mySugr Review - The best Diabetes logging app ever?

When we began this blog almost exactly three and a half years ago (crikey!) I had just made two important and, in their own small way, utterly life-changing discoveries.

One was that I wasn't anything like as good at managing my diabetes as I liked to think I was. And the other, and perhaps more important, was the extraordinary power, knowledge, support and cameraderie of the DOC hive mind. At that stage I felt that my control was 'as good as could be expected' and that diabetes was just pretty random every now and again. Years later I now understand both of those statements to be completely true, but in a very different way - and with the benefit of signficantly better control and confidence in handling my diabetes.

One of the main changes I made at that time, and perhaps the one that transformed my self-management more than any other, was to start testing more frequently, and to record the results more systematically. This information then enabled me to spot patterns in the apparent 'randomness' and apply the knowledge & experience of the DOC to experiment with the whole 'pretending to be my pancreas' business. Identify a problem... find out what others do... experiment... try something else... develop a strategy... test... review... adjust. None of that would be possible for me without a decent feed of data to try to keep track of the million and one variables.

At first I used the ever-faithful pen and paper route, which is fine in its way, but doesn't really let you do anything with the information you are so carefully collecting. Shortly afterwards I started using different apps on iPod Touch and later iPhone (other smartphones are available etc...). I must have tried the best part of a dozen apps in quick succession before settling on one which allowed me to log and track everything I wanted to without making me want to chew off my own fingers in the process. A couple of years ago I saw a mention by Mike Young of Diabetes in Spain about an app he was using called mySugr so I had a look. I've been using it ever since. Recently they launched a major upgrade as v2.0 and to my mind mySugr has now become something really rather special.

Overview
Well let's see...

Fast/easy data entry? Yup.
Pretty graphs? Absolutely!
Useful averages over different time frames? All present and correct.
Additional analysis like SD and number of high/low readings? Correctamundo.
Suitable for pump users? Certainly.
Export data in a variety of formats? Of course!
Fun? Yes!

Erm.... what?

This I think was the biggest difference I found when I first started using mySugr. The team behind it (which includes quite a high proportion of T1s) understand that logging, while potentially *very* useful is not the most fun to be had. Underpinning all mySugr's seriousness and analytical clout is a healthy dose of wit and charm. When you first set the app up you choose a name for your diabetes monster and every time you make an entry you go some way to taming it day by day. They turn diabetes logging into a sort of game, scoring points with every entry made. This may not appeal to you from the outside, but there is something inexplicably smile-inducing about the animated gurgling reactions of your monster when you make an entry - especially one that is above or below your ideal range, which is exactly when I need distraction most.

mySugr allows you to log all the things you would expect - BG (in mmol/L or mg/dl), carbs (in exchanges/CPs or grams), meal boluses, exercise/activity, basal dose for those on pens/syringes and temporary basal rates/duration for pumpers. Naturally you can also make copious notes alongside your entries which I find essential in terms of interpreting the data later. In addition you can also capture photos of meals and even add the geographical location at which the entries were made which is a nice touch. Entries can be tagged with one or more predetermined icons which range from the inevitable 'breakfast' and 'sport' to more emotional options like 'stress' or 'chilling' adding further detail to records. A very useful 'search' option allows you to quickly scan back through months worth of entries to find what you last tried for 'pizza' or 'chinese takeaway' then jump to those records to see how it went and what you might try this time.

mySugr operates on a 'freemium' basis. The fundementals of the app are available absolutely free of charge, but full functionality (eg photos with records) requires a 'pro' subscription. When you install the app you get all the bells and whistles for a few weeks. Following that you can just use the (excellent) core functions, pay a small monthly fee to upgrade to pro, or complete motivational 'challenges' to earn days of pro subscription for free by logging several entries per day or exercising. EDIT: As of January 2014 mySugr seem to be moving away from a subscription-for-pro set up towards a single payment model.

The data analysis on offer in mySugr is excellent. The home screen (above) gives you a general overview of how things are faring over the last week/24 hours in different ways. The graph itself recolours to give you instant feedback if things are altogether too high/low (red) or a bit marginal (amber). There is a logbook screen with pleasingly swooshy draggable graph and table of entries that allows you to quickly scan back through previous week/month - the graph dragging side to side as the table of entries scrolls up and down. A separate analysis screen allows you to see 7-day, 14-day and month-by-month changes in average BG and crucially the SD of those entries (how closely grouped or wildly scattered they are). Dig a little deeper and you'll see a summary of numbers of high/low readings, tags, photos and other useful detail to help you work out what has been going on. If you enjoy your own number crunching and/or want to amaze and impress your clinic with how marvellously you are getting on you can choose between different .csv formats for Excel or export your data as a slick PDF report.

mySugr is registered as a 'medical device' and CE marked (I think it is perhaps the only logging app to have achieved this). Data storage is safe and secure and the entries are seamlessly uploaded and synced in the background. I experimented early on with this and if no data connection is available mySugr will just wait patiently without pestering you until a connection becomes available. If you own more than one device you can log from whichever is closest to you at the time and the data will stay in sync on all of them.

What? No niggly complaints?
If you've read a review here before you will no doubt be waiting for the 'but...' followed by a long list of things I really hate about mySugr. Well it surprises me as much as it might you that I can hardly think of *anything* I would change about the app. I would love to be able to edit the preconfigured list of 'tags', either to just hide the ones I'll never use, or preferably to allow me to customise the text myself. The options they have are decent enough, customisation would be perfect - I gather this is on the 'wish list' for future versions. There seems to be a slight glitch with data export for Excel in that dates are coming through as text rather than an Excel-friendly timestamp. This has almost no relevance to any other user I'm sure, but it makes some of my occasional attempts at analysis/graphing in Excel go a bit wonky. I'm going to drop them a line about that, and it's just the sort of thing they fix in one of their version updates. (Edit: as expected, this has now been fixed!)

So I quite like it then?
I noticed something a few weeks ago that really surprised me. The way mySugr helps me keep track of my readings actually helps me improve them in a way no other app has done before. There is a sort of 'sliding scale' of reward and motivation going on that on one level just lets me know if things are slipping a little, but then - even when they are pretty much perfect manages to encourage me to keep trying harder. That's not a bad effort for some lines of code, comedy noises and a sprinkling of funky graphics. In general terms the BG average and SD over 24 hours 7 days, 14 days or month-so-far offer me a ready reckoner of how well (or badly!) any time period is going. I have a tendency to think 'things have been terrible for ages' so it can be encouraging to look back a few days and see that results were not so bad after all and a little basal testing will probably fix things.

Aiming for amber
For about a quarter of this year things were not going well for me diabetes-wise. Looking back it wasn't a disaster (see previous para) but every month I'd hope for a better average, lower SD, fewer highs and fewer hypos only to find that the results would be slightly worse not better than the previous month's. Despite the fact that I felt like I was trying harder. This is not particularly encouraging... But following my annual Pump Clinic at the end of June where I made some small basal and ratio tweaks things all seemed to slot into place. Day after day with bewilderingly good levels. I felt like I was winning. Even when we were away on holiday (a notoriously chaotic experience for my BG in previous years) I pushed to maintain this success*. Why? Well during this period I began to notice the 'high/low' marker on mySugr's home screen (see the big picture above) was no longer it's customary Red. Quite often it was Amber. Once or twice it was even Green! So in a rolling 7-day period I would find myself pushing to avoid a high or low reading that day, because if I could make it with a 'no hitter' then tomorrow the wobbles from this time last week would disappear and I'd be in amber again. I was playing my diabetes like a game.

The fact that my logging app was providing that motivation should make the folks at mySugr very pleased indeed.

mySugr is available for iOS devices in the App store and an Android version is currently in 'beta test'.

Final score: 5/5

* Fear not. Normality is resuming this week... along with some set failures and hilariously jaggedy mySugr graphs that well and truly revoke my #teamsmug membership.

Disclosure: I wasn't paid to write this review and I have no commercial interest in mySugr at all. I was lucky enough to be one of the beta-testing volunteers for 2.0 and have spoken to Frederik a couple of times but that's it.

All supporters need support.

Mine is a supporters voice. As Mike's wife I would like to say I am there to support him in all that he needs. I try; though I freely admit to getting as fed up of diabetes as everyone else, I am not a particularly patient person. Anyway, I think the point is that I try. I'm pretty sure we all want to try, all us supporters; but it is not straight forward.

I recently met with a friend who was diagnosed with diabetes over ten years ago. I visited him in hospital, he had pneumonia along with a heap of complications which sounded suspiciously diabetes related. I asked him whether he had type 1 or type 2. He said, "I don't know." I'm not sure how well I hid my shock, I was pretty much lost for words. My friend lives with his mother. He was diagnosed when he was thirty. He is not adept at communication.

I also know his mother, who I am sure has all the feelings that any mother has when they find out their son has diabetes. I know from Mike's mum that that can include guilt, fear, and the desire to wrap in cotton wool and never let out of her sight ever again. My friend, unlike Mike, did not talk to his mother, and his mother, unlike Mike's, did not like to push for answers to the thousand questions simultaneously forming in her head. She has had to cope alone. She hasn't felt able to admit that her son's inability to communicate has left her at a loss as to how to support him. So what she does is try to look after him. She makes sure he always has a good big bowl of cereal for breakfast, and that there is always a choice of puddings on hand after his evening meal. He happily tucks in. The only piece of advice from a dietitian she has ever been present to hear is that a combination of grapes and banana is a really bad idea.

As the mother of a diabetic diagnosed in adulthood, she has never received any support. Mike's mum was in the same position, but blessed with Mike and then of course I came along and took him off her hands, again with no support and it is scary, but Mike helped me through. I am aware that Mike and my friend are at opposite ends of the communicative spectrum, most people must be somewhere in the middle. Mike is on his way to a long, healthy life, I wouldn't be surprised if he outlived me (my family have a history of heart disease). My friend is on his way to dialysis, losing his sight, losing his feet and dying before his mother. I believe his control would be greatly improved if his mother had been offered support. My guess is that most adult diabetics don't live alone, that many don't cook their own meals, so the responsibility for the control of their condition does not fall entirely in their hands. It can and should be shared.

All supporters need support.

Diabetes Week - Artificial Pancreas Project

It's Diabetes Week in the UK this week and after my rather forlorn post about the apparent disappearance of C8 medisensors non-invasive CGM last week I was pleased to read this little update on the Artificial Pancreas Project (APP) from Diabetes UK today.

It's still reasonably early days, and to my mind we are still quite a way off a 'real' management solution, but step by step people are cautiously being allowed to hand over the reins overnight to an automated system in their own home rather than under strict lab conditions with technicians standing by the bedside clutching Lucozade and NovoPens.

For those of you who have *no* idea what I am going on about, the Artificial Pancreas Project is seeking to 'close the loop' between two clever bits of diabetes kit. A Continuous Glucose Monitor (CGM) that can measure glucose levels and an insulin pump that can provide varying doses of insulin. In fact most people who happen to see my pump tend to assume that we are there already, and assume that a pump will just somehow 'know' how much insulin is needed and provide it automatically. Sadly it's not quite that easy, and while an insulin pump is a brilliant therapy option it does still require a fair amount of effort, guesswork and to be honest more than a little luck in balancing all of the hundreds of variables involved in day-to-day BG tomfoolery.

Part of the problem with the APP of course is that the technologies involved are improving, but still rather less than perfect. Continuous Glucose Monitors make an estimate of blood glucose levels based on glucose concentration in interstitial fluid (the stuff sloshing around between cells in tissue). This tends to lag a bit behind actual BG values, and those lucky enough to have access to CGM will know that what you are really getting is 'trend' information rather than the accuracy* of blood-based fingersticks. CGM manuals/marketing are usually pretty clear that any doses/corrections made should be done after confirming results with a fingerstick test. But the closed loop system needs to use this very same stream of trend information in order to make dosing decisions.

Currently the human trials of the APP are showing relatively promising results for looking after things overnight. To know that you had a smart system carefully tweaking your levels while you slumbered would be fantastic, but of course a full Artificial Pancreas would have to go much further and tackle the thorny issue of mealtimes. Personally I think we are a looooong way off that. For one thing current 'rapid' analogue insulins are hopelessly inadequate for the task. They take far too long to get going (1 hour for corrections to start taking effect anyone?) and act over far too long a time period to give a bunch of electronics, however smart, the ability to take over entirely.

What I would hope for instead is a commercially viable 'smart pump' which combines much of the effort and user knowledge/experience that currently goes into effective pump use, but with automated AP trickery to take the edges off the errors and irritations of daily pancreas impersonation. A system whereby you would bolus for meals, set TBRs for activity and generally do the basics, but the pump would be constantly monitoring how things were going and have the ability to tweak things and make corrections to keep things on a more even keel.

Now that really would be something.




* It should be noted, of course, that fingerstick BG tests in themselves are not particularly accurate and only really serve as a general guide as to what is going on.

Has the light gone out on C8 Medisensors optical CGM?

Someone left a comment earlier today asking if I knew any more information about the C8 Medisensors non-invasive CGM, which was given CE mark approval late last year. Some of you may remember me getting quite excited about it after having seen the device in action.

At that stage, the general expectation seemed to be a European launch in the Spring of this year. In January I got wind that the launch had been put back slightly to allow for 'further enhancements' to be made prior to the launch in mid-2013.

I've had a little look around the internet, but all I can find are reports/stories from late last year. Trying to look up the C8 folks I met via LinkedIn suggests that they stopped working for the company in January this year. It seems that at about the same time John Kaiser took over reins at the company - so what happened then?

With an increasing sense of doom, I realised that their website seems to have gone offline in the past few months too.

To be honest, I'm gutted.

Just wondering if anyone knows what the story is? I really believe that their non-invasive CGM, if it lived up to the promise shown, genuinely had the ability to completely change the landscape of diabetes care across Europe, and CGM pricing/availability in particular. £2000 for 4 years, rather than £3000-£4000 every year would put self-funded CGM within the grasp of many more people in the UK. A currently frustrated and untapped market.

I can't have been the only one waiting for lauch with one hand reaching for my wallet.

Anyone from C8 Medisensors out there?

Splish splash - aquapac insulin pump case

The sun is shining... thoughts turn to Summer holidays.

This year we will be returning to Cornwall, to the very same place we stayed a few years ago. When we were there before the girls and I quite fancied a little gentle sea-kayak pottering in the wide open bay on our doorstep but never quite managed to bump into the kayak hire people who seemed to have a rather relaxed approach to timekeeping (and attendance in general). This year we are hoping to give it another go.

The last time we were there I was on MDI, but this time, of course, I have Artoo to think about.

I don't suppose we will be out for very long so I could just detach and leave the pump on the shore. I suspect there will be enough activity involved in paddling to make hypos more of an issue than raging highs, so the lack of basal for an hour or so would probably not be much of a problem. But... what if something happened. The last thing I'd want if anything untoward were to occur would be to be bobbing about awaiting rescue with the added 'excitement' of being just a few hours from DKA once my last bit of basal runs out.

Having asked around I've had very good reports of the Aquapac waterproof pump case, so I've decided to order one. The case is clear so I will be able to check on how Artoo is doing and it's waterproof enough to cope with anything from a bit of gentle splashing to some full-on dunking - for a short while at least!

All we have to do now is hope the kayak hire people actually turn up!

The Moldy Cupcake Awards: Artificial Sweetener Alarmist Crap, by WHO-TV Channel 13

Copyright © 2010 Julie King 
/ Gleeful Things. All Rights Reserved.

Welcome to another edition of the Moldy Cupcake Awards.

The award we give out for excellence in communicating nonsense, lies, misinformation, and outright uninformed, alarmist drivel, about diabetes and related health information, for the purposes of garnering ratings, by the mass media, and others.

This installment's winner is: WHO-TV Channel 13 News, Des Moines Iowa!

I'm not much of a TV viewer, these days, but I must confess: I had a little accident this week -- I accidentally spilled water on my laptop, so I had to spend a good day without the internet. What was left, but the TV? (Yes, I know... reading, walking, exercising, crafts, etc. lol) Anyway... after a year or so of not watching any TV, I was quickly reminded why I had given it up: gullibility, stupidity, emotional appeals, and alarmism for the sake of ratings. They sure know how to hook us in. 

So, here I was, taking a dose of mental junk food, when I saw a commercial for the local news regarding artificial sweeteners. In it, the anchors sounded the alarms of doubt... "are artificial sweeteners and low calorie foods safe for you, or are they just a sweet deception?"

Oh, there was no way I was going to miss that... and they did not disappoint -- by which I mean, they completely disappointed me, as I expected. I am always amused by how the media portray their stories on artificial sweeteners, and other controversial subjects. They violate every law of sound journalism: 

•  You first portray anecdotal evidence, by someone that has really no proof of their claim, just a gut feeling;
• Then you speak to expert sounding non-experts;
• And finally, you have them make lofty claims, with absolutely NO scientific evidence or basis...

And there you go! A recipe for just about every "investigative" segment on the news, today. 

This 'investigative report' is no different. They start out with the story of Renee Chiaramonte, a woman who is a registered nurse, at one of our local hospitals. That, by default, would give people the idea that Renee has some 'authority' on what she says, because she's a nurse. In my experience as a diabetes advocate, assuming one has sound medical knowledge or health expertise by virtue of being a nurse, simply couldn't be farther from the truth. 

But I digress... We're left to ponder on the life of Renee, who was not feeling healthy, and felt like this was
likely due to poor diet; artificial sweetener abuse, to be exact. She claims she was consuming up to 500 artificial sweetener packets a month (besides countless diet sodas) and that she experienced weight gain, joint pain, and a torn tendon in her knee. These are some pretty hefty claims to make of artificial sweeteners. 

But it doesn't stop there... How dare these companies try to sell you artificial sweetener?!

They want to build a case of blame against artificial sweetener companies, so they interview a Marketing Professor at one of the local universities. "Oh, no, companies make you crave the sweet stuff by giving the boxes pretty colors, and putting them on the most accessible shelves! How dare they!" Yeah -- it's called being a company with a product, which you want to sell. Should they package it in corrugated boxes, written over with Sharpie marker? Please.

Then, for the clincher: A "medical" expert's opinion. Now, is this expert a registered dietitian? Is she an M.D.? Is she, perhaps, a food scientist? Maybe even a scientist with the FDA, or the Department of Health?  I would've even accepted a researching chemist. 

No... that would be too ideal. The woman in question, is "Dr." Ann Buenger -- a chiropractor. 

Listen here, fools at WHO-TV News Channel 13... 

A chiropractor is not a medical expert. In fact, they are not really doctors of anything, but of pseudo-scientific claims, and most of their claims and services are WOO. How dare you ask this woman's mere unscientific opinion on this subject (of which she is NOT an expert, by any means)? Let's limit her to such things as back adjustments, for crying out loud.

So, instead of interviewing an actual expert, they interview Mrs. Buenger (I refuse to call such a person a doctor) and she makes even more preposterous claims: 

• Artificial sweeteners are stored in your fat;
• They are all a "chemical," thus they are toxic to the body;
• "Experts" say artificial sweeteners can trigger weight gain, migraines, depression, and cancer;
• Consuming artificial sweeteners is like directly injecting them in your veins; and
• 75% of your neurons have to die before all your symptoms of artificial sweetener consumption come out.
• "Adverse symptoms" can last for several years.

I really miss the days when journalists were actual journalists, and did investigative work. NO ONE in their right mind would want to quote such a non-expert on such a subject. I wonder if all the other real experts simply told them there was nothing to discuss? No controversy? They had nothing to work with, and were grasping at straws. 

I sure would love to know to which so called studies and experts this woman was referring. Since she doesn't say, and even a cursory search on google doesn't yield any credible links (medicine journals, with findings, for one), I am left with assuming 99% of her claims came right out of her ass. 

You see, artificial sweeteners are not stored in fat; they do NOT affect your neurons in such a way that most of them have to die off, somehow, before you can feel better, nor do they trigger any of the symptoms mentioned above. And if something is toxic to us, just by virtue of it being a chemical, well lady... throw away ALL your medications, and you'd better hope you don't get any major illnesses. 

Aspartame, for example, has no more likelihood to induce headache in people who consume it, than a placebo; further studies of the association between aspartame and cancer found this association to be exclusive to rodent physiology, and not supported in humans; and any idiot who has any knowledge of the body's digestive process knows that drinking something is NOT the same as injecting it in one's veins... otherwise we'd drink insulin. DUH. 

Now there is some truth as to the likelihood of weight gain and usage of artificial sweeteners, but it is not due to artificial sweetener 'storage' in adipose tissues. 

You see... the desire to eat is driven by the same reward-circuitry we have in our brains for other pleasurable activities, such as sex, and drugs (hot damn!) When we consume sweet foods in particular, they reward our pleasure senses, but they also trigger satiety mechanisms which tell our bodies we have had enough. Since artificial sweeteners do not possess any caloric content, they thus trigger those 'hedonistic' pleasure neuronal signals, but do not seem to trigger satiety signals. The hypothesis is that a person can end up over-craving, and overeating, or looking for more food, because they didn't feel 'satisfied.' Also, if one abuses sweet foods, one trains one's palate to prefer such sweet foods, over other foods, even craving them. The studies for these behaviors are not, by any means, definitive; they are often large population studies, from the 1980s, over a 7-8 year period. Food attitudes, and diet notions can change a lot in such a period... especially in the 80s, when people would often eat a slice a cake with a diet Coke, and think they were doing well; or consume honey, in place of sugar, and think they were cutting out problems. 

This does not, by any means, mean that consumption of artificial sweeteners immediately leads to weight gain, on its own. It does not. If one is aware of one's eating, has a well balanced diet, and consumes enough water through the day, there really should be no problems. One of the prime examples of how artificial sweeteners do not lead to weight gain are the foolish anchors of this story, themselves, which at the end of the story (while not shown on this clip) were freaking out about all the foods they had consumed through the day, or earlier in the week -- while being the picture of fitness. 

Interestingly enough, just to show HOW psychological this woman's perceived malaise was, from her artificial sweeteners, she claims she now consumes Stevia (by way of Truvia), which is "the only healthy alternative, right now." They assume this because Stevia is naturally derived... but in fact, Stevia is no different in way of 'anecdotal' symptoms expressed by consumers -- as well as, also, not having caloric content. If it's sweet, and it has no caloric content, it should behave in the same way as the other sweeteners when it comes to partial activation of food reward pathways. 

One is left to ponder upon the other ways in which this woman was possibly not taking care of herself: not enough sleep, poor diet (hence a lack of vitamins), and dehydration. If she has any history of carpal tunnel, lack of enough Vitamin B-6 and Vitamin B-12 can seriously affect her joint health. It could have also been the result of poor hydration, if she was simply not having enough water (just chugging diet sodas), and was retaining a massive amount of water weight from dehydration (a safety mechanism), as well as causing her joint pain, and even muscle cramps, and torn tendons, in the presence of high activity (such as a 12 hour work day). These are all well known side effects of dehydration.  

This was, simply, an inexcusable piece of irresponsible journalism, WHO-TV. A lot of people greatly depend on artificial sweeteners -- many with various illnesses they need to manage, such as diabetes. We live with enough guilt, as it is, without uneducated lay people giving us crap over a 'piece' they saw on your channel. When you create such poorly researched segments, what you do is push people into the arms of conspiracy theorists, scammers, and quacks, claiming they have the latest and best in 'natural' medicine, or a quick fix for their problems. Not to mention, WHO-TV, that you slander an industry. Sweeteners are used in all kinds of things, from toothpaste, to Lean Pockets. 

This woman was simply living a poor lifestyle, and instead of taking responsibility, decided to blame the artificial sweeteners. And instead of researching, you went with questionable sources. The worst part is that you brought NO balance to your piece, only adding a lame 'Editor's Note' at the end of your hard-to-find written piece, with 'differing opinions.' WHO-TV, these aren't simply 'opinions.' You can have your own opinions, but you can't have your own FACTS, and then call those opinions. SHAME ON YOU! 

The Seasons of Diabetes

I wrote this post last fall -- and left it to 'simmer' under my drafts, until I felt I could more fully, and more maturely, develop it. 

It's cool outside. The air is crisp, and clean; tinged with so much moisture that I can feel its mist on my cheeks. Wondering home after work, in the early afternoon, gives me pause. The crunching leaves underneath my feet, the neon yellow colors, and the scent of trampled ginkgo biloba wakes me right up. Ginkgo biloba is pungent, that's for sure; it's scent is something between icky bodily functions, and rotting flesh.

No matter though. The heavy atmosphere begins to release a mild rain... and though there's no umbrella and it's quite cool outside, I find myself embracing the very awareness of being alive that the new season brings upon my senses.

I realize, suddenly, that I love Fall. But then, don't I also hate it sometimes? I know I've told myself that before... Why is that?

[Walking gives one much time for thought. Deep thoughts by Jack Handy kind of thoughts, I guess. (If you hate walking for the exercise, well, at least love it for the thinking.)]

So... what is it that I love about Fall, or any season, anyway? The answer is both obvious, and not so obvious; one of those much clichéd "Aha!" Oprah kind of moments. I love seasons because of their promise of RELIEF.

This brief moment of relief brings my soul much healing from the previous season; a much needed break from the burden of dealing with whatever else was before. Yes, relief. You see, I start out loving a season, and then it slowly becomes annoying to me, and outright burdensome... I then get sick of it, or even depressed from it. I get sick and tired of the stupid season! It seems long, and never ending... and there's only so much of -20°F or 100°F (and everything in between) one can tolerate. So, every new season brings me relief from the previous season. It brings me a much welcome change of pace. It brings me an opportunity to love life again. To smile... to take in the wonder of how much nature can change from one moment, to the next.

And it's much the same with diabetes, and our "seasons" of self care, isn't it? We make up our minds to begin caring for ourselves, anew, and start out with the joyful promise of good things to come... and then we get sick of it. We seem to perpetually live in one season, and one season only -- often with little flexibility with our routines; we impose the new "season" on ourselves --with strong militance -- and then we burn out. Then after a little while, we start yet another season, but with the mindset of 'rectifying the previous bad behaviors.'

But, should we change things before our "season" changes us into something we don't want? Maybe we ought to begin a new season simply pondering what lead to the 'bad behaviors' in the first place... I know I'm guilty of it, particularly with my routines. With it's dietary calculations, carbohydrate juggling, testing, supplements, medication management, exercise routines, and doctors appointments -- diabetes can be one long, and boring, and often, depressing season. Some people thrive in that kind of season, just like some love perpetual sunny days... but once in a while, my soul needs a little rain.

So, how do we avoid this cycle? What can we do so that we don't get stuck being miserable, in a crappy season, and completely giving up on diabetes management, over and over again? Well, it's obvious that we're creatures of spontaneity -- we need, and crave change, so wherever we can, we must allow ourselves some flexibility. With this in mind, we must take a moment to consider...

a.) Which things are negotiable; and
b.) Which things are not negotiable.

And we must be realistic. We need to sit down with ourselves, and realize that we simply cannot put everything in the "not negotiable" camp. For example -- as much as I, in principle, would love to eat nothing but eggs, every morning, so that I have the best blood glucose numbers -- I know that I am quite sick of eggs. I don't want eggs all the time; I don't want flax seed meal muffins, I don't want weird food. I want to eat a chicken soft taco, with lots pico de gallo, lettuce, and a little hot sauce. It's about 35-40 carbs. IT'S FINE. My morning blood sugars aren't below 100, but quite frankly, they don't go over 150, either... and I'm okay with that.

Will I have a bunch of cereal, of any kind, for breakfast? No. Cereal is not negotiable for me, and not even because of the spike. It's just not satisfying to me -- psychologically, it doesn't seem like I've eaten anything, and physically, it just doesn't fill me up. It makes me need more food, and I'm not much of a pleasant morning person to be going around, making extra things. I tend to like regular meals at that hour, OR, a light snack and a brunch later on. If we think about it, most breakfast foods are just an excuse to eat desserts in the morning, anyway. So... I'm not going to kill myself with eggs, nor cereals, nor weird substitutes.

Now, in my desire to eat with awareness, what I seek to avoid is binging; that is not negotiable. (As non-negotiable as completely giving up testing.) Overeating may happen from time to time, as we learn our limits -- but binging is not negotiable. So, what does my body want to eat, intuitively, the most? These days, my body wants and craves veggies the most. Non-starchy veggies, and lean proteins. Sometimes, though, I might crave a bit of creamy tomato soup, with a small portion of gnocchi in that soup -- and I can have that. I need to recognize, though, that I will NOT and CANNOT live forever on just veggies, and just protein. That the occasional starch and/or grain is okay -- even if it's not 'whole.' I am perfectly aware that this is not deadly, that it is not untenable, and that some people make the change, without issue -- but if I did this, I know I would soon fail.  I am not a person, psychologically, to endure such a restriction -- to endure deprivation and strict eating rules. I do eat low carb most every day -- but every once in a while, I am OKAY with my blood sugar not being perfectly below 120 after every meal. If it's below 160, sometimes, it'll do. Yes -- it'll do. So... I tend to cycle some days when I eat very low carb, with some when I eat moderately low carb, and with some when I allow myself a treat. Studies have shown that an intermittent low carb diet is still much better at reducing insulin levels in one's blood, than a Mediterranean diet (or standard dieting). We're not speaking of insane changes, here... It's not like I'm going to sit out in the rain all day, because I got tired of sunny days. (No, no... sorry, there's not going to be an "all brownie day." Put down the icing.) But maybe one or two days of splashing in some puddles might do me some good. After all, who wants to go to a favorite restaurant and ALWAYS have to stick to the same food option?

No one. They'd soon fail. So then, we must learn to be realistic, and keep a balance between our own desires for freedom, spontaneity and change -- and our limitations.

Another change in season which we may consider, is simply changing how we view the way a meal affects us. Not every meal is going to be perfectly within blood glucose goals -- but perhaps the bigger question should be: "how well do I feel when I eat it?" Quite frankly, I have to limit heavy breakfasts -- proteins with too much fat, or calories, will make me feel bogged down and sick -- even if they give me great numbers. Most of the time, I cannot handle a great work day, if I'm bogged down in a very heavy breakfast. I also can't eat very bitter or tart foods at that hour, like yogurt, or grapefruit. Hey, I admire the people who eat that every day, and can get away with it -- but it seems to be unsatisfying to me, both physically, and emotionally. On the other hand, a home made tomato soup, with lots of veggies, and a bit of gnocchi -- while giving me blood glucose levels sometimes in the 160s -- make me happy, joyful, and healthy. And the highs do not last very long. Since I've started eating more like this, I've also had better fasting numbers in the mornings -- usually in the 80s.

But perhaps, by far -- one of the things we ought to consider when managing our 'seasons' with diabetes, is to enlist the help of our friends and family. If one has a "Type 3" person enlisted in one's care, one should use this moment now to plan out a 'new season' with them. That could be as simple as choosing one or two weekends a month, where they are the person who makes meals, so that you don't have to be the main meal maker ALL the time. Or, it could be the other way around... maybe we can be the main meal maker, so that we give one's Type 3 a break from having to make our meals all the time. Learning to plan, and prepare, diabetes-healthy meals can be a lot of fun, sometimes.

What concessions are we willing to give ourselves in order to learn why the caged bird sings? Diabetes is a steady stream of seasons; it's best to let ourselves change and flow with the wisdom they bring. I'm only 36, and I have a good 30+ more years with this disease, so I have to learn to run a good race... and be consistent at it. This, for someone like me, is a HUGE challenge... and though I may seem like I have it all together, believe me, I'm still, very much, a work in progress.

I never have quite the same consistent answers about my eating habits, or exercise routine... because well, there is no consistent answer. I simply try to do whatever makes me feel healthy, so long as Mr. Meter approves... and I'm not sick of it. Mr. Meter, though, is going to have to learn to be a bit more flexible, sometimes. Or he'll end up decorating my wall. As you can see by this 14 day average, he can be a real drill Sargent, sometimes... even with those silly, googly eyes.

In order to survive, we need to change our seasons. We need to redecorate, to transform, to change the same four 'diabetes walls' we stare at, every day... because we need RELIEF. 

Sometimes, our souls just need a little rain.