A Diabetic Manifesto...

I love my Christmas tree... I light it. I enjoy it's silent cheer; it's proud glow. Perhaps, a memory of a 'perfect' childhood, at least, in my own imagination. The room is messy, but the tree makes it come to life. It brings a certain peace to my heart. It makes everything... 'perfect.' I probably won't take it down for a few more weeks.

Peace is a little hard to come by, these days... The worries of adulthood, and the insecurities of employment and finances, really take their toll... on one's joy, one's dreams, one's relationships, one's family, you name it. Still, I sit, and wonder... at the 'magic' of it all. When folks sort of stop paying attention to the "mess" in their lives, for a moment, and just stop for some peace.  

And peace, hope, growth, and prosperity is what I wish for all of you, this holiday season. I wish all of you to be BLESSED in one way, or another... And to make NO resolutions. 

NO RESOLUTIONS. Instead, look back upon the year, with bittersweetness; say goodbye to friendships that are parted, and welcome new ones... Say thanks for all the hardships, lessons, and opportunities life has awarded you, and for all the mistakes you have made. Especially, for all the mistakes you have made. Cheer on the challenge a new year will present, and be hopeful for what's to come.  

Be hopeful... 

• That friends and family will embrace, love, and support their fellow diabetics through this hard and challenging journey, without recrimination, and judgment, but with education, and a listening ear. 
• That diabetic patients receive the respect and dignity every person with a chronic illness DESERVES to be afforded, without gimmicks, media misinformation, doctors selling their profession for fame and a quick buck, and discrimination. 
• That government, and employers, strive to learn, educate themselves, and accommodate diabetics and their needs, and realize that we are just as capable, and just as willing to do a good, and proper job. That we can be just as productive, and careful good citizens, as anyone else. 
• That doctors will EDUCATE themselves, and not make insensitive comments or unfair comparisons,  uneducated assessments, guilt trip patients with the blame game, give uneducated guidelines, and endanger patients lives. That they become aware of the HUMAN EQUATION, and grow some bedside manners. 
• That patients presenting diabetic symptoms will NOT be ignored until it's dangerously late, and they have developed irreversible complications.
• That patients will be properly educated at diagnosis time about their disease, and ALL their treatment options, and not left wondering in the dark about what to do, or how to make adjustments, and NOT DENIED access to proper specialists, such as endocrinologists, certified diabetes educators, or dietitians, but be left with only limited options such gastric bypass for those who are overweight... either because of professional ego, or because of insurance restrictions.
• That patients will not be diagnosed based on biases -- but that every person out there presenting diabetic symptoms be given COMPLETE testing to determine not just whether they have diabetes, but where their insulin production stands, and their type of diabetes, REGARDLESS of their age, or their weight, so that they can receive the PROPER CARE they need to manage their condition, and educate themselves without much danger, second guessing, grief, and confusion.
• That patients will receive proper access to medicines, and NOT DENIED access to insulin, needles, or test strips. That patients be allowed to test as often as THEY deem necessary. It is THEIR right to be vigilant, and it is THEIR right to stay alive. Test strips might seem expensive, but they are not, in comparison to the costs of the complications of poorly controlled blood glucose levels.
• That patients will receive proper access to any care they need, and any tools to management they need, including pumps and CGMs, and diabetes alert dogs, without exorbitant expenses, or insurance games; in fact, that insurance companies will one day not be necessary.
• That diabetic research organizations devote enough resources and work into finding a true CURE, because we are not a lost cause once we have gotten diabetes... We are just as important as those they hope to help avoid the risk of getting diabetes. ALL of us deserve a TRUE cure. Not gimmicks. 
• That together, we can tackle the challenges we face because of our many health concerns, and realize that we are all the same... Just folks wanting to be acknowledged, and heard; folks wanting to be UNDERSTOOD. 

This is what I long for, hope for, and work for... in the year 2012... It is my Diabetic Manifesto. If we work together, we can slowly turn the tide... Won't you join me? 

(I am sure glad that, in my culture, the holidays last a little longer... At least for now, I'll have a little more hope, and a little less mess.) 

Your Number One Diabetic Treatment Goal

Dear Friend,

I heard you were recently diagnosed with Type 2 Diabetes, and that you may have some mixed emotions right now (sadness, shock, anger, guilt, shame, denial, grief, fear, just to name a few...), and I just wanted to let you to know that it's OKAY to feel the way you do. Life, invariably, takes us through periods of transition, of growth, of personal reflections in which we must face, not just who we are, but our own mortality as well. This is a normal part of life: it's called the human equation. It can be frightening, to say the least... but you are NOT alone. No matter how "perfect" some of us humans may seem, we ALL go through this. Life plays no favorites.

No doubt you are already searching the internet left and right for all manner of information on how to best care for your diabetes, and may even have already developed a plan of action. If you are like most Type 2 patients, your doctor probably put you on a course of Glucophage/Metformin, without many other indications, and just sent you on your way. This is very typical. At least, here in America, most doctors really don't sit down with patients to find and discover what their needs are, what their BEST tools for diabetes management should be, what their individualized blood glucose goals should be, nor what their OVERALL TREATMENT GOAL should be.

I want to commend you for taking the initiative to take the upper hand in managing your condition. It takes guts to face a chronic health condition, and take a long hard look at ourselves, and what may need changing. With that in mind, I want to warn you... that while there are many voices of reason out here, in the internet, and many well meaning voices, there are also many confusing messages. Now, I'm not trying to say here, in any way, that you shouldn't do your own homework... oh, no! We would be in a hard place, as Type 2 Diabetics, without the internet. PLEASE DO YOUR HOMEWORK.

What I am trying to do, though, is put it all into a little perspective for you.  

You see, the voices of the internet are many... 

Some are naive, uneducated, patients... optimistic, and with their hopes misplaced. 

Some are well intentioned, go-getters, who may see the world as one of "black and white" solutions.

Some are from the "ignorance is bliss" bunch. They never, ever, question their doctor, or dietitian, ever.

Some are trying to sell you something -- a book, a diet, a supplement, an exercise regimen or way of life, etc.

Some are the naive, uneducated, misguided, optimistic patients, mentioned above, who have fallen for the ones who were trying to sell you something... 

Some are patients, who like you or I, started with little... and have now lived with this disease for many, many years. They have seen the good, the bad, the ugly, the unrealistic and unhelpful, and the scams... They are healthy, they live and thrive, WITH diabetes, and they are doing just fine. (Latch on to these people.) 

...and while they all have different agendas, they are ALL trying to tell you exactly what your doctor should have sat down, and told you: 

• What your BEST tools for diabetes management should be;
• What your individualized blood glucose goal should be; and
• What your overall TREATMENT GOAL should be.

Now, we are ALL different... And I cannot, and will NOT pretend to tell you what your BEST tools should be, or what your individualized blood glucose goals should be. And NO ONE should, either. Your health is different than mine. You may have more challenging health hurdles to clear than I have, or you may not. And you should DEMAND to discuss this with your doctor, at length, based on your own research. As they say, your diabetic mile may vary. Your shoes, your trail, your journey. 

There is one thing, though... that I can UNEQUIVOCALLY tell you: What your treatment goal should be. 

Let's start by what your treatment goal is definitely NOT: 

• Getting off of oral medications
• Getting off of insulin or avoiding it
• Losing weight
• "Reversing" diabetes 

The first three are POTENTIAL symptoms of what your unequivocal, overall goal should be. The last one is a  fallacy, and a buzz word. One may potentially "reverse" some symptoms and complications of diabetes, but not the diabetes itself.  People claim there's much debate on this, but there really isn't... Just watch as this M.D. sidesteps the entire term, in this Q&A column: http://health.msn.com/health-topics/diabetes/taming-diabetes.  But I digress... 

We focus far too much on the pretending we can cure diabetes, especially by avoiding the "evils" of oral medications, and the "evils" of insulin, or the "evils of being overweight," to understand that this one goal far outweighs them all... 

That goal is GOOD GLUCOSE CONTROL.  

In your war on diabetes, THIS IS the goal. IT. IS. THE. GOAL. 

Do not lose perspective. Do not feel discouraged, and give up, if you have weight to lose, and you haven't lost all of it... 

Do not avoid seeking help, if you need it. While many medications have their downsides, and side effects, they also have some upsides, and they are not a shame or a failure, when needed. If after changing your lifestyle, diet, fitness regimen, eaten nothing but chia seeds for two weeks, ran marathons, etc, etc... you find that you still have blood glucose control issues... it's OKAY. Explore your treatment options with your doctor.

STOP FIGHTING THE WRONG BATTLE. 

We age, life passes by... This disease is progressive.  Should the heart patient feel bad for taking lithium? Should the cancer patient feel shame for needing chemotherapy? NO. Of course not! 

The enemy here is the heart disease, the cancer, the HIGH BLOOD SUGAR. Do not let yourself stay in a state of danger because you were pushing for the WRONG goals... 

 Remember... Your shoes, your trail, your journey. Your diabetic mile may vary... But your number one, overall, UNEQUIVOCAL, treatment goal... will NOT. 

When Diabetics Become Bullies

The things you say, and do, have an effect on people. This one should be a "no brainer," right?

Well, not quite.

At least... not quite for folks who see you as "something to crusade against." A faceless mass, or a faceless evil, or villain, that it's okay to heckle, taunt, or verbally assault for the "benefit of humanity, at large," whatever that might be. And that, I'm afraid, is what the internet has done to Type 2 Diabetes and obesity. Coupled with anonymity, the internet has sort of given a voice to the uneducated, the predators and snake oil pushing charlatans, the frustrated, and yes, even the downright abusive bullies among us.

Quite honestly, it is NOT easy for me to be active online when people left and right are trying to sell me books, supplements, Chinese herbs, or whatever the latest craze is to "100% cure" my Diabetes. (Diabetes, of course, has no cure... and in my opinion, this is dangerous and should be against the law. But alas, the FDA doesn't give a rat's ass.) But it's even more difficult when you THINK you have found a "haven" from the mean-spiritedness of the world in a Diabetes page, group, forum, or social community.

As a newly diagnosed person... you may think others are kindred spirits. I am sorry to say, many times they are not... and we need to learn to be emotionally mature, and confident within ourselves, to be able to handle these situations (which, of course, we are not, when we are newly diagnosed.)

Just yesterday, a well known diabetes site asked the question "Medicare announces that it will cover weight-loss counseling for the obese, but critics argue it will make little difference. Who's right?"

I'd love to say polite debate ensued... But it was mostly a "blame the fat, lazy person" tirade.

"Do we really think "counseling" will help the obese? Really? If you're obese, it's due to a lack of discpline and complete laziness. NO EXCEPTIONS TO THIS RULE!!!" 

"I don't believe any type of counseling will work for people over weight. You either truly want to loose weight or you don't, and if banding your stomach doesn't work then counseling isn't either." 

"Can you honestly tell me that people don't know eating McDonald's every day isn't a good idea?!" 

" Weight loss is really self control & few people really have it..."

People are raging at many things; things they don't understand, or think they understand. It really reminds me of the Cold War, and the "Red Scare." We just have these simplistic "notions" of what's the enemy, and what's "right," and what the tv tells us is wrong, and bad... and we run with them. We think, "it's okay, these are 'faceless people' on the internet... We can hate them. We can abuse them." It's easy. Doing these things doesn't entail you to actually WORK at being a HUMAN BEING; to actually be an ADULT, and use your empathy skills. 

Doing these things keeps you from seeing people as mothers, fathers, brothers, sisters, spouses, other people's loved ones, other people's children. 

And worse yet, we may think "these people have taken from me, and my loved one...," and we fail to see how the system has failed EVERYONE, and not just us. Instead, what we are doing is PROJECTING our own bitterness at others. We have developed Diabetic Penis Envy. 

I am sorry.  

I have to call it something funny. I have to call it something funny, or else I'll cry.  

I'll cry when I see fellow diabetics verbally assaulting other diabetics because they are HUMAN and STRUGGLING, and they are brave enough to share their broken pieces with the world. I'll cry when I see mothers attacking other mothers over how they care for their child... I'll cry when I see someone putting down another person's personal loss "because they had it coming to them... they were Type 2." 

I'll cry over your bitterness. I'll cry because I know this disease has blinded you. It has blinded your heart. You either found a little private island in the middle of the sea, and wonder why no one else has gotten there, OR you are exiled in the desert, with nothing but mirages in sight, and no respite. You either judge for attention, or want to be the victim, for attention.

My heart goes out to you because I know it's not about me. No matter how much you try to make it be about me, or about any other type of diabetic there is... it's not. It's not a war of types. It's about YOU. It's a war WITH YOU. And it shows when you write jokes putting down folks, when you character assassinate people who may be struggling with their control, or their weight, or their kids, or when you try to make it sound like your type or your way is the paradigm of good health. It's not. We all need to work on something. 

If we want to help unity in our community... if we want to help diabetics out of the hole of shame and fear they may have... And help them know it's OKAY to be them... then we need to help GUIDE and SHEPHERD them... I would like to ASK two things: 

• I would like for communities to develop a ZERO tolerance toward judgmentalism, abuse, abusive language, and bullying of anyone, but especially obese persons and persons with Type 2 Diabetes, including warning folks, removing their comments, posting discussions redirecting attitudes and educating, and up to, and including banning; AND
• I'd like especially abusive folks to be directed to counseling. We NEED to be reminded that we need help. If it's 2011, and we are adults, and we are still bullying other adults, especially ones with a chronic illness, we OWE it to that person to let them know they NEED COUNSELING. And their bullying behaviors will NOT be tolerated. It is, quite frankly, DISGUSTING. 

The First Amendment is for the GOVERNMENT to not invade our freedom of speech; it is not for a community to allow people to bully other people. EVER. Directly or indirectly. Until this is fixed, you will see many people join... and then fall off, and not participate. It gets old. 

Don't just call for change in our communities... Help ENFORCE the change; BE the change.

And yes, friend... if you read this... and you find yourself a little bit bitter... It's okay. I'm often, a little bit bitter too. 

I add this sort of cruel, and yet "funny," video... as an apt comparison in 'reactions' to my "gift" of Diabetes. 

Oh... and by the way... I forgive you. 

The Greatest Lesson You Will Ever Learn

I don't recall exactly how I got there...

But I think it was just one of those "I'm really unhappy with my body, so I'm just going to go on another diet," kind of moments. However it happened, I had been referred to a nutritionist, or dietitian, or whatever the heck she was, by my Primary Care Provider (PCP) at that time. (My PCP... a man who never cared to talk much about certain things. Including, telling me my blood sugar was high.) 

I sat there, waiting in an office... in the usual weirdness of waiting for one of these folks. Fake plastic foods lining wall to wall shelving, and giant tomes and texts which I am not entirely sure had ever been read. This office was the size of a small bathroom, sterile, and with dark wood paneling to boot. A large, round table, took up most of the room, while a cluttered desk sat at it's opposite. 

"So, what exactly is it that you want?" -- says the woman... doctor, who? I am not sure. She's wearing a white lab coat, and it's making me rather uncomfortable. I thought this woman was just going to help me find a diet plan... why is she being so curt? And why the heck is she wearing a lab coat? You don't need a lab coat to write a frigging diet plan!!! Rather shocked, I explain to Doctor Who that I want to lose weight, that I am not happy with my body, and it's time I got things figured out, with a little help. 

Doctor Who stops to take a very long, stern, look at me. She demands to know what my life is like, and what I do. Of course, at the time (2002), I was in employment limbo -- much like I am now. I lived with a large, religious family, active in the local college campus community, and I minded their kids in exchange for housing. I lived in their basement. Their dark, dank, gloomy, depression fit inducing, basement. I also worked a minimum wage job, with grueling physical labor, and even more tedious hours. I was at great odds with myself, and with my faith, and to top it off, the family and church I belonged to at that time were extremely controlling, and extremely judgmental. One of those types of churches that need to know and control every single aspect of your life, from what to study, to whom to marry. How I got to be in that state, however, is a story for another day.

"I am NOT giving you a diet. You don't need another diet," said Doctor Who, in her Indian accent... really without knowing much about me. "Then...? What am I supposed to do? I mean, I AM paying to be here, after all..."  Her features soften, only for a moment, just enough to tell me that I have an eating disorder.  "A what??" ... "Yes, an eating disorder. You don't need another diet, and I'm not going to give it to you." 

Stunned, I just sat there.  I'm nowhere near skinny enough to have an eating disorder; in fact, I'm quite overweight, even obese. Morbidly obese. (By the way, thanks for that, Polycystic Ovarian Syndrome.) 

She hastily draws up a chart ...  

Explains to me I am living in a vicious cycle, and gives me four rules.  

1. Eat only when you are physically hungry.
2. Eat ANYTHING you want.  Anything at all.
3. Eat only until you are satisfied, not full. 
4. DO NOT SKIP MEALS. 

She then asks that I buy the book Breaking Free from Compulsive Eating, by Geneen Roth, and sends me on my way, though not before telling me that "... but even that won't work, because you're too busy right now, to focus, and need to wait until you're at a better place to make some changes." 

Oh. My. God. Who the hell does Doctor Who think she is? I *payed* her to do what she went to college to do... GIVE ME A DIET PLAN.  And instead, she gives me a frigging book review, tells ME that *I* have an eating disorder, and spits me out of her office, just like that! How dare she?!?! &$^#^%$@!!

Of course... She was right.  She was a total bitch about it, but she was right.  

Through much tracking, and tracing, I eventually found the book... because of course, it wasn't an easy off-the-shelf kind of book, either. It was an old 80's book, and it sat on my shelf gathering dust for a good while before I decided to finally crack it open, sometimes just chancing upon segments, and paragraphs, before having the courage to actually read it cover to cover. 

Now, this is NOT one of those moments where I tell you I've lost a gazillion pounds (which, at times, I have...), and Oprah comes and finds me, and hosts me on her show... or Dr. Oz... or whatever other idiot flavor of the month happens to be. I am still fat. I still binge. I still get up, gather up the pieces of ME, and keep going.  

This is NOT the time when I tell you that that was the most inspirational book of my life; it wasn't. In fact, it's probably one of the cheesiest books I've ever read (and please, never read it while drinking anything... much less soda of any kind).  

But it is the time when I will tell you that I learned what was probably the MOST important lesson of my life... and what should probably be the most important lesson of YOUR life. 

NEVER ABANDON YOURSELF. 

It doesn't mean you are perfect, and will always follow the rules. It doesn't mean you are only relying on yourself. It doesn't mean you won't ever become depressed, nor sad... nor compulsive. It doesn't mean that you need to find 20,000 inspirational post-it notes for your bathroom, either.  

What it does mean... is that whatever you experience in life, or whatever it is you choose to do... BE THERE with yourself. Actively keep yourself company. Be conscious and aware. Acknowledge yourself. 

Acknowledge and OBSERVE from a non-judgmental place the rhythms and intricacies of your emotions... just observe them. No need to judge them. Turn off the TV, and step away from the electronic gadget.  

Do not run away into the occult recesses of your mind while you... ______________. (Enter favored compulsive behavior here, including, not taking care of one's Diabetes.) Acknowledge what it is you need, and seek, and GIVE it to yourself with the REAL DEAL. Not a substitute. 

Know that whatever it is we do, we do it for a reason... seek to LEARN those reasons. 

Allow yourself to be human, and just learn. Learn from the moment. Learn about YOU. Take life... one second at a time. Life will never be easier, or less complicated, like Dr. Who suggested, so just start TODAY. Start with one moment. One action. 

Consider the power of one snowflake... one snowflake every second can lead to a perfect Winter storm. This is YOUR storm. 

Your Diabetic Feng Shui

Stop and smell the flowers...

She stood proudly, next to the small, Thanksgiving pie table, and announced to the world that "This is Liz. She's a diabetic, and every year, this is the ONE time she will allow herself a piece of pie." Great, thanks, lady. Thanks for outing me like that in front of everyone... I really needed a roomful of eyes peering down on me the moment I decide to have a second slice. 

My best friend's mother in law really means well. She does. She, herself, is diabetic, albeit she is a lot more liberal with her food intake than I am. I don't think she has a great understanding of what's going on in her body, or that perhaps how her body handles food shouldn't be, entirely, left up to the pills she takes... but at least she tests, and pays attention. At least, that's what I like to tell myself, anyway. She's in her late 70s, has a lot of very serious health problems, a big time smoker, and not at a place where she's open to making many changes. But the fact that she tests as often as she does is really quite great, considering how little information doctors give older folks with Diabetes, and how Medicare curtails test strips. I'm not sure how well she uses the information, though...  But she DOES test, and she DOES mean well. Maybe I can credit Wilford Brimley with that.

This whole mess is my fault, really.

When I was diagnosed, I was running HARD on tight control. Two years ago, I didn't really give myself much time to sit through and think on things. The stark images of the last few years of my father's life quickly came to the surface, along with fear, anger, and resentment. I believe it was that same week, and I got a phone call from my best friend's husband asking us to come over for pizza. Kind of embarrassed, I really didn't know quite what to say... except "I have diabetes." They had already planned out this expensive meal, all home made, in exchange for asking my husband to come over and look at their computer, and router. I really didn't want to make anyone feel bad, so I tried to muddle through the meal, tried to manage my numbers, failed miserably, and then explained to my friend that I couldn't have that many carbohydrates, to please try to help me with things like salads, etc., or other low carb alternatives to meals.  What's wrong with that, right?

Well, at face value, not much... BUT...

(and there's always a but, with Diabetes... It should be called Diabut, really... or Diabutt in some circles. heh Or just plain ol' PainInDiaButt...)

There can be LOTS wrong with it... If you are newly diagnosed.

For Starters, Diabetes Needs Grieving... 

A part of who we are, is really, GONE, and that needs to be acknowledged.

We may not know who or what we are, at that time, but we know that we will NEVER be the same again. We need some processing time to help dig ourselves out of the deep emotions we might be experiencing so that they don't end up marring the GOOD that's STILL in our lives, by being accidentally misinterpreted by others... We don't want, for example, to instill FEAR in others that they can no longer hang out with us, or have us over for dinner. We can be in control, really! Even if it doesn't seem like it at that time... :) My friends love me, but they are quite hesitant to have me over for dinner, and when they do, they bulk up on low carb everything... lol  (Thanks, by the way...) Lots of folks WILL ask stupid questions, too; it's the nature of the beast. We need to be able to go outside, without weeping uncontrollably... or murdering people.  Once we've had some time to settle down... we can try the experience again, from a place of self awareness.

Diabetes Needs Feng Shui...

Now, I don't really care for new age views very much... (nor about most things, really...) but the notion of Feng Shui is helpful for this exercise. Before you go to the library and start reading up on Eastern philosophy, let me explain a little bit... According to About.com, Feng Shui is an ancient art and science developed over 3,000 years ago in China. It is a complex body of knowledge that reveals how to balance the energies of any given space to assure the health and good fortune for people inhabiting it.

Now... I don't need to be an old Chinese philosopher, to know that Diabetes IS an art and a science; that it is a complex body of knowledge that can reveal how to balance our body's energy (literally, glucose), and our health, and can give us 'good fortune,' for our bodies which we inhabit, IF we take care of ourselves well (most of the time). Each one of us, just like each dwelling, is different and needs to be 'balanced' accordingly. Each one of us needs to find ways to deal with the positive, and negative aspects of our lives... Each one of us needs to learn that in order to be healthy, we need to cheat, and in order to cheat Diabetes, we need to be healthy. That's our Diabetic Yin Yang. And just like it supposedly takes years and years to master Feng Shui, it can take years and years to master Diabetes.

What is Balance, Though? 

Here's the problem...

There are a MILLION experts on how you should live your first year of Diabetes, and how to get started, but there are NOT many on how to finish.   

Diabetes Needs Realistic Expectations

The balance of Diabetes is in pacing ourselves; in understanding that Diabetes is NOT a punishment, or a call to perfection. In fact, we are perfect in that we are IMPERFECT. We can't show others how to effectively live with this disease until we have a few knee scrapes to show for it.

It's not a NOT a sprint. We say that all the time, but it truly doesn't hit home for many until after a few years have passed trying to actively manage the disease.

If you keep running, and running hard, you'll find Diabetes is EXHAUSTING. For me, this "simple" diet and exercise thing to try to mimic a perfect pancreas might have seemed 'easy' at first, but it takes SO MUCH THOUGHT, and trickery... Yes, trickery. It's like I'm some kind of witch doctor; my mind is FRIED from all the overthinking of simple meals... and all the crappy supplements (and medications for other conditions) to keep things in gear.

You have your spaghetti, as usual... I have it after 12 hours of sitting in the fridge so it can develop resistant starch. You have your spaghetti, with bread sticks... I measure mine dry, before boiling, and only consume 1 serving, balanced with at least 3-4 servings of vegetables blended in.

We take care of ourselves more than ANYONE I know. Aside from athletes, I really don't know many people who are healthier than a diabetic. Constant monitoring, eating well, balancing carbohydrates, proteins and fats, constantly thinking about what we put in our bodies... new ways of making or preparing meals which will cut back on, or eliminate spikes. Constantly working hard toward intangible goals.

Let's be clear here. I believe YOU can do this. I believe WE ALL can do this.  It's hard, it takes work, and dedication, but we can do it... But when I say Diabetes needs to be realistic, I don't believe for a second that people don't have it in them to take good care of themselves. This is NOT about not trying hard enough. I don't believe ANY of us is lazy.

But if you have been living with Diabetes for less than a year, there are some things you need to know:

• You are NOT Diabetes; 
• You are NOT grounded, or in "time out," for your previous eating habits (whatever they were); 
• Your NON diabetic friends are JUST as important as your diabetic friends;
• You are NOT your A1C; 
• You are NOT your glucose meter readings;
• You are NOT perfect, BUT you are NOT out of control;
• You are NOT your weight; 
• You are NOT your diabetes management method; 
• You  are CREATIVE, and you can MANAGE, without the need to deprive; 
• You are HUMAN, and HUMANS live, and most importantly... 
• NO ONE diets on Thanksgiving. 

Everyone who shops Black Friday knows that balancing a checkbook religiously does not mean you can't splurge on occasion, for a Big Screen TV. Neither that splurge will bankrupt you, nor that extra piece of pie at Thanksgiving is going to make your foot fall off, or make you gain 5 lbs overnight.

So, my advise to you... on your second, or third year... is to loosen up. You were in a scary, close call of a health situation, but you're in a place of control now.  It's now time to start finding your balance... the happy medium that doesn't cripple you emotionally, but doesn't cripple you physically, either... your Diabetic Feng Shui. Your Diabetic Yin Yang. Oh, and if someone comes and tries to guilt trip you for drinking diet soda, or for not making "fat free" pie, or stuffing... tell them to fuck off.  

What Some Would Call Diabesity, I Call Diapression...

It's a blue Sunday today; a Sunday marked with gray Fall skies, transitioning into Winter blues. The trees are mostly, leafless, and it's long past the time when you could get away with taking an afternoon stroll outside with just a light sweater.  Looking out into the landscape, it's hard to image all this pervasively barren world will come right back to life next Spring.

Such can be the seasons of Diabetes.

There are moments when one feels invincible, unstoppable... committed more than anything in the world, and running full steam ahead.  And then there are the not so honest moments; the moments when one speaks to others, gently keeping behind the curtains the deep feelings of struggle bubbling within.

Depression, and other mental health concerns, are probably the most ignored symptoms of Diabetes.  Though, quite honestly, it is hard to call Depression a symptom when studies have shown that if you are predisposed to Diabetes, it really doesn't matter which one came first: if you had Depression first, it may very well lead to Diabetes; and if you had Diabetes first, it may very well lead to Depression (http://www.webmd.com/depression/news/20101122/new-links-seen-between-depression-and-diabetes).

Adding to the clinical predisposition for Depression is the heavy guilt burden being heaped upon patients by outsiders, and by what I would call an "Uneducated Doctor Epidemic", compounded with the "Lazy Researcher Virus," and exacerbated by the "Ratings Addicted Media Tsunami."

Seriously.

What comes of all of this is a perfect storm of judgement and derision toward people with Diabetes (indiscriminate of the type.) Not that the type should even matter; NO ONE gave themselves diabetes.  No one wants this disease.  But it's easier to mock overweight people; it's easier to blame them for disease, and economic burdens. Why else would they come up with such a thoughtless, hurtful, and insensitive term as "Diabesity?" Because it's much easier than having to self examine the health itself of our country...  Who wants to look at pollution, pesticides, HFCS, BPAs, FDA guidelines, Big Pharma medicine side effects, and COI within health guideline organizations, when there are fat people we can accuse of giving themselves a disease.  (Never mind that 33.3% of Americans are obese, but only 8.8% of Americans are diabetic, and that includes all types.) This leaves most diabetics, frazzled (to say the least), most of the time.

Now, Depression in itself, is a poorly understood, and stigma filled illness. I've had Depression since I was, at least, 12 years old and I can't tell you the number of times people have advised me to just look on the sunny side of life, to accept Jesus, or to just shut up and 'deal with it.' Many people really can't tell the difference between the occasional bout of sadness, and clinical Depression... and just like with Diabetes, few medical professionals are equipped with the tender understanding required to help a patient overcome and manage Depression, or monitor a diabetic patient for symptoms of Depression. What's worse, many people think Depression is a made up, modern era disease, in which people just lack will power... the same lack of will power that led them to be overweight (or eat poor food), and give themselves Diabetes. (Even if these statements are far, far from the truth.)

Even without clinical Depression, Diabetes, in itself, can be depressing for many reasons...

• It's just a frightening disease, with many complications and dangers -- some immediate, and some compounded over time. 
• We have to work HARD to be healthy, without any apparent 'reward.' Most people I know struggle, as it is, when the rewards are very evident (like weight loss, or muscle building, or training for some sporting event)... When people have to work hard at something, every day, so they can avoid 'unknown', 'random' complications they CAN'T SEE happening to their bodies, or won't know about for many years to come... it's like trying to hit a piñata in a pitch black room, with a 6 inch ruler. There aren't many immediately gratifying rewards in this game... And if you do ever get that piñata, you still have to mind that candy. 
• Some folks work incredibly hard, and they STILL develop complications. Sometimes our genetics are the damning factor in whether or not we develop a bad complication, and this is apparent in folks who aren't even diabetic, and develop many of the complications some diabetics might get, like neuropathy. 
• Folks who develop complications, often go their medical professionals only to be treated with judgement, and contempt -- told they weren't compliant, and did this to themselves. Type 2 Diabetic patients often get little support from the medical community, are given little to no education, and little to NO tools (such as test strips to monitor their numbers), and then expected to have tight control. 
• Family and friends are often NOT understanding, and judge from the outside, looking in: they may think life changes should be easy enough (because they're not 'rocket science,' right? -- except, they CAN be lol) and shouldn't burden the patient... yet I can't tell you the number of diabetics (particularly women with diabetes) who end up making two sets of meals, three times a day, because the rest of their family doesn't want to change their eating habits, as well. Diabetics NEED a supportive environment, and supportive families, and CHANGE AS A WHOLE, in order to thrive. 
• It just gets old.  Get up, test your blood sugar, take pills... wait... wait... wait... test, take pills, count carbs, eat, test... exercise, test... test, take pills, count carbs, eat, test, exercise, test... test, take pills, count carbs, eat, test, exercise, test... test... take pills, count carbs, eat, test... Can you keep track of it? Can you do this every day, for the rest of your life? For once I'd like to SLEEP IN, or eat without thinking so much! Can you schedule bathroom breaks in between, for the side effects? Can you schedule exercise breaks, in between work, when you're not at home? Can you plan snacks to stuff in your pockets so you won't go low at work? Remember to pack your lunches, every day, for work, and always get up early enough to eat breakfast, and always pack your own meals and drinks when you go to get-togethers because no one bothers to think of diabetics or those with health needs? Can you remember to schedule all the doctor appointments for your routine care? The eye doctor, the foot doctor, the A1C, the yearly physical, the CDE? Can you remember to have enough strips and snacks when you go outdoors? CHANGE YOUR LANCET. Can you still spare an extra 20 minutes to talk to the idiot who just said you shouldn't eat that candy in your pocket for your lows, or it will give you Diabetes? Are you tired, and annoyed yet? Because let me tell you, it's not fun to be the fat gal at work, with candy in her pocket, because her Polycystic Ovarian Syndrome gives her hypoglycemia, and she unloads trucks for a living, but she has Diabetes... So everyone else needs to have a say in that. And oh, yes, all throughout your day... remember to drink enough water. :) Lots of water. heh Or you'll go high from dehydration.  FUN.

I don't really think we realize just what we're doing to persons with Diabetes.  We worry so much about about an obesity epidemic, but instead we're creating a Depression epidemic in more ways than one. We are creating an epidemic of people who want to die, in silence, from shame, rather than talk about their Diabetes, or openly care for it.  An epidemic of bullied children, and young Diabetic girls with eating disorders. If we have enough courage to not judge someone who just got infected with the HIV virus, whether it was their fault or not, why would we not have enough courage to not judge someone who just got diagnosed with Diabetes? Diabetes kills more people than Aids and Breast Cancer COMBINED.

Diabetic patients need well rounded, overall care, and mental health services to help cope with this chronic, life long condition. Diabetics need support; not judgement.

If you are depressed today, friend... Understand that Winter doesn't last forever.  Just like your trees, plants, shrubs, and lawn, may require some tender, Winter loving care... So do you.  Be KIND to yourself. It is OKAY to feel the way you do.  I feel it, too.  

It seems like the end of the world out there, in your heart and mind, but it is not.  I GET IT.  You want the roller coaster to stop...  If you are struggling today, with Depression, hiding behind society fabricated shame is not the answer; please, open up. Talk to your doctor, or find a new doctor.  Find a Diabetes support group in your area, or online... Leave unsupportive environments, and judgmental people (even if they themselves have Diabetes.) Do NOT go down into that Wintery scene...   You can do this, and I'm no different than you... Spring is just around the corner. Let yourself bloom. 

Unexpected consequences of pumping

Thanks to everyone who has been tweeting to ask how my first few weeks of pumping have been going. Very much appreciated. Sadly I've not really got time to write a post in any kind of detail today (inevitably work has gone crazy because I've got some time off booked before Christmas).

I always knew that the first few weeks would be a bit of a rollercoaster, and so they are proving. I've had a bit of everything really, mostly unexpected highs and one or two lows (a mix of user error, dodgy sites, bubbly tubing and general set-up shenanigans as far as I can tell). I've had ketones* for the first time in I can't remember how many years. I've had absolutely amazing support from my DSN who has been on the phone and emailing regularly to see how things are going. I've also had great support and encouragement from you lovely people in the DOC. It feels a bit odd to have 'friends' that you are never likely to meet face to face, but who nevertheless go out of their way to send positive vibes from hundreds or even thousands of miles away.

My first week on insulin went really quite well. I made a few tentative basal tweaks and generally got used to things. I'd expected to need less insulin on a pump, as this often seems to be the case and for the first week my Total Daily Dose was perhaps 60% of what I'd expect on MDI.

This week has been a little different though. A little unexpected. I've managed to fit in a basal test, but have been fighting high BGs much of the time. It seems that the basal doses and insulin:carb ratios that worked fairly well in week one have failed dramatically. Interestingly I have been exchanging tweets with the mum of a new pumper whose son went through exactly the same thing after about 10 days. My total basal dose is now back to almost exactly what it was on Lantus.

Another unexpected consequence was my first delivery of sets and reservoirs from Medtronic. I'd been advised to get around 3 month's worth and good grief! That's a lot of stuff! I'm going to have to find somewhere different (and significantly more spacious) to keep all my spare diabetic gubbins.

More updates to follow. As fellow newcomer to #teampump Dave would say, keep the faith.

* Ketones are poisons that can build up in the bloodstream when blood glucose levels run high/insulin levels are too low for any length of time. Risk of Diabetic Ketoacidosis is one of the things you need to watch for when pumping since you have no long-acting insulin sloshing around to get you out of a fix.