Linky Bits…
It’s been a bit of a crazy week – it’s amazing what activities you’ll plan for yourself when you’re not working out. I seemed to think that I have extra hours on end due to not hitting the gym. Note to self: cool it. Therefore, I’m a bit light on posts this week, but here’s a few links to happenings that have perked up my ears lately:
Type 2 diabetes is STILL on the rise in California, and it’s still hitting minority populations disproportionately. With elections coming up and health care reform already in motion, diabetes is a more pertinant issue than ever. Beyone the lives at stake, diabetes is one of the most expensive issues in America these days – between lost work days and the cost of this disease, it could sink us faster than a double dib recession.
Newly diagnosed with Type 1 diabetes? Then you could be eligible to enroll in a clinical trial studying a medication that might help preserve beta cell function and halt Type 1 in it’s tracks. Click here for the details and sites where you can enroll.
In artificial pancreas news, it looks like MannKind Corporation will be providing their newly formulated, super rapid acting, oral insulin to the project. Check out their press release for details on their contributions to the project, and let’s all begin the countdown until a closed-loop system is available. I know I’m ready.
And if you’d really rather just waste some time today because you’re over it, look no further….
Low carb love…
This past weekend was action packed – it involved one bar-b-que, one outrigger canoe race, one outdoor movie night, one 25-mile bike ride over the Coronado bridge, and, thanks to a certain awesome boyfriend of mine who happens to be a Top Chef-quality culinary artiste, several super low-carb meals that kept my BGs cruising nice and normal throughout the weekend. I was amazed at how little insulin some of these meals required - I just had to share them with you readers out there. The benefits to eating this way are that I require much less insulin and find much less variability in my blood sugars throughout the day – both welcome items given my semi-sedentary state while I’m letting my joints take a break.
Friday night we made faijtas with low carb tortillas – there’s a few brands that offer tortillas with only 10 grams of carb per serving. I had two tortillas topped with seasoned chicken and veggies, sour cream and cheese (plenty to keep me full) and still only had to bolus 2.2 units for the whole meal. Unfortunately, those went down the hatch so fast that I failed to take a picture.
Saturday we left the house around 10am, but not before loading up the crock pot with seasoned turkey meat and tons of veggies. We arrived home around five that evening to the delightful aroma of turkey chili. Again, a low bolus and a very satisfying meal – boo ya.
Sunday however, was the piece de resistance – and pure heaven for anyone who knows me as the cheese hound I am: fondue. Real, creamy, hot off the stove fondue. Instead of dipping the traditional high-carb bread chunks in there, we used grilled meat and lots of fresh vegetables – some cooked for flavor and others raw for a good crunch. This meal was
super low carb, but I had to account for the massive amount of cheese and the fat in it that would break down more slowly. Instead of bolusing for this one, I raised my basals by 35% for the six hours following the meal, and saw nary a blip in the DexCom all night long. All around diabetes meal perfection and a VERY successful blood sugar weekend, even with all of our activities. I can’t ask for anything better! And that adorable fellow in the photo below certainly helps 
Putting me back together…
Soooooo, two doctors appointments and approximately 9 kajillion x-rays later, I think I’ve got a plan for putting my body back together.
Upper limbs first: My hand doctor was disappointed to hear that I still wasn’t at full strength in my right hand, a year plus after carpal tunnel surgery, so he immediately took some x-rays to make sure there wasn’t something weird going on. Upon finding nothing out of the ordinary, he surmised that I had probably lost quite a bit of strength even before I had surgery last year, meaning I was in the hole by the time I went under the knife. He was pleased to hear that I wasn’t struggling with anything day-to-day, like carrying groceries or driving, but more when I did high-impact stuff like push-ups and tricep dips. He prescribed some physical therapy that would focus specifically on building strength instead of mobility like we did right after surgery. And although hand PT isn’t the most exciting activity in the world, sometimes they let you dip your mitt in a hot wax bath, which I’m personally looking forward to!
Moving down this train wreck of a body I have going on here, my knee didn’t seem to concern the doctor so much. I still have a tilted right patella (full name: lateral patellar tracking issues), and the doctor expected this to bug me more when I did high-impact activities like running. The x-rays revealed nothing had changed since last year, so nothing in my regimen (read: ice packs and ibuprofen) needs to change either. That thing is gonna bug me when I run or wear heels a lot. Period, get used to it. I was ok with that, but I was rather unprepared for the reaction my doc had when he began testing my hip to isolate the pain.
I hopped up on the table and as soon as he pushed my right leg to the outside, I winced from the pain in my hip. “Not good” he said, and brow furrowing ensued. He studied the x-ray to ensure there wasn’t a bone fragment catching on the hip socket, which can easily cause that kind of pain. After reviewing the pics and finding nothing though, I fessed up about my nearly eight year martial arts hobby, and he knew immediately that we’d found the culprit. My hip problem: overuse while doing a completely unnatural motion repetitively; namely, roundhouse kicks.
Roundhouse kicks are the most common type of kick used in kickboxing, and the fact that I did competative karate for four years and have been kickboxing since 2007 means I’ve put both my hips through thousands of mega-rotations with every kick. A roundhouse kick involves taking the back leg from a boxing stance and rotating the hip joint to move the leg out to the side, raise it up to head-level, and then kick inward, with the impact being on the top of a flat foot as you strike your target. Long story short, it’s not the gentlest or most natural movement for the human leg, and I’ve been doing it hundreds of times a week for eight years. This hip is simply tired and needs a break.
Which would be no big deal if kickboxing were not my most favorite activity in the universe, but unfortunately it is. I have to take a break and let my hip heal a bit, or I could be in real trouble down the line. Taking a break from my favorite sport reaches an all-time high level of lameness, but it’s what has to happen. My doc also said I need to work on strengthening my inner quads to help protect and strengthen my legs all the way up. This means my kickboxing classes need to be traded for some good old-fashioned weight sessions, with a concentration on those muscles. In addition, I might have to resign myself to some walks/hikes instead of running, and dial back on anything else that could irritate my joints – like wearing heels for work.Finally, I’ve also been prescribed some physical therapy to learn special exercises I can do to strengthen and protect my hip and knee.
All around, I’m not stoked about what the next five weeks look like, exercise-wise. Exercise is my sanity – my time alone to blow off steam and take care of myself. Not to mention to help manage my diabetes – I’m already afraid of what this change in activity level will do to my BGs. But, at the same time, I’m thankful that it’s not more serious and that I have some options here. I don’t want to be confined to a walker by the time I turn 30, so I have preserve what I’ve got right now. Yoga anyone?
Low moments.
I felt the low start to creep in about 15 minutes after lunch. I was just a little lightheaded, and had the telltale heaviness to my body that I get when a low starts to set in. In the middle of running errands, I was annoyed to have to deal with this. I sighed as I reached into my purse for a GU pack. It was the last one I had with me.
I gulped down the GU and headed for the check out of the store, a thin line of sweat starting to bead on my lip. I feel like crap, I thought to myself. I pulled out my DexCom and saw the arrow pointing straight down. I told myself to calm down and wait for the GU to kick in.
By the time I walked out of the store, my vision had started to blur and I felt weak in the knees. The drops of persperation on my lip had broken into a full-fledged sweat. I limped to my car and snatched my glucose tablets out of the center console. My hands shook as I twisted open the cap and began shoveling the powdery tablets into my mouth. My head spun, I felt faint, and I had to concentrate on the act of chewing the tablets. I swung my feet out of the car door, dangling them like a Muppet while I forced down the chalky sugar. I felt so shitty I wanted to cry. This was the worst low in a long time.
I moved back into the driver seat, full well knowing that I wasn’t driving anywhere for at least 15 minutes. I cranked the AC as I poured sweat, my body’s reaction to the extreme lack of glucose. Help me! my brain screamed, SUGAR. NOW. it begged. Just wait, I told myself, you’ve had 40 grams of carbohydrate at this point, it will come back up.
And it did come up of course. But not before I had lost almost 30 minutes of my day. Not before I ingested 200 extra calories after a full lunch that I didn’t want. Not before taking me to almost passing out. Not before making me feel like a failure for forgetting the insulin on board from 10am that had caused me to stack my lunch bolus. Not before sucking the life out of me for the rest of the afternoon.
Sometimes, I really hate this disease.
Guest Blogger Matt Neal – BMX rider, Type 1, and all around badass!
Hey guys! I am so excited today to have Matt Neal guest blogging for me. Matt was diagnosed with Type 1 diabetes last year at the age of 28, just as he was on his way to building a successful BMX bike riding career. But read his story below and you’ll find out that Matt doesn’t let that hold him back – in fact, he’s taken on diabetes management with the same passion he has for BMX riding – and in the process is showing everyone that he won’t let that – or anything else – hold him back! I loved reading his story to learn how someone with an unusual sport manages their diabetes, and I know you guys will enjoy it too. Take it away Matt!
My name is Matt Neal and I have been very active my entire life. I always enjoyed being outside and playing sports when I was a kid. I went to school with a few kids that raced BMX and I enjoyed riding with them after school. I kept bugging my parents to let me start racing with them. Finally, my dad took me out to the BMX track for my 10th birthday. I was hooked! I loved racing and started taking it more seriously after a couple of years.
I was very fortunate to be able to travel around the country racing different events. I was even more fortunate to experience a great deal of success in the sport that I loved. I was top 10 nationally in my age group for several years and I even got 2nd at the world cup when I was 18. I turned pro for a few races at the end of my career before hanging my bike up to finish my degree.
Fast-forward about eight or nine years and I got the itch to get back on my bike. I started riding again and went to a couple of national events. I was riding decently for not racing for so long but I was a little off. I didn’t feel like I had the power that I should and I started losing weight, a LOT of weight. I couldn’t gain a pound to save my life and I knew something was wrong.
I completed a health screening at work and my fasting blood glucose was 358 and my fears were confirmed, I had diabetes. I was officially diagnosed Feb. 20, 2009 with Type 1 at the age of 28. Believe it or not, I felt very fortunate to have a manageable disease. I took some time off of my bike again to get a handle on my blood glucose and I knew I wanted to race again. So that’s exactly what I did! I started racing at the beginning of this season. I’ve been doing really well so far. I have two wins in the Arizona State Series and I have won a national main event!
Diabetes adds a whole new challenge to racing BMX. I test my glucose levels a LOT on race days. National races are especially difficult because you don’t know exactly when you are going to race and the races take place all weekend long. They are also challenging because my adrenaline tends to raise my levels. My target level for race time is 150 mg/dL so I always keep my meter, insulin, and carbs close by. I recently started using the Dexcom CGM system. I have raced one national event with it and it was awesome to have the extra data. It helped me to keep my levels stable all weekend long and made it easier for me to be close to my target before all of my events.
The main thing I try to do to optimize my blood glucose at races is to make small adjustments. I try to eat small meals and snacks throughout the day to avoid having big spikes or crashes. It also helps so I don’t have a really full stomach when I need to race. I tend to have a few extra carbs at breakfast to bring my levels up. If I have a tougher race coming up and I know my adrenaline will be kicking in, I will try to get my blood glucose up to about 120 mg/dL because I know that adrenaline will take it up even higher while I’m warming up. If I know that I have a while before I race I will take a small correction to bring my levels back down to 100 mg/dL and then eat something to pick me back up when my next event gets closer.
After the race day is over, I try to have a few extra carbs at dinner to replenish/refuel and make a small correction to bring my levels back down. I make sure not to overcorrect because I tend to run lower the day after as my body is recovering and using up more glucose.
Overall, racing BMX with diabetes has been a good experience. It makes me feel even better when I beat other people who don’t have to manually control their blood glucose all day long. It makes those wins even sweeter!
Relief…for now.
Phew. It’s over, and the news was good – another complication-free eye exam has passed, and I’m another year deep into living with diabetes without any issues. Victory dance ensued in the parking lot of my doctor’s office. No – really.
As I mentioned before, that eye exam conjures so much emotion in me – it’s as if the fears of complications I keep tucked in the back of my mind are unpacked right before that appointment. And although fear can be a powerful motivator, it’s not my weapon of choice.
Kerri Sparling, my personal hero and favorite d-blogger, posted recently about a video that’s circulating “to create awareness about diabetes” for World Diabetes Day. And although I’m all for awareness, I don’t like fear tactics. Threats about losing limbs and sight have always been a reason for me to keep my diabetes in check, but the real motivation for me actually stems from the hope that I can live without any of those issues if I work hard. The difference is the fear of something going wrong versus the hope that nothing will – for me that’s a positive spin I need to put on things to stay motivated. As I’ve said before, if I let the dark rainclouds of fear come creeping in here too often, I feel like giving up. But hope, well hope keeps me happier.
But fear seems to be the weapon of choice for many providers out there. I can’t tell you how many patients I’ve talked to who have been threatened with lopped off limbs or losing their sight by their doctors. And working in the industry, I know waaaaay to many people who don’t take this disease seriously and need a healthy dose of that tough love. I also know firsthand from providers that they have patients who just won’t do what they have to do to stay healthy – fear might be the only option that gets results. But what would the right motivators look like in a perfect world? What would be the ideal way for us to have patients take care of themselves? And is fear appropriate to use when all else fails?
What motivates you guys? Do you use that fear to keep yourself in check? Or does positive thinking help keep you on track. I’d love to hear from any providers out there as well – how and when should fear be leveraged as a compliance tool?
The ‘betes burden.
Walking back to my car after a visit to one of my customers, I had an interesting interaction. I wasn’t quite sure what to make of it, but it got me thinking.
I was carrying a branded bag on my arm containing sales materials, and a gentleman in the parking lot spied it as he and I walked in the same direction.
“How’s the drug business these days?” he asked, clearly knowing that I was a rep.
“Pretty good,” I said. “I have diabetes and I represent diabetes drugs, so it’s important to me!” I said.
“Me too,” he replied. “How long?”
“I’ve had it since I was 10 years old, so 17 years” I told him.
“Oh so you have the genetic kind. Mine is supposedly related to lifestyle.”
I looked over at him – he was maybe approaching 60 years old, a small belly above his belt and graying hair– a very normal looking baby-boomer type.
“Well I think Type 2 diabetes is more complicated than that.” I said. “I think it’s always a mixture of genes and lifestyle, in varying degrees depending on the person” I said with a smile. It sounded like he didn’t like being in the “lifestyle induced” category.
“When the doctor told me, I didn’t come back for a year” he said.
This is the part where I got confused – did he mean that he was so pissed at the doctor for telling him he had diabetes that he didn’t come back for a year? Or was it the way the doctor framed it? Or maybe it was neither – maybe he meant he just didn’t want to deal with it and so he took off for a while? I wasn’t sure, and we didn’t really get to finish that conversation - we had to split off to reach our respective vehicles.
Although I’m not sure what the exact issue was with, the conversation did get me thinking. If perhaps the doctor had blamed him entirely for his diabetes when he was diagnosed, I can see how that would not have left a good impression on the patient. On the other hand, maybe a year ago his health was out of control and he needed the tough love. And if it was option three, his desire to deny it that kept him out , then how could that have been prevented? Maybe an immediate appointment with a CDE? A phone call from the doc? What if he had a lost a year of time in managing his diabetes – and a year’s worth of damage had piled up.
Whatever his reasons, the sad part of this conversation was that it’s all too common. The diagnosis of diabetes often warrants an adverse reaction from patients – understandable – who on earth would want to deal with diabetes? Type 1 or Type 2- they both suck! In an ideal world, every new patient would get a free trainer, chef, life coach, once-weekly CDE appointments and maybe a shrink to boot. But with the way our healthcare works, patients are lucky if they learn how to test their blood sugar, and healthcare providers are lucky if they even have TIME to show a patient how to do that! It made me so sad to know that this gentleman had lost a year of managing his health. And until our country and the rest of the world start to place a premium on preventative healthcare, that’s exactly how it will remain. It makes me shudder to think about the burden to the world and future generations that diabetes will create.
Eyes on the prize.
Nervous nellie over here. I have my annual eye exam this afternoon, and this appointment, more than any other doctor I see make me more anxious than anyone else. Why? Because I’m always wondering if THIS is the year that I start to see a diabetes-related complication. Is this the year that retinopathy has crept in? I’m just shy of having had diabetes for 20 years, and every year I skate by with a complication-free eye exam, I’m grateful and relieved – until the next appointment starts closing in. And now it’s today and I’m feeling the nerves.
One of the toughest parts about having diabetes is this waiting game – this torture of meticulous care year after year in the hopes that we will stave of complications for as long as possible, or ideally, forever. I know there are great treatments out these days for people with retinopathy – laser surgeries and other options that can restore vision, but the looming threat of complications is enough to send shivers down my spine. After all, it’s what we’ve been threatened with for all these years. Do what you’re told or you’ll become a statistic: blind, amputated, or on dialysis. My fear is that if I start to have any sort of small complication, I’ll feel like diabetes is starting to win. And then my entire resolve will crumble and I’ll spiral out of control into a black hole of depression and powerlessness.
Holy downer on a Friday, Lexie. Moving on.
I know I have to think positive and remind myself that everything is going to be ok no matter the outcome. I can’t let diabetes take over, even if there are hurdles to overcome. I am in control of my diabetes and doing everything I can to make sure it doesn’t get control of me.
Deep. Breath.
Pain in the knee…and hip…and hand.
I’m falling apart people. Not literally – but well, almost. The knee problems I discovered last year while training for my half marathon have returned full force, and now also seem to affect my hip. Yep, that’s right. I might as well be 90 years old with the way my right hip has been acting – I’m getting all sorts of weird pain whenever I extend it outward away from my body (or roundhouse kick the heavy bag…but that at least makes more sense…). I’m not sure if the knee/hip things are related, but either way, I’m in pain. It’s become a daily ritual for me to come home from the gym and pop two ibuprofens and throw on the icepack while I watch The Real Housewives of New Jersey CNN.
As if I didn’t have enough going on with my lower extremities, my right hand still isn’t up to speed. As many of you know, I had carpal tunnel surgery on my right hand about a year ago – I was losing sleep due to the numbness that would occur at night, and finally decided to go under the knife so I could get a a decent night’s sleep. Although the surgery relieved much of the numbness, I was dismayed to still have some irritation post-surgery. Further evaluation with my doc showed that I also have some ulnar nerve problems. Which has been awesome. And my left hand is still carpal-tunnel ridden and has not been operated on, so that one keeps me up nightly as well. My right hand still isn’t up to post surgery strength, which has me concerned since it’s been a full year since surgery.
I know that the fact that I spend several hours a week beating up the heavy bag while kickboxing or pounding the pavement running and cycling isn’t helping said knee/hip/wrist. But in my humble opinion, that royally sucks. I exercise so that I keep myself healthy, not to damage my body. I work out for overall health, to control my diabetes, and to maintain my sanity. It’s so unfair that the very activities I’ve been told will help me live a long and healthy life seem to be causing trouble.
I’ve made an appointment to see both my knee doctor and hand doctor next week to see if they can help me alleviate some of this pain. I’m afraid they’re going to tell me to take some time off working out, and that’s gonna be a tough one for me. Exercise has become my escape – my way of taking some time for myself. I love nothing more than to go to a kickboxing class, get my ass kicked for an hour, and leave the gym a sweaty, satisfied mess. Call me crazy, but it’s my form of therapy. If the doc says I have to take a break – or worse – stop doing some of my high impact stuff all together, I might have a breakdown! I’m trying to stay positive, but having to limp when I put on a pair of heels for work because my hip and knee can’t take the elevation just ain’t cute.
Now if you’ll excuse me, I’m off to grab an ice pack…or three….
I Run on Insulin Voted one of the net’s best!
Holy smokes party people! I Run on Insulin was voted one of the 2010 Top 50 Diabetes Blogs by bloggingawards.com and Medical Coding and Billing! The coolest part about this award is that bloggingawards.com bases their awards on content alone – meaning that the number of visits the site gets has nothing to do with the selection. They only award reader-nominated blogs based on the value the blog brings to their audience-so that means that I Run on Insulin was selected purely because of good feedback from you guys – WOW!
This was voter driven, so a million thanks goes out to all of you readers who supported I Run on Insulin. I started bloggig because I realized that the ‘net had become one of the biggest and most valuable sources of support in my diabetes management, and every day, reading your comments and other blogs helps me feel like I’m not alone.
I can’t thank everyone enough for voting I Run on Insulin on to the amazing list of 2010′s Top 50 Diabetes blogs, but if you voted and you are out there reading this: THANK YOU. And thank you for being part of the online support that means so much to so many people every day.