leaves

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.

Travels with Diabetes, Part 1: Boston to Vienna

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!

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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.

 

Revisiting my new year’s resolution

I’m using the bonus hour that I acquired this morning when a low blood sugar woke me up to write this post. Last night I couldn’t fall asleep. I was pleased that my blood sugar was in the 80’s, having come up from a slight post-dinner low and stabilized at this most ‘normal’ of levels, but I had the nagging feeling that it wouldn’t last through the night.

See here is my big blood sugar-sleep dilemma: earlier in the week I’d had a bedtime snack close to bed and woken up with high blood sugar the next day. I was frustrated by this, but I had slept wonderfully. I find that the snack helps me fall asleep, but presents the challenge of usually requiring a little bit of insulin. Just the right amount though – too much and I’ll wake up low in the middle of the night (which is kind of dangerous you know), too little and I’ll wake up parched and drowsy the next morning (high bg).

So last night, I managed to avoid the bedtime snack. I’d brought up my low with a little bit of fruit right after dinner and then coasted. But being so close to 80 mg/dl made it hard to fall asleep and then I dropped over night.

Instead of sleeping this morning I’m doing research. I want to experiment with some of the food recommendations made by Adam Brown in this month’s issue of Diatribe. I think if I can find more foods that fill me up at dinner time without spiking my blood sugar, I’ll have less of a desire to snack later on.

There is always something great in Diatribe! I am amazed at how much I enjoy it and find useful diabetes wisdom every time I drop in. Check out the links above to see for yourself.

Finally, just in case you aren’t already in awe of sleep, I’ll leave you with this Radiolab podcast about its powers.

Wild Adventures with Diabetes

Today diabetes took me on a walk. I’ve been a little resentful of diabetes lately. Sometimes it feels like my blood sugar controls every move I make. It decides what I will eat, if I’ll give myself a shot and how much insulin I will take, if I’ll exercise and for how long and how hard, and sometimes even how I feel about myself.

The last few weeks have been so busy and I’m longing for a little break, just a weekend away from everything, blood sugar included. But you know what, there really is no taking a vacation from diabetes. Checking my blood sugar less and loosening some restrictions in my diet might mean that diabetes takes up less of my time for a day or two, but pretty soon, not feeling as good as I could if I was sticking tighter to my ideal range doesn’t feel very luxurious at all.

So today, around 3 pm, when I was supposed to be working on my manuscript and doing other computer-based tasks, I checked my blood sugar and it was 180 mg/dl. I don’t like sitting when my blood sugar is over 150 – it agitates me to know that I could go on a walk or run to bring it down. It also agitates me when I think about how often blood sugar interrupts my plans. I’ve gotten better at choosing my plans over my perfect blood sugar in the past few years, but it’s a Sunday, and despite my agitation, I decided to let diabetes take the reins.

Immediately, driving off into the countryside around Chapel Hill, I was glad that I did. The sun was bright on budding green fields edged by thick stands of trees waving in the breeze. The trail I found was soft, dirt and gravel, easy on the feet. A muddy Piedmont creek ran alongside it. Towering strong-armed beech trees lined the path. And just when I was almost back to my car, I look up ahead on the trail and saw…

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My poor photography skills do not do her justice. Also, I was not going to get any closer.

a six foot long Black snake. I was mesmerized. My mind left diabetes and everything else behind, and as she slithered away I felt some real freedom from all of it for the first time in awhile.

 

Applying for Marketplace Health Insurance

Last Saturday I graduated with my Master’s of Public Health! I’m so excited for everything that’s ahead of me, except losing health insurance coverage on May 31st.

A friend and I who help each other get through life’s hurdles, sat down to apply for marketplace coverage together. She just turned 26 and has had to go off of her parents’ health insurance. As for me, my coverage as a student research assistant only extends to the end of May. Because having health insurance is vital for all people, but especially those living with diabetes, I wanted to share my experience with the process.

Website screening tool: First I went to www.healthcare.gov and clicked the big green button that says “SEE IF I CAN ENROLL.”

Turns out after entering all of my info that losing coverage was a ‘qualifying event,’ so I was eligible.

Creating an account: At some point I had to create an account – which I did. The security questions for this process were really funny to me – I would suggest writing your answers down somewhere because they weren’t the easiest to come up with.

What if I don’t know?!?: The hardest part of using the screening tool and applying was estimating my income. I’m at a point where my income is in flux – my hours at work and the way I get paid are changing. I’m also hoping to find full-time employment soon and know that if I do, my annual income will be different than what I’m able to estimate now. Dealing with that uncertainty is hard, but in keeping with all recent blog posts, it’s just a part of life. In this context, the instructions make it clear that it’s important to update your account frequently if your income changes. There is also flexibility with how much of the premium tax credits you can use if you qualify, which can help those whose income might change.

Premium tax credits: Based on my current income, I qualified for a substantial premium tax credit which I could apply towards my premium when selecting a plan. I didn’t realize this before beginning the process, but you don’t have to use your whole tax credit each month, rather you can choose to use only part of it and have the rest applied as a credit at the end of the year when you file taxes. On the flip side, if you use it all and then your income goes up, you may have to pay back in some of it on your taxes. It wasn’t super easy to decide how to use this information, so I just elected to use enough of my credit to make my premium manageable each month.

Selecting a plan: This step involved a lot of reading and deliberating. The website helps to point you in the right direction by allowing you to enter your preferred doctors and prescriptions to see if they are covered under various plans, along with the level of health care you plan to use. For us people with diabetes, that’s a really hard one to estimate. Additionally, I was frustrated that no matter how I wrote ‘test strips’ or with what brand name I used, I could not get the system to register them under preferred prescriptions. Hopefully others will have better luck with this. Ultimately I chose a plan banking on at least one type of test strip being affordable. I’ll report back on my experience with this once coverage starts.

More documents: It seems like there are always more documents. I have to prove that my health insurance coverage is ending, so I have to send in a document/letter to this effect by the end of the month. Oh and I have to pay for the first month, which I can’t fault them for. What I did like about the process is that you could begin the application and revisit it and then select a plan and confirm enrollment before having to send in the supplementary documents or payment. This way, I was able to move forward and secure coverage that will begin June 1st, even while gathering my other resources.

Overall experience: Applying for marketplace health insurance coverage is not easy per se, but it is doable. My personal suggestion (based on my typical approach to things) is to get the process started, create an account, do the eligibility screening, and then know that you can find the information you need and log back in once you have it to complete things. If your situation is not very clear cut, I think it’d be really helpful to have a navigator (i.e. real person) to help you through the process. At our school there is an insurance office above our student health clinic and I’m assuming this is the case at many universities. During open enrollment, volunteer navigators are available to walk you through the process, and although I don’t know if that is true at all times of the year, I suspect real-person assistance is available and would be helpful. If you have experiences with this, please leave a comment with your thoughts!

How to beat the springtime blues

Springtime blues? “What’s that about?” you ask. After about four years of consistently feeling miserable for about a week every April, I think I’ve finally realized that for me, something about springtime wreaks havoc on my diabetes management.

I find myself suddenly feeling sluggish, cloudy and hungry.

My blood sugar levels go up and stay up, like they’re stuck on a higher plateau.

Insulin just doesn’t bring me down like it typically does and because I’m running higher, my appetite increases and I just want to eat…carbs.

And then all of a sudden the insulin will bring me down like a ton of bricks and I’ll be arrested by an intense low blood sugar.

So…I have some hypotheses. It does make sense to me that the same inflammatory response caused by seasonal allergies would not be so great for T1 diabetes, which by its nature is an inflammation of the immune response. My friends with T1D have turned me on to some research to suggest that springtime is a hard season for many people with various autoimmune conditions.

Spring is also a time of new beginnings, change, waking up from winter and everything suddenly gets so busy. In this space of having so much to do and so little time to do it (and feeling like my head is full of pollen), my typically stress and diabetes management technique of daily concerted exercise hasn’t been as attainable. So I’m here to share – with no guilt – that this week I got a massage.

This was actually my second of two 30 minute massages with Monique Kennedy, who I recommend highly if you’re in the triangle area. Check out her practice: Exhale Massage Therapy – where you can book directly online.

And the name really says it all – exhaling (a topic I’m excited to write more about soon) and its partner inhaling are so hard to prioritize and yet so very beneficial. Since the massage and the reminder to breathe deeply, to prioritize resting and recharging, my blood sugars have been just a little bit more ‘normal.’

I’d love to hear other people’s experiences with autoimmune conditions and spring time and about massage as part of a healthy life!

Choices

On my first day of grad school, my pod alarmed in the middle of an orientation session and I had to rush home, still unsure if the bus I’d chosen was the right one to get me to my apartment. On the way, my iPhone 4 and I struggled with the spotty internet to email my advisor and let her know I wouldn’t be able to meet her – technical difficulties. That’s not really what I told her of course. I explained it all – because you can’t just explain a little bit of diabetes once you get going. It’s hard to just say “My blood sugar was low” or “My insulin pump malfunctioned.” I always feel like I sort of have to justify that statement with, “Oh and I have Type 1 diabetes. And I’m ok – I’ve just got to handle this.” The good-hearted people of the world want to know that you’re ok, which is touching. It can be really hard to give people who want to help and be there for you some reliable protocol to follow, because so much of diabetes is adapting to the moment. So much of it is being in-tune with your own body and responding in what might seem, to an outside audience, like a contradictory way from how you responded before. Sometimes I eat cake, sometimes I don’t. That doesn’t mean that in one situation I’m thinking about diabetes and in the other I’m not. It’s always there, presenting choices or at least weighing in on them.

This post is meandering because my thoughts are meandering right now. If there could be a central theme here, it’s choices and how they fit into our otherwise unpredictable lives. Diabetes reminds me that I make many choices in the day, from how I treat my body to how I communicate my identity, positionality and needs to others. It also reminds me that no matter how fixated we become on one choice or path or reality, our pod could always alarm right in the middle of it and we’d have to respond. This is another diabetes metaphor, but please don’t let that prohibit you from translating it to your own life if you are a person without diabetes (or not, maybe you don’t like metaphors). I’m just grappling with this – the contradiction between writing and reading our lives, both of which (I’m gently arguing), are quite necessary.