroin.” Try it. Substitute an evening on the couch with the dog and the first half of this season of The Walking Dead. (Beth…noooooo!!!)

Life with diabetes is freaking hard, man. Life with diabetes is about so much more than just diabetes. Life with diabetes is a complicated balance of biometrics, medical therapies, activities, unexpected events, important considerations, random emotions, bright sides, dark places, and things left unsaid that have to be factored into an inarticulate equation that hopefully results in a personal definition of success.

All of this is what it takes to get my A1C where I want it, to get my BG’s on a more level plain instead of high or bouncing all over the place, to get back to Weight Watchers and better control of all of the delicious things that I’ve been cramming into my face hole, to develop the strength and stamina to avoid future injuries, and to drop some pounds and be able to haul ass without it taking two trips. That is what it takes to focus more on the things that I do have in my world that bring joy, for me, Martin Wood. Like these two…

That is what it takes to start to feel better. To feel happy. To feel able. To feel normal. And if I can’t do it on my own, then I’ll have to figure out who the right people are and get them on my bus to help me get further along down that road. For now, it’s one mile at a time.

–MW

The Case for CGM

It can be extremely difficult to get an insurance company to cover the costs of continuous glucose monitoring (CGM) systems. The excuses that these holdout insurance companies provide as to why they don’t want to cover CGM are becoming less justifiable thanks to research and advancements in the way we think about the needs of people living with diabetes. This is why I am a Diabetes Advocate.

So far in 2014, I have only been able to get four Dexcom continuous glucose monitor sensors out of my health insurance company. Four sensors is a one month supply. It is now July. That means for five months out of this year (so far) I have not been able to wear my CGM or benefit from the data that it gives me and the alarms that it uses to tell me when my blood sugar is dropping too low or rising too high. Each time I try to get more CGM sensors, I have to restart the approval process with my insurance company, spend weeks going back and forth between Dexcom, my endo, and insurance trying to get all of the documentation together to submit for approval, just to be denied because either Dexcom isn’t a preferred provider, or because the insurance company has decided that there isn’t enough evidence to support that CGM is a benefit and results in better control of diabetes. So then I appeal. And I know there are many, many other people struggling with getting CGM coverage by their health insurance just like I am.

This is also why I am a medical librarian. Challenge accepted, health insurance industry. Bring it on.

The most dangerous side effect of insulin is hypoglycemia, or risk of dangerous low blood sugars. The ability of CGM systems to alarm and notify a person with diabetes is one of the most valuable and beneficial advances in diabetes technology ever. EVER. The fact that there are small devices now that can warn us, as if to say, “Hey dude, your blood sugar is dropping. It might be a good idea to get a snack or something,” is incredible. This is an incredible benefit to people with diabetes so that they don’t get in a dangerous situation with a low blood sugar that can leave them incapacitated, unconscious, or possibly even dead if it happens in the middle of the night while they are asleep. Do you know how health insurance companies make money off of a dead person with diabetes? They don’t.

CGM technology benefits insurance companies too. It is incredibly cheaper to provide the technology that will alarm and cue someone to get a sandwich, a juice box, or a Level gel to get their blood sugar up on an ongoing basis than it is to pay for home or work visits by paramedics, rides in the back of an ambulance, hours in an emergency room, and likely overnight stays in the hospital depending on the severity of the lows. A low blood sugar can happen at any time, and is usually unpredictable based on varying amounts of food, activity, stress, varying absorption rates of body tissue from one spot to the next, and any other factor in life that can cause any amount of change. Sometimes they happen for seemingly no reason at all, and therein lies the danger.

How about…

…a systematic review from 2012 that concludes, “There are indications that higher compliance of wearing the CGM device improves glycosylated haemoglobin A1c level (HbA1c) to a larger extent.”

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008101.pub2/abstract

…the research that concludes, “CGM with intensive insulin therapy appears to be cost-effective relative to SMBG [self-monitoring of blood glucose] and other societal health interventions.”

http://www.ncbi.nlm.nih.gov/pubmed/21917132

…the research that finds that regardless of prescription approach, “…patient-led and physician-driven prescription. Both modes of using CGM provide similar long-term metabolic improvement.”

http://www.ncbi.nlm.nih.gov/pubmed/22208716

…the one with early analysis of cost-effectiveness of CGM that says…well, I’ll just let is speak for itself. “…the overall quality-of-life effect of CGM arises from its ability to both improve the immediate quality of life of diabetic patients as well as reduce future complications through enhanced glycemic management.” But wait, there’s more! “The provision of greater glucose control data may have improved the quality of life of patients by facilitating decisions related to food intake and insulin regimens as well as by reducing the risks and fears of hypoglycemia.”

http://www.ncbi.nlm.nih.gov/pubmed/20332354

…real-world benefits of CGM. “Personal CGM, in a real-world setting, improves glucose control and reduces the rate of severe hypoglycemic episodes.”

http://www.ncbi.nlm.nih.gov/pubmed/20551007

This is only a start. There is more research out there, and more research on the way that shows the benefits of CGM on the lives of people who use insulin to manage their diabetes. It is time for health insurance companies to get with the program, and it is time for us to speak up and shout from the rooftops what we need, and make it happen. Some health insurance companies are better than others (PPOs tend to be more willing to cover CGM than HMOs, for example). Until coverage of CGM is non-negotiable, our work as advocates for our own health and well-being is not done. We should not have to beg and plead to get this widely accepted diabetes technology that has already been and continues to be proven to improve and save lives. Coverage of CGM should be non-negotiable, expected, and mandatory.

Now that we are staring down the barrel of the potential for the bionic pancreas in a few more years, the need for CGM acceptance by insurance companies is only going to grow. Without insurance companies accepting that CGM is indeed a good idea for people with diabetes, and without insurance companies making CGM technology accessible without the barriers and complicated processes of getting approval, and without more research documenting the cost benefits and effectiveness of CGM versus emergency responses to hypoglycemic episodes (low BGs), the bionic pancreas will never make it past the prototype phase. And we need this forthcoming technology that the bionic pancreas, and the research behind it, provides.

I’m tired. I’m so very tired. I’m tired of living every single day and running every decision that I make through a diabetes filter. I’m tired of having to prick my finger before I leave for work in the morning to make sure that my blood sugar level is okay for me to be able to drive. I’m tired of checking before meetings to make sure that my blood sugar isn’t dropping, for no other reason than so that I don’t get caught in the middle of a meeting not making sense because my blood sugar dropped too low. I’m tired of having to check before I put any bite of food in my mouth, and then having to check an hour or two after to see if that food and the insulin that I took to cover it worked the way that I thought it would. Sometimes it does, and sometimes it doesn’t. Most of the time it defies explanation. I’m tired of having to decide if I get to go to the gym and workout today based on what my blood sugar is right before I go. I’m tired of having to check so that I can drive home. I’m tired of having to check before I can go to bed. I’m tired of not being able to go to bed because I did check, and having to wait for my blood sugar to go up or come down.

I’m tired. I’m tired of the hassle. I’m tired of the bullshit. I use that word because that is just how tired of it I am. I don’t have pipedreams of a cure for diabetes. I’ve had diabetes for 33 years. It’s all I know, and all I have ever had to deal with, and I don’t walk around with imaginary hope that a cure is coming in five years, ten years, or even necessarily in my lifetime. I hope it does. Maybe it will, but short of a scientific breakthrough, I don’t feel like that is the best place for me to invest my energy. In this age of technological advancements, this age full of the smartest people that have ever lived on this planet, and this age where people are open to change and progress and opportunity, I want to be able to rest my mind when it comes to diabetes. Let’s work together to support things like the bionic pancreas, CGM coverage by insurance companies, and these things that simply make life with diabetes easier and better.

I don’t feel like making life easier with diabetes is really asking too much. If you think it is, then you try it. See if you can make it 33 years counting fingerpricks, carbohydrates, activity levels, insulin doses, times you’ve found yourself in a room waking up and not knowing where you are because of a severe low blood sugar, a tongue chewed up from a low blood sugar seizure, bruises that you don’t know how you got, and cracked ribs from the physical exertion of just trying to survive that low. Survive that, and then I dare you to tell me how CGM isn’t effective and isn’t necessary.

I double arrows down dare you.

CGM Double Down Arrows

Update, 7/30/2014:
I am so fortunate to have received a few sensors from other PWD who had the extras to spare. Thank you! You know who you are, and you have been a big help (he types, as he is recovering from a BG of 39 and still a little shaky). I received a call from Dexcom this afternoon, confirming that they finally got all of the pieces that they needed with insurance approval and documentation from my endo, and they are overnighting me new sensors. Yay! It took 7 months, which is ridiculous, but people with diabetes are experts at being stubborn and steadfast until we get what we need (*cough* bionic pancreas *cough* encapsulation *cough* smart insulin). So thankful that it appears to have finally been worked out. Ciao for now! (Did I really just type “Ciao for now!”? I must still be low…)

Update, 8/21/2014:
Order got delayed, again, before it could be shipped to me. Today I finally received a 90-day supply of Dexcom sensors, allegedly with auto-renew when I need more. Still not clear on what took so long, aside from the explanation from my Dexcom rep that it was dramatically delayed by all of the authorizations required in order for insurance to approve. I’d demand more of an explanation, but it’s been a long battle, and I’m tired. Glad to finally have CGM data again, even if it did take 8 months longer than it should have.

Finding My Inner Ryan Reynolds

Every year right around this time we all dream up our New Year’s resolutions. Some form of weight loss, get in shape, go on a diet, or eat healthy is almost always at the top of everyone’s New Year’s list. This year, I’m feeling the stretch, and I realize that I need to do something to get back to my size 4 bikini body again.

Actually, I don’t even know what that means. I just heard it on an infomercial for some kind of magic beans that are supposed to make your clothes fit better. Truth be known, they probably have a better chance of turning into a beanstalk and leading to a land of giants than they do making me lose weight.

I bet they are good with ham though. Anyway, moving on…

I freely admit that I weigh more than I want to right now. I’m overweight. Heck, I might even be considered obese by the current standards of how big a person’s butt should and shouldn’t be. (And don’t you dare tell me what the difference is. I don’t want to know.) What I do know is that my clothes fit a little tighter than I would sometimes call comfortable. I can’t really button the top button on my dress shirts right now because my head and neck resemble Jabba the Hut. If someone told me to haul ass, it’s questionable if it would take me one trip or two to get it all. At least, that is how I feel.

I’d love to lose some of the extra pounds that I’m carrying around. I know it would make me feel better, both inside and out. I mean, there is a Ryan Reynolds under all of this that is just waiting to get out. I’m just trying to find a real solid purpose that I can grab onto besides, “Skinny people are happier.” Oh yeah? With that kind of logic, rich people must also be less lonely, hairy people have more style, and short people enjoy the smell of toots. Give me a break. Happy has nothing to do with weight, just like loneliness has nothing to do with how much money you have.

And everybody hates the smell of toots. Unless you’re a proctologist. Then it just smells like money.

When I signed up for my last gym membership, my goal was simple: I wanted to look good naked. I could have said that I wanted to be able to run a marathon, or be in good enough shape to teach spin class, or ride my bike for miles and miles and miles, but…well…yeah, naked. You have your goals, I have mine. Unfortunately, 2012 was a really hard year for me to establish and maintain a routine of exercise, working out, riding my bike, and keeping active consistently, and I feel like I’ve lost my way a bit. I could blame it on a chaotic schedule, being overwhelmed by other things going on, not having enough time, or that the Mayan’s had predicted that the world was going to end anyway, so why bother. When it really comes down to it though, it was me. I didn’t take time or make time, and I realize that I really need time to exercise and work out for both my physical and mental well being.

In order to change all of that for 2013, A-Flizzle and I worked extremely hard in our garage over the holidays to get it organized so that we could have a functional workout space that would be available despite my busy and often chaotic schedule. If I want to work out at 11 o’clock at night, I can. I don’t have a bunch of expensive equipment, but what I do have I can definitely make the most of now. I’m SUPER excited about it.

In 2013, I’m trying to get back to establishing consistent exercise routines. I’ve really got to find a way to make time to train and get to where I want to be. The first place I want to be is on my bike in a few months for the Tour de Cure. My goal is to train consistently this Spring so that I can complete the 100 mile century bike ride in May. From there, who knows? Hopefully by then there will be other bike rides that I can train for. Or maybe even a triathlon. Wouldn’t that be exciting?! But, first things first.

I know that exercise is only part of the story. In order to get fit and have a set of abs worthy of doing laundry on (thanks Ryan Reynolds for setting THAT bar so high), I realize that I also have to eat right. What does “eat right” even mean these days? I look at all of the options for supposed “eating right” and I wonder how in the world I can adopt something like Weight Watchers, Atkins, Paleo, eating clean, gluten free, zero trans fat, and all the other whoop-tee-do diets out there for the rest of my life. I don’t want to make a change that gets me to where I want to be with my size and weight, just to reach that goal and balloon back to being the fat kid that I am now all over again. I also don’t want to not be able to have a Burger King fish sandwich WITH fries when I have one of these:

Basically, I’m a walking contradiction.

Weight Watchers I don’t get because of the point system. It’s difficult for me to understand how a banana (about 24 carbs, take or give) is zero points. It sure doesn’t feel like zero points when I’m having to bolus for the carbs and then check my blood sugar a couple of hours later to make sure I guesstimated properly and am not sitting at 300. Fruit is like jet fuel for blood sugars when you have Type 1 diabetes (YDMV – your diabetes may vary). “Free food” is really just a matter of perspective. Yet it works for so many people.

Then there is Atkins. How is it healthy to eat that much meat? I mean, essentially the diet is a version of a low carb diet, but it also talks about putting your body into ketoacidosis. Aren’t we supposed to be staying OUT of ketoacidosis? Diabetic ketoacidosis (DKA) can mean a hospital trip for many of us people with diabetes (PWDs). But there again, it works for so many people.

Correction: It’s KETOSIS, not ketoacidosis. Easy to get confused. Thanks Allison!

Those are just two examples, and clearly I don’t understand all of the ins and outs of them all. I see info about this meal plan and that weight loss option, conflicting testimonies and experiences, and I can’t seem to come to any conclusion about what is right for me. It is this lack of understanding that is paralyzing my decision making process on what it means, for me, to “eat right.” I see successes and failures with every single option. How do you pick one? Which one is the “right” one? It’s like walking down the cereal aisle at the grocery store. Can’t I just get the one that is delicious and has the best prize?

I don’t have an answer. I probably just need to commit to something and try it. For now, I know I can work out. I enjoy that, and even look forward to it once I get into the routine. Maybe my rule needs to be, “If you eat it, burn it.” Or maybe it’s, “Sweat like a pig to look like a fox.” It’s one of those. In any case, we’ll call it the “Running on Fumes” plan, and I’ll try to talk Chuck Norris into being my spokesperson. After all, Chuck Norris never loses weight; he knows exactly where it is, and it’s very afraid of him.

Just Another Day

This past weekend was a good weekend. No deadlines except that one that made a nice whooshing noise as it went by, nowhere to be, just an opportunity to enjoy things at a leisurely pace.

Saturday, A-Flizzle and I got a wild hair and decided it would be fun to go on a six mile urban hike, which is a more adventurous way out saying that we walked through a few neighborhoods and down a few sidewalks. It’s kind of amazing the things you notice when you are on foot that you never see from driving around in a car. We found a house with a dinosaur in the front yard, several Florida rooms off the sides of houses with beds in them that we were hoping to catch someone dozing in, a new sports bar and restaurant being built, and we learned that the pedestrian crosswalks have absolutely no rhyme or reason for when they decide to let you cross the street.

Throughout the day, I thought I had done a really good job of counting carbs, factoring in activity, and doing a good job of keeping tabs on things so that I didn’t go low from the activity or high from any of the delicious things that I ate, like the banana and Nutella crepe that I may or may not have had for lunch at about mile 4.5 of our urban hike. And by the way, this is my blog post, and I call it Nutella, not Noo-tella…because there’s a freakin’ “nut” in it. YPONMV. (Your pronunciation of Nutella may vary.)

After a day of near perfect BG’s, around bedtime on Saturday night I realized that I wasn’t feeling too well, so I did a quick check to see where things were. 342. I was pissed. Are you for real?! I counted everything! I know I got the math right, or at least in the ballpark enough to not merit a stupid 342 BG. What the #$@#%#$?!!!!

After I got done pitching a fit, I tried to think what might have jacked my BG up so high. Surprisingly, I don’t think it was the banana and Nutella crepe. There was nutritional info, and I’m pretty sure I was in the ballpark on that one. Since it was sunny and over 90 degrees outside when we were urban hiking all over town, I settled on the idea that the insulin in the tube of my pump probably got a little too warm during the activity and had lost its effectiveness. Insulin is supposed to be kept cool or at room temperature, and let’s face it, late Spring and Summer in Florida is far from being room temperature by any stretch of the definition. Something you have to be aware of if you’re going to sport an insulin pump is that, every once in awhile, heat happens.

I dosed down the 342 BG with a shot of insulin via the old faithful syringe, and then switched out the insulin in my pump. Either I overestimated how much I needed to pull that 342 BG back down to normal, or the activity of the day finally caught up with me, because I woke up around 3:00am at BG 35. After a juice box and a couple spoonfuls of peanut butter (which I may or may not have shared with Hopper dog), I woke up in the morning with a perfect BG of 88.

Diabetes is a total game of numbers. In order to stay alive we have to count everything. And guess. A lot.

We have to know how many carbohydrates are in everything that we put in our mouth, what our blood sugar (BG) level is at the time, and guesstimate how much activity (or lack thereof) is going to affect our metabolism and BG level. Then, on top of that, there are ever present questions about how accurate our BG meters are, we never really know for sure how effective the insulin that we’re injecting is going to be (especially after it has been in an insulin pump for a few days), and our bodies sometimes process that magical life elixir differently than yesterday, when we had the same food, the same activity, and the same BG levels.

My endo says that “doing the same thing over and over again and expecting different results is insanity…unless you have diabetes.” In Martin World, it’s just another day.

2012 Goals & Resolutions

Last year I put together a post of some of the things that I wanted to accomplish in 2011. My first goal was to get my A1C under 6.2. At my last three endo visits, my A1C was 5.6, 5.7, and 5.6. Goal achieved, sort of, but with that low A1C came a couple of dangerous lows. Those A1C’s don’t make me a “good diabetic” anymore than those dangerous lows make me a “bad diabetic.” It’s just proof that an ideal number goal that signifies that diabetes is in good control is also very close to the edge of a low blood sugar disaster.

I made a resolution last year to wear my CGM more regularly. I did mostly, yet those two aforementioned lows both outran my CGM’s ability to predict the low blood sugar in time for me to fix the problem myself. During the first low, my CGM started beeping while A-Flizzle was feeding me glucose tabs. (See also: This CGM technology stuff has got to improve if we ever hope to see a closed-loop artificial pancreas in reality.) Unfortunately, due to expired sensors, supply refill woes, and now a CGM transmitter that is no longer transmitting, I’ve been without my CGM for 2-3 months, and I can definitely tell because my BG’s are all over the place. Like that sweaty 35 this morning, followed by a headache inducing 237 at dinner tonight. I’m concerned about my next A1C, but I know that it is just data, and I know that I’m struggling, and I’m just going to put my faith in my endo, my CDE, and myself to work together and turn this beat around. Diabetes is hard enough. Why beat myself up about it?

My #2 and #3 goals were really all about exercise, and if I look at them explicitly, I failed them both. I did not run a 5K, nor did I find a group to start cycling with on a regular basis. I did, however, discover the joys of spin class, so I’m chalking those up as a sort of win.

One goal I had that I’m extremely disappointed about not achieving is to get down to a stable 165 lbs. The first half of this year I did phenomenal at losing some weight, eating low carb, getting some exercise in, and really feeling like I was on my way to a more fit me. Then I had that low BG seizure at the beginning of July, where I chewed up my tongue and could only eat really soft, bland, room temperature foods for about 2-3 weeks, and that sunk my battleship. I was traveling at the time, so I resorted to eating total garbage like macaroni and cheese, soft cookies, potatoes, and starchy things that I had done so well at resisting in the first half of 2011. Now, here at the beginning of 2012, I’m right back to where I started, maybe even a little heavier. I have some new weight-related goals in mind though, so rather than throwing myself a pity party, I’m going to try a healthy helping of encouragement instead.

Another resolution I had was to go to the ophthalmologist. I’ve written about this experience, but suffice it to say that I did indeed go, and I got my card the other day reminding me to make a new appointment, and it isn’t something I’m as afraid of as much as I once was. I’m calling that an accomplishment.

Other goals and resolutions involved having adventures, paying off some bills, getting diabetes stuff that I needed (like a new medical ID bracelet), and remembering that even though diabetes is ever present, it isn’t the only thing that is important in life. All of those things I can mostly say I succeeded at, and am not opposed to carrying those ideals forward in the new year.

So without further ado, I present my 2012 goals and resolutions.

Goals
1. A1C <= 6.2. Less would be good.
2. Pay off at least two debts.
3. Have an adventure…regularly. Take pictures. (I really can’t emphasize this one enough. It’s a MUST!)
4. NEW for 2012: Drop some heft. Goal weight, 175 lbs. I will re-evaluate once this goal is achieved.
5. NEW for 2012: Complete an urban disturbance/warrior 5K, where you climb walls, jump fire, wade through mud, etc. I don’t know the exact name of these types of races. I just know I want to do one.
6. NEW for 2012: I will have a pool nearby this year, so I’m going to start swimming again. I miss it bunches. Plus, I need to get my bikini body ready for…*cough*…nevermind. Nothing to see here. Move along people.
7. NEW for 2012: Be successful with at least one big thing for diabetes advocacy. Measure of success to be determined based on specifics of the diabetes advocacy activity. That should leave me plenty of room to cause trouble.

Resolutions
1. Wear CGM consistently.
2. NEW for 2012: Find and go to the dentist, in addition to endo and ophthalmologist.
3. NEW for 2012: Exercise at least 3 days a week, even if work, blogging, and rest have to be sacrificed in order to do so. This will help my strength, energy level, blood sugar stability, and entertainment value while strutting around without clothes on.
4. NEW for 2012: Blog consistently, but only if it meets self-imposed quality standards. Or includes a good laugh. Or both.
5. NEW for 2012: Stop letting other people dictate my emotions. Their Jedi mind tricks are no good here.

Yeah…that’s a good start.

The Plus Factor

National Health Blog Post Month, Day 13: Open a book. Point to a page. Free write for 10-15 minutes on that word or passage. Post without editing if you can!

Presently I’m in the midst of a couple of books, magazines, and academic journals at one time. That might actually explain why I am such a slow reader these days. My reading adventures are as varied and overbooked as my daily schedule. The top book that I’m reading at the moment and getting the most joy out of is “How to Be Like Walt: Capturing the Disney Magic Every Day of Your Life” by Pat Williams.

I am presently about halfway through the book, and I absolutely love it. I have deliberately taken my time with this book, savoring it in small portions, because it is a joy to read and I find it so interesting. It chronicles the life of Walt Disney, both from the personal perspective of Walt, but also by the people that he worked with and inspired throughout his life. I’m a fan of Walt Disney to begin with, but I really appreciate the details and stories surrounding Walt’s life, ideas, and inspiration.

You can find something interesting and thought provoking on just about any page in the book you turn to. I can’t say that about most books I read. To honor the spirit of this blog prompt, I opened the book up and turned to page 154, to a section titled “The plus factor.”

Sometime in the 1940’s Walt Disney coined the term “plussing,” a verb meant to give people more than they expect.

Sometimes we get in the habit of only giving people what they expect, and not much more than that. I don’t think we do it intentionally, but we just get accustomed to a certain level of performance and we ride that wave for as long as we possibly can, until events force us to swim back out and seek the next big swell.

I think of my life with diabetes, and how sometimes I don’t want to do the work required to exceed the expectations of myself (which are impossibly high), my endo, or my CDE. I do only enough to get by, and hope that I get a lucky roll of the dice when it comes to my weight, my A1C, or my blood sugar graphs.

Walt would say that sort of behavior is ludicrous, and won’t ever allow me to grow and be my best. I don’t have to be perfect, but “plussing” is saying that I can always do just a little bit more in an effort to exceed expectations, even if those expectations are my own.

Walt was never satisfied with “good enough,” and that is how our life with diabetes is a lot of the time. We always want to have a little bit better blood sugar numbers, a little bit lower A1C, a little bit less weight, a little more exercise, a little bit less carbs. So much of what we deal with is just data, but it’s hard not to assign emotions to all of those numbers, especially when those numbers keep us from achieving something that we want.

“Walt Disney was adamant about quality. He always found new ways to ‘plus the experience.’ He wanted to give people more than they anticipated.” – Dan Viets, Disney Historian and Coauthor, Walt Disney’s Missouri

Dare to plus your world. Even if you have to take a step backward to move forward, always aim for a bit better than where you are right now.

This post was written as part of National Health Blog Post Month (NHBPM) – 30 health posts in 30 days: http://bit.ly/vU0g9J

Monday Motivation

National Health Blog Post Month, Day 7: Case of the Mondays. Write about something that gets you down, burns you out, or makes you sad. Purge it in a blog post. Turn it around at the end. Tell Tuesday why you’re ready for it.

Based on popular opinion (or at least the folks on my Twitter and Facebook feeds), most people are not fans of Monday. Color me odd, but I don’t mind Monday that much. After the weekend, I’m ready to get back to work and get things accomplished.

I like to feel productive. That doesn’t have a specific day of the week for me. Monday provides me with an opportunity to set the tone for the entire week, and get off to a good start. My intent is that by getting things rolling on Monday, the momentum will carry me through to Friday, when I can look back at my list o’ stuff and feel good that all or most of it is crossed off and completed.

Now, not every Monday is that big of a success. But neither is every Tuesday, Wednesday, Thursday, or Friday. I feel like if I spend my day on Sunday dreading tomorrow, then I don’t really have much choice but to have a sour Monday.

It helps me to set goals for my week. I need to feel that sense of accomplishment, like I’m doing something progressive, getting things done, and moving forward.

This week, for example, I’m going to try to wear my CGM all week long. I’m really having a difficult time wearing it lately. My slacking has resulted in me watching my BG’s tick upward (and I HATE being high with the fire of a thousand suns), along with my BG averages and probably my A1C too. I’ve had sensor errors galore, gushers, and now the few sensors I have left are expired, so I’m trying to get as much use out of them as I can before they all quit working and I have to throw the remainders in the garbage. I’ll get new ones on my next supply order, so I’m not overly concerned, just trying to make those diabetes supplies stretch.

I’m also going to go to spin class at least twice this week. Spin and the gym is yet another thing that I’ve been slacking on lately, and the way my clothes fit is bringing it more and more to the forefront (and waistline) of my attention. I’m not going to start the week saying that I’m going to go every single day. I won’t. Not yet. I need to ease back into it. Two or three 45 minute sessions of spin should be a great start to turning the beat around.

I’ve got some work things to do, and I’m sprinkling in some blog posting, spin classes, and CGM wearing to get my Monday started off right. What’s your Monday motivation?

This post was written as part of National Health Blog Post Month (NHBPM) – 30 health posts in 30 days: http://bit.ly/vU0g9J

Mt. Pwned

Last Saturday was a beautiful day off and a beautiful day outside. After sleeping in a bit, I decided to go for a bike ride. I checked my blood sugar, everything was fine, so I dawned the bike gear, grabbed my road bike and took to the streets. I felt good, and was excited about the ride: Just me, the bike, and the road.

I made it 2.6 miles into the ride and was climbing a steep hill with gusto when I bonked, a term commonly used in cycling or exercise when your body stalls and you just can’t go anymore. I’ve hit that wall before while on long rides, but never less than three miles into a ride.

My heart rate spiked. I couldn’t breathe. I had no power in my legs. I couldn’t catch my breath. I was seeing spots. There was no choice in the matter, I couldn’t even make it to the top of the hill. I had to stop before I blacked out.

I coasted into a driveway, unlocked my cleats from the pedals, and put my feet down. What was happening to me? Was I low? How could I be low after I just checked only a few minutes ago? I laid my bike down, then proceeded to spew what little bit of water that was in my stomach onto someone’s well-manicured lawn. Fortunately, north Florida has had an extremely hot and dry summer, so those nice folks that lived in that house probably didn’t mind the extra water. After I caught my breath enough, I grabbed my phone out of my back jersey pocket and called A-Flizzle to come and get me and my trusty steed.

That. Never. Happens. And to be honest, it scared the spandex out of me. It was probably the worst bike ride I’ve had since I started cycling six years ago, and I’m still not sure what went so wrong. My blood sugar was fine. Maybe I simply got sick. Maybe I didn’t eat enough before the ride. Maybe I’m more out of shape than I thought, even though I’ve done plenty of spin classes and I did a 24 mile road ride less than a month ago. Maybe my extra weight that has been mentally plaguing me has become a physical problem. Maybe I just took the climb too hard and had an adrenaline overload. Maybe I have no clue.

I do know that I’m setting a new rule, effective immediately, to move around for at least 30 minutes every day. If I can do more, like a spin class or a couple hours in the gym, fantastic! But if I’m busy, and I can do nothing else, at least I’ll have that 30 minutes, even if it is just going for a walk. Surely I can find at least 30 minutes to spare.

It’s already cold here in north Florida (or “cold” as all of you in areas that actually see snow would call it), and I hate being cold. What better way to warm up than moving around? I’m declaring this Winter training season. I have to find a way to make moving around a priority, every single day. Mornings and me do not get along at all, but if that means I have to start waking up early to go to the gym before work, so be it. Or if I have to go late at night (which is more likely), so be it. If I don’t make it a priority, then it will never become one. Plus it’s warm in the gym, so there’s that.

That hill scared me, but fear is not a motivator. Now that hill is taunting me, teasing me, begging me to get back on the bike so it can try to beat me again. I’ve got news for it though. It won’t be long before I stamp my name all over that mountain, and declare it Mt. Pwned.

Resolved

Last Friday I had the privilege of attending the 6th Annual Education Forum on Diabetes Prevention & Management in Tallahassee, Florida. Throughout the day there was talk about all of the various types of diabetes and their differences, along with the growing number of diabetes diagnoses, the obesity epidemic, the lack of education about the beneficial impact of fitness on the human body, and other topics.

One discussion panel consisted of diabetes educators from rural areas, mostly working with their local health departments rather than a diabetes center of some sort. Each of the professionals shared what their communities were doing to educate people who are at risk for Type 2 diabetes, to help those with any type of diabetes to get the resources that they so desperately need, and to help them navigate the often confusing world of healthcare.

One of the panel members, like so many others that took to the microphone throughout the day, spoke about her personal connection to diabetes and how important it is to her. My ears always perk up when I hear someone sharing their diabetes story. We all have a unique diabetes story, and we find common ground in our shared experiences in living with diabetes on a daily basis.

I heard this panel member trying to share her connection with diabetes from her rural perspective, and her view of the importance of education and helping people to learn the skills they need to effectively live with diabetes. She said, “I understand, because I used to have diabetes, but mine has been resolved. My husband still has diabetes, so it is very important to me.”

I looked up from my iPad, where I was taking notes, and probably had a look of “Huh?” written all over my face. “Used to have diabetes?” I’ve always been taught that there is no cure for diabetes, regardless of what type you have. Sure, there are options if you have Type 2 diabetes, including lifestyle changes and medications, but you still have diabetes even if you are able to avoid medications. Diabetes is a progressive disease, and you have to stay on top of it in whatever way works best for your unique situation. They don’t say “your diabetes may vary” for nothing. For Type 1, there is far less gray area for lifestyle adjustments: Insulin or death, pick one.

At first it agitated me that this woman, a diabetes educator, a representative expert on diabetes in her rural community, was proceeding and educating others with the presumption that diabetes was something that could be “resolved.” To me, that implied that diabetes was somehow the fault of the patient, which is not always true, and certainly is not a fair assumption without looking at many other aspects of the individual’s health. Initially, it felt to me like she was blaming her patients for having Type 2 diabetes, which I do not agree with.

Blame does nothing but remind someone of the circumstances that they are in. Blame looks into the past, not the future, and keeps us focused on what we should have done, as opposed to what we can do now.

I said at first it agitated me, because the more I thought about her words and her perspective, the more I came to realize that maybe her choice of words is a direct reflection of the rural community she is trying to help. Rural communities are often lower income, lower educated, often economically challenged, and without extensive healthcare options within the community area. Given this, for the people with diabetes that she is trying to help, it may be easier and more effective in managing diabetes within the community if they proceed with the idea of:

Losing weight + eating healthy + exercise = diabetes resolved.

As opposed to:

Medications = I have diabetes.

I know this equation doesn’t work for everyone, but I decided to give her the benefit of the doubt, because maybe it works for a majority of the patients in her care. Thinking about it from that perspective, it is certainly a lot easier to inspire people to take care of themselves when they can have a goal of “diabetes resolution.” For a rural community that simply does not have the resources to help every single person with Type 2 diabetes, and the community members themselves may not be able to afford medications, prevention and “resolution” may be the most effective options.

At first I wanted to jump up and say, “There is no cure for diabetes! You can’t give people that false hope! That isn’t fair!” Then I thought about it some more, and even if we find hope and can place our faith in things that under a microscope may not be completely accurate, if it gets us to a better place where less people are dying from diabetes, then I can certainly accept that bigger win in the long term.

Back On Track

188. That is the number that greeted me Saturday when I stepped on the scale to see just how bad things were. After making significant progress in losing some of my heft, making as much progress as getting down into the mid-170’s by June of this year, at the beginning of July I had a bad diabetes moment, and despite my intentions to throw myself back into exercise and eating low carb, I’ve really lost focus.

My clothes fit a little more tight than they used to, and certainly more tight than I want them to. I look at myself in the mirror and I’m not happy with what I see. I want to look and feel sexy, and make the mistake of asking my reflection for my phone number when I walk by. I need to get new clothes too, as most of my clothes are well worn, some even with holes in them. But I refuse to go buy them when I’m at a weight and size that I’m not happy with. I don’t want to buy the size clothes that I am. I want to buy the size clothes that I want to be.

I’m also tired all the time. I don’t really sleep that much, and when I do it is restless and dream filled. Part of that is because I’m stressed all the time. I feel like I have for more to do than I have time to do it, all the time. It’s not just work, or life at home, or people I need to see, or things I need to do. It’s just the culmination of everything. It’s as if I can never get enough accomplished, and despite my generally optimistic view of the world, lately I feel frustrated because I end every day with a list of things I didn’t get done.

My eating habits are just plain gross since July. When I had my seizure, I really chewed up my tongue and mouth. For two weeks I could only eat soft foods like macaroni and cheese, applesauce, soft cookies, breads, and sometimes soup if it wasn’t too hot. Because I could barely chew or move food around in my mouth with my tongue, it completely broke down my low carb routine that I had been sticking with and was doing so good at keeping up. Now, because my routine changed, I’ve gotten accustomed to foods that I can eat fast, because I don’t have a lot of time to stop and put together a meal that is healthy and good for me. Rather than a breakfast made of something in the 20 grams of carbs or less family, I end up grabbing the blueberry or banana nut muffin that is 58 grams of carbs, just because it is fast, easy, and available. Rather than opt for a healthy salad or protein heavy lunch and taking time to pause and use both hands to enjoy it, I end up with the carb loaded option that I can eat with one hand so I can continue working with the other.

Emotionally, because I feel so far off track, I’m not happy. Sure, I still have a good time with friends, when I can find the time to get to hang out with them at least. A-Flizzle and I still enjoy doing things together. It’s not a social unhappiness, but rather a disappointment in myself for putting back on nearly all of the weight that I was so proud of myself for losing in the first half of this year. I don’t like the way I look, and I don’t like the way I feel.

So, all that said, the first step is looking at the situation objectively and admitting that there is a problem. Now what?

I looked over my 2011 goals, and I still have a lot of work to do, but I’m not severely off track. I got my A1C down, I joined a gym and started taking spin classes to have a group of people to regularly pedal with, I paid off my insulin pump, I’ve gotten to have adventures in Washington D.C., New York, New Orleans, Tampa, Orlando, Jacksonville, and I celebrated 30 years with diabetes and jumped out of an airplane.

I still struggle with wearing my CGM every single day, I haven’t ran a 5K, I haven’t made it to the dentist yet this year, and obviously (given the topic of this blog post) I haven’t made it to my goal weight yet.

I’m making an effort to be transparent. I want others to know that diabetes isn’t easy, but there are other things in life with and without diabetes that are also challenging. I’m going to get back on track. Maybe it’s shallow, but I want to look in the mirror and like what I see, so much that I throw dollar bills at my reflection.

Starting yesterday, I’m back in the gym. My BG’s are better when I’m active and working out, my disposition is more positive, and in time it will all translate to a lower number on the scale and a higher number on the miles I can go on my bike and the things I can accomplish with my body. I have to make time to do this, for me, and I have to stick with it, stay motivated and encouraged, and share my progress. That means my friends on Twitter and Facebook get to endure my constant status updates about my gym adventures, how I’m in spin class, working on my core, flexing in front of the mirrors, and looking like a complete amateur with my weak self trying to bench press and look all hard in front of all the juice heads.

I may not accomplish every one of the goals I’ve set for 2011, but I’m okay with that. If you achieve every single goal you set, you’re not setting them high enough.

I will feel better about myself and my body. I will get back to liking what I see in the mirror, enough so that I sneak my reflection a high five or a wink when nobody else is looking.

Right now I’m telling myself, “Self! You can do this.” And I will too.

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	Heather Gabel on Diabetes as a Disability