Get Bigger To Feel Better

Do you ever just want to drop kick diabetes out of your life? I was reflecting on this topic as it is a feeling that people living with T1D can experience fairly regularly. The newly diagnosed who are getting used to the necessitated changes and additional duties to daily life as well as the veterans who have years of experience and still sometimes miss the mark (because who are we kidding? The mark can have a mind of it's own!), and all those who undergo burnout in between--we all feel it. Even if we can appreciate how diabetes has made us stronger, we still often wish we could just tell it where to go. The problem is, there's no one to scream at. Getting mad at diabetes is like throwing a pebble at an armored freight train going full steam--nothing makes a dent. We can feel like we have no voice and if our feelings don't have anywhere to go, that animosity we'd like to express to diabetes can turn inward. If it stays inside, with no one to react to our pain, to hear us and engage with it, it can be very difficult to release. Think back to a time when you had a disagreement with someone. Imagine how you would have felt if they'd just dismissed you or ignored you. Yes, we want to prove our point but so many times, we just want others to engage and validate our point of view. We want to know that we're getting through, and many times we'd rather have them yell back than ignore us because at least we can feel that someone else has skin in the game. Much like a computer or traffic light (hmm...which are also computers), diabetes cannot hear us, no matter what we do; it's just doing what it does and no matter how much we tell it that it stinks, it doesn't do anything differently. This can lead to feelings of paralyzing hopelessness and clinical depression and anxiety.

So what can we do? One of the most effective things I've both seen and experienced as a way to cope with difficult realities is what psychologist Mary Pipher calls the "transcendent response". It can be so easy to go into denial, compartmentalization or numbing when we feel overwhelmed. The transcendent response entails taking action by becoming part of something larger than yourself. Whether that's attending small support group or volunteering with a non profit whose mission resonates with your values, we see time and time again ordinary people banding together in the face of natural disasters or traumatic events who "manage to survive by helping each other". In our daily lives, we cannot change the fact that we have a chronic condition. We still have to check blood sugars, take medication, and split our attention between our bodies and whatever else is happening, but knowing that others have to do it too, that they "get it" and are passionate about sharing their own stories, listening and adding to ours, combating isolation and wanting change as badly as we do can alleviate feelings of powerlessness and despair. Pipher also said, "Acting as if we have hope generates hope". Much like a blood sugar after pizza, hope can raise up and dip again. It is during times like these that, when we cannot hold our own heads up to see beyond the finger sticks to the cure that has forever been 5 years away, it comes in handy to borrow the hope of those around us who have also walked our path. It is powerful and contagious to be in the presence of someone who believes that things can get better. When they share their victories, no matter how small, we have the opportunity to refresh our mindset and renew our hope.

Need some help rediscovering hope? Check out how you can get involved in the T1D community or contact me for a consultation to start feeling better today!

The Importance of Understanding Diabetes Within the Context of Mental Health

One of the most unique and important distinctions about diabetes is that it is primarily self-managed (as opposed to being treated by a doctor at clinic visits). Because diabetes is 24/7, there is a whole other level of constant background noise during the course of every day life. People with diabetes are constantly making choices (which tend to boil down to: do I attend to my diabetes or don’t I?) that will affect their prognosis. They very well may choose the latter, and for a number of reasons. From having just completed a diabetes task (I just took insulin so I can relax for the next hour while I eat dinner) to just being sick and tired of it (I know my CGM is beeping high but I have to pick up the kids, get them started on homework and put dinner on the table) and the many spaces in between, there is usually a a reel of nonstop dialogue from a vigilant part of themselves that is always watching, anticipating, checking in, planning ahead, and whatever else diabetes-related. This part can get tired though, and it's normal for the part who wants the doughnut and cares not what it will do to spike blood sugar to win out sometimes.

As we look at the responsibility that comes with choice, the ability to self-monitor can be empowering because it means that the PWD can, for the most part, affect change in their own health; they are not “at the mercy” of their disease. The other side of this—which is often difficult for folks to understand and validate, is the thoughts of guilt, shame, and fear that can come from not being on top of diabetes. “If only I had taken better care of myself, not had that doughnut, checked my blood sugar before bed, I’d be okay. This is my fault. I should be doing more.”  If you are a parent or caregiver of a child with T1D, these feelings can come on strong in a different way since the stakes are the wellbeing of your child. Parents will make incredible sacrifices to protect their children. Many have told me that they would take child’s diabetes and have it themselves if they could, but diabetes doesn’t make those kinds of deals. Whether diabetes is yours or it belongs to someone you love, this kind of thinking can be toxic, isolating, and complex though not uncommon.

When mental health issues come up and diabetes is in the picture, you need a clinician who can tease out Diabetes Distress from related conditions such as depression, anxiety and general stress. Many symptoms of these conditions overlap (see the chart below) and you need a trained therapist who knows where to look and has specific knowledge of each in order to correctly identify and effectively address whatever is going on.

depression vs distress.jpg

Are you experiencing difficulties with your diabetes and aren’t sure which is causing what or whether they’re related? Perhaps you’re struggling with Diabetes Distress and need some help with strategies to overcome these situational issues. Whichever it is, I can help. Get in touch today.

Why Self Worth Matters for Disease Management

What does feeling confident in your own worth have to do with your ability to take care of your health? Why is self-esteem so important to disease management?

For starters, let’s not take self-love for granted. I know some may cringe at the therapeutic concept of “self love” but really, why would you take care of something you don’t even like? Self-worth is one of the fundamental concepts I often address with the people who walk into my office because taking care of a disease like diabetes is a lot of time and energy to spend on something you don’t even believe has value. So many people, especially those in the thick of adolescence who are developing their own identity within the context of consumer culture are constantly and actively disliking themselves for not being enough (pretty enough, smart enough, rich enough, etc) or being too much (too loud, too different, etc). So really, why would you take on the rigors of this 24/7 demanding condition if you didn’t believe you were worth all that work? Even if your disease does not require that degree of self-management, taking care of yourself can be a lot of work--from finding a good provider you connect with to diligently working your way down a list of medications until you find the one that doesn't give you belligerent diarrhea, you must believe something has worth in order to hang in there and care for it.

The second piece of this is that having a chronic condition means feeling and being different—not necessarily in a good or bad way, but there are things that diseases like diabetes require the folks who have it to do that are not a “normal” part of other people’s days.

Clinical research (not to mention the experiences of anyone who knows or has been a teenager) has shown time and time again that a normal part of adolescent development is the desire to fit in and connect with peers. So unless you live in some magical/horrific place where T1D runs rampant and everyone you know has it, doing things like bleeding in public or stopping in the middle of a game of an avid game of Frisbee-golf to drink a juice can make you feel really different and alone. Many people (not just kids) will do just about anything to avoid standing out, especially when they fear they may be judged (and let’s face it, there’s a lot of stigma out there around chronic diseases, particularly diabetes).  The need to appear “normal” and fit in often means skipping blood sugar checks and insulin doses—not exactly ideal diabetes management.

Those who have developed self-esteem in a healthy way and are able to own their diabetes are far more likely to see themselves as okay and take care of business, even when they are at risk of feeling singled out because they are not as susceptible to what other people think. So how do you promote positive self-regard and up your confidence?

  1. Notice what you do well. We're so good at fixating on where we fail and ignoring or minimizing when we succeed. Whether it’s diabetes-related or not, build on what you're already good at to create momentum. Noticing is a muscle, and many of us could use some targeted strength training. 
  2. Take a frigging break from social media. Studies (and again, experience) show us that being inundated with the unrealistic (yet utterly convincing and wildly compelling) perfection of other people’s lives can lead to feelings of depression. Social media is a great place to compare yourself to others and feel like you’re coming up short.  FOMO, anyone?
  3. Invest in a relationship where you can be yourself. Many of us have things about us that we swear, if anyone knew what they were, they’d run away screaming. One of the quickest and most powerful ways to develop self-esteem is to be vulnerable with another person you trust. We’re often our own worst critic, and you’d be surprised—what is a dealbreaker for us often isn’t a dealbreaker for someone else.

The Importance of "Checking" Blood Sugars

Let's talk about language and how it is significant in the world of diabetes. The way we communicate with our words matters because language is one of the most precise and powerful ways we can describe things and let others know what is going on inside of us. Let's jump right in with one of my favorites: TESTING VS CHECKING. Just like a test in school that you can pass or fail, "testing" a blood sugar implies that there are good and bad results. For most of us, emotions like nervous, anxious, scared and pressure come to mind when we think about taking a test. With diabetes, the goal is a specific range and the variables to control and consider are many. So if you're "testing" 3-7 times a day and every time you are not in that specific range, you are "failing", you might not want to check as often, or you might lie about your numbers for fear of judgment (from yourself or others). Even when you work hard, make sacrifices and do everything you're supposed to do, you are not necessarily guaranteed to get the "score" you want.

"Checking" on numbers gives you information--nothing more, nothing less. Numbers we "check" help us to problem-solve because judgment is not at the forefront of the picture. I once asked a group of people with T1D how much time they spent thinking about diabetes. Then I asked them to parse out how much of that time was spent thinking about the logistics of maintaining diabetes throughout the day, and how much time was spent beating themselves up for not doing things differently. Most said that the overwhelming majority of time and energy went into the latter category. Upon further discussion we determined that when we are not bogged down by judgments, we are able to be more present with what is happening in the moment. This allows us to be more focused on what we are actually in control of so we can take our next steps without blaming or berating ourselves.

Language is important because if we are not mindful, diabetes can be ripe soil for cultivating judgment and shame. The pressure to be perfect is immense and can come from many different places. There is the self-induced pressure of staying healthy and living a long life, and there is pressure to not let others (doctors, family, friends, etc.) down. They worry, not because they want you to feel bad, but because they care and often feel out of control. That said, managing your health for the sake of others (in addition to doing all the other obligatory life stuff) is still a lot to hold. So if we can take some of the pressure off simply by using different language, at least we can cross one ripening agent off the list.

My point in talking about the significance of language is to illustrate that words are powerful, and there is no need to add any additional judgment or shame to life with diabetes. 

Feel like you could use a little more help in this area? Contact me to set up a time to talk.

Diabetes Distress: The Struggle is Real!

If you’ve seen any of my blog posts before, you know I am a huge believer in the mind-body connection. Both my personal and professional experience have shown me that the way the body feels affects our psychological well-being, and vice versa. In fact, the Diagnostic and Statistical Manual (DSM), fifth edition (which is published by the American Psychiatric Association and is the standard classification of mental disorders used by mental health professionals in the United States) agrees! The DSM-5 added both Anxiety due to Another Medical Condition, and Depression due to Another Medical Condition in their most recent edition. And thank goodness! The struggle is real!

Past research has found a high correlation between diabetes, both type 1 and type 2, and depression. However, psychologists William Polonsky, Lawrence Fisher, et al have taken a closer look at this relationship and developed the Diabetes Distress Scale (DDS) to measure and describe the specific ways that diabetes can be emotionally overwhelming. The scale addresses four areas of concern: 1) the emotional burden of having diabetes; 2) the relationship a person with diabetes has with his/her physician; 3) the person’s ability to follow the diabetes regimen; 4) and the interpersonal issues that a person with diabetes might face with family and friends. See an article explaining this in more depth here.

Diabetes Distress is not uncommon by any means, and anyone who has diabetes can tell you that it is a full time job with a unique set of stressors. If Diabetes Distress is getting in your way of living a happy, healthy life, you are not alone and there is help available. Seeing a mental health specialist who understands how diabetes affects mood and energy level (among other things) can be incredibly helpful in getting you back on track. I help people rediscover hope and find peace within themselves—even when it seems like their body and their mind are at war. Get in touch today.

"The Right One"

I recently got married (more to come on that!) and in one of the many conversations recapping the event with my mom, she told me a story she’d forgotten to share during her toast. (Don’t worry—her speech was awesome and very, very thorough.) It was back when I was about 11 or 12 and she was on the board of the Juvenile Diabetes Research Foundation in San Diego. She was at an all-day JDRF training program and Mary Tyler Moore’s husband (who is pretty well-known in his own right for being a rockstar cardiologist) was one of the speakers. I had been diagnosed only a few years earlier and after turning over all of the information she’d learned about the burden that diabetes can be, she couldn’t help but wonder if the disease would not only threaten my body, but also break my heart. I’ll explain—in a stolen moment from the crowd during a break, she told him, “Your wife is so lucky to have you. I worry that my daughter will grow up and some day fall in love with a man, and he will not want to marry her because of her diabetes.” And (now this is her favorite part!) he said, “Then he’s not the right one”. She says that after that, she felt immediate relief. Sure enough, low and behold, the right one did come along! And he has more emotions about my lack of sportsmanship when I lose to him at Dominoes than about the fact that I have diabetes.

No Words

I was waiting in line at the post office today and saw that the woman in front of me had an insulin pump. I got really, really excited, tapped her on the shoulder and pointed to my own. She smiled, and then it was her turn to see the clerk. I found myself smiling as well because I felt as though I had met a kindred spirit. We didn’t even talk about diabetes—in fact, we didn't say anything to each other! If anyone loves processing and talking about emotions, it’s me. But here, there were no words and sometimes, there doesn’t need to be. Something in me connected with her, and that feeling is invaluable. 

Why Camping is Good for You (written by an un-out-doorsy person)

When was the last time you went camping? I don’t necessarily mean in a tent but do you remember what it was like to go to an actual camp with cabins, campfires, counselors with funny nicknames, silly songs and, well, “camp food”? I went to Camp Leo’s Family Camp on Memorial Day weekend and it was AWESOME. I’ve never been one for sleeping in bunk beds and I’ll admit, it’s been a few years since I was last what you would call a “camper” (and even this time, I wasn’t technically one as I was “staff”), but I found myself swept back to the time when I was one. And this one was even better because 1) tons of people, including the counselors, had type 1 diabetes (like me!) and 2) it was a family camp! Don’t get me wrong—as a tween/teenager I was usually more than okay with having separation away from my parents (who worried about me because I had a chronic medical condition and were unsure leaving me in the care of others—which tended to get old), but sometimes, I’d miss them. This camp was the best of both worlds because it included hanging out with friends (under the supervision of fun, responsible people who understood diabetes and how to treat it) while parents learned about 504 plans, exercise considerations and emotional issues tied to diabetes. Everyone got to connect with people who knew what they were going through, and they got to have a good time. Whether you’ve never “camped” before as a family or you’d just like to meet other people who experience the same kinds of things that you do, I highly recommend it.

"You don't knooooow me"

I remember once when I was in high school I got a low blood sugar in the middle of class and went to the vending machines to get a Snickers. Like any normal person with type 1 diabetes experiencing a low, I was wolfing it down and taking no prisoners, and my P.E. coach walked by. I so engrossed in my ravenous, shaky hunger that I barely noticed him. But later that day when I was in his class, he called me out in front of everyone: "I saw Kintner this morning demolishing a candy bar and I thought she was going to eat the wrapper!". In his mind, he was making a harmless comment that I'm sure he thought was hilarious, but I. Was. Mortified. What a huge jerkwad! I'd like to see him handle a low blood sugar. He didn't know me or what I deal with! It really ticks me off when people should know better and don't, especially when it's at my expense. This makes me think of the quotation: "Everyone is fighting a battle you know nothing about." Amen, Plato! He nailed it. There is no sign on my forehead that says I have diabetes (although there may be box of juice in my hand!), and oddly enough, this can be frustrating because although I don't want to be defined by or treated differently because of my diabetes, people not knowing leaves me open to feeling misunderstood, judged, and like a victim of ignorance. This being said, a few years later I attended a workshop with a dear friend and her phone rang right in the middle of it. She noisily left the room, gathering several large bags and bumping into people as she stepped over them to leave. When I spoke with lecturer afterwards, he expressed that he was quite offended that my friend would leave in the middle of his presentation--it was disruptive, loud and he felt incredibly disrespected. What he did not know was that my friend had actually texted me when she left, explaining that her son with special needs had been in an accident and she had to go to the hospital. It's interesting because I totally got the presenter's frustration--I've given lectures before and it can be awful when there are interruptions. But in this case, I saw her side as well and understood the fear and urgency of her situation. Once I relayed the story to him, I saw his heart soften and a connection take place. He told me that he and his wife were pregnant and that he would have done the same thing for their child.

So Plato was right--everyone is dealing with something that we know nothing about. What we are responsible for, however, is remembering to stay open to another person's story and to teaching them about ours, as opposed to living in a place of silent resentment. Years later, I think about what a less reactive, more centered me would now say to that coach: "Actually, I have diabetes and as a result of my medical condition, I had a low blood sugar and one of the symptoms besides feeling terrible is hunger. Let me know if you have any other questions." There is a difference between shaming someone and educating them--and the message tends to be better received when you are coming from the latter. No matter how obvious it may be to me, he didn't know I would feel hurt, and it is my job to explain to him why because I'd want someone to do the same. 

Why can't you learn from your near-death experience?!

Many parents wonder why a child's life-threatening encounter with ketoacidosis would not be enough to scare them into taking better care of themselves and "appreciating the severity" of their disease. 

A very dear friend of mine had a heart attack two years ago. It shook her and scared her to the core, and yet she said she was grateful for the experience because it made her realize how precious life was. As a result of this wake-up call, her diet and lifestyle completely changed. She cut way down on foods high in salt and fat, and began exercising. The fear of losing her life was fresh. But after six months or so, old habits came clawing back. As human beings, we cannot live in fear for long periods of time. The fight-or-flight response did an excellent job of keeping us alive back when lions regularly jumped out of bushes and tried to eat us, but studies (and real life experience) show that extended lengths of time living with fear-induced stress can lead to a whole slew of physical and emotional issues, from poor sleep and exhaustion to difficulty concentrating, anxiety, depression (and, for those of us with T1D, elevated blood sugars as a result of the release of sugar which we produce to be ready for fighting and/or “flighting”). So in the short term, fear can serve as a motivator, but it does come with a cost and it doesn’t last forever. As Gandhi said, "what is gained through fear lasts only while the fear lasts".

Stay tuned for part II next week on why adolescents struggle to learn from mistakes!

 

Miracles

What is a miracle? People wish, pray, ask for them all the time. It sounds like something that happens to you, that you really don’t have any control over. It’s like you’re at the mercy of something or someone else and that there’s no real way to be active in the process. I bring this up because most of us with a chronic illness do not wish to have one and often wish for a miracle--that we might feel better or be healed. I recently read miracles defined in way I had never heard before. Marianne Williamson talks about miracles as a shift in perception from fear to love. What does this mean in terms of a chronic illness? For me, this means seeing my diabetes in a completely new and radical way. Instead of something that is tiring me out, beating me down and, more or less, trying to kill me (all fear-based ideas), I had to re-examine my relationship with my diabetes. This was not easy. At all. And if you ask me, this is a miracle. With everything that diabetes entails (the attention, thanklessness, and no vacations allotted), you better believe that shifting my perspective was a ridiculous miracle. In order for me to figure our this new perspective, I actually had to draw this relationship between me and my diabetes, and do you know what? Much to my surprise, diabetes wasn't a huge monster with teeth eating cookies and screaming at everyone ("Eat all the things!"). It was before, for sure, but I've done a lot of work on this and I eventually figured out that perspective was draining and not at all helpful (because let's be honest--who wants a testy, ravenous behemoth around?). When I draw it now, diabetes is a little girl who needs me to care for her. She is small and scared at times, and she needs me to love her. Whether this idea is "accurate" or not is irrelevant. The part that counts is that when I think of my diabetes as the little girl, I want to take care of her, and my behavior shifts accordingly, as opposed to the evil monster idea. This shift is a miracle, and it had nothing to do with what is outside of me. In fact, no one could do this but me. I decided that my previous notion of diabetes was not serving me so I took control of it and changed it. Chronic illness can be overwhelming, particularly when depression and anxiety are involved, and sometimes we need support. I help people rediscover hope and if you find yourself struggling, I encourage you to reach out

What does diabetes keep you from doing?

Someone once told me that my height makes me ineligible to become a flight attendant. Something about reaching the overhead bin (which, make no mistake, I can do--it just isn't always the most graceful of processes). I was somewhat shocked to hear that this was actually a thing so I looked it up and saw that although different airlines vary in their minimum height requirement, it looked like I would just make the clearance for most of them. I can tell you that I do not actually wish to fly the skies in a professional capacity, but the idea that I would not be allowed to seemed really unfair, and I think there's a parallel here with diabetes. Is there anything you think you can't do because you have diabetes (besides make insulin)? One of the most common things I hear people express worry about is playing sports. The fear of going low is very real, especially for those who have had traumatic experiences with lows. And while it is true that engaging in physical activity does require some extra effort in the diabetes department, it is also true is that we have the tools and the knowledge to prepare and plan for a strenuous (or light!) workout. Sure, there may be a few things to "work out" at first (haha)--for example, when your blood sugar spikes when you first start exercising but then drops soon after. This can be infuriating and confusing, especially when you're trying to do something good for your body and it seems to be going in another direction! Talk to your diabetes nurse educator about why these things happen, how to prevent them and what to do if something does occur. Also, check out Team ConnecT1D's page to connect with other T1 and T3 (or people who love a T1D) athletes. Join Team ConnecT1D for JDRF's Beat the Bridge or check out Ragner, a relay race along the beautiful Northwest Passage.

It can definitely be overwhelming to think about, whether it's exercising or coping with living life with a chronic illness in general. If you find yourself feeling anxious or struggling to get out of a thought pattern that keeps you from doing what you want to do, consider making an appointment to come see me. I help people rediscover hope. 

Mindfulness: It's Science!

Mindfulness is quite the buzz word these days, and not necessarily in a good way. Many of us hear “mindfulness” and picture a lady in stretchy pants sitting criss-cross-applesauce on top of a mountain. Not that it’s a bad thing to do any of those things, but I think it’s tempting to dismiss something that seems to be everywhere and, as far as we can gather from the word itself, entails sitting quietly and thinking about feelings and stuff. The thing is though, the concept of mindfulness is popular for a reason. There is a wealth of scientific research that shows that it does have a lot of benefits, particularly for people living with a chronic illness. 

The workshop was led in 2016 by Dr. Jody Stanislaw, who received her doctorate degree in Naturopathic Medicine in 2007 from Bastyr University. She has had Type 1 herself for 35 years, and she's partnering with ConnecT1D to put on two free workshops for their Speaker Series. I've met with her personally, and she's awesome. Check out the flyer for more details and registration info.

Me, too

Let’s say you made a pact with your friend that you would each go to the gym three times this week. Things got busy (the cat swallowed a washcloth and had to go to the vet, and there may or may not have been a small fire in your garage), and you went zero times. You’re dreading the phone call where you must report that you didn’t quite make it, but as soon as you say hello, your friend blurts out, “Ack! Stuff came up and I didn’t go at all!” What feeling comes up for you when you hear her admission? For many of us, the feeling is one of relief. We feel just a little bit less bad when we find out we’re not the only ones who didn’t reach our goal because we know that someone else had trouble too. The connection around a shared experience—whether it is struggle or triumph—is a powerful one and should not be underestimated because 1) it alleviates guilt (which is a big time energy-zapper) and 2) it adds a valuable member to your support team with whom you can be accountable. Doing the accountability job yourself can be tricky, as opposed to having a supportive person who call you out on and help you with your stuff because they have been in that very same position. Working towards a goal with someone who is/has worked on or achieved that same goal can be incredibly encouraging because they know it can be tough, but they are living proof that you can do it. Or at the very least, they can walk beside you and say, “I feel that way too, and we can figure it out together.”

 

If this kind of support sounds appealing, please check out the upcoming drop-in group for young women ages 14-25 with T1D.

Hemoglobin A1C: what's all the fuss about?

Most people who have diabetes have probably heard the term “hemoglobin A1C” (or HbA1C). Our doctors say it’s important and our parents tend to get pretty worked up about it, but here’s my question: do you know what a HbA1c is? And why it matters? No need to be embarrassed if you don’t because many people have somewhere between a vague idea to none at all.

First, what is it? According to the Mayo Clinic, your A1C result reflects your average blood sugar level for the past 2-3 months. Specifically, the A1C measures what percentage of your hemoglobin—a protein in red blood cells that carries oxygen—is coated in sugar (glycated). Many doctors use the A1C to monitor your diabetes treatment plan because the A1C is supposed to reflect how you’re doing overall. Check out the chart to see how the A1C level corresponds to the average blood sugar in milligrams per deciliter (mg/dL). 

For those who do not have diabetes, your A1C level target is below 5.7 percent. 5.7 to 6.4 indicates prediabetes, and 6.5 and above means (you guessed it!) diabetes.

Some important things to note here: Not once in this post have I used the term “test”. Thinking about diabetes in terms of a test that you pass or fail is not helpful because it can quickly bring blame and shame into the mix (and let’s face it—we’ve already got enough of that in the diabetes world). The A1C provides information. It is an indicator of whether one’s diabetes is being managed safely or unsafely. It is also important to note that there is no “one size fits all” here. For instance, one person may have a higher A1C target due to hypo-unawareness (or when a person does receive the warning signs that many of us do for when their blood sugars are dropping). Your doctor will tell you the best range for you. If he or she does not, ask! I recently heard an analogy comparing an A1C number to the amount of money in a bank account. What would you do if you walked into a bank, asked the teller how much money you have in your account, and heard, “Don’t worry, you’re fine”? The same goes for your A1C. Owning your diabetes means knowing the specifics of what’s going on in your body and understanding what is needed in order to feel healthy. The A1C lets you know if you are in a safe or unsafe place with your diabetes. Remember, this is not a judgment. Blood sugars go wacky for all kinds of reasons (being sick, stressed, depressed or just burnt out) and the A1C is information that can give you and your health care team a better idea of what needs to be addressed so that you can feel your best. If your A1C is higher than you'd like it to be but you've having trouble doing what you need to do or feeling stuck in negative thought patterns, consider reaching out. I help people rediscover hope and work through that stuckness towards a healthier, more joyful life.

“Don’t let where you want to go keep you from being where you are.”

“Don’t let where you want to go keep you from being where you are.” I heard this the other day, and it's kind of an interesting sentence (though somewhat confusing at first). So many of us are future-oriented thinkers—we look forward to the way things will be because we are not at peace with what is going on now. I think this is often the case for people with diabetes. We are told that we should be doing a better job, and we internalize this. We take on this belief. Look at blood sugars for example, and not just the number itself (“good” or “bad”) but how often we check (do it more!). It seems like we can always improve ourselves if we would only work harder, which leads us out of the present (where we feel inadequate) and into the future. The future is yet to be determined! We can still succeed! we tell ourselves. The problem here is that in this moment, we put off taking action. Why? Because the present is informed by our past “failures” (which often seem to be easier to spot than our successes!) It’s easy for us to stay in that same pattern, so we escape to the future, where we will magically be different. This is what keeps us stuck—living in the future and forgetting the now, where we are taking no action. So what can we do?

First, take action right now. So if you want to check your blood sugars more often, check right now. If you wish to be healthier, do something! It can be small, like doing 10 chair push ups (it’s the first exercise). Create a platform to jump off of—give yourself evidence that you can break the pattern. Second, celebrate that action! Build momentum upon your success. You checked! That’s awesome! It may seem silly at first but we find what we’re looking for. If you’ve built a neural pathway whereby you are constantly looking for mistakes, you’ll find mistakes. But if we look for success, we’ll find those, and our neural pathways will change! Sometimes we do get down and we need some help. If you feel stuck in old though patterns and are looking for help from someone who understands, please don’t hesitate to get in touch.

Diabetes & Identity

I went to Florida this past week for a conference. I didn’t know anyone there, and it got me thinking about identity. When you go somewhere new and interact with people you’ve never met before, you have the freedom to be whoever you want to be. This got me thinking about when diabetes or chronic illness comes into play and we are allowed the opportunity to “redefine” ourselves. When do you tell someone you have diabetes?  Maybe you don’t usually tell anyone. Why is that? Many people feel ashamed (and I’ll go into the shame that is so strongly attached to diabetes another time). Others are worried they will be scrutinized for what they eat or seen as “different”. If you do say something, why do you think you do speak about it? Is it for your own safety (for example, so that they know what to do if you experience symptoms), or perhaps because you feel like it explains who you are? And what comes up for you when you do tell someone? Maybe nothing. You might not even think it’s a big deal. Some of us are very uncomfortable with anyone knowing, particularly within the context of romantic relationships, while others wear diabetes as a badge of honor. Some of us feel like victims and want others to recognize our plight. We want people to see our strength, and diabetes is an example of something difficult that we live with every day. Often, it just depends on the day! How does your chronic illness affect the way you think about yourself? There is no judgment, or right or wrong answer in however you feel—seriously. I’ve just found it to be helpful to know so that I can stay balanced—so that I don’t lose myself in it but I don’t neglect it either. How important is your chronic illness to your identity?

Running low on mental energy

I recently attended an event about chronic illness and there was a woman on a panel who has severe rheumatoid arthritis (RA). She was about 28 years old and told me about the extensive thought process she had to go through before attending various events, including the one we were at that day. Although our diseases are very different, it got me thinking about my own diabetes, and the mental checklist I need to go through before I leave the house. It's as though I have a newborn baby with me at all times, and I never get to put her down. She's unpredictable, often demanding and heavy--especially when I have to lug around a giant bag with all those supplies and anticipate her needs. BG (blood glucose) monitoring kit? Check. Back up pump supplies (insulin, at least 2 insertion changes and reservoirs), and glucose tablets. Check, check, check, check, check and check. This task becomes even more complicated if I’m being fancy and carrying a small purse! Where is all this stuff supposed to go?! Not to mention that many of the guys I know with diabetes often carry backpacks, so what would they do if they were trying to be fancy?! I’d like to see James Bond haul all this stuff around in that tuxedo he wears. My point is, diabetes, as well as many other chronic conditions, often require additional mental energy. Over the years, we learn “diabetes life hacks” to make these things a little easier. For example, I carry juice and extra pump supplies in my car and I have multiple tubes of glucose tablets in each bag/purse so that I do not need to continually switch them as I rotate fashion accessories.  I also keep a list by the door of the things I need to have with me when I leave the house (PICKIT: Pump, Insulin, Cell phone, Kit, ID and Tabs). Another thing that has been very helpful is having a network of people who have diabetes and could loan you glucose tablets or other important things should you find yourself in a tight spot. But constantly being prepared can be tiresome. One of the most helpful thing has been to pay attention to when I’m feeling overwhelmed and to “keep tabs” on where I’m at with the diabetes tasks. Some days I feel fine and have no problem. Others I feel burdened and bogged down. Just noticing these things helps because they’re flags that let you know you might need a little bit of extra support that day. When you express this and ask for the things you need, you avoid blow-outs because that frustration is going to creep up one way or another, and it’s often better to say what it is that’s actually bothering you as opposed to getting in a fight with a loved one because they asked if you’ve checked your blood sugar. Sometimes my partner will ask me if I’m low and it won’t bother me but other days, it will. This is a sign that 1) he’s right and I’m actually low—arg! or 2) my tolerance level for diabetes is going low and I need some support—whether that’s a hug or an offer to carry my glucose tablets in his pocket so I don’t have to put them in my tiny purse. 

What's in a number?

This weekend I went to the Behavioral Diabetes Institute’s conference for health care providers entitled “Promoting Behavior Change in Diabetes”. It was fantastic. There were so many important topics discussed but the one I’ll bring up now is the idea that blood sugars are not “good” or “bad”. As we attempt to take the shame and blame out of diabetes, we are seeing that viewing these numbers as information upon which to act is simply a more effective way of managing diabetes. For many people with diabetes, the emotional burden and guilt around “testing” blood sugars is debilitating because it is easy to intertwine self worth with those numbers. Therefore when these numbers are “bad”, we are bad. We are taught early on that so much is riding on these numbers! Doctors, parents and loved ones are constantly asking about them—and it’s good that they want to know. They care! But being “tested” 6-7 times per day and having that result mean you are a “good” or “bad” person—that if you are outside of a certain range, you are failing, well, who is eager to hear that? No wonder kids lie about these things to their parents. I still don’t always feel comfortable showing my number to everyone at the table because I know I might get jumped on and sometimes I don’t feel like explaining the back story (which I can’t even figure out sometimes! I ate the exact same thing yesterday and I’m up 100 points?! Agh! Why?!)

So what can we do? Let’s use the word “check” instead of “test” when it comes to blood sugars. Let’s see it as information—nothing more, nothing less. Say it with me: “I am not my number.” Second, let’s separate out who we are from our disease. It’s a part of us, for sure, but there’s a lot of other really cool stuff about us that can be easy to forget. (For example, I am a huge fan of cats.)  Chronic illness can be incredibly difficult—both physically and emotionally, and sometimes we need someone to help us remember and strengthen who we are apart from our disease. I help people rediscover hope. Call me at 206-858-0247.

Look Who's Coming to Dinner

I was going to a dinner party the other night and I was not looking forward to it. There was traffic on the way over which is by no means my favorite, but that aside, I had been looking forward to this particular evening all week. The people my partner and I were meeting up with were his childhood friends, and I enjoyed spending time with them. This sudden attitude shift can be an indicator that my diabetes (or T1D) is doing something funky, so when we arrived at their home, I checked my blood sugar. It was 476. (For those of you who are not familiar with T1D, a common target range for blood sugar is between 80-180). After a quick bolus (which is a way to administer insulin to cover blood sugar and/or food intake), my very supportive and patient partner asked if he could do anything to help. I shook my head. I needed a few minutes to collect myself, and I told him to go ahead inside. I sat there, tears in my eyes, and asked myself what I really needed. The answer was simple but its effect was profound—I needed understanding. It’s easy for me to isolate in those moments when my diabetes messes with my mood, and as loving as my partner is, I didn’t feel like explaining what I was going through. I got out my phone and pulled up a group text I’d started with two of my dearest friends who also happen to have diabetes. I said what I was feeling (an intense, seemingly irrational and almost crippling sense of irritation), how much I hated having diabetes in that moment, and do you know what? They got right in there with me. No one was trying to pull me out of my frustration—they simply sat it in with me, and it felt amazing. They responded with the perfect mix of commiseration, compassion, humor and unity, as only a fellow T1D can do. Five minutes later I got out of the car and went inside feeling more peaceful, less alone, and dare I say it, ready for a good time. My blood sugar was still high, but I felt grounded in the connection I had made with people who truly understood my struggle and said “we’re in this together”. Chronic illness can be incredibly difficult—both physically and emotionally, and sometimes we need someone to help us remember and strengthen who we are apart from our disease.

 

I help people rediscover hope. Call me at 206-858-0247.