Stress and a Pouch

How does your stress influence your diabetes and vice versa?

It’s a question that I’ve been thinking a lot about lately. Why? I was invited by my friend who teaches an undergraduate class on the Psychology of Stress and Relaxation to come and speak to the class. They’re currently talking about the psychophysiology of stress and the relationship between stress and illness/chronic conditions. I was invited to share my personal experiences with diabetes and stress.

I actually have a lot to say on the topic, but as I was writing up my talking points, I realized that a lot of the stress that I have around my diabetes is this underlying constant stress. It’s the every day worry about my blood sugar control, dealing with the highs and lows, worrying about the long term complications, coping with the unknowns and unexpectedness of the disease. It’s the stress of constant vigilance, alertness, and preparedness.

And as I’ve lived with diabetes longer, what may have originally caused more stress and anxiety, is now just part of what it means to live with diabetes.

But of course, the day before I am scheduled to talk with the class, I had a truly stressful, out-of-the-norm experience.

I keep all the supplies that I need to change my infusion set in a small blue pouch. Inside I keep a couple reservoirs, infusion sets, the inserter, a vial of insulin, test strips and a couple batteries for my pump. I usually keep the pouch in my work bag or workout bag and take it with me for any overnight stays or long days away from my apartment. In the 15 years I’ve had diabetes, I’ve never lost or misplaced this vitally important pouch….until today.

I was busy getting my bags ready for work this morning, I knew I would be running out of insulin sometime during work today so I made sure my blue diabetes supply pouch was packed. However I couldn’t find it. I searched frantically through all my bags, my closet, all around my room and apartment. I went out of my car, no luck. Inside I was mildly panicked, but I remembered that I had taken the pouch in my boyfriend’s car on Saturday so I thought maybe I had left it there. It was 8 am on Tuesday. I’m going out of town on Thursday so if it truly was lost, I would need to have a new inserter overnight shipped to me so that I would have it before I left town.

I sent my boyfriend about 6 frantic texts. But as expected, he didn’t answer. It just so happened that my boyfriend had the day off today and I was sure that he was sleeping in. Since he keeps his phone silenced in a different room, I knew he wouldn’t answer my texts or calls until he woke up…whenever that would be.

IMG_8542So I waited anxiously for him to awaken. And waited, and waited. Finally at 11 am he woke up to my texts and calls.

“It’s not here.”

After making sure that he had thoroughly searched his car and apartment, I was ready to place the order and pay the extra cost for the inserter to be shipped overnight.

“I’m going to your apartment to look. You probably didn’t look that well since you were in a rush this morning.”

How could I say no to such a generous offer? However now I was really starting to worry that the inserter wouldn’t ship in time to get here by tomorrow if I had to order it. “Hurry!”

I waited anxiously for some good news.

“Wtf it’s not here.”

Ugh. My finger was hovering over the “place order” button online. With that confirmation, I clicked the button. I thanked my boyfriend for his thoughtfulness and his attempt to find it. It was unfortunate to have to pay $15 in shipping, but hey, you have to do what you have to do for your health.

Literally 2 minutes later…

“Omg” “I found it!”

Of course. Turns out, as my boyfriend was leaving, he almost tripped on a random paper bag on the floor and felt something inside. Sure enough, the blue pouch was inside the paper bag. I must have thrown it in there when I was getting out of his car over the weekend and completely forgot about it. I was so relieved! I needed that inserter to be able to change my set and now I wouldn’t have to worry about it getting here on time.

I kept the other order so I would have a back up so I could avoid a future situation like this, but called the company and had it changed to the free standard shipping.

Talk about a stressful morning though! At least I have a story to tell tomorrow to the class!

To fast or not to fast?

Yesterday was Yom Kippur or “Day of Atonement”, one of the holiest days in Judaism. On this days, Jews around the world atone for their sins and ask forgiveness from those they have wronged over the year and from God.

One of the traditions of Yom Kippur is fasting. The idea is that you are afflicting the body and soul with an act of self-denial as you repent for your past sins. One is meant to put aside physical desires and instead focus on spiritual needs through prayer, repentance, and self-improvement.

While the Yom Kippur fast is an important ritual, it is never at the sake of jeopardizing one’s health and so Jewish law says that people who cannot fast for health or other reasons, should not fast.

Now this post isn’t meant to pass judgement on anyone’s traditions, beliefs, or decisions. I completely respect and understand anyone’s decision to fast or not fast, regardless of health reasons. I respect the manner in which anyone observes this holiday or their choice not to. This post isn’t about anyone else besides me. It’s about my own personal experiences and struggle.

That being said, I’ve always had a hard time not fasting on Yom Kippur. Over the years I’ve tried many different techniques. Some years I fasted as long as I could until I dropped low and then broke the fast. Other years I intentionally let my blood sugar run high for the day so I wouldn’t drop low. Some years I didn’t fast at all. And while I knew that having type 1 diabetes “excused” me from fasting, I approached this Yom Kippur with an uneasy feeling and internal struggle.

Why was I so conflicted? After all, Jewish law is very clear that not fasting for health reasons is not only completely acceptable, but encouraged. After giving it some thought, I came to the conclusion that it came down to two main points.

  1. To me, I didn’t want it to appear like I was using my diabetes as an excuse, or a way out of something undesirable. I’ve been very careful my whole life to not use my diabetes as an excuse for special privileges when they weren’t necessary or to let my diabetes stop me from doing something that I wanted to do.
  2.  While I know this is not really the case, I could never shake this feeling that somehow I was missing an essential component of this holy day by not fasting, that I wasn’t fully experiencing it in the way that I should.

With this knowledge of where my struggle was coming from, I went on a search for something that could help me come to a sense of inner peace and acceptance over this issue. The internet is a great place, and with a little searching, I came across two websites that had just what I needed to hear.

The first came from Everyday Health and was an article on Fasting Safely With Diabetes. In it, there’s a quote that says, “In the Jewish religion, it is considered a mitzvah (a good deed) if one must eat for health reasons.” What was most striking is the idea that eating for health reasons is not just “acceptable” but is actually a good deed!

The second confirming text came from an article from in the Ask the Rabbi section about Eating on Yom Kippur. The article stated, “Just as on Yom Kippur it is a mitzvah to fast, in certain circumstances the mitzvah is to eat on Yom Kippur. Even if the person wants to fast like everyone else, God sometimes gives a unique test- in this case to eat on Yom Kippur, to remain healthy and serve God.”

What I took from this article was this idea that for people who are healthy, fasting is their challenge. But for me, someone who would really like to participate by fasting but shouldn’t, my challenge is actually eating on Yom Kippur. My test is different, but not inferior, it is still a mitzvah!

Finally after many years, I began to understand my situation differently. To see that my participation in this holy day may be different, but is not any less meaningful. Not fasting on Yom Kippur is truly one of the few things that I’ve had accept that I can’t really do with my diabetes. But this year and from here forward, I embrace this fact.  When I was able to come to a place of inner acceptance, I knew that I would be able to defend my decision to not fast not by feeling inferior, but by feeling proud!

But fasting or not, I still love the break fast food!IMG_8413

On the floor

It was Saturday afternoon. My boyfriend was on a mission to make banana bread with the ripened bananas that he had been collecting. I had finished a 27 mile charity bike ride a couple hours earlier and really just felt like lying on the couch relaxing, but I agreed to be in charge of mashing the bananas. It felt like a job I could handle.

imageI sat down at the table with my bowl of bananas. Suddenly something didn’t feel right. I got up from the table and sat down in the reclining chair. I checked my CGM, it still said 80 but I knew that couldn’t be right. I tested my finger: 63. Hm yea that made more sense.

I ate a pack of fruit snacks, assuming all would be fine soon.

But I was wrong.

Rather than starting to feel better, I felt myself plummeting downward. The walls started to feel like they were closing in on me. My body felt heavy, my brain foggy.

“Are you okay?” my boyfriend asked from the kitchen.

“I need to lay on the floor.” I figured I should probably give him a heads up so he wouldn’t look over and see me on the floor and think that I had passed out.

I tested my blood sugar again. This time it said 42.

I got down on the floor, laying flat on the carpet. I know it’s weird, but with really bad lows, there’s something comforting about laying on the ground. I closed my eyes, willing this low to go away and my body to start feeling better.

My boyfriend got down on the floor next to me, putting his arm around me.

“This is a bad one.” I could hear the concern in his voice.

When I answered, my tongue was heavy and my words slurred together.

“Sometimes I forget that you’re diabetic.”

I was confused by this statement. “What? How? I talk about it all the time.” I managed to mumble back.

“Yea, but it’s just become so normal.”

It was an interesting and thought-provoking statement. A year ago, my boyfriend knew virtually nothing about type 1 diabetes. Today, my “normal” life has become part of his “normal” life, so much so that it took such a drastic and out of the ordinary low to remind him that I still do have a chronic disease that at times can be dangerous.

After about 15 minutes I started to feel better, my blood sugar hovering around 70. I got up off the floor.

“That was scary. I don’t like seeing you like that.”

“Yea. Me either.”

I’m glad that such a low is out of the ordinary, that fortunately I don’t experience many that are quite that bad. But lows like that are jarring shake back to reality, a reality where scary situations like that are not entirely outside of the realm of my “normal”. Even if sometimes I, and those close to me, forget that they are.

I went back to mashing bananas for the banana bread, doing my best to return to “normal”.

Yoga high…and low

I walked down Main street with my yoga bag slung across my shoulder, already sweating in the evening heat. About 6 weeks ago I started taking a weekly yoga class after work. I snuck a peek at my CGM, it read 153, a comfortable number to be starting to exercise. I arrived at my yoga studio and removed my sandals, stuffing my bag including my CGM into the small cubbby and grabbed a pack of fruit snacks just in case of a low.

While I’m not new to yoga (my mom is a certified yoga instructor), I have never had much of a consistent practice. My choice of exercise has always been more cardio based: tennis, bike riding, boot camp classes, cycling, etc. There’s always the chance of dropping low while exercising, and it’s happened during all those activities. But there’s enough movement and noise with those exercises that treating a low can often go unnoticed by those around me.

yogaI’m not embarrassed to treat a low. I do what I have to do. But at the same time, I don’t like to be disrupted or disrupt those around me. Every time that I made it through yoga without dropping low, I would breathe a secret sigh of relief. It’s just yoga is so quiet, so calm. I don’t want my CGM breaking the silence of a meditative moment or the crinkle of my wrapper interrupting someone’s flow.

In the tiny one room studio, mats and bodies lined the floor like sardines packed neatly in a can. I rolled out my mat, careful to leave a respectful distance between me and the woman lying next to me. I set my fruit snacks at the corner of my mat, giving into a brief moment of insecurity where I picture everyone wondering why I have candy out in class. “Just focus on yourself, don’t worry about anyone else.” This is a yoga class after all, let it go.

The class was a blend of different positions. Although not too strenuous, I could feel the sweat forming as I attempted to hold each posture with good form. After ending with some twists, we made our way to our backs for savasana, or corpse pose. My legs  and arms out straight, I closed my eyes, feeling the meditative chants of the music reverberating through my body. My breathing became deep and full as every muscle in my body slowly began to relax. Fleeting thoughts danced in and out of my consciousness. I started to feel this strange sensation in my body. I felt heavy, yet electrified. Something is happening. “This is it,” I thought. “I must be having a transcendent experience.” 

And then I heard it. Buzz Buzz Buzz. Beeeeeep Beeeeep Beeeeeep. That feeling I was experiencing was nothing other than a sneaky low blood sugar. The still silence of savasana was broken by my CGM buzzing and beeping in the background. Even though no one knew those sounds belonged to me, I could feel my cheeks flush with embarrassment. Thankfully just in that moment the instructor began to stir the class back to seated position to end the class. I got up and checked Gigi: 52. I opened and ate the fruit snacks.

So I ended up experiencing the diabetic low instead of a yogi high. But it was a good reminder to myself that it doesn’t matter if its the middle of a yoga class or a presentation at work, there are moments when your health is more important. Just as yoga teaches, it’s about accepting what you can’t change and letting go of what you can’t control and instead focusing your energy into living in the now and being your best self.


Cheesy cauliflower crust pizza

I love food. Mostly I love to eat it and take pictures of it. And tell other people about how amazing it is.

I’m working on loving the cooking part of it. When I added a food section to this website, it wasn’t with the intention of becoming a food blogger. Similar to why I started blogging about type 1 diabetes, I see this as a good opportunity to improve my own cooking skills, to challenge myself to prepare healthy meals, and to showcase some stellar recipes that others have tried and approved.

One person that I plan to feature a lot is my sister. Earlier this year she was diagnosed with celiacs disease. Part of her journey has been learning what she can eat, but also finding and modifying recipes to fit her dietary needs. A lot of times her alternatives are healthier, low carb versions of popular foods (although not always). But every time she texts me a picture of her dinner, my mouth starts to drool. I figured that many of the people who read my blog would also be interested in what she’s been cooking.

So to start us off, here’s a recipe for Cheesy cauliflower crust pizza that my sister made. She found the recipe from the food blog, Jo Cooks and I’ve copied Jo’s recipe below. The only difference my sister did is that instead of making the cauliflower dough into breadsticks, she just made a giant pizza. You can see below how beautifully it turned out.

PREP TIMG_8160IME: 10 minutes
COOK TIME: 40 minutes
Author: Jo
Serves: 8
  • 4 cups of riced cauliflower (about 1 large head of cauliflower)
  • 4 eggs
  • 2 cups of mozzarella cheese (I used a Tex Mex blend because that’s all I had)
  • 3 tsp oregano
  • 4 cloves garlic, minced
  • salt and pepper to taste
  • 1 to 2 cups mozzarella cheese (for topping)
  1. Preheat oven to 425 F degrees. Prepare 2 pizza dishes or a large baking sheet with parchment paper.
  2. Make sure your cauliflower is roughly chopped in florets. Add the florets to your food processor and pulse until cauliflower resembles rice.
  3. Place the cauliflower in a microwavable container and cover with lid. Microwave for 10 minutes. Place the microwaved cauliflower in a large bowl and add the 4 eggs, 2 cups of mozzarella,oregano, garlic and salt and pepper. Mix everything together.
  4. Separate the mixture in half and place each half onto the prepared baking sheets and shape into either a pizza crust, or a rectangular shape for the breadsticks.
  5. Bake the crust (no topping yet) for about 25 minutes or until nice and golden. Don’t be afraid the crust is not soggy at all. Once golden, sprinkle with remaining mozzarella cheese and put back in the oven for another 5 minutes or until cheese has melted.
  6. Slice and serve.
Nutritional information based on 1 cup mozzarella cheese for topping.
Serving size: 99g Calories: 164 Fat: 9.8g Saturated fat: 5.2g Unsaturated fat: 0.0g Trans fat: 0.0g Carbohydrates: 4.3g Sugar: 1.0g Sodium: 296mgFiber: 1.1g Protein: 15.6g Cholesterol: 104mg

Diabetes Social Media Burnout Day


Burnout. I’ve been there. In fact I just returned from about a two month hiatus from blogging. But my burnout was more self-imposed, independent from the happenings of the DOC. I’ve been fortunate that I haven’t encountered any hurtful, argumentative, or mean comments directed at me or what I wrote. That doesn’t mean they don’t exist in the DOC, but I’ve never felt personally attacked. But I’m sure that has to do with my own level of involvement. The more you put yourself out there, the more you dive into the DOC, the more vulnerable that makes you.

With anything on the internet, if you search hard enough, you’ll find information, opinions, and support for both sides of any issue. So while you’ll find people who have the opposite viewpoint as you, you’ll also find like-minded people. Everyone has opinions and everyone is not going to agree. But by putting your thoughts out into the vastness of the Internet, you have to be prepared for and strong enough to handle people who disagree with you. But that doesn’t mean your thoughts are not still valuable to others.

When you reach a state of burnout for whatever reason, instead of thinking about why you stopped, remember why you started.

Why did you start blogging? Why did you first become active in the DOC? What was and is your purpose for being here?

I started blogging because I wanted to hold myself accountable. But more than that, I wanted to share my unique experiences with a shared community. I wanted to educate those who don’t know what it’s like to live with T1D. I wanted to connect with others. I wanted to be inspired and to inspire others. I started sharing my story so that others could see bits of their own life in my posts, and for me to find pieces of myself in theirs. I started so that together we would strengthen one another, support one another, and together help each other through the ups and downs.

Sometimes I get so caught up in the day to day that I forget why I started. Sometimes when I don’t get comments on or offline about my blog, my purpose starts to drift away. Comments aren’t the reason why I blog, but they are good fuel. All it takes is one person telling me that they love reading my blog or commenting that I’ve inspired them to make some difficult changes that keeps me going. The hard part is remembering that even if no one tells me these things, there are lots of people who read my blog without commenting that still find value.

So from this social media burnout day, I’ve decided that the next time that I feel like I need to step-back and take a break, that I instead will write 3 nice comments on someone else’s blog. Because those comments might just be enough to help that person through their burnout.

Insurance frustrations

bubbleDuring the time that I was on my parent’s insurance, I was pretty much removed from the entire billing and insurance process. I was lucky in that my dad took care of the paperwork and the phone calls. I lived in my nice little naive bubble where all I worried about was going to my appointments, ordering my supplies, and taking care of my health. I didn’t worry if a certain device or procedure was covered by my insurance, everything just magically worked out. Oh what wonderful times those were.

Then I got a job and my beautiful bubble popped.

I know that I’m very fortunate that my job even offers insurance and that it has pretty good coverage. However, if you ever want to simultaneously raise your blood pressure while feeling like you want to bang your head against the wall, try calling your insurance company to argue a claim.

Take a few weeks ago as an example:

It all started with an email notification that I got that a new claim was available to view online. It was about my most recent routine appointment with my endocrinologist. I followed the link to an EOB. I feel like I should be able to say that I speak “Insurance” since it often feels like I’m reading a foreign language while trying to decipher what is being said. I noticed that the entire bill was higher than the past 2 appointments. Scanning the paper, I found a tiny number leading to the appendix with the following text:

Our payment policy limits the number of times this procedure is allowed and that limit has been met.

Ummm huh??? I went back up to see what billing code this was referring to, thinking perhaps it was some unnecessary test or blood work that I may have unintentionally duplicated.


Like I said, a foreign language. But whatever it was, I was being charged the entire amount of $120. But if it has to do with glucose monitoring, it probably is necessary. I called my insurance company. The woman explained that the billing code that the limit was referring to was 95251 (side note: I did some googling and this particular billing code can range from $35-$350!). With some simple googling I determined this billing code was referring to the following:

95251: Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; interpretation and report.

Essentially it’s downloading my CGM and interpreting the numbers. At this point I was starting to get both confused and angry. I checked the EOB. I was also charged for an Office Visit so it’s not like it was the only thing they were billing for. But the part I was getting angry about was that downloading and interpreting my numbers is really all my appointments are since checking my a1c and blood work happens at an entirely different time and facility.

I called back the insurance company, asking what the limit of visits are for that code: 2. I attempted to calmly explain that the standard of care for a type 1 diabetic is seeing their endo every 3 months, so 4 visits a year. How could they only be covering half of them?!?!

The insurance woman explained that I’m going to need my doctor to call the patient management team at the insurance company and get the additional visits pre-certified ahead of time for them to be covered and additionally to appeal the charges from the last visit.

Ugh. Really??

At this point I’m just annoyed. But I’m more annoyed at the idea of having to pay so I call the health system starting with their billing department. After explaining the issue, I was told that the doctor will have to call and that it’s something that the billing department can’t take care of. Okay fine.

I call the doctor, the receptionists says I should talk to billing. No, billing said to talk to the doctor. At this point I’m ready to hit my head against the wall. My doctor is not available so I leave a message explaining the entire issue. The receptionists assures me she will deliver the message.

A week goes by. No response.

I call back. The person on the phone looks at my file. He tells me that it looks like it was seen and sent to billing. The person on the phone offers to have someone from billing follow up with me. Yes please.

I wait.

A few days pass and I finally get a message from someone from Billing. “I see the message in your file,” she says. “It looks like they’re talking with someone at the insurance company. I can call you back when I know more.”


A few more days. “It looks like they are taking off the charge for your most recent appointment.” “That’s great,” I respond “but what about the future appointments? I have one coming up in a few weeks. Are they going to charge me again? The whole point was to get them pre-certified.” “Oh ummm, well I can tell them to look at the September appointment. You’ll have to call ahead of time for each appointment and tell them to contact the insurance company.”

Are you frickin kidding me?!?! Why is this so circular?!?! I thanked her, not sure exactly what was accomplished besides not being charged for the most recent visit. However, the fact that it took almost 2 weeks does not give me much hope if this is the process I’m going to have to go through twice a year, every year!

The funny thing is, I would consider this a successful encounter compared to some of the other arguments and conversations I’ve had with the insurance company. But it’s amazing to me the number of phone calls it takes to accomplish even the simplest task. Working in the health care field and having a masters in public health, I consider myself to be more knowledgeable than perhaps the average person in navigating the health care system. And if I found this process to be arduous, I can’t imagine that many people with much less knowledge are being successful in their efforts.

If anything, I’ve become a much more assertive person through this process, but really I just wish that the whole system was fairer and simpler for everyone.






No excuses

Ugh it’s been too long! I feel terrible for neglecting you for so long! A lot has happened that I want to tell you about, and I will…eventually. But I feel like I need to rewind to the first notable thing that happened since my last post.

About 2 months ago I had an appointment with my endocrinologist. This is not unusual, I have one every 3 months. But I knew this appointment would be different.

When I was younger, I used to say on the day of my endo appointment, “I’m going to the doctor to get yelled at today.” Now my doctor wouldn’t really yell at me, but I knew that I wasn’t doing that well and that they would in a nice and appropriate way, tell me to get my shit together.

I approached this appointment with a similar attitude. I was dreading the appointment. The previous three months were just not great. My numbers were all over the place, but mostly too high. Trust me I had my excuses ready…sicknesses, bent infusion sets, a bout of insomnia. But deep down I knew those really weren’t the reasons for three months of high numbers. It was more like apathy, laziness, and lack of discipline. I knew that really I only had myself to blame.

I got my A1c back. It was high. The highest its been in 3 years. In fact it was the same number that prompted me to start this blog in the first place and make some major changes.

I wasn’t surprised, but I was disheartened and disappointed.

My endo looked at me. “So what happened?”

My excuses were on the tip of my tongue. But I held back. I knew I had to take responsibility for my actions (and lack there of) and for the consequences of them.

“It’s just been a bad three months.”

She nodded. “Do you want to make some adjustments or do you want to try again?”

“I’ll try again.”

It wasn’t a good appointment. But I have to admit, in many ways I feel proud.

I’m proud of myself for not making excuses, I’m proud of myself for taking responsibility for my health. I’m proud of myself for only momentarily becoming discouraged, and instead vowing to “try again” and do better next time. I’m not proud of my A1c, but I know I’ll get back to what I was.

I found a quote online, “Every set back is a set up for a come back.” Well watch out, because I’m making a hell of a come back!


I’ve learned over the years that I’m someone that craves explanations. I want things to make sense, I want to know why something may have happened. I need logic.
Granted, I don’t always need to know exactly why something happened, sometimes we just don’t know, but I find myself still wanting to make an educated guess. And when there is a disconnect between what happens and a proposed explanation, I get frustrated. “That’s impossible! There’s no way that what you just said could have caused that.” Those close to me are all too familiar with my need for logical conclusions, and my irritated response when I’m not satisfied with the answer.
But I know we don’t always get answers. Why do bad things happen to good people? Life is random, mysterious, and unpredictable at times, it’s part of what makes it both devastating and exhilarating. In many cases I’m perfectly content with the explanation that sometimes things happen that there are no logical explanations for, it’s the universe at work.

My diabetes falls somewhere in the middle.

Too many times I’ve found myself frustrated with a high or low blood sugar, not understanding why it happened when it seemed that I did everything “right” to avoid it. I rack my brain trying to come up with a logical explanation, but sometimes there are just too many variables to consider. Was I really that far off in my carb counting? Is this a delayed effect from the exercise I did earlier? Is something wrong with the insulin? Is there a bend in the tubing? Is the insulin not being absorbed at the site? Am I getting sick? Am I stressed? So much to consider, I can’t always draw a one-to-one connection for a high or low.

Last week I was shocked to see a blood sugar that was over 500. A rare event, my first thought was why?? Well really it was “Oh f*ck” but then why did this happen?!? I ran through the list in my head as I tested my ketones, gave myself a shot, and changed my infusion set.

You don’t always get answers for everything in life. I’ve learned to accept it and move on with the information that is available.

But sometimes, when you’re lucky, you get exactly the explanation you need.

bent infusion set cannula blocking insulin from being delivered