Tag Archives: diabetes management

Wednesday Revisit: Diabetes, Self-discipline, and Paradigm Shifts

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I just reread this post I wrote on November 15th 2009 and realized I needed a refresher.  This is one of the most read articles on this site.

It’s about the powerful notion that when we change our perception about things, the right decisions for our health can also be the easier ones.  It’s a journey, not a sprint, however.

Anyway, have a great Wednesday and check out: Diabetes, Self-Discipline, and a Paradigm Shift Part I (the end of the post links you to Part II if you’re interested)

Wednesday Revisit: When Glucose Management Hits Rock Bottom

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Here are a few tips I wrote up 2 years ago about how to deal with diabetes management burn out or bottoming out.  They work pretty well for me so I thought I’d share.

Originally posted:

November 12, 2009

When Your Glucose Management Hits Rock Bottom

Happy Wednesday!

Revive Your Management with a Diabetes Station

 

Mine is on my vanity where a vain person is bound to stop by every so often

 

What is a “diabetes station” you ask?  Well, first off let me explain that sometimes many of us with diabetes seem to need a “reboot” of sorts, don’t we?  I mean, we’re testing and pumping or injecting, counting carbs, exercising, and then oops…a few days go by that we don’t do some of these things as regularly and maybe this turns into a new habit where suddenly you realize it’s been a week since you properly counted carbs.  That week can turn into months in some instances-I know all about it.

Anyway, in the past I’ve used a “diabetes station” to get my brain back on diabetes.  You’d think my brain wouldn’t leave this high and low blood sugar planet and yet sometimes I genuinely forget that I can’t eat something without paying attention to the insulin I need for it.  Someone might be tempted to ask, “how on earth can you forget insulin if it’s what keeps you alive?”  In my mind it makes perfect sense.  One can forget to brush teeth, fasten a seatbelt, and unplug a curling iron.  Giving insulin and other diabetes related tasks are as routine to a diabetic as those things are-only what we have to do with needles and such is much more unpleasant.

So what is a diabetes station?  It’s where you place all your diabetes items in a central and easy to spot location in your home or workplace.  The first time I tried this was when my kids were 4 months old and I was still pumping milk for them every three hours.  I was consumed by milk making to be honest with you.  I wasn’t sleeping much and the last thing on my mind was my diabetes.  So on the dinner table I placed my meter, insulin, and all the supplies that go with that-including extras.  I also had glucose tablets, a bottle of water, a bottle or box of juice, a carb filled snack, a low carb snack, and a notepad and pen for taking notes.  It was hard to pass the table without noticing the mini mountain of supplies and think, “oh yes, diabetes” and this kept me walking over there and habitually testing, and if needed, treating my diabetes.  The dinner table was convenient because sometimes I’d start eating, look up at my meter and say, “oh yeah, I forgot to test”.  Like I said, my brain was not on diabetes, it was on my newborn twins, my bed and pillow, and my swollen appetite due to being a dairy farm to two.

So let’s go over the details of this station along with the reason for each item:

Diabetes Station Supplies (can be conveniently placed on a rotating serving plate)

meter, test strips, lancet device, extra lancets and strips

Make it visible.  How can you look over at your meter and not think “Hmm how’s my blood sugar doing?”

Back up pump supplies in case an infusion set needs to be changed including extra batteries

When I was on a pump I’d sometimes neglect the battery low and low insulin warnings from the pump because I procrastinated in dealing with it.  Having this stuff laid out might make it easier for someone to think, “Well, it’s right here, I might as well change the battery now before the pump turns off.”

If you use shots-insulin vial and syringes.

Make sure to have extra syringes.

Paper and pen

I don’t use a pump so during times of stress or distraction, I will write down the time I give insulin and how much on a notepad.  It takes one second and later on during the day it’s often very helpful to know how much on board insulin or active insulin I have in my system, and for how much longer.  I also note anything helpful that I think of.  I don’t do this on a regular basis, just when I find myself slipping in my diabetes routine and set up the “station”.

Water, juice, glucose tablets, and snacks

High blood sugar can quickly escalate into a bigger problem when we’re dehydrated so I try to have water around me all the time.  I might have juice available for emergency lows.  I usually have glucose tablets because they’re the ideal treatment for lows.  I sometimes have a high carb snack option that is relatively healthy in case of the munchies and a low carb snack option in case my blood sugar is up and I happen to be really hungry.

Someone could set up some version of this anywhere they spend a lot of time, say at an office or at home.  I think yes, it can be impractical but when you think of how important your health is and if you’re going through a stressful time and find diabetes on the back burner, something like this can support your goal of bringing it back to the forefront.  In this case I find it very worthwhile to do for a few weeks until I’m back in the “groove” so to speak.  It’s probably confusing to a non-diabetic who might wonder why we might go to such lengths to remember our diabetes and get into a habit of testing and giving insulin.  It’s confusing to me if I think about it while mentally stepping out of my diabetic body.  But, I’ve been there and done that and I know that sometimes we need help doing even the most quick and easy tasks because sometimes diabetes tires us out to that extent.  So if this happens to you, focus on finding ways to keep managing your diabetes, even if you have to get your screensaver to say “Don’t forget to test!”

Just thought I’d share since this helps me out. :)

If you have any suggestions to add, I welcome your comments!

Book Review: Your Diabetes Science Experiment

I firmly believe in telling the truth when I review a book or product and this post is no different.

There were particular changes I made to my diabetes management several years ago.  As a result, my blood sugars went from chronically high to very well managed.  Nerve pain in my feet and cramping in my legs ceased.  My kidney function returned to normal.  My head stepped out of a fog.  I had the clarity of mind and the physical and emotional energy to change my job, relationship, and diet.  My depression alleviated.  I’m much happier and healthier now, a wife, and a mother.  So it’s my opinion that getting my blood sugars managed was a completely life altering experience.  I now consider blood sugar management my top priority.

The steps I took, the reason that I have improved my blood sugars over the years had to do with a few basic ideas that I acted upon.  Recently I read Ginger Vieira’s book, “Your Diabetes Science Experiment” and practically jumped for joy when I finished it.  The very information that saved my life and changed it entirely for the better is in this book! This book does what every Endocrinologist should do, but doesn’t have time to do or doesn’t do because he or she doesn’t feel the info is relevant to share with patients. This book educates you on how the human body works in relation to insulin, stress, food, and exercise.  This book does not give you any unscientific nonsense.  Instead, the information in it, if taken seriously, has the potential to make your diabetes management what it needs to be.  Our reality is we need to avoid lows and highs.  We need to know how to manage our diabetes largely on our own.  We need to understand how our bodies work so that we can make our own adjustments quickly and accurately.  This book can help you do that.

The info in this book will empower you.  I find it incredibly useful to know for example, that a low uses up glycogen stores in my muscles and is therefore the reason that my post low blood sugar workout is going to make me feel like a wimp.  For someone who isn’t aware of this, they might be the person to say something like, “Sometimes I have energy for my workouts and sometimes I just don’t, there is no rhyme or reason, and it’s because I have diabetes.”  We need to empower ourselves with knowledge and get away from these general expressions that mean nothing.  They just reveal our vulnerability to the facts about the body and diabetes.  They also take away our power to foresee changes in our diabetes management which could otherwise be dealt with successfully or at least more successfully, more often.

I started this blog to share what I’ve learned the hard way over the years and tell you what has worked for me, just in the case it works for you.  Reading this book has confirmed what I do and why I do it.  It does much more however, as it gives you the full, clear, and organized explanation as to why something is the way that it is.  Ginger shoots from the head but is also quite warm and inspiring.  She is a record holding power lifter and uses the information in the book in her own life.  I appreciate the examples she provides in the book which have to do with her own experiences.  I also really appreciate her positive attitude and the clever metaphors she uses in order to make concepts easier to understand.

This isn’t a book published by a huge agency.  It’s not coming to you through the ADA.  I do however, wholeheartedly recommend it to you.  If you have money to buy only one book this year, make it this one.  And when you get the book, travel slowly through it.  Take your time soaking in the information and sit down with your own data to perform your own diabetes science experiments.  Seriously, do them.  As Ginger reminds us, the work involved is well worth it.  I have little adjustments that I do according to variances in my routine which took some time to get right but now that I have those adjustments, I don’t know what I’d do without them-because they work so well.

Diabetes management can be less of a puzzle.  Many don’t like me to say that I usually know why my blood sugars are what they are.  The old me wouldn’t have liked it, either.  Maybe you don’t want to read this book because the idea that there is a scientific reason behind each one of your blood sugar results seems unrealistic or far fetched.  I assure you it’s not.  I completely understand the place many people are in where they work very hard and don’t see the results they deserve.  It’s too bad that doctors never shared any of this information with me and that people like Ginger and I had to look it up and research it for ourselves.  It’s not your fault that your diabetes causes this cycle of ups and downs but the ability to improve your situation is in your hands.  I promise you can improve your diabetes management with the information in this book.

I have a lot of respect for someone who writes a book that has no BS factor and is altogether upbeat, hopeful, and honest.  Ginger, thank you for writing this book.  I did not know how I’d feel about it.  Instead, I was pleasantly surprised to find this book is a treasure and it is my strong hope that you’ll all read it.

You can buy the book here.  Check out Ginger’s website here.

Being Ok with Being Different

The road to health is often lonely  (Thanks to Renjith Krishnan for the image)

 

I often say that acceptance is the key to beginning to really manage one’s diabetes.  You have to work it, not fight it.  A part of accepting your diabetes is to accept the fact that you have to be different.  This, as you know, isn’t easy.  We humans like to follow each other, hang out together and do similar activities.  We feel comfortable and cozy this way.  So when it comes to those who best manage their diabetes, one thing I’ve noticed them doing is standing alone on many of the things they do.  They have the strength and confidence to do so.  Don’t you think?

Check out my post over at Diabetes Care Club about Being Ok with Being Different.

Thanks for reading and have a great Saturday!

DSMA June: Troubleshooting Diabetes

 

Photo courtesy of Renjith Krishnan

 

 

The June DSMA Blog Carnival Topic: When it comes to diabetes, sometimes it seems things change more than they stay the same. Every so often, we may start to notice things going a bit out of whack and some new blood sugar patterns emerging. Part of being an informed and educated patient is learning to identify these problems. So this month we’d love to hear:

What are the best resources you have used to help trouble shoot?

I don’t believe in just counting carbs and then reacting to the subsequent highs and lows.

My philosophy

Well…after 16 years of diabetes and lots of note-taking and troubleshooting and learning about how insulin works and what factors can influence insulin resistance, insulin absorption, and blood sugars….I don’t usually get confused about my blood sugars.  I know that sounds like an arrogant lie but I’m being honest.  I mostly get confused about why I couldn’t muster up the motivation or energy to do what I know I needed to do.  The overwhelming majority of my out of range blood sugars are due to my own self-discipline issues-which are impossible to always avoid because, duh, I’m human.  I try not to kick myself when I choose incorrectly, I just move on.  I believe in accepting full responsibility for my actions but showing guilt the door.  Anyway, here is how I have arrived to this point.  I certainly didn’t get to this place quickly or easily.

Low blood sugars

When my blood sugar is low, the first thing I do is to recall the last time I gave an insulin shot and how much I gave.  (I take mental note of the time every time I inject)  If it was within the past two hours then I know this low is going down fast.  Especially if I’m low and my last insulin shot was within the past hour.  So by remembering this insulin info I know whether or not I need more than 15 grams of carbs or not.  I really stay on top of these lows since they tend to feel more dramatic and are more dramatic.  

If my blood sugar is low and I haven’t given insulin in the past two hours I take my 15 grams of carbs and relax, the low shouldn’t be too harsh. 

Usually, when I’m low, I realize it’s because I didn’t eat as much as I thought I might or I forgot to finish something I was drinking which contained carbs.  This morning for example, I woke up low and right away knew that it was because I gave too much lantus (basal insulin) last night and yesterday morning I worked out 30 minutes longer than I normally do.  I had a light dinner and woke up really hungry and of course, low.  I should have known (and usually know) to have a light snack before bed or to give a little less lantus.  Either one usually does the trick for me.

High blood sugars

When my blood sugar is high, the first thing I do is to go through a mental check-list that looks like this:

-Am I PMS-ing?

-Did I give enough insulin last time I ate?

-Have I been abnormally stressed during the past few hours?

-Did I exercise within the past 48 hours?

-Did I snack on anything without giving insulin for it? (Even a bite of something turns into a high hours later)

-This is a TMI but, when was the last time I had a BM? (Believe it or not, going regularly reallyyy helps keep blood sugars regular, too)

-How much lantus did I give last night?

-Do I have any active/on board insulin?  If so, how much?

-Do I possibly have any infections?

-Am I in any pain?/ Does anything hurt? (Because that can do it, too!)

-Did I overeat during my last meal?

-Have I had any processed foods in the past 24 hours? (this makes it impossible for me personally, to avoid highs at some point in the 24 hours following processed food- and I do mean impossible)

-There are probably more but that’s what I tend to go through when I am high.

99% of the time for me, one or more of these reasons is the culprit.  So I don’t usually change my routine or my insulin doses, I just make a mental note for next time and often, I have to work on my discipline.  Lately, when I’m high it’s usually because I make a conscious decision to do something I know I shouldn’t do-or I don’t do something I know I should do.  Either way, the blood sugar is on me, not on some mysterious phenomenon.  But like I said before, and I really want to reiterate, guilt or shame have no place here.  We’re human.

Along with plenty of blood sugar checks, this is how I have avoided many lows under 50 and many highs over 250. 

After having many of the above scenarios play out, I’ve learned to see them coming and therefore prevent them instead of reacting to them when they happen. Reacting to highs and lows is exhausting and doing it for years really wore me out-much more so than using extra discipline or simply sticking to certain habits that guarantee me better chances. 

Taking notes or the journaling trouble shooting method

I really advocate for note-taking.  Not just blood sugars but activity and physical and emotional stuff, too. 

It’s so important to narrow down the cause for out of range blood sugars.  For example, when I’m nervous, I will quickly go from 100 to 300 and then have a hard time going down (and this is without food being involved!).  Lately, I’ve been dealing with more anxiety and will soon get evaluated for that because I know I can’t ignore something that is messing with my blood sugars.  I wouldn’t be so sure this was a problem without my note taking though. 

Sidenote:  This really is a challenging area for parents of children with diabetes for all sorts of obvious reasons.  The troubleshooting on my blood sugars truly got easier for me as an adult (not to mention I often relayed inaccurate info to my parents and hid emotions from them).  So parents, hang in there and never beat yourselves up.  You’re in a super hard, outside position for troubleshooting because you can’t feel what your kid is feeling and they aren’t always going to be able to articulate certain feelings and symptoms.  Please do not be discouraged.  Keep up the amazing work!

Also, I hope no one feels that I’m pushing advice on them.  I am compelled to share this info because it helped me SO much and I wish someone had shared it with me long ago.  So take it or leave it, it’s brought to you with the most sincere of intentions  :)

Wednesday Revisit: Things To Make Reminders For

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I find that writing down reminders alongside of appointments helps my diabetes management out a lot.  So two years ago I wrote a short post about what exactly I remind myself of.  While we’re on the subject, I’m not a big techie person, where do you keep track of your appointments?  I use the old fashioned calendar!  I’m thinking there are better ways.  Fill me in :)

Originally posted on August 2nd, 2009

Things To Make Reminders For (Diabetes related)

Perspective Helps

 

Something that has helped me A LOT in the past (diabetes-wise) was to have a paradigm shift or change in perspective about certain things. 

For example, I still struggle with feeling “poor” sometimes and yet, thinking about those who have no home, no food, no family, or no clean water quickly snaps me back into the “rich” category.

I’ve said this before but, I used to have a terrible time getting my blood sugar to stay below 200.  My goal was that: to keep it below 200.  I would fail miserably and endure lots of 300’s and 400’s. 

Then I thought to myself, “maybe my target should change?”  So I started aiming for 100-all the time.  No mind that this isn’t possible, the point was, shouldn’t I be aiming at the right place in the first place?  Then when I get a little outside my target zone at least I’m still not doing too bad?

I thought this was a silly thing to think although I tried it anyway.  And I couldn’t believe it but, it worked!

It was the equivalent of raising my own bar.  It was bringing up my expectations.  As a result, my actions met these expectations and I got much closer to where I needed to be. 

A major change in perspective also helped me in another crucial area:

I used to feel like the most unlucky gal in the world because of having type 1 diabetes.  And so I blamed every single negative thing in life on my diabetes.  I didn’t push myself through college because: diabetes.  I didn’t have confidence in myself because: diabetes.  I didn’t exercise regularly because: diabetes.  I wasn’t happy because: diabetes.

The truth is that diabetes DOES make everything in life harder.  I know that.  I want you to know I know that.  Problem is, not taking care of our diabetes will eventually make life EVEN harder later! 

I often think, “It’s like I can’t win”.  Maybe you do too, sometimes.  Well, we’ve got to scratch that line from our brains.  We need to just focus on how we’re alive (others have not made it to whatever age we’re at).  We have a roof over our heads (many others do not).  We can afford insulin (unbelievably so, some cannot).  And many of us still have the ability to gently exercise each day, have confidence in ourselves and be happy simply because we choose to, and push forward with our dreams and aspirations even though we’ll have to push much harder than others.  We can! 

And having the right perspective…helps.

PS: Don’t let any negative person tell you that diabetics don’t want to hear that perspective helps.  If we’re humble, we’ll know it’s the truth and if we let it, it helps.

Let a Diabetes Routine Checklist Help You Out of a Diabetes Rut

 There are many ways to get into a diabetes rut.  Frankly for me, something as simple as a late night or a cold can snowball me into a rut that lasts a month.  Meaning, my numbers aren’t right, I’m not feeling 100%, and I don’t even know where to start in order to get back on track.  So it has occurred to me to try something to prevent and remedy this. 

Here is my Simple Daily Checklist:

Test first thing in the morning

Remember to give insulin before eating

Wait the appropriate time between insulin dose and eating

Drink enough water

Exercise

Remember to give Lantus

Watch carb intake

 

These items may seem obvious, and they are.  The thing is, during the holidays, or busy weeks, or stressful times, etc., obvious things are forgotten. 

The other day I wasn’t feeling well and my blood sugars were running higher than normal and I looked at my check list and realized I hadn’t been drinking much water-in fact, two days went by and all I had were two coffees!  Yikes.  (The color of my urine should have alarmed me, but I guess I didn’t pay attention?)

Anyway, I put this list somewhere I can see it each day and even though it seems dumb to read, “exercise”, surprisingly enough, when I read it I’m like, “oh yeah!  I need to do that!”

Now not everyone responds to a list, or likes it, or is motivated to keep up with it.  Which is totally cool, but, if you’re the type that does like a little checklist (and boy do I love them!) then give it a try.  Make it personalized.  Perhaps you don’t need to mention water intake because you’re not as goofy as me and feel it’s only natural to drink enough water/liquids.  Maybe you tend to forget to give insulin before taking a bite from that cookie?  That has happened to me, too.  In any case, this might help you.  At least during months like, December, oy!

The basic things aren’t typically what we put on a list and yet, why not?  They may be the most important!

Apply Pareto’s Law to Your Diabetes Management

 

Things which matter most should never be at the mercy of things which matter least.

~Goethe

There are things we all do for our health and things we undeniably don’t do for our health-that we know we should.  Many of us are aware of a number of things we should do and in order to compromise with ourselves, we pick and choose a few things to focus on instead of do them all.

But don’t you want the most bang for your buck?  What I mean is, don’t you want the efforts you make, to provide the greatest positive impact on your health possible?  Sure you do!  I know I do!

This is where Pareto’s Law or the 80/20 rule comes in to possibly help.  Here is a little bit of history.  Vilfredo Pareto was an Italian economist.  In 1906 he noticed that 20% of the pea pods in his garden gave him 80% of the peas.  He applied this observation to many other places.  For example, he found that 20% of people in Italy owned 80% of the land/wealth.  Even today, it has been observed that (according to Wiki) “In health care in the United States, it has been found that 20% of patients use 80% of health care resources”.  (I wonder if a good chunk of those 20% are diabetics and I wonder if the government placed more importance on helping us diabetics manage our health better, would we all save and benefit? Hmmm…)

So what if 20% of your actions created 80% of your overall state of health?  Are you doing the right 20%?

For example, you could drink plenty of water, exercise, eat healthy, and control stress, but if your blood sugars are always high, you’ll be dehydrated, unable to get much out of exercise, have difficulty controlling stress, and your healthy eating won’t save you.  That is because managing blood sugars is very key to your overall health.  In fact, it’s crucial. 

Let’s say we have five goals right now. (For the purpose of this example)

1.  To make more money

2.  To spend more quality time with friends/family

3.  To exercise more

4.  To improve blood sugar management

5.  To lose weight

A lot of people have these goals.  They are relatively common.  Realistically though, if we try to tackle all five of these goals at once, we’ll quickly either become overwhelmed or unmotivated. 

How about we just focus on blood sugar management.  Years ago, these were my five goals at some point.  And after ongoing failure to achieve any of the five goals I decided to tackle the biggest one-blood sugar management. 

To my surprise, I started losing weight, which helped me exercise more.  My mood, focus, and energy levels improved and I became more productive at work.  Eventually I started making more money. 

I just needed to take care of that which yielded the highest results.  And since I only had one goal-blood sugar management, all of my focus and energy went full blast, enabling me to succeed.  Not to mention, having great blood sugars impacts all areas of one’s life.

I could have focused instead on trying to make more money or losing weight, but, with blood sugars still out of whack, I might have never really become more productive at work or lost any weight. 

We don’t have to necessarily think about 80/20.  In some cases it’s 90/10 or 60/40.  The point is however, to place your focus and energy on that which will yield the greatest impact. 

Pareto’s law is mostly used in business.  Remember, Pareto’s law means that 80% of consequences or results come from 20% of causes.  Business students are taught (or should be taught) that 20% of customers provide 80% of sales.  And 20% of customers also provide 80% of business complaints and hassles.

From the above last two sentences, which 20% of customers would you focus on?  And that’s the point.  There are only a few things which are really important.  If you spend your time and energy on those few things, you’ll profit, in business and in life.

So back to our diabetes…let’s say we want to break down things we need to do in order to improve our blood sugars.  Make a list of 10 things you know you need to do better in order to improve blood sugars.  Put a percentage next to each.  The higher the percentage, the more positive impact on your blood sugars you foresee that one item providing you.  For example, I’d personally rate “testing blood sugar more frequently” as a much higher percentage than I would “eating healthier”.  This is because if I don’t test, eating healthy may still mean I’ve got unmanaged blood sugars since without testing I don’t even know where they are.  Get my drift?

Anyway, when you’re done with your percentage values, take a step back and pick out the one or two highest percentages.  Those are the one or two things you need to focus on.  Those one or two things will greatly impact your blood sugar management.  Once you’ve got that down as a habit, you can move on to tweaking your blood sugar management by addressing the other items on your list which hold lower percentage values.

Few things really matter…the rest, not so much.  I know we can think of all sorts of ways to apply this.

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