Shy faces peeking up from the forest floor
Hiding in plain view…
Be mindful where you step – the trout lilies have awoken!
Shy faces peeking up from the forest floor
Hiding in plain view…
Be mindful where you step – the trout lilies have awoken!
February can be rough. The days are short, the weather is temperamental, winter closes us inside of its blue shutters…
But luckily, we have created several traditions to get us through, one of my favorite being, in atypical fashion, SUPERBOWL SUNDAY!
I, like many of you, went to a Superbowl party a couple weeks back and found myself so INSPIRED. Let me preface this by saying that in between the 2017 and 2018 Superbowls, I watched 0 minutes of football. So, it’s always a fresh experience for me. I couldn’t believe how physically strong the players were. I was also very captivated by how delicious the various party foods involving potatoes were. There were waffle fries (not from Chick-fil-A!), homemade potato chips (in three varieties!), and baked potatoes with gruyere. So, based on these two observations, I added two resolutions to my list for this year: 1) workout more; 2) eat more potatoes.
When I got home from the party, my blood sugar, despite a lot of extra insulin and monitoring, was above 200 mg/dl. I don’t like this – I don’t feel good when my bg is high and taking extra insulin before bed is a little frightening because of aforementioned nighttime lows. So I put the potatoes on the back burner, so to speak.
I did start moving more though. Yoga and walking have been good, along with a class or two at the student rec center. So with goal #1 underway, I got back to the potatoes.
Recently, I ordered a dish with shaved celery root when out at a restaurant. Between ordering and receiving my food, I forgot about this, and when it came I thought I was eating hashbrowns. Fancy hashbrowns, but still. So this weekend at the grocery store, remembering my positive celery root experience, I decided to branch out of my cooking rut.
If you’ve ever bought a celery root (also known as Celeriac), you know just how unappetizing it looks in its natural form. Celery root is, in fact, so ugly that I can’t believe we discovered it was edible. I can’t imagine being that first person to look at it and think, “I’m gonna eat that.”
But someone did and I’m glad.
It’s really a vegetable that you have to tackle – which goes well with the general metaphor of this post. I used this recipe from Bon Appetit for Celery Root Steaks with Tomatillo Salsa Verde as a basis.
Except I didn’t make the salsa because I planned to just pile my other food on top of the steaks.
Here’s a detailed play-by-play:
Pro tip: if the steaks are tender but you want more of a golden brown look, flip them over to serve; most likely they are browned on the pan side.
So, how do celery steaks stack up to potatoes, ounce for ounce?
1 cup celery root weighs in at 66 calories, 14 grams of carbs, and packs a powerful punch of 2.8 grams fiber, according to google.
Potato comes in at nearly double all of the above (except fiber): 116 calories, 26 grams carbs, 3.4 grams fiber, per cup.
So to me, diabetically speaking, Celeriac is the clear winner!
Oh and finally, Happy Valentine’s Day.
If you don’t have diabetes (and you speak a little Spanish), you might think I’ve come up with a new intention for how I want to live my life, sort of a ‘take it easy’ non-attachment type attitude. She’s living free style, libre man. But if you do have diabetes, you’ve probably checked your bg on a FreeStyle meter and at least heard of the new device that was just approved for sales in the U.S., the FreeStyle Libre.
I both like and hate the tendency of medical companies to give chronic illness management supplies names that inspire images of smiling people flying kites on the beach without a care. I dislike this tendency because it’s a false promise. These words couldn’t attract us to the product if it wasn’t true that diabetes, like many chronic conditions, imposes it’s own barriers. I won’t talk about those right now – maybe later. But what I like, is that these companies are recognizing what is truly hard about diabetes: not simply the pain of finger pricks or shots, but the hassle, the baggage, the constant back-of-the-mind thought (as covered previously) that it inspires.
For the past few weeks, I’ve really been wanting a break. There’s nothing to do with this desire, no accrued vacation time to take, no money to spend that can buy it. And yes, there are some strategies that one could employ to alleviate some of the pressure in these moments, but even thinking those up and navigating their implementation is the opposite of a break. It’s effort. A lot of effort.
And then, suddenly: FreeStyle Libre Now Available in US Pharmacies
In case you’re not familiar, the FreeStyle ‘reader’ looks like a normal blood sugar meter, but it is equipped to scan a little sensor, about the size of a large quarter, that you wear on the back of your upper arm, in order to measure blood sugar in interstitial fluid. I bought myself a reader and three sensors. For the past ten days, I could know my blood sugar anytime I wanted to, but not when I didn’t. Unlike a continuous glucose monitor (CGM), which I’ve always resisted, the Libre let me remain in control of the amount of information I receive. As someone prone to over-management, this is ideal.
A couple of specific examples:
So here it is, the day after my sensor ended and I haven’t put on a new one yet. I feel like I just got back from a diabetes vacation. I feel restored. I’ll put the new sensor on soon, but I’m rationing them, because my insurance plan still doesn’t cover them, and while they are relatively affordable out-of-pocket compared to a CGM, test strips, or an insulin pump, they still feel like an indulgence at this point.
Indulgence. It shouldn’t be an indulgence to know what your blood sugar is, right? I feel like it should be, how do I want to say this…a basic human right. But it does feel like an indulgence, because I know that my many of my friends in Bolivia and elsewhere who are living with diabetes, can’t afford to check their blood sugar more than twice a day, on a good day. Here I am, able to scan willy-nilly, a luxurious level of management that is not at all equitable across the globe. And it is an injustice.
Today is Martin Luther King, Jr. Day – a day to celebrate the undeterred pursuit of social justice. It’s not always clear what this means or what the clearest path to it might be, and I often find myself uncertain of how to nourish solutions rather than feeding problems. In this situation, there are big questions I have to ask myself when it comes to wearing this device while others can’t. I haven’t answered them yet, but I do know that this is a situation to at the very least, recognize my privilege and remain aware that the current state of inequity in access to medical care and technology is not OK. It’s also a time, I think, like many (most? all?), to be grateful. I’m grateful to the developers of this technology, to those who’ve funded the research behind it, those who’ve advocated for its coverage by Medicare, those who will tirelessly advocate for other insurance plans to cover it, and for the new found freedom it has afforded me. Finally, it’s a time for action, to ensure that all children and adults with diabetes can enjoy more freedom from disease and greater opportunity for wellness.
Lately I’ve been on a ‘getting rid of stuff’ kick. I’ve given away several bags of clothes, donated books to the library, shredded mounds of semi-private information and bank statements, cut up clothes I should have already been using for rags, and just thrown some stuff away. One thing I recently gave away was a book called, Zen and the Art of Diabetes Management. Turns out, maybe I should have read it.
I don’t know if my shedding belongings is connected to my deeper desire to shed emotional and mental refuse, i.e. the crunchy, brown leaves of thought and preoccupation that long to fly free from the branches of my mind, but it’s possible. A note on this – I was recently out for a walk, when I came around the corner and stumbled upon a pile of leaves so high and long that I was immediately enraged at: leaf blower machines (they require so much gasoline), the thought that a homeowner would be so careless as to jeopardize the safety of all who walked and drove on the road (half of the street, on a curve, was piled six-feet high with leaves), and the fact that we thwart the natural process of composting and earth replenishment by bagging and throwing away leaves. I find it bizarre. Then I walked past the great wall of leaves, turned, and looked up at the nearly denuded oak tree whose branches twisted and furled in every direction. The pile was mostly oak. This one tree had blanketed the yard, filled the road, and was left standing above what it had discarded from the previous year. I smiled at its abilities. The wind blew and I walked on.
What a diversion, you say, from the original point of this post. But I’m getting back to it.
So, I’ve been going, very irregularly, to a Zen center for meditation with others. I find these accountability buddies help me very much. I don’t have to hold all that silence alone. And this past week there was a lecture, which I didn’t know about, but felt compelled to stay for (because I had meditated for 30 minutes and was actually calm enough to consider staying for an unexpected lecture). The teacher, a woman who exudes peace and goodwill, talked about an experience she had near the Zen-dō, seeing a plastic bag on the ground and experiencing anger, only to ask herself, “is it trash, or is it my mind?”
Her question brought me back to the tree and its pile of leaves. Here I was, painfully debating over whether to keep each t-shirt, each novel that I’d read or never wanted to read, and more than all that, deciding what I wanted to mentally let go of, and here was this tree, who had just let it all go. And I just expected it to, not even marveling at its abilities to grow and grow and grow, and then courageously release the product of its work. All this stuff, these thoughts, the richness of past experiences, they become our soil. We have them, we grow, and then the we move on. Needing and desiring to let them go does not mean that they weren’t good or that they are wasted – it’s just natural. It’s time, I thought, to take the mind out of it, stop deciding, and just to feel what is dry, crunchy, no longer producing fresh growth and let it fall to the ground, where it can be good again.
Back to Zen and the Art of Diabetes Management. I had read some of it – a good book – about managing diabetes with an attitude of peace. But currently, I’m trying to figure out how to manage feeling at peace while maintaining diabetes in mind. Remember the name of the blog, Adventurous Living with Diabetes in Mind? That is totally possible, but it sort of defeats the purpose of meditation if diabetes is in mind…doesn’t it? I thought that the point of meditation was to clear the mind of all thoughts…so nothing should be in there. Especially nothing as seemingly mundane as, ‘what’s my blood sugar?’
Sometimes it feels like my whole life is a pancreas meditation – instead of trying to get down to the truth of who I am in a sitting session, I’m trying to get down to the truth of my pancreas, ‘what are you doing buddy?!?’ And – ‘how am I doing?’ I had felt low about 30 minutes before I had to leave the house to drive to the Zen-dō, so I ate a few extra slices of apple. I checked about 10 minutes before I had to leave and I was 99 mg/dl, meaning I was fine to drive (I don’t drive when low, i.e. <80 mg/dl). Because the meditation was longer than usual, and I unaware of this fact until in the middle of it, my thoughts started to creep to what my blood sugar might have crept up to. Usually I take a walk in the morning after breakfast – I factor this movement into my insulin dose knowing it will bring my blood sugar down immediately. I hadn’t walked, but of course I’d limited my carbs at breakfast, but it had been a long time since I’d last taken insulin and I knew those last couple slices of apple wouldn’t have been reflected in my pre-driving number because it takes about 20 minutes for any change from what I’ve eaten to show up on my meter so…
Is it blood sugar, or is it my mind?!
We’re all up against a lot of obsessive thought. And here’s the thing, mine and everyone else’s matters and, often, makes sense. So I sat there during the Zen lecture listening but also wondering what my blood sugar was and how I would ever stop wondering about it long enough to be fully present. So I decided to feel. I started with my breath, how did it feel in my body, and then my heart, moving outwards towards my toes and fingertips. I felt good. I stopped feeling like a mind-pancreas in a body and began to feel like a whole being. I thought of blood sugar again. I went back to thinking about breath.
I got back to my car with my meter (where my mind had been part of the time) and checked my blood sugar, it was 139 mg/dl – hardly a number to worry about. I thought back to the teacher’s story, about becoming angry when she saw a plastic bag that someone had carelessly tossed on the ground, and then realizing she could simply pick it up, and put it in the trash (*yes trash, not recycling, because plastic bags clog the recycling machines so should only be recycled at grocery stores, where they have those designated plastic bag receptacles). When she realized she could take action, throwing the bag away, she felt a sense of peace and moved on about her work, she told us. I think I had this option too with my blood sugar. Diabetes takes a lot of action (and that action is required for health and in fact, survival). Something I’d like to work on in meditation is relegating the heavy thought to moments when action is needed. I knew I was safe in the Zen-dō, diabetically speaking. I could feel that I wasn’t too low or dangerously high, and I made the choice to stay. I could have left and dealt with my blood sugar, satisfied that piece of me that has to know, but I didn’t. And the koan for me, and everyone in the room, was to be fully there, blood sugar and all.
I don’t know. The end to this blog post is – I really don’t know. I’m in no way trying to minimize the necessity of thinking about blood sugar for a person with diabetes, but I’m thinking about ways to move towards fuller presence – unified body and mind – without layers of judgement, in regards to diabetes management. I’m taking recommendations, asking for them really. Maybe I should have kept the book, or maybe I just need to revisit the tree.
To awaken quite alone in a strange town is one of the pleasantest sensations in the world. – Freya Stark
I stayed in a small Air BnB across an azure blue river that ran straight through the middle of Innsbruck. I walked there for the first time from the train station – my gracious host offered to pick me up, but I screwed up military time in a text message and told him I was coming 2 hours after my actual arrival. He gave me directions and I looked them up using the train station’s wifi (which was the only way I could use my phone) and headed on my way.
Google Maps estimated a 25 minute walk. I arrived an hour and a half later. Although I was toting my backpack stuffed to the brim, a rolling suitcase, and finally my purse, flung around my shoulders, I wasn’t slowed down too much by my baggage. I just simply couldn’t stop spinning around in circles to take in the shining spirit of the city. Here’s my walk in pictures:
I strolled across the street to a pedestrian only plaza where shoppers and diners milled and mingled.
…before finding this strange alley of murals. That closest one is a kiwi on a chicken bone. Perhaps a show of peace among vegans and carnivores (although I’m doubtful).
I didn’t stay at this hotel; I just took this picture to prove I was really in Innsbruck.
I walked across the bridge towards my new abode in the wake of mountains all around.
Et voila, practically home. The huge wooden door was tucked behind a swath of climbing red ivy between two classically Austrian buildings.
Everyone was walking or biking up and down the steep hills. In many places there were wide pedestrian sidewalks next to double-lane bike paths, bordered by a line of trees and flowers, before finally meeting the edge of a quietly buzzing road on which the motorists dutifully slowed on yellow and stopped on red.
It took me awhile (I mean like two weeks after I returned) to realize why I felt (at least in part) such a sense of peace in Innsbruck. It could have been the mountains all around or the fact that I was at a conference where everyone was thinking and talking obsessively about diabetes (just like me!), but another huge part of it was the pervasive walkability of the city. Pervasive because it was unavoidable – you couldn’t get where you needed to go without walking. It didn’t just feel safe to walk alongside the cars, but in many places there were no cars at all. The restaurant I ate at twice – Osterreich – which I actually thought had something to do with an Ostrich, before I realized how painfully complacent my brain was acting – was only accessible via foot. And, what’s more, the whole time you sat, enjoying grilled chicken or roasted sausages, fluffy piles of freshly grated horseradish, or mounds of sauerkraut, you could watch, not cars whizzing by, but a live feed of humans doing human things.
For example, this brass band bedecked in green, who lined up to play in the heart of the city.
Walking is one of my favorite things. But also, walking is one of my favorite things about traveling. I’m grateful to have a car, but I don’t like cars. I like moving more slowly through life and having the chance, if I so choose, to reach out and touch it. And diabetes loves a walk. People talk about the benefits of exercise for diabetes management, as if exercise was some strange set of unnatural activities that the body must be guided through. I’ll admit, I go for a run every now and then, and it does bring my blood sugar down, but for me, there’s nothing like walking to bring my body into balance. Adam Brown, a writer often featured on diaTribe, explains the blood sugar benefits of walking beautifully here. When my bg is high, instead of dropping rapidly like I do while running, I glide towards a more reasonably blood sugar. Instead of tiring me out, a long walk makes me ready for another walk, or a night of dancing (lucky for me too, because of all the specialists, pediatric endocrinologists are the best dancers).
My last day in Innsbruck, after cramming my head full of presentations and standing up to do a couple myself, I took myself on a mind-clearing walk. My host had told me there was a tram to the top of the mountain, so I headed up the hill towards the peak. Shockingly, I did eventually find the tram, but then decided that my budget preferred continuing to walk. Oh also, that’s another thing, walking is cheap!
Not to mention beautiful.
Gazing out over Innsbruck, I felt overwhelmingly grateful for my experience and for all the people who helped me get there. Although I enjoy the feeling of solo exploration, traveling, more than anything else I think, makes our interconnectedness blazingly obvious. I was guided by countless mentors and passed from hand to hand of old and new friends on this journey. Thanks to each and every one.
**Monday of this week was World Diabetes Day 2017, so in honor of all my diabetes sisters, brothers, and supporters, this post will offer a little more intimate look at the diadetails of my life than others.
After yoga Monday evening in Vienna, I followed a group of yogi/inis to a delicious dinner of Vietnamese food. Yes, definitely Vietnamese and not Viennese – although I would end up eating a lot of traditionally Austrian fare. I was just a little bit low by the time we arrived at the restaurant [70 mg/dl or so], which was really a pleasant surprise after battling some higher numbers on the sedentary plane ride. I ordered an ‘Elderberry Water,’ description in German, so I was taking a total leap. It was, in fact, an elderberry-infused glass of water – and totally delicious.
I also ordered several other things – Vietnamese crepes and spring rolls with interesting mayo-based sauces. As a lover of sauce I was delighted. I was also almost delirious from exhaustion, approaching the evening of the day that should have been a night, but it was wonderful to be sitting at a table with people living their lives in this new city I’d just stumbled in to.
That night, teeth brushed, ready to climb the ladder to my lofted bed, I found the walk back to the apartment could not compete with the long plane flight, screwed up schedule, and reduced control over food choices. Nevertheless, despite a blood sugar of 201 mg/dl, I took an extra shot and crawled happily into bed.
Every morning I wake up and check my blood sugar. Then, as my coffee is percolating, I take my shot – the same amount each morning unless something exceptional is happening that day. I have my first cup of coffee and plan the day while my insulin activates, so to speak. It’s a wonderful routine – a forced stillness and reflection courtesy of diabetes. When I awoke in Vienna to a dreamy light pouring into the vaulted living room, my blood sugar had evened out to some degree (mid-hundreds). I drank my coffee staring out onto the criss-cross of streets below and apartment windows across.
Unless you have it, at this point you may need a diabetes glossary to understand a few concepts:
Walk competing with a plane ride…What?
The day-to-day details of life with diabetes are heightened when traveling, precisely because of the exciting release of control that a good adventure requires. So at the same time that you’re sinking into the moment, diabetes can loom even bigger in the back of your mind. But I’ve learned, slowly, painfully over the years, to not let it steal the joy of the unknown from me.
A few ways I’ve successfully experienced this reclaiming of joy:
My diabetes travel guidelines in summary:
I packed a yogurt in my icepack for my four-hour train journey to Innsbruck, during which I would retrace on the ground the route I had flown the previous day. I jostled back in forth from one side of the train to the other trying to catch views of mountain peaks and aquamarine waterways, before finally being lulled into a nap by the hum of the rails.
I returned about a week ago from a ten night trip spanning Boston, Vienna, and Innsbruck. See timeline below:
Night 1: Boston > Night 2: The sky > Night 3: Vienna > Night 4 – 8: Innsbruck > Night 9: Vienna > Night 10:Boston
Along the way I was blessed to have the company of my gracious hosts in various cities, my mentors at the ISPAD (International Society for Pediatric and Adolescent Diabetes) Conference, and others who are passionate about diabetes care and research just like myself. In fact, the abundance of miracles that transpired during my time has left me in awe. Still, traveling with diabetes, my constant companion, was as always, a little tricky. Diabetes can really be a pain – especially when your body is tired and out of its normal routine. So this post is going to employ grounded idealism – which I find is becoming my default (side effect of aging?) – and will follow a ‘challenge,’ ‘reward,’ ‘strategies’ format.
Challenge: Many legs of travel make for a lot of time on airplanes and lugging around luggage while sort of lost, eating snacky food all day.
Reward: Time with one of my best friends who has recently moved to Cambridge, MA. We explored the city, identified magnificent trees, ate vegan-ish food, and ‘played’ with her turtle Zeke.
Strategies to keep Type 1 diabetes (T1D) happy: I spent about 24 hours in Boston and had plenty of time Monday morning to take a long walk (thankfully the weather was magnificent) across the bridge (in view of the iconic Citgo sign), climbed on some trees, and moved for a solid hour. This brought my blood sugar down, increased my insulin sensitivity, and prepared my body for the long 7+ hour plane ride ahead. If you can’t take a long walk before your flight, some yoga or stretching is definitely better than nothing!
Flight attendant – “What would you like for breakfast?” Me – “Sleep.”
Challenge: Jet lag! And missed sleep while crossing time zones and traveling
Reward: A full day in Vienna
Strategies: So I guess this is always the case, but at the time the wonderful flight crew (thanks Swiss Air, I mean really, you should fly Swiss Air) brought around breakfast, it was 11:30 pm in my world and body. Still, I pressed on, drank another cup of coffee, ate half a croissant, and tried to prepare myself mentally to begin a new day. I learned that perhaps I approached jet lag all wrong. Having slept 0 minutes, I arrived in Vienna and somehow, although I don’t remember the process, made it to my hosts’ 4th story flat. I was graciously welcomed and then immediately fell asleep on the lofted guest bed for 3 hours. One of my hosts woke me and warned that if I slept any longer I’d feel even worse tomorrow. I remembered to check my blood sugar and was pleased to find it wasn’t so bad, 145 mg/dl or so. I took half my Lantus dose, because my schedule was all screwed up and I needed to begin working my doses back towards ‘morning’ and ‘night.’ And then I began the remediation process. After showering and drinking more coffee, I followed my hosts’ directions to Stephansplatz – the city center and location of the giant Stephansdom Cathedral, which I just learned from Wikipedia is one of the tallest in the world. I wandered among the young men in period costumes who showered me with flyers for the Mozart theater experience that I just had to see. I walked inside the giant wooden doors of Stephansdom, carved elegantly and polished, to enter the quiet cavern of worship. It was dark, as most giant cathedrals tend to be, but the stained glass scenes were vibrant and prayer candles lined the front iron rails. I added a candle to the bunch, walked slowly around the wooden floors listening to the echo of my footsteps, snapped a no-flash picture, and exited, emerging again into the light.
My next stop, after more meandering, was my host J’s yoga class at Feel Good Studio. This is what really saved me. Huge life tip: when traveling, look up local yoga studios and see if you can stretch out your body and shake off your jet lag. The amazing side benefit is that many studios offer new student deals, which means that often you might even be treated to a free class. J’s teaching style was just perfect for my state of being – a solid flow with individual attention and mindfulness every step of the way. He recommended plow, with heart lifted toward chin, as one of the ultimate anti-jet lag poses. Afterwards, although I fell asleep completely in savasana, I felt somewhat reenergized and ready to meet the next leg of the trip.
I’m going to break this post up, because it’s important to rest and not rush an adventure in its unfolding.