Monthly Archives: December 2012

New Year, New You

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During my time in college, I used to dread Januarys at the gym. As someone who regularly frequented the gym between and after classes, I had figured out the best times to go when it was relatively empty and I could use the machines I wanted without having to wait for them. I developed a schedule and could usually count on completing my workout routine without interruption or delays.

That is until January came around.

Suddenly the gym became filled with people whose New Year’s resolution was to get in shape, lose weight, and work out more often. Instead of being able to jump on my usual machine, I now had to wait in line for the first available one. Don’t get me wrong, I love that people had suddenly decided to become healthier, I just wished that they didn’t all decide at the same time. By mid March however, the gym had mostly returned to its previous occupancy.

What happened? Pretty simple to figure out. By March, most of the people who were driven by their New Year’s resolutions to become healthier had begun to lose their motivation and eventually returned to their typical schedules. This phenomenon happens every year for all sorts of behaviors. Perhaps you begin the year with the intention to eat healthier, to cut back on smoking or drinking, to gamble less, save more money, to exercise more, the list goes on and on. But as each of us can probably attest to, many New Year’s resolutions go unfulfilled. I know many of mine have.

With the New Year right around the corner, I started to think about why. Why do so many of us fail at keeping our resolutions, especially when we are so motivated in the beginning? There are many reasons why this may happen, but I identified 3 major areas that I believe are critical components to any successful New Year’s resolution.

1. Scope
One of the biggest problems is that people set goals that are too lofty. Perhaps ideally you want to lose 20 pounds in the New Year, but that task can be daunting and overwhelming, especially if in the first few months you’ve only lost a few pounds. With such a large goal, it is easy to become discouraged in the beginning and not follow through. It’s important that your resolution is realistic. Saying that you want to lose 2 pounds a month may seem more surmountable than to lose 20 pounds. Even though you are setting a goal for the whole year, it becomes more manageable if you can break it into smaller monthly or even weekly goals. If you want to quit smoking or dipping this year, perhaps you begin by picking a number to cut back by each week. Setting these smaller goals can help make your overall resolution more attainable.

2. Concreteness
This brings us to the second problem. Resolutions need to be specific. What does it mean to exercise more or to eat healthier? The more specific and concrete a resolution is, the easier it is to follow through. Perhaps exercising more means doing at least 30 minutes of moderate cardio, 4 days a week. Eating healthier may mean incorporating at least one serving of fruits or vegetables into every meal. You want to save more money this year? How? Does that mean cutting back on the number of times you go out to eat? Does it mean spending less on clothes or electronics? Saying to yourself that you will only go out to eat twice a week gives you a concrete task to adhere to rather than an abstract objective.

3. Preparation
Without this third aspect, your resolution is doomed from the beginning, however many people do not spend enough, or any, time at this stage. This involves the planning and practicing of the new behavior. It involves identifying potential obstacles that you may encounter and planning for how you will overcome them. If you want to exercise more, do you have the right equipment? Do you have gym shoes, a gym membership, or routine for working out on your own? If you want to cut back on smoking or drinking, have you thought about what behavior will replace it? This may involve rearranging the environment you live in, removing triggers of a negative behavior and putting in things to remind you of your new positive behavior. Throw away old alcohol bottles, lighters, and junk food. Put your running shoes in a place that you will be sure to see them, leave motivational sticky notes around your house, keep healthy snacks in your car. Tell people about your resolution and find people that support you. Anticipate slips in your journey, but don’t let them become falls. Even with preparation and motivation, you may still resort back to old behaviors from time to time, but persevere! Behavior change takes time and the occasional detour is okay, just try not to stray too far off course.

During my public health education, we would talk a lot about how objectives to any program should be SMART. The same applies for your resolutions. Any resolution should be:

S: specific
M: measurable, meaningful, motivational
A: attainable, achievable
R: realistic, relevant, results-oriented
T: time bound

So time to take my own advice. What is my New Year’s resolution? I want to lower my A1c. Well that’s pretty abstract. I want to lower it by 0.5 in the next 6 months. Okay, that’s better, but how exactly will I do that? I suppose there are lots of things I could try, but based on my past behaviors there are 2 main areas that I want to improve on:

  • The first is that I want to be better at bolusing right after I finish eating, instead of occasionally having 15-30 minutes pass before I remember. How can I be better at remembering? Perhaps I can set reminders on my phone or move my missed bolus reminder closer to when I typically eat my meals. 
  • The second behavior is that I want to be better about sending in my glucose numbers to my endocrinologist when I notice that my numbers may need adjusting. For me this means finally putting the CGM software on a computer so that I can download all the data and then email it to my doctor. It also means remembering to do this every few weeks. Perhaps I can also set a reminder on my phone every 2-3 weeks to email my doctor my glucose numbers. 
Hopefully by accomplishing the above 2 behaviors, it will help to bring my blood sugars under tighter control which will ultimately lower my A1c. By coming up with concrete steps that I can do to accomplish this goal, I feel more confident that this year’s New Year’s resolution will not go unfulfilled.

What about you? Have you thought about what your resolution is going to be? Whatever it is, just remember to be SMART. 
Good luck and Happy New Year!

Happy Holidays!

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I love the holiday season. I love waking up to a fresh layer of snow blanketing the grass and trees in a sparkling white. I love seeing the trees, streets, and buildings twinkling with colored lights. I even love braving the crowded malls and stores in search of the perfect gift. For me, the holidays mean spending time with family, getting together with friends, and enjoying delicious food. Despite my affection for this time of year, winter and the holidays are also a challenging time. This may be true for a lot of people, but I find it especially hard at times as a diabetic.
Being a visual person, I decided to create a series of photographs, my interpretation of the holidays through the eyes of a type 1 diabetic. Inherent in these photos is the juxtaposition of beauty and pleasure with disease and discomfort. Sweetness and enjoyment isn’t without careful deliberation and vigilance.
Cold weather brings challenges with blood sugar testing. When the temperature drops and your fingers get cold, it becomes even more difficult to get enough blood to take a reading. Sometimes I think my fingers might as well be covered in snow with how little circulation there is in the winter cold.
I love sweets. I’ll admit it. Being diabetic doesn’t necessarily mean that I can’t enjoy these treats, it just means knowing exactly how many carbs I’m having, giving enough insulin to cover it, and anticipating spikes in my blood sugar. That being said, it’s hard for me to look at candy, alcohol, or baked goods without thinking about calculating insulin, counting carbohydrates, and testing blood sugars.
The holidays are about remembering and appreciating what is truly important in your life. That may mean ignoring those questioning looks when you grab a brownie or excuse yourself to check your blood sugar. It’s about remembering everything you have to be grateful for instead of focusing on the inconveniences.
 
Warmest thoughts and best wishes for a wonderful holiday and a very happy, healthy, and prosperous New Year to you all! 

Let’s give this a shot

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The first insulin shot that I gave myself was motivated out of anger. It wasn’t anger at my diagnosis or even my diabetes, at least not on the surface; it was anger towards my mother. I was just over 12 years old, a pre-teen caught up in the drama of middle school. I can’t even tell you what I was so mad at my mom about, but that fury led me away from our heated discussion, down the hall and into my room, slamming the door behind me. I lay there brooding in my bed, watching the fan above me spin in slow circles. I knew my mom would try to come talk to me, but in that moment, I was determined not to see her.

Unlike most moody teenagers, I now found myself in an even bigger predicament. I needed my mom in order to eat, a loss of independence I was still grappling with. Having only been diagnosed with Type 1 Diabetes a few months earlier, I still relied on my parents to give me my insulin shots before my meals. Suddenly I went from slowly gaining my independence and more responsibility to having my every move micromanaged and being treated like a child.
In that moment, all I knew was that I was going to be stubborn. I was not going to see my mom, not even so she could give me my shot.
I was angry. But now it wasn’t just at my mom. I was angry at my loss of control, my loss of my independence, and in a way, the loss of my freedom. I had had enough; I was determined to take back control of my life.
I was going to give myself my insulin shot.
I had always hated needles, closing my eyes whenever receiving a shot. The unease still remained even after dealing with needles on a daily basis. I got up from my bed and opened the dresser drawer. With the boxes of syringes, test strips, needles, alcohol swabs, and other supplies, the drawer looked like something out of a hospital room. Sometimes I still couldn’t believe this drawer was for me.

I pulled out the insulin vial, alcohol swab, and a syringe. After watching my parents perform this task hundreds of times, I knew exactly what I needed to do. The rubbing alcohol felt cool against my skin as my heart began to race. This was really happening. I stood there pinching my skin with one hand, holding the needle with the other. I can still remember the conversation in my head as I attempted to coach myself through the endeavor.

 “Come on, you can do this! It probably won’t even hurt. Well, it might hurt, but if it does, it’s only for a couple seconds. Do you really want to have someone give you a shot every time you need one? Of course not! They aren’t the ones with diabetes, you are. This is your responsibility. Okay ready? One, two, three…now. Now. Now…”
Fifteen minutes passed as I just stared at the needle. Nothing ever looked as sharp and menacing as that needle poised against the skin of my stomach. My hands were shaking and I was light headed from holding my breath in anticipation. I could practically hear my heart beating outside of my chest. But I knew I was too close to quit; I knew I had to do this.
The first insulin shot that I gave myself was motivated out of anger. But anger was the last thing on my mind when I raced from my room, down the hall, and into my mother’s arms, hugging her in triumph. 

The Travel Bug

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I love to travel. As I write this, I’m sitting on a plane on my way to Boston. Whether it’s to a new city or different country, I love the experience of visiting a different place. There is so much to absorb when you go somewhere new; food, fashion, language, culture, art, music, architecture, and scenery, just to name a few. I’ve traveled far distances (Australia, New Zealand, Nepal), for long amounts of time (6 months in England) and on many different forms of transportation (planes, trains, buses, boats, cars). While there are inherent challenges to any type of traveling, traveling with diabetes does present some additional obstacles.
The first is packing. Between my meters, insulin pump, and CGM, I need to travel with a lot of supplies. I always take more than I think I need. For instance, if I will need to change my infusion set twice while I’m gone, I’ll bring at least 2 extra sets with me, if not more. You never know if there will be something wrong with the supplies so it’s always better to have extra. I also always bring extra test strips, batteries, syringes, tape, insulin, and of course fruit snacks. I try to fit most of my supplies in my carry on bag, and not a checked bag. If I can’t fit it all, I at least have enough to last a week. I’ve had luggage get lost and not be returned for days, if I didn’t have my supplies with me, I don’t know what I would have done.
Most of the time I don’t have any trouble going through airport security. I usually disconnect my pump and keep it in the bin when I go through, but I’ve also left it attached and just explained what it was and that it was connected to me, and everything was fine. The only time I was ever questioned was when I was flying to Nepal. I had to explain why I had syringes in my bag. Once I explained that it was for my diabetes, there wasn’t any problem.
The last part about traveling is one that I often forget about, changes in time zones. For places where the time difference is 3, 6, 12, or even 14 hours, it’s very important to change the time on my meters and pump. Since I get different amounts of insulin throughout the day and have different carb ratios, left unchanged, things can get very off schedule and mess with my blood sugar levels. I made the mistake of not changing the time on my meter while I was on vacation in Australia and New Zealand. It wasn’t until I had my appointment with my endocrinologist when I got back a week later that I realized that all my readings would be useless since it was completely off schedule. What was a reading taken at 2 in the afternoon showed up as 4 am. It was hard to make any adjustments when everything was so off.
Traveling can be stressful, exhausting, frustrating and overwhelming. That alone is enough to disrupt my blood sugar levels. Even with as much traveling as I’ve done, I still get anxious from time to time with figuring out logistics. One thing that I think every traveler learns is to be flexible. Things happen unexpectedly when you travel, there are delays, cancellations, miscommunication, wrong directions, etc. I’ve learned to become flexible with my diabetes as well, sometimes having to change my infusion set in bathroom stalls or treating a low while rushing through a busy terminal.
When you need your supplies to survive, you learn to make them a priority. They are at the top of every packing list, first into any bag, and always on my mind. Whether I am leaving my house, hotel, or walking through airport security, I always do that awkward pat down, except I’m not checking for my wallet or phone, I’m making sure I have my insulin pump and meters.
I don’t have the option to leave my diabetes at home, but I refuse to stay home with it. I’m going places, and you better believe that it’s coming along for the ride!

50 Shades of Low Blood Sugar

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It’s hard to accurately describe what it’s like to have low blood sugar (hypoglycemia) without really experiencing it for yourself, but I can say that the feeling sucks. Low blood sugar happens when there is not enough glucose (sugar) in the body to be used as fuel for cells. Most people, whether you are diabetic or not, probably have experienced a mild form when you’ve gone a really long time without eating. Maybe you get a little grumpy or light headed. Now take that feeling and multiply it by 100. While some symptoms are more common than others, people with diabetes experience their lows differently, you just learn to recognize your symptoms. I’ve compiled a list of common and possible symptoms, starting with the ones I’ve experienced personally.

1. Shaky– my hands literally shake when my blood sugar drops
2. Light headed– kind of a dizzy, out-of-it feeling
3. Hungry!– It’s your body’s evolutionary response to tell you to eat and get more carbs. The lower the blood sugar, the hungrier I feel, even if I just ate a huge meal. More than I’d like, I find myself raiding the refrigerator and eating until I start to feel better and that awful low feeling disappears. This is one of the worst symptoms for anyone on a diet or trying to watch what they eat! And this over-treating can lead to high blood sugar and a seemingly endless roller coaster of ups and downs.
4. Lethargic– Sometimes it feels like my limbs have become really heavy and all I want to do is lay down.
5. Trouble thinking/concentrating–  It becomes really hard to put together coherent thoughts when my blood sugar is low, which was incredibly inconvenient if I was taking an exam or writing a paper in school.
6. Irritable/short tempered– This symptom I personally never noticed, but I’ve been told that I can occasionally get “mean” when my blood sugar drops.
7. Pounding heart/racing pulse– This symptom can be deceiving, often when I’m nervous or anxious I confuse the feeling with having low blood sugar.
8. Suddenly feeling very warm/hot– I’d imagine its kind of like having a hot flash? Nice when it’s cold out, but not so great any other time.
9. Numbness in mouth and tongue– This symptom freaked me out! It happened for the first time recently and I had no idea that it was a common symptom.
10. Confusion

11. Dizziness
12. Headaches
13. Pale skin
14. Sweating
15. Trembling
16. Weakness
17. Anxiety
18. Poor coordination
19. Nightmares or bad dreams– that’s interesting, I actually didn’t know that one (thanks WebMD)
20. Skin becomes cold and clammy
21. Drowsiness
22. Sleep disturbances
23. Blurred vision
24. Slurred speech
25. Depressed mood
26. Restlessness
27. Personality changes
28. Tingling in hands or feet
29. Frequent sighing
30. Nausea or vomiting– for me, this is a symptom of high blood sugar, not low, but apparently it happens to people

So these next few I’ve personally never experienced (and hope to never!), but it is what happens if a person’s blood sugar drops dangerously low:

31. Passing out/unconsciousness
32. Seizures
33. Coma

Not quite 50 symptoms, but there are definitely a lot.

While I try to avoid having low blood sugar, I have accepted it as part of being diabetic. And while I don’t think I can ever get used to the horrible feeling, I’ve learned to tolerate it. However, having an episode of low blood sugar might be the most disruptive part of having diabetes. Sure it takes time to test your blood sugar or give insulin, but we’re talking less than a couple minutes for those tasks. Most episodes of low blood sugar last about 15 minutes before I start to feel normal again. That’s 15 minutes of not being able to think straight or concentrate, 15 minutes where your body feels shaky, weak, and light headed, 15 minutes of wanting to just sit or lie still. Most of the time I don’t or can’t completely stop what I’m doing at the time. I eat my fruit snacks and carry on with my life, but it’s not always an easy thing to do. And while I enjoy the taste of my fruit snacks, there’s nothing worse than exercising and working hard to burn off those calories to then have to turn around and eat sugar because my blood sugar had dropped.

Sometimes I will go days, maybe even a week without experiencing a low, but there have been other times where I will drop low 3 or more times in a single day. The scariest part is, you never really know when or where you will be when it drops low and it can become very dangerous very quickly, so you must always be prepared. That’s why I carry packets of fruit snacks with me everywhere. The best thing is to learn to recognize your symptoms so that you can react and treat it early before it gets too low. That’s one of the reasons I really like my continuous glucose monitor, it tells me when I’m dropping low sometimes even before I feel it. 

I’m sitting here trying to think of what kind of silver lining there might be from having to deal with low blood sugars. I could say that it has taught me to always be prepared and to expect the unexpected. But maybe, it’s more that sometimes things in life just suck! There’s no better way to put it. Having low blood sugar is awful, but it’s part of having diabetes and just something you have to learn to live with and deal with. I think everyone has something in their life that they wish they didn’t have to deal with, something that might be disruptive, uncomfortable, or unpleasant. Maybe you’re lucky and can find a way to deal with it so that it disappears, but for the rest of us that are stuck with our “low blood sugars”, it’s recognizing that sometimes even though life has handed you lemons, you can still have a great life.

(Images from DiabetesHealth- http://www.diabeteshealth.com/cartoons/)

Why me?!

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I first learned how to give a
shot by practicing on an orange

My diagnosis was a really hard and scary time, not just for me, but for my family and even friends. Part of what made it so difficult was that it was literally out of the blue. I had gone in to my pediatrician for my 12-year-old yearly check-up, seemingly healthy. I had no family history of diabetes and wasn’t showing any symptoms. The diagnosis was a complete shock to everyone. I remember sitting on the examination table, crying. I had no idea what diabetes was and what having it would mean for my life. From that moment on, everything was a whirlwind. We checked in to the hospital and over the next few days, I was visited by nurses, doctors, nutritionists, health educators, counselors, you name it. My family and I were bombarded with information, absorbing as much as we could in that short amount of time. I learned everything from how to count carbohydrates to how to give a shot. It was when I was released from the hospital that the fear and anxiety truly set in. How was I going to remember all of this, let alone give myself finger pricks and shots?? At this point, the idea of inflicting pain on myself to poke my finger was so appalling that it would sometimes take me an hour before I got enough courage to push the button.

I remember feeling a lot of different emotions: anger, confusion, frustration, sadness and fear. However, I kept most of that to myself, bottled up inside. Finally one day a few weeks later, I lost it. I have this image of me, lying in the middle of our foyer, curled in a ball, bawling. I remember this day vividly because for me, it was a turning point. I laid on the floor, repeating over and over in my head, “why me, why me!?” Then suddenly I knew my answer. In my 12-year old mind, I said to myself, “My life is pretty perfect, God is just giving me a challenge”. I told this to my parents, and my mom to this day, has never forgotten that sentence. She told me it was what helped her to begin to heal, to know that things would be okay.
To me this statement isn’t about God or even about the diagnosis having a higher purpose, it was about knowing that this was something I could handle, even if it wasn’t going to be easy. It’s hard for me to say that everything happens for a reason when there is such sickness, tragedies, and atrocities that happen to good and innocent people in the world every day. How can you tell a mother who lost a child or someone who died too young from cancer that it happened for a reason? I believe that horrible things happen for no reason at all. However, I do believe that some kind of meaning or purpose can come from a bad situation IF you are open, willing, and active in accepting this possibility, even if this takes years or even decades. A death of a loved one can lead a person to become an advocate for a certain cause or to prevent others from having the same fate. Tragedies can bring families and communities together. But on the other hand, it can tear them apart. This is where the type of person you are or want to be plays a role. This is where resilience comes in. Do you let something bad that happens to you defeat you, or do you rise above it? Do you become bitter and resentful, or do you find a way to move on, to make things better? At 12 years old, I had a realization that my diagnosis was going to be a challenge, but that it was something that I would learn to live with the best that I could. It was an obstacle to be overcome, not a dead end.
I wish every day for a cure. Obviously I would never have chosen to have this disease, but having diabetes has also played a role in the person that I am today. My choice to pursue a master’s degree in Public Health was largely influenced from my experience living with a chronic disease. I’m not sure where my future will take me personally or professionally, but I do know that my diabetes will play a role. You can’t always choose what happens to you, and unfortunately bad things happen to everyone. You just have to learn to make the best of it, any way that you can.