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The Challenges of Managing Two Diabetics

It’s been tricky managing my daughter’s diabetes alongside my own. Here are some things I’ve found particularly challenging:

There’s Only So Much Room Up There

There’s only so much space in my head and I’ve always hated taking notes and logging information. I have lower conscientiousness–in the form of organization skills than I’d like so I have struggled with laziness regarding doing these things.

But when managing my diabetes and my daughter’s, there just isn’t enough that I can reliably commit to memory. One thing that helps is that I’ve synchronized our schedules. We give insulin at the same time and eat at the same time (I homeschool so this works well). I also teach her what I’m doing as I do it and that helps me when I’m trying to keep things straight.

Double the Emotions

My daughter’s blood sugars are stellar but once every month when there’s a 140 and she feels awful, it doesn’t matter if I’m 80, I feel awful, too. And that’s been tricky to cope with because too much feeling awful is a recipe for a disaster. So I’ve been trying to just breathe and not get too caught up in those moments, as they are temporary. There are moments of despair though, like if I’m high and she’s low and our allergies are flaring and I’m trying to figure out if we can afford stuff and if I have the energy to pack more than one Frio with all the supplies and pre-cooked low carb food in a large backpack for a park on a hot day. Sigh.

Who Did I Just Inject?

It can be hard to remember who I just gave an insulin shot to. Especially around dinner time when I’m busy finishing a hot meal and setting the table and timing it all with my husband’s arrival from work. I’ve asked my daughter, “Did I just give you a shot or was that me?” Scary, right? I’ve had to nearly slap myself on some early mornings to make sure I’m fully alert and mindful.

Mindfulness is crucial. I have to make sure I don’t switch our doses. I can’t give her my basal or bolus dose without turning things into a life-threatening situation. So I’ve learned to inject only once I’m fully present. If I am not or if I’m rushing, I stop myself and wait until I can inject safely. If someone is talking to me I ask them to stop. If there is a lot of commotion, I remove ourselves to another room.

The same thing happens with checking blood sugar. “Were you 104 or was that me?” It’s easier to keep track of whose blood sugar is whose now that she checks her own blood sugar, though.

We have different doses, different insulin correction factors, different glucose needs to correct lows, and I have to remember my diabetes is very different from hers right now. I’ll go higher and lower much more easily so I can’t mimic her schedule completely. I have to remember to check more often and still remember to check her at the right times. She still makes some of her own insulin and I probably don’t.

Exhaustion

Sometimes I just get purely exhausted. This is mostly due to the physical hit I take from waking up in the middle of the night for our blood sugars. Now, in most cases like ours, I’d say the other parent should be getting up to check the diabetic child and that way everyone shares the “burden”. In my family’s case, my husband works 12 hour days doing hard, outdoor physical labor in construction with dangerous equipment, sometimes on high scaffolds–my point is that he needs to not be sleepy during the day so that he doesn’t make a critical error and lose life or limb (he’s already lost a tooth and his wedding band and almost lost an eye and a finger). You understand.

Some nights, I get up twice for my daughter and twice for myself and that kind of interruption to sleep is brutal if repeated too often within a week. My lymph nodes swell and I start feeling like I have a cold.

Master Mind I Am Not

Forgive me, the kids are really into Star Wars, lately.

Due to being the diabetes expert and stay-at-home parent, all the diabetes stuff automatically falls on my shoulders. My husband and I have a plan for using the weekends as training times for him because he needs to be able to do and know all I do and know. It’s intimidating for him because he sees that I get intimidated sometimes, and I’m an expert in living with type 1 and this is our dear little girl. But if we get a habit of synchronizing our giving insulin and stuff, him taking over on weekends seems like it can cause me to get out of my routine and screw up my flow, so there is a lot of creative trouble-shooting we’ll have to do to work things out. Mainly, I have to work hard to remember my own diabetes. You’d think this wouldn’t be an issue after so many years, yet here we are.

It’s hard to know exactly what it’s like unless one lives with type 1 and also manages it in someone else. If you’re like me, your mind is constantly analyzing and accounting for various factors like food, illness, stress, exercise, insulin doses, and more and when you’re doing that all the time for two people, it can be overwhelming and one person’s diabetes may suffer as a result. In our case, it’s been mine because that’s what parents do.

The Cost of Two Diabetics

The toughest part of everything is something I won’t go into too much because people paying for one case of type 1 diabetes can already imagine–the cost of two diabetics in one household. I grew up with a type 1 sister and these days, it’s a completely different ballgame to pay for two type 1s. We’re talking tens of thousands of dollars. Geez, makes an incredibly tough medical condition almost pale by comparison.

Pity Me Do Not

I like being understood but please don’t pity me. I’m so glad to have a wonderful family and to know how to keep my daughter and I well-managed. This hard work leads to focus, dignity, and gratitude. And in a blink of an eye she’ll grow up and I’ll only be managing my diabetes, once again. Though If I could magically manage both forever, so she wouldn’t have to, darn it, I would lol.

Due to writing this post, I can see what we need. To adopt a strict write-it-all-down habit where our every detail is responsibly tracked. Forcing out my own stubbornness (I hate logging!) won’t be easy but as is evident from all I’ve shared: necessary, it is!

(Sorry, again.)

2 Reasons Why I Split My Basal Insulin Dose

2 Reasons Why I Split My Basal Insulin Dose

More Even Coverage

The first reason is obvious and common–it helps provide better “coverage”. However, I take Tresiba and most providers do not encourage splitting the dose of that insulin due to its approximate 42-hour action profile. When I took one dose, I had an extreme drop in blood sugar at one point of the day and didn’t like that.

So, I was splitting it like this at first: 6-8 units in the morning and 3-5 at night. I check at random times, often at night and things seemed to be working very well. Then I discovered through trial use of two different CGM systems that I was dropping in the early morning hours while I was sleeping. Sometimes I would stay around 30 for an hour before waking up. Other times the graph simply indicated that I dropped to the 30s or 40s and then rose on my own (thanks lifesaving liver!) to about 60 or 70 by the time I got up.

Is this why I’ve been waking up really tired and groggy and with a headache for such a long time? Sheesh. Maybe I should just be grateful I’m alive…

Anyway, after that, I tried flipping the dose around giving the larger one at night and the smaller in the morning. This makes the drop happen around dinner for me–and it’s also a more moderate drop, I guess I need a bit more insulin in the afternoon as opposed to the middle of the night. It’s certainly safer than a blood sugar dip while I’m asleep and not plugged up to a CGM of any kind.

Not surprisingly, I’m much more chipper in the morning since I figured this out.

I share this extra bit in case anyone out there splits their dose and isn’t aware of nighttime lows–beware and check at different times during the night to make sure there are no consistent lows happening without your knowledge!

For Safety

As for the second reason I split my dose, it has to do with safety. Before I took Tresiba I took Lantus and I before I split the dose, I didn’t, and you know what happened to me, twice? I accidentally gave about 20 units of Humalog in place of Lantus. Both of these instances were awful and involved a ridiculous amount of grape juice. I can’t even smell grape juice today without gagging. The fear though, that was the worst part.

After that, when I started splitting Lantus, if I were to ever draw up Humalog to the dose of Lantus, I would be giving half that amount and I’d manage the emergency where I was instead of finding myself being rushed to the I’m-going-to-bankrupt-you-ER.

Tresiba requires less in terms of daily units of insulin for equal strength so if I ever goof up with Humalog again (I don’t plan to) then I will be giving at most, out of habit, about 6-8 units of Humalog or R insulin and I can handle either of those doses with glucose tablets that I always carry on me.

 

Feeling a Disturbance in the Force

“A disturbance in the force” is how I like to approach the topic of feeling lows. I think that for me, it accurately describes subtle symptoms of lows that are not immediately obvious.

For example, most of my lows start out with certain symptoms and then those symptoms evolve with increasing severity. But sometimes symptoms of lows are masked by a number of possible factors including but not limited to:

  • exhaustion
  • major stress
  • excitability
  • nervousness
  • being in a hurry
  • being under the influence

I’ve found over the years that I do a better job than ever before when it comes to sensing low blood sugar. And the way I do it involves asking myself if I sense a disturbance in the force. This means I tune in to my body for a moment. I mindfully scan myself real quick and I check for:

  • increased/uncomfortable heart rate
  • sweating
  • slight hunger
  • sense of urgency (hence the famous lows that occur while cleaning)
  • weak core muscles
  • poor attention and slow thinking

If I’m feeling confused and irritable, I usually pop a glucose tablet in my mouth because for me, those are symptoms of being very low and I don’t mess around when that’s a possibility.

Checking for my heart rate is, for me, the most reliable because as I get lower, my heart races faster. Eventually, it starts to beat out of my chest. However, that’s how I feel when I’m giving a presentation or doing high-intensity exercise so a blood glucose meter is needed to confirm in certain situations.

I treat lows differently based on circumstances. If I’m driving, I don’t check, I get a glucose tablet and pull over, first. If I’m alone with the kids or in another vulnerable situation, I quickly get glucose before fumbling with a meter. What if I only have time to ingest the glucose? I’ve never gone unconscious from a low in the almost 25 years with type 1 but maybe that’s partly due to the precautions I’ve learned to take.

The overwhelming majority of my lows these days are gentle ones in the 60s. For those, I confirm by checking and giving a small measured amount of glucose so that I only bump myself back up to the 80s.

It’s tough being mindful about our bodies at times but trusting ourselves when we have a split second thought about a “sense” we’re getting might be a valuable early warning we can act on to help keep us safe. Getting in the habit of “scanning” our body for symptoms is one I highly recommend.

How to Do Easter With Diabetes in Your House

Too many people seem to go overboard on Easter candy, in my opinion, and as a result, their kids do, too. The effects of sugar are such that if your child has any major stress happening, they might be tempted to sneak candy in when you’re not looking and this can wreak havoc on blood sugars.

Trying to dose for and cover candy doesn’t usually lead to any consistent positive results, either. Unless you’re ok with a 160 mg/dl and in that case, therein lies our fundamental disagreement.

Either way, havoc-wreaking on blood sugars is a very big deal and is to be avoided for your child’s immediate and long-term wellbeing. It’s not “ok” if it’s often happening because we’re letting it by doing things that make success highly unlikely, you know? Like, if it usually doesn’t go well, why keep doing it?

Here are some ideas on how to celebrate Easter if you do (or don’t) have diabetes in the house:

  • Make a special roast or something that you don’t eat every day.
  • If you’re a Christian, here’s a reminder that you obviously should know where to put your focus and this can help you avoid too much emphasis on all the other Easter activities.
  • Bake a low carb treat to have after dinner. This splurge isn’t going to mess up blood sugars and there isn’t going to be a bucket of more of it tempting you or your child for the next few weeks.
  • Plan a fun activity. It takes creativity, especially if you have kids of different ages (though they all have different personalities). Talk to your kids and find something the whole family can enjoy.
  • Start a new tradition. This also summons creativity but it’s worth it. Kids are ok leaving behind something like typical Easter egg hunting with candy if there’s a worthy replacement. Some people stuff eggs with coins, others do erasers, stickers, and other small toys.
  • Put on music.
  • Bring a festive attitude–it’s infectious to your child and other family members.

Here’s what I’m considering (my kids are 9):

I am thinking about filling eggs to put around the house with numbered instructions for a treasure hunt. The kids would have to find all the eggs, put the instructions in order, and then answer riddles and questions for clues to the treasure. I don’t know what the treasure is, yet, but I think that it won’t be as fun as the treasure hunt itself, especially if it involves me getting up early to hide more clues around town. We did that once for my husband, Alex and the kids thought it was the greatest thing we all ever did. It takes effort but you gotta admit, it sounds fun, right!?

You can even plan for the treasure to end up with your church service. I’m not religious but for those who are, that sounds like an excellent idea to me! Unless it’s really early in the morning, then you’d have to get more creative, I guess, like starting the hunt on Saturday and ending on Sunday. Or the treasure could be a small gift that’s waiting at home. This works for all ages because you can make simple or hard questions and riddles and keep the locations as close to home as you want (living room or backyard is totally sufficient for very little ones).

Your kids will enjoy all this quality living that focuses on relationships, things of special meaning, and enjoying that which nurtures us and they won’t need the powerful effects of sugar to soothe or stimulate them. Yes, it’s hard with everyone doing loads of candy and chocolate but you can do different and maybe others will join you over time in tweaking the way we celebrate Easter and other food and kid-centric holidays.

We have to lead the way if we don’t like “how things are done” instead of just complaining about it all or bemoaning the consequences.

Children With Diabetes Deserve Insulin Concentration to Meet Their Needs

Young children with type 1 diabetes face a serious conundrum and that is that the available insulin is often too concentrated for their needs.

As a result, endocrinologists wanting to avoid terrible lows (and subsequent lawsuits) in these little ones order parents to feed a certain number of grams of carbohydrate per meal or they convince parents to put their child on an insulin pump, which can dole out smaller increments of insulin to meet their requirements.

However, the high number of carbs many type 1 kids get these days is a dangerous thing for these children because it crowds out essential protein and fat and can lead to weight gain and directly paves the way to roller-coaster style blood glucose management that I promise you, is worse for the child than the parent–no matter how much work and worry is involved on their part.

In the case of an insulin pump, not everyone wants this technology which comes with concerns about tubing issues and scar tissue development and also, not every family can afford one.

Why isn’t insulin made at different concentrations? I mean, it is, but mostly to meet the needs of the type 2 diabetes population which generally has very high insulin requirements. I’ve talked with many type 2s who use in one day, the amount of insulin I use in a week. This isn’t a judgment on them, it’s me pointing out that adults are getting their needs met in this regard and children are being left behind because why? Is it that they can’t advocate for themselves and their parents are being misled by pediatric endocrinologists who don’t know better? Pretty much, I think. One may argue that they grow up quick and then they don’t need such small insulin quantities but childhood health is essential to the rest of one’s life and so optimizing their care while they’re young is morally imperative.

There is a solution for those who want to give their child a smaller amount of carbohydrate and who don’t or can’t use an insulin pump. Diluted insulin. Special diluent fluid is provided free upon request from insulin makers and shipped to your nearby pharmacy. You can do it yourself or have a healthcare provider do it (if you can convince them to). The diluted insulin means you can dose to correct and cover for your child without the elevated risk of sending them low or needing so many extra snacks. This offers the potential to lower their carbohydrate intake, leaving sufficient appetite for what drives growth in a child–protein.

Regarding growth, look up the science, there is nothing indicating your child requires a lot of carbohydrates to grow. I think this is oft repeated mostly due to the above phenomena or lack of time and willingness on the part of physicians to do the proper research as well as their overreliance on what they’re told by other physicians and by governing associations. My daughter, on a very low carb diet, just shot up over 2 inches in 4 months. Before that, she was on a moderately low carb diet for a long time and her height is over the 90th percentile. Her bones and musculature are impressive. Her hair is thick and long, her nails are strong.

Aside from adequate nutrition, kids also need something else to grow to their full potential and that’s normal or near normal blood sugars, which only low carbohydrate diets achieve and which diluted insulin in children enables.

Diluted insulin could be a service pediatric endocrinologists provide to parents of young children with type 1 diabetes if we demanded it. I admit it’s intimidating to do one’s self. First, we have to educate ourselves and then them. Health care professionals feel really bad for us because they know what type 1 diabetes means in the long run for our children and they know the demanding lifestyle we parents lead (because we advocate well for our own suffering–lack of sleep, anyone?) but they’re not being very brave or ethical by ignoring what is going on with kids these days. Too many aren’t thriving!

Not only do most type 1 children have poor blood sugar management, but many are also gaining excess weight. This doesn’t bode well for their future and it’s not fair that adults have appropriate insulin and children don’t. As parents, we have to fight for our kids. Maybe I’m completely wrong. Fine. Maybe you should find out if any of this is true and if so, I implore you to think and discuss the topic with others. I was one of those kids with high blood sugar and weight gain after diagnosis and it made me extremely depressed and unmotivated, totally slowing down the trajectory of my life which has only got back on the rails by a bunch of miracles, sweat, and tears.

I’ve had enough of this poor treatment of children with diabetes and will not stand for it when it comes to my dear daughter. Children deserve medicine that is dosed for their size. They deserve myths to be expelled by our careful investigation and attention to the matter. And they deserve normal blood sugars.

Is a 6.5% A1c Good Enough for You?

The premise that a 6.5% A1c is great for a type 1 diabetic is based on the widespread belief that we simply cannot expect better results than that and still maintain safety from low blood sugars. The truth is that a 6.5% A1c in a non-type 1 diabetic is medically diagnostic criteria for type 2 diabetes. It is well established that type 2 diabetes is detrimental to one’s health, especially in the long term, though probably also in the short-term, though that is more difficult to quantify due to comorbidities.

It’s possible that a type 1 with a 6.5% A1c is different from a type 2 with a 6.5% A1c because the type 1 might be having more blood sugar variability, which the body doesn’t like. The type 2 in many cases has additional metabolic distress in the form of insulin resistance, obesity, high blood pressure, and fatty liver disease which would also make a difference when comparing their 6.5% A1c to that same A1c in type 1. Therefore, there are factors making this a nuanced issue.

However, if you look at cardiovascular outcomes of people with A1c averaging in the lower normal A1c range and compare them with those whose A1c averages in the upper normal range, you’ll find that the former does much better than the latter. Many people with type 2 diabetes experience complications and most likely their diabetes started after they became adults. So imagine what may happen to the type 1 child who experiences an additional two or more decades of harmful blood sugar by the time they’re 50? If you’re thinking that’s not fair, I agree.

If you have type 1 diabetes and have a healthy weight (which is increasingly less common) and you have low blood sugar variability and you feel good and all other vitals are in optimal normal range and you’re not making visits to the emergency room, then you may be completely content with your management. Or you simply may not be willing to make certain changes for what you may deem a very minor improvement in the quality of your life. Or maybe you were diagnosed much later in life so you have a long and protective history of excellent blood sugar. Or perhaps you aren’t willing or ready to aim higher right now. We all have this freedom to choose what is right for us and I wouldn’t want it any other way.

As for children, ethics would dictate that our choices must reflect much higher standards on their behalf.

For those who want better than diabetic blood sugars and are willing to do what it takes, there is a way to manage diabetes so that you can achieve normal or near-normal blood sugars and see less severe hypoglycemia. I don’t know of another way to do this than to eat a diet that is comprised of very low carb, high protein, and fat to the degree you require. There is more to it than that, though. You may be tired of hearing this but if you read Dr. Bernstein’s Diabetes Solution, you’ll learn what you need to know to get on the road to optimally healthy blood sugar management.

Ultimately, I want you to know that if you want it, it’s possible. Regardless, I wish all diabetics the very best of health.

The Diabetes Post I Never Wanted to Write

I knew quite a bit about type 1 diabetes before I diagnosed myself with it at age 11. My sister was diagnosed earlier the same year and I read up on it at the library in order to be useful to the family.

I still remember sitting in science class in 1994 when it hit me. I knew I had type 1 diabetes.

Days ago I got out the diary I wrote in between the ages of nine and 14. I read my early entries to my two nine-year-olds. They thought a day in February was hysterical which just said: “I’m SO bored!” I read to myself some of my age 10 entries, leading up to my diagnosis. Boy, was I moody…I couldn’t help but get a feeling of deja vu later that day when my daughter said something similar to what I had written on December 8th, 1995: “I just don’t know…” I wrote that so I know the feeling behind it and the way my daughter said it when I asked her if she was ok actually gave me the creeps. She sounded dazed and confused. I felt panic because it seemed that if I didn’t know what was wrong, and she didn’t know, then how could I help? She is an articulate child and generally knows herself so this kind of response was disturbing and abnormal.

Then on a typical Wednesday, my son comes up to me and says he is nervous because his vision is blurry. I stay calm and tell him that I’m going to check his blood sugar just to rule that one thing out. Type 1 diabetes in my children is a constant worry of mine.

I have two siblings with type 1 and an uncle with it, too. We definitely carry the genetic predisposition for it.

Alex is home from work now and he encourages our son to let me prick his finger.

He’s very nervous but he lets me do it. He’s 108. My stomach falls. I wish it was lower. That number is just good enough and just bad enough that I sit there dumbfounded. He looks worried and says, “that’s a little too high, isn’t it?” I have never lied to my kids so I tell him, “I think so…but it’s not too bad, we’re just going to keep an eye on your blood sugar going forward, ok? You don’t have to worry about it right now.” (His vision was back to normal after we checked him, turns out he had been pressing on his eyes, you know, things kids do).

Then suddenly, I decided I must check my daughter’s blood sugar. She is afraid of having her finger pricked so she runs away to her room. Alex has a chat with her and I am able to do it, though it’s no easy task. She has generally always been a very tough patient and I’m distracted by trying to keep her calm and keep her from pulling her finger away until the meter quickly counts down and beeps and the strangest number shows up on the screen: 245 mg/dL making my jaw fall open.

I’m speechless. I show Alex the meter and he looks just like me. He mouths the word “no…”. I tell our daughter there was a mistake and that I need to check her again. She’s upset by this and asks why. At this moment our son is looking at the result on the meter and says, “Was that her number? She’s really high…oh no, mom, I’m scared” And he starts to cry. She is on the other side of the room avoiding another finger prick. We check her again and confirm the high. She walks away to the couch and is upset about her bleeding finger and the slight throbbing. I accidentally pricked her too hard due to being unable to stop my shaking.

I check Alex’s blood sugar, for some strange reason. I don’t know what I was hoping for, the possibility of a screwy meter? He’s 100 mg/dL. I feel a rush of despair as I realize that our kids, who should have lower blood sugar than their dad, both have higher blood sugar than him.

Immediately I start thinking about research that shows what the chances are for a fraternal twin to get type 1 if one has it. I think the chance was about 22%, which is crazy high. For identical twins, I think it’s 50%.

I sit crying quietly with Alex at the dinner table for a few minutes. Then, while he’s holding our daughter in his arms, I ask him, “should we tell her?” Our daughter still doesn’t know what’s going on while the three of us are all mourning for her. Alex nods to my question. So I tell her that her blood sugar was high. She immediately knows she has type 1 as she covers her face to cry. She’s lived with it all her life by being my kid. Since she’s always been homeschooled, we’ve spent all our days together and she and her brother have not only seen all that I do to manage but have also heard me talk about it often. She even knows the risks and complications that can come with type 1.

I inform her with strong conviction that I have learned how to manage type 1 diabetes well and that we would take care of her. This is true. I have been a weird type 1 diabetic. I’ve talked and written about it much more than most type 1s would ever want to. Recently, I had told Alex that I still didn’t know why I have been obsessively compelled to learn so much about diabetes and to constantly read about it.

Sometimes you work hard and spend all your free time on something and you don’t understand why you’re driven to do it, you only know you must. I don’t enjoy learning about diabetes or talking about it or writing about it all the time. But now I know what I was training for, apparently.

A few years ago I imagined what I would feel if one of my children were diagnosed with this and I vividly saw myself on the floor, a puddle that no one could pull up and console–a pitiful shell of a person that couldn’t help anyone. I truly imagined that I would be so emotionally injured that I would die. But since my kids need me, I decided then that I had to toughen up. Because I can’t die on them.

Over the last few years, I have changed dramatically. My mindset is different now and many of my beliefs, too. I studied philosophy to learn how to determine was it real, true, and good and I started looking at everything more objectively. I was able to stop being mad at certain things and start being mad at things that deserved my wrath. I began to hold myself accountable and responsible for my life and my emotions. I stopped being fragile, honestly. I have been transmitting all this to my kids, teaching them how to think critically, be resilient, be righteous, and brave.

So I realized that night, standing in the kitchen with Alex’s arms around me, that I wasn’t a puddle on the floor. I was full of adrenaline of course, but I was standing tall and determined. If type 1 diabetes were a person, I’d be glaring at it, calculating just how I was going to beat it down.

Alex and I had a meeting with the kids the same evening about how we were all going to eat from now on. I eat a very low carb diet to manage my diabetes and now my entire family is going to do it. They are already used to a low carb diet but the step down to “very low carb” is not easy. I was surprised by how willing our son was to do this for his sister.

My daughter hasn’t cried again since…even after seeing me break down after the official diagnosis at the doctor’s office days later. She just took my hand and looked me in the eye and said firmly, “Everything is going to be alright.” I told her I was just so sorry and that I never wanted her to have what I have. She said, “I know, mom, it’s ok. Let’s go home.”

When did she grow up? Was it the day she was diagnosed with type 1 diabetes?

We caught the type 1 early so she doesn’t need insulin, yet. Her diet is keeping her mostly in the 70s and 80s. I check her during the day and in the middle of the night. She’s like a new kid when it comes to the finger pricking. She easily gives me her pinky, her favorite finger–mine, too coincidentally, turns her head away and covers her eyes with her free hand.

I’m still bursting into spontaneous tears at times but I don’t feel weak and hopeless. I am devastated. Yet, my love for my kids fuels me. I will take care of my daughter’s diabetes and teach her how to have excellent blood sugar management. I will keep an eye on my son’s blood sugars. I will make sure my husband knows what he needs to know to feel confident when I’m not around.

If there’s anything I’ve learned thanks to diabetes is that life is hard but much harder if you don’t learn to defer gratification and be stoic and use restraint and wisdom and curiosity. It feels good to avoid sweets in order to see better blood sugars. It feels good to check blood sugar in the middle of the night to stay safe. Everything you do that is wise but difficult will boost your self-confidence and self-respect and make you the person you always wanted to be: healthy as is possible, brave, and in some very meaningful ways–triumphant.

I strive to be humble, patient, empathetic, calm, and respectful with my daughter throughout this journey. I know that if I do these things, she’ll likely treat herself that way the rest of her life and she only deserves good things–including normal blood sugar.

Traveling with Diabetes

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I’ve travelled several times each month this year and it’s given me some lessons:

I’ve learned that I get motion sickness on planes and cannot travel without taking Dramamine.  I tried to forego it once and that one time we just so happened to have a bumpy ride.  It is not fun to worry about dropping blood sugars while throwing up and being jostled about in the tiny plane lavatory. 

Taking all the airport stairs and skipping the moving sidewalks (is that what they’re called?) is a good way to combat all the sitting involved in travel.

Staff on planes are always happy.  I still haven’t met one that isn’t, which is freaky, but if I’m feeling low, so far they are quick to grab juice if I need it and want to conserve my glucose tablet stash for later.

The food situation when in an airport is mighty tricky.  Temptation abounds and yet the easiest way I’ve found to travel is to keep it real low carb because if things get hectic, and lately in airports, they always seem to, low carb often saves me amidst skipped blood sugar checks.

Given how close one’s next seat neighbor is in coach, I find it remarkable how injecting insulin in front of that neighbor has never been an awkward experience.  In fact, it’s a great conversation starter and I’ve literally written down each starting line for your own amusement:

“Wow, those needles are tiny, I’m so glad for you.”

“So you have diabetes, huh?”

“OMG, do you need sugar?”

“Ok, what do I do if you pass out on this flight?”

“Wow, in and out, just like that, eh?  It takes me longer to sneeze.”

“How long have you had it?”

And my personal favorite:  “Does it hurt? I’m sorry, of course it hurts, what was I thinking? That was such a stupid thing to say, I’m so sorry, I didn’t mean to say that, I just figured that it hurts but maybe it doesn’t or maybe you’re used to it, is that it, are you used to it? Wait…I take that back, I get migraines and I seriously doubt I’ll ever get used to them.  Just forget I said that, ok?”  5 seconds later:  “So, where ya headed?”

Smile

What Diabetes Technology Can’t Replace

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If successful diabetes management is based upon a multitude of decisions we make during the day, why is technology often regarded as the number one asset in our diabetes management arsenal?

It can’t possibly be.  Take some important daily decisions that all impact diabetes:

-what to eat

-when to eat

-how much to eat

-how much insulin to give

-when to give insulin

-when to exercise

-what type of exercise to do

-how much to exercise

-when to test blood sugar

-how often to test blood sugar

And on and on!

Now basic technology like a meter is huge.  But, only if we choose to use it.  And a pump, for many of us, makes it easier to eat and deliver insulin as needed and to do a wide variety of exercises, as long as we choose to use it properly.  A CGM gives us information about trends and helps us catch highs and lows before they get too high or low.  Not to mention it can help save our lives by alerting us to dramatic blood sugar levels. 

So technology is awesome!

That’s indisputable.

It would seem that those using all of this technology would always have better diabetes management than those who only use a meter and syringes, right?  And yet, in my personal experience, I’ve met many people who use a meter and syringes and do very well and people who use all the technology available and don’t do very well. 

There are other important variables that always need to be considered.  So when a person is struggling with their diabetes management, often times more questions need to be asked than what is often asked.  Most likely, a person who can do well with a pump, can do well without one.  And CGM’s are most dramatically beneficial to those who can’t feel their lows or have young children with diabetes. 

My cautioning is really about avoiding the conclusion that, “If I had a pump, my diabetes would be controlled” or “I probably just need a CGM to have controlled blood sugars” without considering other factors. This isn’t to say these tools won’t dramatically help one’s management.  There is no guarantee and the decisions a person takes throughout the day is a better indicator of how a person will do with diabetes technology.

So if you’re struggling with your diabetes management, assess the root of your individual struggle.  Some people’s issues are best addressed with technology, but many issues are addressed outside of technology and skipping this facet of diabetes management can prove extremely frustrating and detrimental. 

I know because I’ve been there, done that.  Address your personal needs and let your blood sugars be your guide.  What technology can’t begin to replace is you and your knowledgeable decisions, which require knowledge about your diabetes.  Make sure your bases are covered before relying on gadgets.

Minimalism in Diabetes and Life

Thank you for all the emails of concern over my blogging break this summer and fall.  It was very nice to be missed.  I’m happy to be back.

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Over 6 years ago, when I ended my 7 year run with a Minimed insulin pump and switched to “the poor man’s” vial and syringes, I discovered something interesting about myself.  I functioned better when I practiced minimalism.  Not having so many balls in the air at once just feels easier.  I don’t even replace my syringes or lancets but once every week and several months, respectively.  I’ve never had an infection or any other problem as a result-at least not one I’m aware of.  And this makes me feel a bit more streamlined in my diabetes management.  I’m not saying I recommend being lazy about changing needles but practicing overall minimalism in my diabetes management works for me at the present time. 

In the past, all my constant logging, pumping, and the checks and balances that goes along with that overwhelmed me into not doing anything well.  Whereas now, I do the few essential things as well as possible, with A1c results I’m happy about.  It may be my personality type or my lifelong struggle with anxiety but either way it’s true for me and we all need to work with what is true for each of us.

I’ve been travelling a lot lately and I’ve been amazed at how I can go days with just a small carry on bag and my purse and not even need all that I packed.  And that includes carrying all my back up diabetes supplies which take up a good bit of room. The experience has taken away this fear I’ve always had where I ask my anxiety ridden self, “but what if I need it?!”  Now I just think of how much nicer it is to get around the airport with a small bag and how quick and easy packing is.  I’m less likely to forget something crucial, as well.

True and lasting change takes time and my moving towards minimalism has been a slow and deep process.  For the first time I’m truly aware of how ridiculous our consumer culture is.  I hate what we’re doing to the environment and ourselves.  I notice my sense of calm when I go somewhere that is totally uncluttered.  I can think and focus better in that environment.  I also have learned that more stuff does in no way translate to more happiness.  Though I can admit that being above the poverty level and therefore having sufficient safety and health affirming opportunities is important and absolutely impacts happiness levels.  But if we only refer to extras, I just spent the summer in a huge house at a lake paying zero in rent and I felt depressed the whole time. 

My favorite thing since childhood has been the computer.  I don’t know how many kids had a computer at home in 1993 but I did.  I saw the potential of this great mysterious box and as they took off better and better every minute, I became only more grateful that I had been born at a time when the world was at our fingertips.  Not to mention accessing information that was more real time than a book was super exciting.  Like most people, I love learning and the age of the internet has been my greatest ally, especially as a drop out college student married to a drop out college student.  We haven’t been hindered by our drop out status in terms of knowledge (unless you beg to differ) and that’s a righteous equalizing factor.  (Though in job searching we all know a degree still outweighs so many other valuable assets and qualities but that is a discussion for another day).

Part of what being globally connected has done for me is give me a very real view of how others think and live.  And it’s been impossible for me to ignore the fact that we have enough resources for all humans to have all they need.  We just don’t have enough for all of our wants.  Suddenly I feel greedy and I welcome that feeling because I don’t want to be talked about by my great grandchildren as the stubborn old woman that was gratuitously a part of a careless, destructive, insensitive, and idiotic generation that put greed before humanity.  I want them to know I was doing my tiny part to mitigate damage in my own home, community, and country.  I want them to know that I didn’t carry the attitude of a victim, of someone who says, “well, what do ya do” or “if you can’t beat em’, join em’”.  Bull.  Bull!  I want my grandchildren and great grandchildren to know that I felt guilty about how I was living and motivated and inspired by others to act and make any change I could to make something, anything, better. 

And that leads me to where I feel I’m now more quickly headed.  The movement of minimalism is becoming more popular.  Now there are those who criticize minimalists for being trendy.  But I’m glad it’s catching on and truthfully, it’s being criticized because every time someone talks about it we are basically causing others to self reflect and to feel that we are rejecting much of society.  It’s not like my life’s goal was to reject much of society.  It’s actually in my nature to agree with you as much as possible.  But self reflection and awareness has put me here.

Anyway, what’s great is that there is no right way to practice minimalism  The key is to be aware, to be conscious of how we live and to make changes where we can.  To reject it is fine.  But there are consequences.  That’s just a fact.  I no longer feel comfortable living the way most do in the US.  That doesn’t mean I judge you for not feeling the same way.  It just means that we should all be discussing this and supporting each other.  In other words, I tell you about my minimalism journey and stop right there and you tell me about all your shopping trips and stop right there.  I don’t tell you you’re doing something wrong and you certainly don’t tell me I’m nuts for trying to live with a lot less.  This has been a very recent change for me and even now I still waste paper towels like nobody’s business so I don’t have room to judge.  I do like talking about it because that’s how I got introduced-by others talking about it with me or writing about their experiences with it.  I am so thankful for their time and willingness to share how and why they do what they do.

So what is my family doing now?

Well, first of all, I’ve been getting rid of a lot of material goods this year.  It stung for a second and then I forgot I ever owned any of it. 

I also grabbed a few items by the dumpster and refurbished them with my husband.  He fixed them up and I painted them-which turned out to be some of the best meaningful fun I’ve had all year. 

Our cheap dining room table set broke years ago and we couldn’t afford to replace it so Alex (my husband) made a farmhouse style table with simple benches and together we stained it teak and Caribbean blue.  The entire project cost less than $100 and we are so proud of our table.  Our children loved witnessing planks of wood turn into something so useful. 

I’ve been scanning and backing up documents in order to free ourselves of paper weight. 

We sold our second car super cheap in an act of charity and just go everywhere together.  This works well for us because Alex drives a company truck to and from work.

My brother in law gave us his TV but we still don’t pay for cable TV, instead we use Netflix or Hulu to watch TV using the WII my husband received as a gift.  It’s cheaper and we spend a lot less time in front of the TV.

We just bought a 900 square ft house with no basement or functional attic.  My son and daughter will share a bedroom, which is going against the norm unless you go to other parts of the world where entire families eat, sleep, and entertain in one room.  We hope to have a smaller footprint that way and to be forced into not buying so much stuff because, “where on earth would we be able to put it?” 

Alex and I have never had credit cards. And when there is extra money, we’ve paid off tuition, medical debt, whatever we can, instead of taking a vacation. We haven’t had a vacation since our honeymoon 5 years ago but there is definitely less stress in paying things off when possible.  When people say “you can afford that” we say, “no we can’t”  And it’s a dignified, “no, really, we can’t and don’t want to be burdened with debt, be irresponsible with money, or give in to the seductive pleasure of mindless shopping and imaginary needs.”  And I am just like anyone else.  I get cheered up by buying things.  I love clothes.  I love books.  I love STUFF.  I have fooled myself into believing I can heal my anxiety with a shopping trip.  But, what I’ve learned is it’s a temporary fix.  And then I’m back to where I started, only, with less money.

We try to eat very simple whole foods with few ingredients just to make preparation and clean up that much easier.  We are slowly getting rid of kitchen supplies.  It’s a little scary but eventually we want to just have a bowl, spoon, fork, and mug for each of us and just wash after every use.  No more piles of dishes!  I know that sounds crazy but if you come over I will have delectable finger foods for you, great wine that we’ll drink out of, I dunno, something, and fun conversation-all to distract you from our primitive approach.  I’m trying to make my new mantra, “people, not things”.

We plan on growing some of our own food.  There will be a major learning curve but, we are committed to giving it a good shot. 

We plan on homeschooling the kids which will help us with having a more pleasant schedule and less hectic times throughout the day.  Less stress is always a plus.  Additionally, it has been brought to my attention that right now, the greatest indicator of a child’s outcome in school is their family income and not their performance or work ethic or testing ability.  I’m not playing that game.  If we can manage and meet everyone’s needs then we’ll do it, if not, then we’ll try something else.

I have been slowly getting rid of clothes.  I noticed a while back that my husband is always better dressed than me and I think it’s because he sticks with a simple routine:  button up shirt or polo, khakis or jeans, leather shoes-and done.  He gets colors that he likes and he gets high quality so he can use his clothes for years.  So I’m trying to simplify my dressing by getting rid of everything that isn’t awesome on me (because, really, why do I want to wear anything that looks less than awesome on me?)  As a result, I’ve gotten rid of 75% of my closet!  But, it feels great and laundry is sooo much easier!  I’ve heard of people who own two pairs of pants and two t-shirts and that’s all they wear and it sounds amazing but I’m definitely not there,  yet. 

I’ve discovered the magic of Goodwill.  It’s hit and miss and I’ve learned you have to be picky, but people have been amazed by what I get from there which cost next to nothing.  The key is to make sure it serves a strong purpose and doesn’t add to clutter, something I should write on my hand before my trips there. 

Well that’s it, I think.  Again, these aren’t things anyone else should do, this is just what we feel we can do and we have a long way to go but it’s a process.  We’re just going to do what feels right. 

A part of me does feel like I’m making a statement with my minimalist diabetes management approach.  I want to be an example to those with limited resources and say, “you can do it with the basics, and do it well.”  A lack of money absolutely harms health but just enough money is another story.  I have just enough money for the basics which does include sufficient test strips for each day-excellent blood sugar control is not up for discussion.  I don’t need a pump or continuous glucose monitor, though it’s relative isn’t it?  If I die tomorrow of a middle of the night low blood sugar everyone will say I did need it.  But, if I die tomorrow in a car accident, you could say that I needed perhaps a different car or that I needed to have taken a better route or skipped a dumb errand.  If I die from a stroke, you could say I needed to have changed some part of my lifestyle or taken some type of medication.  The point is with so many variables each day affecting our well being it’s just not cut and dry.  I feel that my very simple approach forces me to maintain an important discipline that extends into all parts of my life.  That discipline is ultimately responsible for my diabetes management and how well it goes.  And that’s what I really wanted to share today Smile

Do you practice any kind of minimalism?  If so, I’m interested in learning more, please share in comments.

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