food

Numeracy

Unconscionable Numeracy

Last week at the 6th Annual Education Forum on Diabetes Prevention & Management conference, I witnessed clinical healthcare professionals learning and sharing about the impact of diabetes, issues from the patient perspective, issues from the healthcare professional perspective, and enough data and PowerPoint slides to make Bill Gates proud.

Two presentations really stood out to me. As a person with type 1 diabetes, or a type 1 diabetic if you prefer (you say “noo-tella,” I say “nuh-tella”), I gravitated toward those portions of the conference that I could identify with the most. I like hearing various perspectives of my particular flavor of diabetes, especially from the side of people who work with and deal with diabetes without having the disease themselves.

First, there was a presentation about numeracy.

Numeracy: adjective; able to use or understand numerical techniques of mathematics.

In other words, numeracy is the ability to understand and use numbers in our day-to-day lives. Those of us with diabetes, especially type 1 diabetes, do it all the time, seemingly without thinking because we’ve done it for so long that it has become almost habit. We can do carb and blood sugar math like it’s nobody’s business! For example, I know that my insulin to carb ratio is 1:8. That means if I have a meal or a snack with 20 grams of carbs, I’m going to have to take 2.5 units of insulin to cover it so that my blood sugar doesn’t spike and make my head explode. (Not really, but my blood sugar will go high, and I hate, hate, HATE being high.)

I loved this presentation because the presenter really linked it to the patient perspective of living with diabetes. She highlighted the fear of all the numbers that sometimes paralyze us to take action. That applies no matter what type of diabetes you have. She said, “Something that healthcare providers have to realize is that if we make a mistake in math in our checkbook, it’s really no big deal, but if a type 1 makes a diabetes math mistake, they can die.” There is not a lot of room for mathematical forgiveness with type 1 diabetes.

Numeracy

The next presentation I went to was awesome because the presenter was my endo. I love my endo, so pardon me a minute while I gush. I really appreciate him because, even though he doesn’t have diabetes himself, he gets what it is like to live with diabetes as well as anyone I have ever met. He was sharing with the room some of his experiences with helping children and parents adjust and learn to live life with type 1 diabetes. Having grown up with diabetes myself, since age 2, I could appreciate a lot of the stories he had to share; many of them could have been about me.

He opened his presentation by telling every single diabetes and healthcare professional in the room that “it is absolutely unconscionable what we ask people with type 1 diabetes to do to stay alive.”

Unconsionable: adjective; not in accordance with what is just or reasonable.

Yes, yes, and more YES! I’m paraphrasing here, but he explained that sustaining the constant counting and checking and pricking and poking and dosing and everything else it takes to live with diabetes is really not reasonable or realistic. He said, “Albert Einstein said that doing the same thing twice and expecting different results is the definition of insanity,” then added, “…except with diabetes.” A person with diabetes can do the same exact thing and eat the same exact foods for two days in a row and get totally different results. The best that can be hoped is that people with diabetes will do as much as they can.

Something that I’ve always appreciated about him, and the reason he is still my endo even though I am 32 years old (still a kid at heart people, don’t get it twisted!), is because of the perspective he shared at the end of his presentation. He said that in his practice, he refuses to tell a person with diabetes to “test” a blood sugar. A test you can pass or fail. A blood sugar check is just a check, returning a number that is neither good or bad, just possibly something that needs to be addressed. All these numbers that come with diabetes are just data. Just. Data.

What we have to do to live with diabetes may sometimes be unconscionable, but the numbers that we see staring back at us should never be that. We have to learn to use all of these numbers in our diabetes world to make decisions, and react to the best of our abilities.

That has to be enough.

Stop Diabetes

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.

Stop Diabetes

The New World Of Martin

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.

The New World Of Martin

Lying Sweet Potatoes

Never Trust A Sweet Potato

Wednesday was one of the hardest days with diabetes I’ve had in awhile. Well, at least since this day, which actually wasn’t that long ago. But anywho…

This episode began on Tuesday night, when I noticed that my blood sugar was stubbornly high after having dosed enough insulin to take down a small rhino. I thought I had dosed correctly for the sweet potato that I had for dinner, but apparently sweet potatoes put on a good show, with their sweet and seductive scent, but they are actually full of lies and half-truths when it comes to their nutritional info.

Lying Sweet Potatoes

This is a Public Service Announcement: Sweet potatoes are not to be trusted!

I woke up with a BG of 235 mg/dl on Wednesday morning, which I attributed to the fact that I probably didn’t dose enough before bed. Not a huge deal, go-go-gadget correction bolus, and it was off to work I went.

The correction bolus should have done the trick. Instead, my BG wavered a little, but mostly it just hovered in the mid 200’s all morning. For some, that isn’t that high and they can go all day long in that range and not be out of sorts. For me, it made me want to dig a hole and throw myself into it. I’m accustomed to numbers closer to the 90-100 range. I had a headache, I was nauseous, I felt like someone had replaced my blood with syrup, my insides ached, I had no energy, I wanted to go lay down, and all I could focus on was how awful I physically felt.

After giving the insulin plenty of time to work, and still being high, I corrected again. I wondered if maybe the morning BG spike had also included the dawn phenomenon, along with the errant sweet potato bolus, so maybe that was why my BG was being stubborn and not dropping down to normal.

I tried to get into working and distract myself from the awfulness I was feeling, and give the whole situation a little time to work itself out. Apparently it worked too well, because by lunch I had dropped down to 45, after ignoring my CGM alarm and then getting busy and forgetting about it. For future reference to you CGM-ers out there, don’t do that.

Lately I’ve been working through lunch, only to look up at the clock and realize it is mid-afternoon and I haven’t stopped to eat yet. Since I was at 45 and low brain had kicked in with full force, I quickly grabbed some chicken nachos for lunch. I figured there would be enough carbs in that to cover the 45, but not so many that I couldn’t easily manage a proper insulin dose for it.

I thought I dosed properly for it. I even looked up the nutritional info online. Still, I was back up to 245 by the end of the workday, and also back to feeling like someone had replaced my insides and physical well-being with frustration flavored Jell-O.

I remained sky high for the rest of the afternoon and well into the evening. By 8 o’clock that evening, I was physically ill. I thought I was dropping at one point, and that it was safe to eat and dose for dinner, so I had one serving of eggplant parmesan so I didn’t skip a meal and end up low again. Unfortunately, the eggplant parmesan had much more of an effect on my blood sugar than the insulin I had dosed to cover it.

I can’t say for sure, but I really think I spent all night and day dealing with insulin that had lost its mojo, its libido, its life force, its essence, its right stuff. What the French call a certain… I don’t know what.

Once I got home, I cracked open a cold one (a new vial of insulin, that is), refilled my pump, and my BG’s since then have been rock solid and right where they are supposed to be.

Moral of the story: Beware of skunky insulin. And never trust a sweet potato.

Diabetes Art Day 2011 - Family

The Big & Small of Diabetes

Diabetes is sometimes larger than life.

Big Prescriptions

There are all these really BIG prescriptions, written with really BIG pens.

Big Fingersticks

Then you've got all these BIG tests you have to take.

Big Pizza

Sometimes you get to eat really BIG food.

Big Shots

But then you have to take really BIG shots.

Big Success

And if you do it right, you end up a BIG success.

All the BIG things that go along with diabetes are important, but it helps to remember the small stuff too.

As A-Flizzle reports…

I think most people would consider me creative, but not artistic. I love crafts, but I also like detailed instructions on how to get it “just like the picture.” What can I say? I have OCD and am a type A personality to a tee. Nevertheless, I was very excited when Martin asked me to participate in Diabetes Art Day and make something that expressed how I feel about being a Type Awesome. I feel like the whole undertaking of the craft project brought us closer together and, of course, was so much fun!

Diabetes Art Day 2011 - Family
This is what I consider my “family” (featuring Martin’s dog, Hopper, but absent my dog, Bindi and Martin’s cat, Squirt) and how sometimes I feel like Martin is in a bubble with his diabetes, where he takes on too much all on his own and no matter how supportive I am (as evidenced by my “Good Job” ribbons) there will be some things I just can’t and don’t “get.” This is perfectly okay, but a hard pill for me to swallow, as I am a fixer and like to take care of people. In the end, I think we are both continuously working to pop the bubble and find a greater understanding that while it’s his disease, we are in this together.

Pump Double Vision

Double Vision

So last night after work was fun. I left the office on time and made a beeline to the grocery store. That means I went directly to the store, without passing Go, and without collecting $200, for those of you that aren’t familiar with insect street slang. I wandered around the store looking for Italian bread crumbs, tomato sauce, and rat poison. Yes, I have strange grocery lists. You should see what happens when I go shopping for birthday gifts.

After the grocery store, I stopped by my house to let the dog out and change out of my work clothes, then went over to A-Flizzle’s house so we could make dinner. We were trying an eggplant parmesan recipe that she found. Don’t worry, I couldn’t find rat poison at the store, so there was no foul play involved. Or fowl play, for that matter. Vegetarian, for the win!

When I got there, A-Flizzle had all of the ingredients and baking dishes and bowls and forks and spoons and knives (oh my!) out and ready to start putting the meal together. One problem: I couldn’t read the recipe. As I tried to study the paper, all I could make out were fuzzy words like “mix” and “lightly” and “weight watchers.” Wait a minute…Weight Watchers? Are you trying to tell me I’m…oh, nevermind. It’s just a recipe.

I stopped trying to read and went to my Adidas backpack (aka, man bag) that I carry everywhere with me and fished out my BG meter. Sure enough, 47. Well that explains why I couldn’t read anything. I found my glucose tab keychain and ate glucose tabs, and then went back to the kitchen and struggled through the recipe. The more I tried, however, the more my vision blurred, and eventually I was seeing complete double. I already have glasses! Cut me some slack here diabetes!

30 minutes later and an eggplant parmesan in the oven, I tested again, and BG was 74. Still, I had complete double vision. Defeated, I went and stretched out on the couch and just closed my eyes, determined to give my body a few minutes to catch up and get right.

Pump Double Vision

Just Sunday, A-Flizzle and I were out and about and I had a BG of 37 with absolutely no symptoms at all. She said to me tonight, “How is it that you can have a BG of 37 with no symptoms whatsoever and I’m the one freaking out, but then your blood sugar is 74 and you can’t even see clearly?”

Wait for it…

“Oh, I know why. It’s because you have diabetes.”

She’ll be here all week folks. Don’t forget to tip your waitress.

Giant Chicken

Wrestling with The Giant

It has been a couple of weeks since I’ve put together a solid blog post. I’ve been busy. I’ve been traveling. I’ve been exhausted. I’ve been preoccupied. But mostly, I’ve just been out of whack.

Normally, my blood sugars are prone to running low. I can be eating and run low. It’s just the flavor of diabetes that I’ve been blessed with, despite the basal testing and best precautions. The past couple weeks though, I’ve found myself in the 200’s on more than one occasion. At work sometime around mid-morning, 229. Before spin class, 250. A few hours after dinner, 240. Granted, I still have an occasional low, like yesterday’s lovely panic-laced BG of 37, but still. I hate running high.

Since I am accustomed to running numbers in the double digits rather than triple figures, I can feel every single mg/dl of a 200+ blood sugar. It makes me tired, it makes me irritable, it makes me unable to focus, and it makes me wonder what in the Sam Hill is going on?!

To try and figure out where this out of whackedness is coming from, I figure it’s worth taking a step back and looking at the bigger picture. I can’t keep proceeding like this, so I have to find out where my stresses are, and remove them.

So my blood sugars are higher than normal. Why? The first guess is something to do with my diet. I will admit that I’ve had a few more carbs in my meals than I should have lately, but I’ve also started back at the gym for the past three weeks. I need those carbs for fuel. I’ve discovered spin class at the gym, and I can’t keep up the pace for 45 minutes that burns calories, gets my heart pumping, and leaves my entire body covered in sweat if I don’t have the proper fuel. My blood sugar can easily drop 100-200 mg/dl in one single spin class, so it requires a careful balancing act of fuel in and power out. Still, if I’m being honest with myself, I probably don’t need ice cream, pizza, or Chinese take-out to fuel my gym experience. I know I could do a bit better job. But is that it, just my diet that could use a little fine tuning?

Being tired is easy to understand. I don’t sleep enough. But why am I not sleeping? Probably because I have way too much on my mind lately. My mind is all work, responsibilities, money, worry, friends, family, never feeling like I am getting enough accomplished, needing outlets and not being able to find them, not being able to share and say what I really think about things, not getting the support that I need, keeping way too much bottled up inside…too much thinking!

Or maybe too much coffee. Naa…no such thing.

Ironically, I can’t focus because I have too much to focus on. To give one thing my undivided attention, I stress out over everything else that gets ignored and suffers. It’s this constant vicious cycle that keeps repeating over and over, and meanwhile I feel like I’m falling further and further behind.

As you can see, it isn’t just one thing that is the challenge that must be overcome. It is all of it added together that makes it a giant. I don’t know what the exact solution is, but I know I have to keep trying, and hope that I’ll find a way to bring this giant down to size before he looks at me and says, “Hmm…tastes like chicken?” and then eats me alive.

Giant Chicken

Today I’m going to put a new CGM sensor on my body, and I’m going to pull the rug out from under these high blood sugars at least. I hate them. They make me feel awful. So goodbye to them. I’m bad about taking breaks away from CGM, but I didn’t get it just to look at it. I got it to warn me of when there is a problem, diabetically speaking. Be it warning me that I’m high or low, the CGM has a purpose, and I’m not giving it a fair opportunity to help me when I’m not wearing it. And clearly, I need the help right now.

I’m also going to resign myself to focusing on just one project, at least temporarily. Not 30 projects and things that I need to get done. Just one. And I’m not going to stop until that one is done. Because then I will have 29, instead of 30. And that is progress, no matter what speed it travels at.