Insanity

I once read this quote by Albert Einstein, which (heavily paraphrased here) said that "Insanity is doing the same thing over and over and expecting different results."*

The other day, as I was meditating during my yoga practice, this quote popped into my mind and I let it guide my practice. Suddenly, right in the middle of a downward dog I began to laugh. Very slightly, of course, but really I couldn't help but let out a big chuckle. Because isn't this exactly what everyone warns you about with diabetes? That even though you might do exactly the same thing two days in a row, eating, exercising, bolus, basal, everything, you can still get different results? That what works Monday is not guaranteed to hold up on Tuesday, or even any other day of the week?

So apparently the lesson here is that living with diabetes=living with insanity. Accepting that the rules of the universe no longer apply to the chaos inside your body. So, laugh away, people, laugh away. Because I (and my pancreas) have disproved Albert Einstein. Watch out Galileo! I'm comin' for ya....

*I did not bother to verify this quote because I already had this whole post worked out in my head. 

Give Yourself Permission

I read a great article today about wellness, and attitudes towards wellness. There was a section in there that really resonated with me, with quotes from Dr. Michelle Segar, who writes about the science of motivation and exercise. 

Here is the passage:

'Also important is giving oneself permission to make self-care through physical activity a priority. Dr. Segar wrote: “When we do not prioritize our own self-care because we are busy serving others, our energy is not replenished. Instead, we are exhausted, and our ability to be there for anyone or anything else is compromised.”'

I mean, how true is this?! In some bizarre, psycho twist of today's society, we do not give ourselves permission to prioritize our own self-care. It feels very true. We all know that exercise, that movement is important. It's essential. We know that it's good for our hearts, our brains, our circulation, our diabetes, whatever. Yet we still view it as essentially selfish, isolated, independent. It's rarely something we share with others, and it's not okay to prioritize it over many things. The idea of taking care of yourself so you can take care of others? Virtually nonexistent, and unfortunately this is especially true in the teaching world (and in others' view of the teaching world...).

Nowadays, people are very respectful of my needs to eat healthily and prioritize exercise, which is one of those weird "silver linings" of diabetes that I keep running into. While I really appreciate this, I also want to stress the importance of exercise so that you don't wind up with a chronic disease. There is so much wrong with policy and attitudes towards health in the U.S. today, and I really think this is a big one. Why why why do we only value our health once it's already endangered?! Why is preventative care selfish, when treatment here is bankruptingly expensive? Now, I'm not saying that every disease can be prevented, because obviously I have one that can't. But there are side effects that I can prevent. And there are millions of people with side effects of unhealthy living that could be prevented too. There's much more I can (and probably will) say on this topic, in terms of food deserts, institutional foods, and lack of access to resources (including safe outdoors space). 

But right now, I just want to ask you to give yourself permission to take care of yourself. Take care of those around you. Quit guilting yourself about your yoga habit and start appreciating the fact that you're spending money on something that really matters.  Don't think about the fact that your jog takes you away from the people you love and think about how much more time it actually gives you with them in the long run (the long run....see what I did there?). Get out of this mindset that you're only worth worrying about if you're already broken. 

Afrezza Update

So, in a previous post, I mentioned that I would be giving a bit of an Afrezza update based on how it fits into my "Carb Counting Lite" diet, per se. I figured now would be a good time to give an update, too since I've been using it for about 4 months and a lot of the internet chatter seems to have died down about it.

So we'll start with addressing the pros & cons from my old post to see if/how those have changed. Follow along with the grey text, to see my older comments, and the bolded font to see my new opinions.

CONS:

• Suuuuuper awkward in public. I've gotten used to quietly beep beep booping away in the corner with everyone else oblivious to what's happening. Of course I'm pretty nonchalant about doing finger sticks, but people are generally cool with that because it's familiar. We've all seen the obesity documentaries. We know what diabetes is. But shoving powders into a plastic whistle and doing your best Snoop Dogg impression? Attention grabbing, to say the least. This one is still very true. It's also happened multiple times that people just start asking me a bunch of questions and I just have to kind of nod along and gesture while inhaling deeply with the whistle hanging out of my mouth. Actually though, one time someone just thought I had asthma so that was kind of a relief. 
• Dosing is confusing, to say the least. It's just in and out so fast...it's hard to know how much is actually going "in." And it doesn't seem to hang around very long, so it can lead to some roller-coastering around mealtime. Some people have recommended doing a pump bolus and an Afrezza bolus...I'm still investigating. Pump/Afrezza combo is definitely the way to go. I will sometimes use Afrezza instead of a pre-bolus if I don't feel comfortable dosing an hour before a meal, or if I simply don't have the heads up on eating. I use it to stave off an initial post-prandial spike, but I always (okay mostly) make sure to do an adjusted pump bolus at the same time so that it will hit essentially right as the Afrezza is finishing up.
• Still have to wear a pump--for basals, for food bolusing (because I'm still figuring out the dosing, I mainly use the Afrezz' for corrections). So that means I'm a whistle-blowing, ever-beeping cyborg now. Still wear my pump. 
• It doesn't keep for very long (although I haven't tested this) but once you open a foil pouch (which contains roughly 10 blister packs of 3 cartridges each), it's only good for 10 days. And it takes up more space in your refrigerator, too. This is not an issue...I definitely take more than 10 days to use a pack and I haven't noticed significant problems. 
• It's hard to keep track of--I rely on Diasend to help me manage things, but since I'm taking less pump boluses and there's no way to automatically upload my Afrezza use (and no app that lets me upload all my data plus add in manual timestamped notes in once place), it's messing with my organization. And since I'm also Type A, in addition to Type 1, I don't love that. Ugh still annoyed by this. The right diabetes app is harder to find than good real estate!!

PROS:

• It works. It works. It works, it works, it works. I CANNOT say that one enough. It just does. Wicked post-prandial spikes after breakfast? Accidental snacking binge at the staff meeting? random CGM delay that shows you at 113 --> one minute and 181 double arrows up 5 minutes later? SHAWTY DON'T PLAY. One 4U puff and things are smoothing out. No rage-bolusing. No vigorous, frustrated walks or bike rides that BF is forced to endure. No 5 hour snooze alarm on my Dexcom going off to remind me that I've been out of range for way too long. We're talking results within the half hour. STILL VERY TRUE!!!! Nothing works faster, even on high fat/high carb meals. 
• It works, just the right amount. As in, this weird flattening out effect where I never seem to drop below 65 with it, as long as there's little to no other insulin in my system. And then I usually drift gently back up into the 80s or 90s. It's confusing, sure, and I sometimes treat for hypos that never happen...but still...Soooooo, this is less true now. I am generally pretty insulin-sensitive, and I think 4U is really just too much for me. If I haven't eaten in the past 2-3 hours, and/or I don't have plans to eat immediately, it's a little too strong for me to take unless I'm above 250 and still rising. 

BOTTOM LINE: Afrezza is great at what it does, but it's no substitute for subcutaneous. It's perfect for those formerly really frustrating situations, like a blood sugar of 200 when you're about to go out to dinner with friends, or an unexpected meal opportunity, or wanting to eat right after exercise/waking up and not being able to pre-bolus. It can help if you accidentally eat the fridge AND the kitchen sink after a low blood sugar, too. It's also really helpful with foods that are guaranteed to give you a spike, like fruit or non-chocolate candy. I also like to take it if I know I'm going to be hiking soon--I'll eat breakfast, cover it with Afrezza only, then leave on the hike about an hour later, as it's wearing off. Since it clears out so quickly, I don't have to worry about IOB while hiking. 

However, it's still a little too tricky and unpredictable to really be a basis for good control, in my opinion. It is definitely a tool to get there, but it is so strong (at least initially) that if you have any other IOB, or exercise going on, the risk of going low is too high in my opinion. It's also not enough to cover a full meal on its own--even with two doses spaced apart, I usually end up yo-yo-ing a lot, and have to spend a lot of time glued to the old Dexcom. 

I still highly recommend Afrezza, however. While it's true that a low-carb diet and rigorous bolus-ing with a pump and super-accurate basals and a consistent schedule can control your blood sugar better, that's just not a 100% reality of life. Afrezza allows you to have a bit more freedom and breathing room (HA.HA. See what I did there? Because it's inhalable?) while still living your actual life. I recently went on a 2 1/2 week road trip and it was invaluable to keeping things relatively under control. Of course I still ran higher than I preferred, but have you ever tried asking for a carb count on a meal in rural Wyoming? Or a salad? 

BOTTOM BOTTOM LINE: Guess what, big surprise, Afrezza is still not your pancreas. But it can help you feel a lot less of the stress and guilt of being pancreas-challenged. 

Uhhhhh Doyyyyyyyy (Plus some recommended reading material)

(Author's note: I'm not really sure on the correct spelling of dooooyyyyy. But imagine it said to you in the most annoying, 13-year-old "cool kid" voice)

So, it's always thrilling when people tell me they read my blog and enjoy it. It is definitely flattering, a little dose of celebrity. I always feel just a teeennny tiiiinnnny bit famous. Even though it is always someone that I already knew in real life, who would probably listen to these things if I said them to them out loud.

But then one of my friends said something about how when she reads this blog, she sometimes feels dumb because she doesn't know things like what a bolus is. And I'm like, uhhhhh doyyyyyyy (to myself, of course). To me, this blog has no real, definite audience. Or manifesto. But I do view it as sort of a "letters to my past self" type thing, or really more like a "diabetes for dummies." (Side note: this is not really a good place to get your basic diabetes info if you actually have diabetes. You should read Gary Scheiner's excellent, scientifically accurate and well-researched book Think Like a Pancreas for that). I want people who might know a bit about T1D, or who might know someone with T1D, to feel like this blog is a place where they can get factoids, tidbits, first-person narrative, in-the-trenches perspective, and of course my signature wit. Most importantly, I want people to feel like they actually learned something from this, especially if they're my friends and so T1D is now a part of their lives, too.

So without further ado, I present to you all, the definition of the word BOLUS:

Bolus: (Noun) A one-time dose of insulin, calculated by you (the PWD) in order to correct a high blood sugar and bring it down to normal range or to cover food that you are about to ingest. SEE ALSO: To bolus (verb)

If you're interested in more fun diabetes terms, my favorite D-blogger has a cool glossary here: http://sixuntilme.com/blog2/2011/09/diabetes_terms_of_endearment_e.html

And one last note, if there's anything else you're curious about, please please please don't hesitate to ask me! Drop a comment, or mention it to me in person (it shouldn't be hard to find me since I'm pretty sure the audience here is all close, personal friends). 

Wise Wisdom

"I do not associate with people who blame the world for their problems. Because you're your problem. And you're also your solution."

Okay so yeah maybe it came from Bridesmaids but it still feels pretty relevant...

Diabetic Playlist

I don't own any rights to anything. But if you're a diabetic (or if you're not) you should still know about these songs.

1. A Tribe Called Quest "Oh My God". Because you too can be a funky diabetic. 

2. The Killers "Human". Sometimes after a hard day, you're asking yourself, are we human? Or are we dancers walking pancreases?

3. Aaron Carter "I Want Candy". This is on here partially because we all need to acknowledge and process our feelings re: frosted hairstyles. But also because, well, the title really speaks for itself.

4. Haim "Don't Save Me". First of all, just a wonderful, wonderful band. Second of all, in Taylor Swift's inner posse (no shame in the loving T-Swizzle game on this here blog). Third, they're a sister band and the youngest one actually has T1D. So that's rad.

5. Maroon 5 "Sugar". Another one where the title speaks for itself, but you can feel less ashamed about your sexual attraction to them because Adam Levine is maybe just sex personified. Especially in this screen capture here (kidding...or not?)

So there you have it. 5 songs. It's short. It's not really comprehensive, and I'm not too sure in what context these exact songs actually go together....maybe while you're having a low blood sugar and are too scatterbrained to notice that they actually don't? Or something? But this blog post has certainly got me curious what searching Type 1 Diabetes on Spotify will produce. 

Confessions of a Guilty Diabetic Part 2

Okay I will add another, bonus confession to this one: this is not actually a new post. I wrote it at the same time as the last one, as a part of the same entry, but I thought things were getting a bit long so I split it. SO SUE ME. Okay, actually, given the way the world works these days, I feel like I should add: PLEASE DON'T SUE ME. It would be a waste of your time, anyway. My pump is the most valuable thing I own. Whoops! Another bonus confession....lucky you! I should probably just quit this intro paragraph now before I tell you my social security number. So here goes, confession number....whatever:


I don't carb count. Okay, new diabetics, don't throw away your hospital-issue "Calorie King" bible quite yet. I do carb count, in the sense that, over the past year I have strived (strove? striven?) to understand/memorize the carbs involved in most of my go-to foods and indulgences. And I do use that knowledge to help me make informed bolus decisions. But here's the thing, peeps. There is so much more to bolusing than just carbs. There's things you can see and calculate with, like IOB, and fat grams, sugar, and fiber. But there's also, EOB (my term for Exercise on Board, aka a workout you just did [metabolism running faster] or have planned), stress, fatigue, unexpected bus system crashes leaving you to walk home, etc. There is no perfect bolus. So in a way, I have given up. I'll admit it! I mostly look at my meals as sort of Large, Medium, and Small in terms of bolusing. Large being, high-fat, high carb bombs, for example a grilled cheese with tomato soup and/or french fries. Anything where you have dessert. Medium is more like, pretty high carb, moderate fat, some protein to calm things down. You've indulged but nothing crazy. Maybe a bit of pasta salad, or fruit salad, or a sandwich. Small (which is where I generally try to stay) is exactly what you'd guess. Lots of veggies, carbs mostly from legumes and/or fruit, protein-heavy and moderate fat. An example would be veggie chili and a salad or something of that nature.

But here's the thing that really helps me with any meal size, and that is pre-bolusing. Many times, I don't know exactly what I'm going to eat for lunch or dinner. But regardless of whatever ends up happening, about an hour beforehand, I use the advice I gleaned from this wonderful blog post by these wonderful people about carbohydrate absorption rates in order to do what I consider to be a pre-bolus. Most people do this about 15 minutes beforehand; however, I found that I was still experiencing considerable post-prandial spikes with that timeline. Upon googling around, I found the #DIYPS blog and it really answered a lot of my questions about that. So I set about testing pre-bolus times/amounts and recording the data and eventually settled on a routine that works for me. Yes it required a lot of eating the same meals at the same time and googledocs. But yes it was worth it. You should definitely try it if you plan on being a diabetic for a while.

So back to my not-carb-counting. Based on my earlier experiments, I give myself my standard "Hey I'm going to eat soon" pre-bolus (Note: I do not use this exact method when I'm experiencing out-of-range blood sugars) an hour or so before I eat. Then, when it's time to eat, I give myself a general bolus based on my meal size and contents. I generally call Large meals 60 grams, Medium meals 45 grams, and Small meals 30 grams. Then I eat. And that's really it.

I keep an eye on things via my Dexcom, and sometimes I need to give myself more insulin, or eat some fruit/juice/glucose tabs to keep things copacetic. But you know what? Even when I was religiously entering everything I ate into MyFitnessPal and sweating out all the details of exactly how many peanuts I was consuming, I still had to do that. I rarely got it exactly right, and now that I've relaxed, guess what? I still rarely get it exactly right.

Relaxing on my carb counting was right for me, because it allowed me to relax myself in general. Although I feel guilty admitting it, I felt way more guilty every time I blamed myself and my addition skills for falling down on the job. But you know what? You know who really fell down on the job? My pancreas. And my immune system. They're the ones who have the capacity to get this perfect. Not me.

Coming up soon: A follow up on this & how Afrezza can help/interact with this system

Confessions of a Guilty Diabetic Part 1

I feel that this is a safe space, in that, after a massive spike in interest in this blog due to a Facebook announcement, my daily blog views is safely back down in the 0-4 range. Google Analytics has breathed a sigh of relief, and so will I once I get all this off my chest. Maybe one day I will reveal this blog to fellow PWDs and feel shame once again, but more than likely I will simply click "revert to draft" on this one and guard it safely forevermore. So, as follows, here is one of my guilty confessions. And no, Usher fans, there's no unexpected pregnancy involved.

I don't turn down my basal insulin when I work out. Seriously. Unless it's late in the afternoon and I haven't eaten since forever and I have a plan for something super cardio-intensive, I just don't. It's way more trouble than it's worth to deal with the aftermath of a basal insulin decrease, for one. But also I pretty much don't really need to. Despite my literal sweat, blood (yeah I've been known to pop a finger prick spot or two by accident) and tears (ya okay not really those) during my power yoga/boot camp/dog-walking, apparently my body is just like "Meh. You could go harder." In my head, I rationalize it with terms like "anaerobic exercise" and "breaking down stored fat" but I can't lie, my pride gets injured sometimes.

Phew!! That feels better I guess, and if you're out there somewhere in the same boat as me, then, well woo hoo! Let's just sit here comfortably in our insulin-filled boat, with our pumps ticking away peacefully and not judge each other.

Feel the Burn

So, I definitely unironically and unabashedly love the Fast & Furious franchise. There's just something so right about its cheesy wonderfulness, and the latest installment is no exception. Not to mention the touching tribute at the end.

However, that's not the scene that really spoke to me. No, the scene I identified with more is present in this gif: https://pbs.twimg.com/tweet_video/B1jFw36CUAAk9Lz.mp4. For those of you who are literally SO LAZY that you cannot click and watch a 2 second video, or maybe you have poor internet connection and it won't load, I will summarize for you. Don't worry, it's not really a spoiler here.

Basically, in this scene, The Rock (yes, both words capitalized) has a cast on his arm. I won't go into why, because, you know, spoilers. But there are bad guys to be fought. And The Rock has gotta fight them!! Because, The Rock. So what does he do? He's sick of being laid up. He's sick of the BS. He's sick of those doctors putting BS-y plaster all over him when he's THE ROCK and he's got BAD GUYS TO FIGHT. So he just, you know, mind over matter, flexes his incredible, The Rock-y arm, and flexes right out of the cast. I sh*t you not. Flexes that cast right off and trots off to fight and obviously defeat the baddies.

And I have to tell you, that scene speaks to me. Because I often feel as angry as The Rock at diabetes BS. Like when I'm trying to go a leeeetttle bit uphill on a hike and get totally foiled by a massive, double-arrows down zinger of a low blood sugar that I have to treat, meaning a mandatory pause and sugar break. When I have to eat a snack, right after a snack, because of an over-bolus. When I ignore students, miss my bus, or skip a meal. Basically any time diabetes makes me do something I don't organically actually want to do, I wish that I could just power on through. Flex my....pancreas? liver?..... and get on with my life.

It takes a huge amount of humility to say to myself, and whoever I'm with, "Wait." "I'm not okay." Because I don't want to scare them. Because they don't know the difference between a little not okay and a lot not okay. Because I don't want to admit that I'm struggling and not in control. Because I hate thinking that I've made the mistake. Why didn't I do a temp basal decrease? Why didn't I under-bolus? Why did I bolus at all? Why didn't I plan better? Why wasn't I better?

But really the question is, why isn't my pancreas better? Why, after all the love and attention and mindfulness and medicine and money and lost brain cells and sugar and exercise and vegetables and doctors and frustration and triumph and lessons learned and lessons forgotten and tape and bruises and rashes and blood given and taken, why is that still not enough? Why is my reward for each day to wake up (sometimes in the middle of the night) and do it all again? Why can't I just put mind over matter, for once?