Menopause and Diabetes

Yikes! Who would write a blog post about menopause?? Who would read it??

As I quickly approach that time in life, I am thinking about things like cardio (heart) protection, blood glucose swings, sleep, bone health – all the things that menopause (and diabetes) affects.

I once had a patient call me and say that her blood glucose levels were all over the place and she thought it was menopause. That was my first exposure and now I’m experiencing it first hand. So the thing I tell parents of newly diagnosed children with type 1 diabetes – you’ll get it down, then it will change; then you’ll get it down again and it will change again – is true! Welcome to menopause where it can change every week (day? minute?). And I really had it down!

Anyway, in addition to blood glucose swings, with menopause come difficulty sleeping, which can certainly be exacerbated by pump and CGM alarms; loss of bone protection – people with diabetes already have a higher risk of bone loss; and loss of cardio-protection.

So where’s the good news in all this? Well, women at this age are wiser, have more experience, have more perspective… blah, blah, blah. Exercise. The good news is that we can still exercise and if we do, we will be doing our part to protect our bones, get better sleep, and protect our heart. In fact, this article says that one workout could protect the heart for hours or even days!

Despite the hot flashes, mood swings, glucose swings, lack of sleep, we are strong and intelligent and we can figure this thing out. It definitely takes patience and a sense of humor…and those of us with diabetes already have those qualities, so we’re all set. Bring it on!

 

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Different Kinds of Hope

I recently heard someone say that there are different kinds of hope. She talked about lazy hope and authentic hope. She shared that we’re displaying lazy hope when we say things like, “I hope you do well.” On the other hand, authentic hope is hope with action. That’s when we actually help make something happen.

I have long questioned whether it’s even possible to live without hope, yet I had never thought about the possibility that there are different kinds of hope.

Immediately I started thinking about how this applies to life with diabetes (because everything does). Lazy hope could be thought of as sitting around hoping for a “happy” blood glucose level, or a cure for diabetes, while authentic hope could be doing the tasks that lead to “happy” blood glucose levels.

Authentic hope could be helping those with diabetes in disaster zones or providing support to a loved one or stranger who’s struggling with the daily frustrations of diabetes. Authentic hope could be supporting work toward a cure – financially or in other ways. Authentic hope could be finding ways to stay strong, healthy and motivated until there is a cure.

I once heard about parents who threw away all their child’s diabetes supplies when they heard about a “cure,” only to call the diabetes center in a panic when they realized they still needed that stuff to help their child live until they had access to the “cure” (which, by the way, wasn’t actually a cure). What kind of hope is that?

In the hope department, I still have more questions than answers. I believe in hope, and I believe in working hard to get the best possible results. Maybe that’s hope in action.

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Thankful for Insulin and More

thanksgiving1It’s a good day to think about thanks. All the other days I’m so busy getting life done. I’m checking blood glucose levels, taking insulin, counting carbs, making appointments, going to appointments, working, working, working, driving kids, teaching kids to drive, walking the dog, going for walks, preparing meals, eating meals, working some more…

Days, weeks, months and years go by faster and faster all the time. They weren’t kidding when they said time flies. It’s all good, and fun, and challenging, and it flies by. So fast that I forget to slow down and think about thanks.

I like to call today CarbFest. I am thankful for insulin, because without it my body couldn’t metabolize (break down and use for energy) carbohydrates. Thankfully, on this day I can figure out how many carbs I’m about to eat (thank you to whoever invented carb counting) and take the appropriate amount of insulin (thank you, Banting, Best, Collip, and Macleod). I can also take a long walk to burn off at least some of those calories (thank you, all the diabetes educators and other health care professionals who have taught me about healthy choices over the years).

It’s good that Thanksgiving falls within Diabetes Awareness Month, because it gives us a designated time to both be aware and give thanks. Happy Thanksgiving – enjoy your carbs!!

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People Helping People

WDD-logo-date-EN-2048px

Today is World Diabetes Day. It’s the anniversary of Fred Banting’s birthday. It’s Tuesday. Today we wear blue, display blue circles, and talk about diabetes – funding, research, new technologies, new devices, new treatments, a cure.

 

Last week I worked with two kids who are brand new to diabetes. For the first time I found myself unable to say that they’d have diabetes for the rest of their lives. I’m confident they’ll benefit from the artificial pancreas and it’s likely they’ll be alive when a cure is found.

Holy cow! Did I actually think that?

I am grateful to the individuals, groups, and organizations who are dedicated to making life better for those of us with diabetes. Thank you to those who are working on ending this thing once and for all.

In the meantime, I will continue to work on making the world a better place for people with diabetes right now, today. And I will be cheering for those who are working on making it a world without diabetes tomorrow.

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National Commission on Diabetes

public_meetingsDid you see that Trump signed a bill to establish a “national commission of health care experts” on diabetes? I’m actually very excited about this! And what better time to do it than during National Diabetes Educator Week?

My hope is that this national commission will look at a variety of challenges in the world of diabetes:

  • risk reduction
  • technology
  • access to care
  • access to technology
  • aka coverage
  • healthy food availability
  • healthy food pricing
  • medication pricing
  • language and stigma
  • hypoglycemia
  • education
  • support, trust

There are so many areas we need to address and fix in diabetes; I’m not quite sure where this commission will start. My hope is they will start by getting the right people in the room. Then they can dig into the discussion, come with ideas, and make change happen. If they don’t ask me to be on this commission, I hope they will at least ask for input (smiley face).

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Official Candy Taster

unnamedI once owned a t-shirt that said “Official Candy Taster.” I loved that t-shirt, and every October I wonder what happened to it. The other day the parents of a child with diabetes asked me for suggestions on how to deal with Halloween candy. This is a common question this time of year and there are many different ways to deal with it.

When I was young my neighbors would give me chips instead of candy. One year my mom gave me a new purse (the understanding at Halloween was that I turned my candy over to my parents and siblings. That year I got something in exchange).

When I was a teen-ager and trick-or-treating for what was probably the last time, I went low while walking all over the neighborhood and treated it with something out of my bag. Candy was just not a big part of my childhood. It wasn’t really around our house much and it wasn’t something I remember craving (that changed in young adulthood).

Here are some more ways to deal with Halloween candy (several have been used on my own kids):

  • send it to the soldiers
  • leave it for the “Halloween Fairy” in exchange for a toy, movie, or in my daughter’s case, bag of mini pumpkins
  • buy it back from your kids (be careful with your pricing!!) then discard, take it to work, or send to soldiers
  • put one piece of candy in their lunch every day until it’s gone (or until you decide to get rid of it)
  • have them eat it all in one sitting, get sick and swear off candy forever
  • ask your child how they’d like to deal with all the candy

Have lots of conversations with your children and adolescents around candy, healthy food choices, healthy eating, healthy living – all the time and not just at Halloween! They will learn and take these messages with them for life.

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Words Matter: The Language of Diabetes

Words Have Power Concept

The language people use to discuss and write about diabetes and the people who live with it has long been questioned. Becoming aware of and changing the language and messaging related to health is not unique to diabetes. In fact, several other disease-related organizations are discussing and changing language as well.

Today is a big day for people who have diabetes. Today two major diabetes organizations in the United States published a paper on the use of language in diabetes care and education. This is a significant step toward improving the way we talk to and about people with diabetes. Language really does matter and we are making progress.

Thank you, American Association of Diabetes Educators and American Diabetes Association, for caring enough about people with diabetes to support this work and publish this paper.

Here are the paper and resources. And here. Enjoy!

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Engagement Stories

Gold wedding ringsI went through a phase where I was fascinated by couples’ engagement stories. I had several friends and family members who had especially cute or romantic ones. Now engagement has a different twist for me. It still means a connection or a commitment, of sorts. Instead of two people in a relationship; however, I now think of engagement as connecting with diabetes management – a commitment to take care of ourselves.

These days we often hear the phrase “patient engagement.” This, too, has different meanings. Health administrators may think of it as engaging with the system: making appointments or looking up lab results online, for instance. I think of patient engagement as healthy relationships between patients and providers. And between patients and their health.

When did you get engaged in your diabetes management? When did you take an interest and start learning and doing more? Maybe it hasn’t happened yet…

For me it was in 1994 when I started getting engaged. It became solidified when I started working in diabetes. Being a role model really helped me take my diabetes management seriously. Once taking care of myself became a habit I stopped thinking about it and just did it.

While there are certainly moments when I’m less engaged, in general, I’m pretty married to my health. My health is like my life partner: I pay attention to it (most of the time), I take care of it, and I’m aware of it. Because I want my health to continue to be a positive thing in my life, I put in the effort required to maintain it. Being engaged in my health definitely takes work; so far I’d say it’s worth it.

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Health Alert

smoking-quiz-promoRemember cigarettes? My kids tell me no one smokes anymore (they vape, etc.). Yet, inactivity has more recently been equated with smoking in terms of the health effects.

If sitting is the new smoking, then I’m a chain smoker. I sit all day in front of a computer. I love my work – it’s fulfilling, challenging, stimulating. But it’s not active.

I wear a Fitbit, which tells me from time to time to get up and do some steps. I mostly ignore those notices because I’m in the middle of something. I do try to hit 10,000 steps a day by exercising each morning and walking the dog twice a day, but mostly I sit.

I have learned the hard way the toll sitting takes on a middle-aged body. My plan is to get in the habit of moving every hour during my work day. I already pace when I’m on (most) phone calls. Another idea is a treadmill or standing desk, but I haven’t made it to that point yet.

At any rate, I often think about quitting smoking. And by quitting smoking I mean sitting less and moving more.

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The eXercise Factor

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Yes, that’s my treadmill in the garage!!

Exercise means different things to different people:

  • dreaded
  • addictive
  • fun
  • boring
  • enjoyable
  • tedious
  • social

For those of us with diabetes, exercise is an important part of managing blood glucose. It’s not easy and it’s not always consistent. Whether you ride competitively for Team Novo Nordisk or go for walks around your neighborhood, exercise can be challenging to incorporate into your daily diabetes routine.

Some people avoid exercise altogether because they were never taught how to make it work with diabetes, or because they are afraid of what might happen, or they’ve had a bad experience.

I have found, after years of practice, the following works best for me:

  1. exercise at about the same time every day (I like morning)
  2. exercise after eating (and after having taken insulin for the meal)
  3. take less insulin before aerobic (cardio) workouts
  4. take more insulin before anaerobic (strength-training) workouts
  5. carry blood glucose monitoring and low treatment supplies with me when working out away from home
  6. eat extra carb before exercising if it’s an unplanned activity and insulin is already on board

From time to time I see recommendations for exercise and diabetes that say to eat more carbohydrate, take less insulin, or exercise before taking insulin. This is simply not what works for me. I have practiced enough to know that if I exercise before taking insulin I will go high and if I take less insulin before a strength-training workout I will go high.

The bottom line is that exercise is good and each of us has to figure out what works. Recommendations are certainly a wonderful place to start. If they work – fantastic! If not, we have to do some careful experimenting until we find the solution. Even then, there will be times when what usually works doesn’t work. That’s life with diabetes!

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