Casting Stones

I originally started this post a few weeks ago after I read some comments about type 2 diabetes on the My Diabetes Secret Tumblr, along with various commentary about the recent New York Times article. It’s no secret that in the diabetes community, there is a schism between people with type 1 diabetes and type 2 diabetes. Sometimes it feels like we’re factions at war with each other (Divergent, anyone?). I was working on it for a little while, but then felt that the time had perhaps passed. But now I read that a conversation about diabetes misconceptions was held at last weekend’s Diabetes Sisters conference. I didn’t attend the conference, but that doesn’t mean that I don’t have something to say on the subject.

You don’t have to live long with type 1 diabetes to realize that there are a lot of people who don’t have a clue what life with diabetes is like. Whether it’s a complete stranger, your next door neighbor, or your mother, someone is bound to say something that isn’t only inaccurate, it’s also a bit cruel. People comment on everything from your activity level to your food choices to how you look and somehow it’s all okay.

Type 1 diabetes is an unusual monster. It carries some similar qualities another monster, type 2 diabetes, and yet it also has some very unique features. It isn’t the same disease, and yet the two are constantly conflated with each other in the media and with people outside the intimate D-circle of life. Because of this, we suffer through comments about causing our own diabetes (we didn’t), getting off our medications (we can’t), and well at least we don’t have cancer (… the hell?).

It’s no wonder people with type 1 diabetes are a little angsty about being connected with people with type 2 diabetes, when it seems that people have such a poorly formed idea of what type 1 diabetes is like. I can totally understand where the frustration comes from. After twenty years of living with diabetes and more than ten years of being deeply ingrained in the diabetes community, I’ve heard my fair share of stupid, misinformed statements.

But the surprising thing? The thing that maybe we as type 1 PWDs don’t want to admit? Is that there is a boatload of stupid, misinformed statements about type 2 diabetes, too. And those who perpetuate these stupid, misinformed statements is often… us.

Like Kerri mentioned on her blog post, I’ll admit that I haven’t always thought very kind things about people with type 2 diabetes. I was raised to think they were fat, old slobs. And while that is sometimes the case, it is by no means the only description for people with type 2 diabetes. In fact, it wasn’t until I attended a conference of the American Association of Clinical Endocrinologists that I heard a leading endocrinologist from New York share that there is evidence of twenty different kinds of type 2 diabetes. Twenty!

Later, when I was interviewing the president of AACE, Yehuda Handelsman, that I learned that people with type 2 diabetes needed to have the genetic component in order to have type 2 diabetes. It wasn’t as simple as just be lazy and obese, but that there were genes that played a role in the onset and development of type 2 diabetes.

Another stereotype I used to believe was that type 2 diabetes was easier to manage. Then I learned from a friend of mine with type 2 diabetes that when her blood sugar is out of range, there isn’t much she can do about it. Sometimes she goes for a walk, but she doesn’t have the option of just “shooting up” to bring her blood sugar down, and she has to stay with a more confined meal plan because, being on metformin only, she can’t take extra insulin to cover the carbs. When I was at an ADA Diabetes Expo a couple years ago in New York City, I was recommending snacks to some type 2 PWDs and was shocked when they said they had to stay around 10 grams of carbs.

The grass isn’t always greener on the other side. Sometimes it’s just another shade of crap.

It was these little nuggets of information that opened my eyes and realized that maybe I didn’t know as much about type 2 diabetes as I thought. In fact, our impressions of type 2 diabetes can be likened to what non-PWDs think about type 1 diabetes. We get so frustrated and so up in arms when people treat type 1 diabetes with simplicity, and yet we treat type 2 diabetes with exact same kind of simplicity that angers us.

Oh you just have to take a shot. Oh you just have to avoid sugar. Oh you just have to do this for the rest of your natural life.

At the end of the day, both groups are victims of assumptions, stereotypes and generalizations. We hate when the general public makes stupid comments about us, and yet many of us are more than ready to make the same kind of inconsiderate comments toward people with type 2 diabetes. And so type 2 PWDs at the end of the day are not only dissed on by people outside the diabetes community, but they are also verbally beaten down by us, people with type 1 diabetes.

What I hope people understand is that both types of diabetes deserve to be fully understood and respected for what they are. There are differences between the two types of diabetes — I’m certainly not arguing that — but there are also similarities, and for the time being, we are part of the same diabetes family. Even if we weren’t part of the same diabetes family, even if we were to suddenly have two very different names for each disease, that does not excuse the perpetuation of stupid, misinformed statements. Bad information is bad information no matter what you call it. While it is frustrating to have the type 2 stereotypes placed on the type 1 community, it is equally frustrating and wrong to have type 2 stereotypes in the first place. We are angry about something that we ourselves are contributing to.

Next time you feel inclined to make a comment about something that you don’t live with and don’t fully understand, I encourage you to remember how frustrating it is to hear comments from people who don’t live and don’t understand your life.

 

 

Running A 10K With Diabetes

16BEST_SPAN-tmagArticleOn Saturday, I ran my first race of the year and in Minnesota. It was my second 10K, having run my first one in New York City last September. I’ve done a lot of running since then, and learned even more about what I need to do to manage my diabetes while running. Of course, just because something works most of the time does not mean it will work every time, so there’s always a bit of crossing the fingers (and toes!) when it comes to diabetes and exercise.

My husband and I had gone out to dinner the night before and that can always set things up for catastrophe, but it had been a long, stressful week so I really needed a little date night. We went to an Asian / Latin fusion restaurant in Minneapolis called Chino Latino, and had quite a bit to eat. Paired with a delicious raspberry margarita, we had two eggrolls and a paella with chorizo, shrimp, calamari, and chicken with Spanish rice. We also decided to splurge on dessert! Yikes… Thinking back, it was probably not my finest decision but it was certainly tasty!

Around six o’clock in the morning, I woke up. I didn’t have to go to the bathroom and I didn’t feel low, but I only wake up when there’s something wrong with my diabetes so I tested and saw that I was 283 mg/dl. Eek. I debated what to do, but finally decided that since I had a good three hours before my run started, it would be okay to give the full correction. I would go ahead with my usual plan of bolusing half for my breakfast to bump my blood sugar, and I figured that the remaining active insulin from the correction wouldn’t be too bad. Turns out, I was right.

When I woke up and tested at 7:30 a.m., I was only down to 235 mg/dl. I didn’t even look to see if I needed more insulin or not, because I knew that any extra insulin this close to the run would basically double in my system and I would crash. So I just rolled with the 235 mg/dl. I had a bagel with a schmear of peanut butter with a cup of coffee, and bolused half the carbs in the bagel. I don’t turn down my basal when exercising, and just rely on my fuel to also help with my blood sugars.

I’m not currently wearing a CGM (looooong story and one for another day), so my last test before the run was at 8:30 a.m. when my husband dropped me off at the race in a park in South Minneapolis. My blood sugar had spiked to 313 mg/dl, but I was okay with that because I had insulin in my system and I didn’t feel sick which means it wouldn’t affect my run.

In my SPIbelt, I carried my phone along with two GUs for low blood sugars, and in my Nathan’s belt, I carried an additional GU that I planned to use as fuel at the halfway mark. It wasn’t necessarily for my blood sugar, although that definitely helps, but also because I know that on a long run, I need to fuel to stay energized.

Everything went according to plan on the run. I alternated between running and walking, which my CDE Jenny Smith told me can help with blood sugar. She explained that when the body stays oxygenated, it more easily can burn fat for fuel. If not, it starts burning glucose faster. Since I didn’t want to tank and go through blood sugar too quickly, I wanted to do interval running. It’s something that I normally do anyway and have always had good results, but it’s nice to hear that there’s a reason!

At the 5K mark, there was a water station, so I grabbed a glass and tore open my GU, although my fingers were so sweaty it was a bit tricky. I felt fine the whole way until the end. Although I didn’t PR, I did well and finished the run with a blood sugar of 151 mg/dl.

When we got home and had lunch about an hour later, my blood sugar had started to rise to 202 mg/dl. I underdosed for lunch, which ended up backfiring and I spiked up to 254 mg/dl. Bummer. Although I don’t usually have lows during or right after exercising, I do have lows about 12-18 hours after exercising. Usually I have a low blood sugar early in the morning if I don’t lower my AM basal rate. My basal rate goes up for the dawn phenomenon, but something about exercise negates the dawn phenomenon, so that’s when I have to turn it down. This time, I went low just before bed, but I think it happened earlier because I exercised earlier in the day rather than my usual late afternoon/evening routine. I’m not much of a morning person!

In other news, I’m also training for my first half marathon! I’ll be running a half marathon here in Minneapolis in July, so I’ll start increasing the length of my runs. I’ve never gone farther than six miles, so it will be interesting to see how my blood sugars react to increasingly longer runs. See also: where to put all the GUs?

Coming Soon: Best of the ‘Betes Blogs!

bbblogo-finalI’m thrilled to announce that I’m hosting the May edition of the Best Betes Blogs!

For those of you who haven’t seen it around the DOC, it’s a monthly selection of some of the best blog posts in our community, as chosen by that month’s host.

There’s still another week to get your nominations in, so head over to fill out the nomination form.

Then come back here on May 1st to see the posts that have been chosen!

DSMA April Carnival: Keeping Up With The Joneses

5229943Yikes! So this post ended up getting published early this morning even though, as you probably could tell, I hadn’t written anything yet! I thought I had just saved it but instead, I scheduled it for publishing! How embarrassing…

Anyway, I do want to talk about social media burnout. It’s the topic of this month’s DSMA Carnival and something that I think is really important. It’s not something that is isolated in the diabetes community. Regardless of what online community you belong to or if you even just use the Internet to keep up with friends and family, sometimes you just get tired of keeping track of so many people.

Social media has expanded my community beyond anything I could have imagined. I got more involved when I was in college because I hardly knew anyone with diabetes and I really wanted to share my experiences and learn from others. As this community has grown over the years — and Lord, has it grown! — it’s become harder and harder to keep up with everyone. While I’m so excited that people are finding their way into the community, it can put a lot of pressure on people to follow and keep up with everybody.

Something I discovered a long time ago was that this just isn’t realistic. I stopped putting the expectation on myself that I needed to follow everyone, friend everyone, and read everyone’s posts everyday. I wish I could, but that would leave little time for anything else. I love the diabetes community, but not at the expense of the rest of my life! I started forming my own mini-community, and I focus more on the people with whom I really click with. Some people might think that’s “cliquish” but I think it makes sense. If you have limited resources, you’re going to spend them on the people who really bring something special to your life.

This has been an enormous help in preventing social media burnout, because I no longer feel compelled to keep up with Jones. In the real world, keeping up with the Joneses usually means you’re spending a ton of money doing what the Joneses are doing. But on the Internet, keeping up with Joneses means spending a ton of time just knowing what the Joneses are doing!

My biggest piece of advice for dealing with social media burnout is to first identify whether or not you’re really getting something out of all the various people and organizations you follow. Which blogs do you consistently skim or wish you could “mark all as read”? Is there anyone on Facebook or Twitter that you don’t even recognize? It can be a little embarrassing to unfollow or unfriend, but I think it’s becoming more respected when people realize they need to pare down their online life.

Sometimes you don’t want to completely cut someone out of your life, which is why I find a certain amount of organization is helpful. Facebook has become a place where the people I’m friends with are people I actually know in person. Twitter is a bit more open, but I’ll be the first to admit that I don’t follow people just because they follow me. I have to be interested in what they’re saying, but I’m also more flexible and willing to follow people I don’t know personally. And finally, there are a blogs, which I’ve organized into different topics. Sometimes I just don’t feel like reading about diabetes, so I can save them for a time when I want to catch up on things.

The Diabetes Online Community should be a place where you feel refreshed and refueled in your life with diabetes, but that’s not always going to be the case. Sometimes it’s just a matter of stepping back into the rest of your life — especially after some heated controversy like the NY Times article — and sometimes it’s a matter of figuring out the best way to incorporate social media into your life. Social media can often spur comparisons between how we do something and how they do something. Social media can encourage growth, but it can also create unrealistic expectations. We need to know our own limits and how to be best take care of ourselves. Even if that means unfriending the Joneses.

 

This post is my April entry in the DSMA Blog Carnival. If you’d like to participate too, you can get all of the information at http://diabetescaf.org/2014/04/april-dsma-blog-carnival-4/

Exercise + Diabetes = You’re Kidding Right?

It’s been awhile since I’ve posted a personal blog post on TBSW, and honestly I wasn’t sure what I should even write about. Things have been more or less pretty stable on the diabetes front. A few highs, a few lows. The usual, and pretty boring. I’m in the process of finding a new endocrinologist here in Minneapolis, but I’m not quite ready to write about that. So I popped over to the results of the poll I did awhile back to see what people were interested in. Out of all the topics, the number 1 result was Fitness & Nutrition. I’ve been dealing with some stalled weight loss, which I’ve written about over on my other blog, With Faith & Grace. I haven’t written that much about it over here, so feel free to catch yourself up on the saga.

That being said, I thought it might be good to share a bit about how I exercise with diabetes because exercise is such a big part of weight loss but it’s also a really big part of overall diabetes management. Even if you’re not actively seeking to lose weight, exercise can be a doozy. More than one PWD I know has said they actively avoid (pun intended, duh) exercising because it can sometimes create more problems than it’s worth. Ever hear of “drinking the gym”? That’s when you consume via a juice box all the calories you just burned because you went low. It’s not fun and it can be really discouraging.

Since I’ve been trying to lose weight for so many years, I’ve had a lot of practice exercising with diabetes. It takes practice to learn what your body does in response to exercise. As I’ve learned through observing myself and others, there is not one set way that your body will respond to exercise. Some people have their BGs go up, some go down. Some go down later, some go down right away. Some need to eat, some need to lower their basal, some need to suspend. It’s all very unique and of course that makes things really aggravating because why can’t there just be one way to do this?

One thing I’ve learned about myself over the years is that my body really despises going without insulin. When I was on the Medtronic pump, I could  never take it off without ending my workout with a sky-high BG, or at least one about an hour after I was done. I grew accustomed to actually bolusing to replace the basal after a workout. My body knows when I’ve deprived it of insulin and it is having none of that. Now that I’m on the Omnipod, I don’t have as much of a problem because the pump doesn’t flop around the way that the tubed pump did.

I’ve also learned that I can’t exercise with my blood sugar to low either. So I need insulin, but not too much. For awhile I was doing my exercise after dinner, because I had the boost of carbohydrates from my meal, which helped my blood sugar stay stable and also gave me some extra energy, and I would bolus half of my usual dose. I rarely eat just so I can exercise, but calories from a meal are calories I’m going to be consuming anyway as part of a healthy diet. I just time things so that they are to my benefit for exercise. Insulin takes time to start working so I won’t tank while I’m exercising. The exercise also helps boost the insulin so that it keeps the BGs from spiking once I’m done.

Of course, this isn’t perfect. I sometimes still go high or low, depending on how my body reacts to the exercise or if my carb counting was off. For the most part, this system works pretty well. Sometimes I will exercise before dinner if I know I won’t have time after, and in those cases, I make sure that I don’t have any active IOB and I will make sure that my blood sugar is in the upper 100s. If I have IOB from a full bolus, I don’t usually exercise because I know that’s too much insulin in my system. I also like to make sure my BG is up high enough, usually upper 100s or lower 200s, because that gives me a cushion for the inevitable drop. But I try not to exercise before a meal because it’s more unpredictable.

I don’t typically eat anything after a workout,  but I will drink a Nuun water to replace electrolytes. It really helps me feel better post-run! Nuun is calorie and carb-free, so it’s a great way to replace some nutrients without spiking my blood sugar. Occasionally I will eat a snack, if I’m hungry, and in those cases I usually bolus normally unless I’m low (always test after exercising!).

Finally, my big post-exercise headache is the morning-after low blood sugar. When I exercise in the evening, I switch over to my Exercise basal profile which lowers my basal in the early morning hours. For some reason, that’s when I go low and changing my basal keeps that from happening. I change it back to my Normal basal setting in the morning, or even the next evening, since the daytime basal rates are the same for both profiles (so I have a big window of opportunity for remembering to switch). Of course, if I exercise two days in a row, then I just keep the basal profile the same.

So that’s how I do it! Or at least, how I try to do it. How do you combine diabetes and exercise?