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!

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’ 4^th 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.

The Best Thing About Backpacking: Part 2

A light breeze was rustling the rainfly when we awoke the next morning, but the downpour was over and waves of sunlight rolled past, lighting up our little orange home. I flipped from side to side a couple of times on the hard ground, trying to keep myself from tumbling down the slope. More sleep being evasive, I was eager to start the water heating for the first cup of coffee in the woods – a unique pleasure that combines two of my favorite things into one. I sat up and put on my old pair of backpacking glasses, found my meter case safely stashed in a plastic bag, and checked my blood sugar. 160 mg/dl – a little high. This was, I thought, to be expected, since I was 137 when I went to bed and I’d cut my Lantus dose by half in preparation for the day of hiking. Better than fighting lows all day, I thought. I unzipped the soaked rainfly which now clung to the tent after its stick stake had crumbled and given way overnight. I managed to haul myself and my pack out from under it and stumble into the bramble patch that we’d appropriated in the night. Ahead of me, a few short oak trees canopied blueberry bushes and huge ferns. Further, at the border where the land turned steeper, big Balsam fir trees spread their evergreen branches into regal teepees. To the right, mountain after soft mountain, rolling in the Virginia way. Behind me, a taller peak with a bright green bald was dotted with what could have been nothing else but a herd of wild ponies.

Unbeknownst to us, we had set up our camp in paradise. I ran back to the tent and crawled into the deflated vestibule. “It’s so beautiful out here!” I shouted to my slowly stirring companions. “Really?” “Oh yeah?” I had already run back outside. The Navigator unzipped the trail side door of the tent, just in time to say hello to a pair of early morning hikers. Also unbeknownst, we had set up our camp at most 10 feet from the Appalachian Trail. In the night, in the rain, it had felt like we were far from the pedestrian thoroughfare. This was an accident of minor importance though. We set up our first breakfast on a small rock to enjoy the views of ponies and passersby. I took about half my normal dose of Novolog to go with a higher carb breakfast than usual and halved my morning Lantus dose (I’m on a split Lantus regimen right now) once again, to set myself up for a day with less lows.

From there the skies just got bluer, in every way. After we’d retrieved our wet clothes from the branches we’d decorated with them, we set off again, this time North on the AT, to begin our ‘loop.’ Within moments we stumbled upon this scene:

Unlike my last eager venture to Grayson Highlands, I decided that this time I would allow the ponies to come to me if they wanted, but I would not approach them first. Luckily this worked out just fine. They were very friendly. They also seemed intrigued by my hiking poles (just another reason among the many to carry hiking poles).

Sometime later, we said goodbye to the ponies and continued on our way. Light clouds dappled the sky and the colors around us shone in response – bright greens, sunset oranges from the just-past blossoms of the wild, fire azalea bushes. It was slow going because we had to keep stopping to greet and photograph every pony in the area. We could probably provide a pony census to Virginia if it was ever needed. And just when we thought ponies had come to rule the Highlands’ ecosystem, we happened upon…

these lovely (and somewhat intimidating) ladies. They were lunching on a high mountain pasture, so we decided to as well. For the first few minutes of lunch I fed the low blood sugar that had crept over me as I gazed out over the 360 degree views in a partial daze. It seems like for those first few hours of backpacking I can’t ever eat enough to keep my blood sugar up. I slowly came back to our beautiful reality while Raindancer, who had quickly become comfortable with the herd, fell asleep for a 15-minute nap.

Somewhere before or after lunch the trail took us over a little stream and we stopped to refill our Nalgenes. Hiking/life in general with diabetes requires a lot of water. I recently learned (remember this for your next trivia night) that diabetes comes from the Latin for: “It has to flow” (I know that clinically this is not a good thing, but philosophically I really dig that slogan). So anyway we got out our Aquamira and engaged in the process of readying our water. In life, I’m not always patient with the process, but there’s something about the process of purifying water with Aquamira that I love. Maybe this is part of ‘the best thing’ about backpacking – engaging deeply with the process of getting where you want to go.

Sometime around 7 pm we made it to a crossroads, literally and figuratively. We needed more water, we had reached a large boulder that supposedly offered good views, and we were tired. We decided to set up camp and go in search of water, rumored to be just around the bend, after eating dinner. Prior to eating dinner though, we ascended the curved face of the boulder and were met with a literally breathtaking view. You hear people say things like, “she looked breathtaking,” or “wow, this sunset is breathtaking,” but if something is really breathtaking you can’t speak because you are gasping. And that’s how this view was – like, “Ahh!” So beautiful, so unexpected. The sea of clouds had parted and the mountains were everywhere. Although I’ve grown to love the Piedmont of NC, views like this remind me that there’s just nothing like having your breath seized by the mountains. Could this be the best thing about backpacking?

Minutes later, I had wondered if perhaps tearing into a tortilla bowl of beans, tofu, cheese, and avocado as you stretch your tired legs out on the bare ground was perhaps the best thing. There’s nothing like eating dinner in the woods when you’re really tired after a day of hiking. Also, here’s where I’ll make my plug for never going backpacking without hot sauce – it’s worth the weight. I carry mine in a small Tupperware given to me by none other than the Navigator, who understands my love of sauces. It’s very lightweight and a huge improvement over the whole glass bottle of Cholula I carried last time I was in Grayson Highlands.

The day was perfect – magical in every way, and so it shouldn’t have been a surprise to us that the night sky would have been perfectly clear, illuminated only by the pinpricks of a million tiny blazes of light. Why should we have been shocked that the ground flickered with the slow awakening of mountain fireflies, who move with more direction and purpose than the rapidly flitting lowlanders? And yet still, with stars above and around us, we stood mesmerized. I’m all about favorites, ultimates, zeniths, etc., and so I could say that if there was a thing that was best about backpacking, it had to be this mountain field under the cover of darkness – air the definition of fresh, a comforting silence filling the space in between the calls of katydids and click-click of bat wings.

But, I just can’t say that. In fact, no one of the miracles of the day could take the title of ‘best thing.’ To categorize our time would have been to leave out the process, the parts of sum; to forget that each moment was a combination of feeling connected to the Earth and to each other. Perhaps, if I want to answer my friend’s question, I’ll land on connection as the best thing about backpacking. It’s different every time, but it happens, somewhere in between bailing water out of the tent with your bandana, spotting a speckled salamander under an old log, and helping each other find the trail.

A quick acknowledgement and plug for the amazing blog of Hiking Bill. He provides in-depth descriptions of many hikes in the Southern Appalachians and includes helpful ‘hike planners’ at the end.

You can find his description of the Pine Mtn/AT Loop that we used to plan our route here.

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.

Find your break

This past weekend I went on a run with a friend. I resort to running when I’ve crammed my life so full that I feel it’s necessary to expedite working out. My usual preference is for walking, which I’ve just returned home from.

Here are some of the things I saw on my walk:

White and pink Dogwood blossoms. Dogwood trees have a distinct smell – sweet and earthy.
A black and white cat tiptoeing through an overgrown corridor of leggy flowering grasses.
A mockingbird trilling from a tree limb.
Tightly packed azalea flowers flocking front porches.

This walk and yesterday’s yoga class were inspired by suggestions from two people whose wisdom I value. They suggested that in order to get everything I needed to done, I take a break. Different times call for different sorts of breaks, and lately I’ve needed a computer break. Like my friend, I’ve been losing productivity as one assignment blurs into the next. I’ve been losing sleep too and waking up with high or low blood sugars. These past couple days, stepping away and doing something slowly has made space for me to breathe – which, one could argue, is just another way to practice public health.

It’s frittata time!

I actually did it! I saw an intriguing recipe and made it-successfully!

This past week, I discovered a magical source of energy that allowed me to prepare multiple meals in advance. I became inspired to bake as a present for a friend who was turning 30, and then I couldn’t stop.

Everything I’ve made has involved cheese. In my fridge right now, I have over five kinds of cheeses, which admittedly is just average for me. I am most excited about this mini-frittata recipe that I found in an article titled, The Morning Meal, which was featured in a recent issue of diaTribe.

The recipe came from a food and diabetes writer named Catherine Newman, who edits a magazine called ChopChop which looks to have some great recipes that kids can help prepare.

For the recipe, check out her full article. There are also other diabetes-friendly, delicious, and Sunday morning appropriate recipes in her article!

I tested the frittatas out on a friend who doesn’t have diabetes – she was equally impressed. They were the perfect brunch meal paired with a little salad and buttered toast.

A couple more shout-outs:

Ricotta cheese – oh my gosh, ricotta cheese is so delicious. Now I have a bunch of it in my fridge that I’m eating with a spoon.

Lifeway Organic Kefir – This stuff if amazing and helps me eat less ricotta cheese.

Immersive Experience

I’m at the beach, looking out at the ocean. As my mom pointed out, the horizon line is choppy and each wave is being attacked ferociously by the wind, causing a thick fan of mist to spray from it.

This morning, inspired by the rhythm and beauty of the sea, we talked about moments in life that become preserved (perfectly?) in our memories. Of course as mother and daughter we had some shared moments to talk about – and also some individual ones. I told mom about a moment I shared with a friend of mine on a backpacking trip, when we rushed to the tip-top of a peak called ‘Shining Rock,’ with just too little time before the sunset to search for and find out cameras in our wet packs. When we hit the crest of the mountain and emerged onto the quartz outcrop, the sun was breaking through the clouds in an array of colors and beams that took our breath away. It reminded me of the ocean in a way – like seeing underneath the water. The clouds set a soft horizon line over the expanse of blue ridges.

There was a moment in this moment when we both were exasperated by our lack of picture-taking devices – but then came the freedom. When ‘preservation’ with a camera is possible it’s hard to resist the fantasy that holding on to these moments in our lives is possible (oops, I guess this is a continuation of my explication on change). When preservation is impossible, say we don’t have cameras and we left our phones locked up in the car, immersion becomes possible. What are the ingredients of immersion? Dedication, curiosity, gratitude? I don’t know. I would say though, that those moments in life that we can never forget, are most likely ones in which we were not concerned with holding on.

Everything in life I ever needed to know…

“I decided many years ago that a high blood sugar does not define me any more than a great blood sugar defines me. For 42 years I have been chasing the perfect blood sugar. It has never happened for more than a minute just the same as the really high ones do not last any longer.”

– Rick Phillips

I want to give a shout out to change. Year after year, change has stood by me. More than that, change even visits me day to day and moment to moment. So here’s to change: a truly dedicated friend.

Obviously, I also want to give a shout out to Rick Phillips, whose response to last week’s question is today’s featured quote. A big thanks to everyone who responded and added to our conversation around high-blood sugar blues and how to pick yourself up from them. Rick’s quote jumped out at me because of its utility for maintaining perspective as we manage (versus ‘control’) blood sugar and also as we manage (versus ‘control’) life. Last week I was talking to a fellow graduate student, job seeker and swimmer in the sea of uncertainty at a social for public healthers in my program. She mentioned that it’s taken her a year and a half to feel like she’s truly gotten her footing here and now it may be time to shift everything once again, perhaps even in a totally new place. I thought of Rick’s quote – how many ladders of learning and accomplishments and life experiences do we climb up, only to reach the end and realize we’ve moved not to a new plateau of constancy, but simply on to the next challenge? That sounds a little pessimistic I think, but it’s not intended to. Blood sugar management from the accept and let go perspective can sound a little pessimistic to – like, no matter how hard I try, even if I check my blood sugar and get that magic 90 mg/dl, it’s already changing, I can’t hold on to it. But! BUT! In truth, this is a comfort too. This wisdom of letting go is so helpful in diabetes and in life, because it directs us back to the process, not the product.

I think I’d like to make one of those posters like you see on the wall of dentist’s offices: ‘Everything in life I need to know I learned in kindergarten,’ except it would say: ‘Everything in life I need to know I learned from diabetes.’ That’s a little over-simplified though. In truth, not knowing has led me towards these conversations with friends and others that help me to break free from dichotomous thinking and see that there are ways of seeing and thinking about challenges that I have not even considered yet, which is itself a comforting thought.

So change, you may be a wildcard, the guest who comes to the party in sequins, carrying a jello-cake and two days early – but, you might as well come in.

Interdependence

This is the English version, slightly adapted to the current moment, of my last post from Sunday.

There’s a lot I could write about, but I’d like to start with a discussion about the word ‘neighbor.’ This word has entered my mind and my world a lot lately, and I’m thinking about what it means to be a good neighbor. Another word that has appeared again and again is ‘community.’ I went to a community this past weekend where it is evident that there is this idea of living, in the words of one resident, “in an interdependent way.” It is, she says, an alternative to living so independently, without recognizing that we do depend on each other. Why is it so hard in our culture (in all cultures?? in some more than others??) to accept help? I think that it’s a function of our perceptions about the relationship between ourselves and others, or saying it another way, between our inner world and our outer world.

It’s here that I’ll bring diabetes into the conversation (did you know that everything relates to diabetes?). A week ago I fell down the stairs (or more like I fell on the stairs while going down them). When I fell, it scared the woman who was climbing up from the other direction and she gasped and grabbed her heart. For a moment she looked worse than me. It was captivating to me that my movements and an action occurring to my body could move her too – that we were connected in this way. Later, in dance class with my leg hurting badly, I realized that my blood sugar was very low and that maybe that was why I had fallen. The level of sugar (glucose, officially) inside my body influences my movements in the world. This is a perfect metaphor for the influence that we have on our surroundings. Our thoughts, beliefs, prejudices, and personal histories have an impact on our environment whether we like it or not. We are connected. We can only operate in the world without recognizing that we depend on each other while we maintain power, or rather, until we lose control. For me, when I fell I lost control. It was a humbling experience that temporarily transformed my body. We’re always talking about shoes, but this journey taught me that a novel way to experience empathy is to imagine what life would be like in another body. Empathy is the key (for me) to being a good neighbor. Obviously, there is another moral here too for my friends who have Type 1 diabetes (or Type 2 for that matter), that is, please check your blood sugars regularly and be careful when you’re having a low.

Today my leg is feeling much better (I danced – joyously, today), and once again I’m thinking about how we can use the word gratitude as a verb. If our heart is struggling to let empathy in, maybe gratitude can help us tear down the wall.

¿Por qué bailar solo?

Hay mucho sobre que pudiera escribir, pero quiero empezar con una discusión sobre la palabra ‘prójimo.’ Esta palabra ha entrado mi mente y mi mundo mucho recientemente, y estoy pensando en lo que significa ser una buena prójima. Otra palabra que ha entrado es comunidad. Fui a una comunidad ayer adonde es evidente que hay esta idea de vivir, en las palabras de una residente, “de una manera interdependiente.” Es, dice ella, una alternativa de vivir tan independiente, sin reconocer que somos dependientes el uno del otro. Por qué es tan dificil en nuestra cultura (en todas las culturas?? Algunas más que otras??) a aceptar que no podemos hacer todo por nuestra cuenta. Por qué se da tan mucho miedo ser vulnerable y aceptar ayuda? Pienso que es una funciona de nuestras percepciones sobre la relaciona entre nosotros y los demás, o sea, entre nuestro mundo interior y mundo exterior. Es aquí adonde traeré diabetes entra la conversación. Está semana me caí por las escaleras. Le di un asusto a la mujer que estaba subiendo desde la otra dirección. Fue interesante que mis movimientos y la acción a mi cuerpo podría moverla también – que estábamos conectadas en esta manera. Luego, en mi clase de bailar con mi pierna doliendo mal, me di cuenta que mi azúcar fue muy bajo y que posiblemente era por eso que caí. El nivel de azúcar dentro de mi cuerpo influye mis movimientos en el mundo. Esta es una metáfora perfecta para la influencia que tenemos en nuestros aldrededores. Nuestros pensamientos, creencias, prejuicios, y historias personales tienen un impacto en el exterior sin nos guste o no. Somos conectados. Solo podemos operar en el mundo sin reconocer que dependemos de otros mientras tenemos poder, o sea, hasta que perdemos el control. Para mi, cuando me caí, perdí control. Fue una experiencia humillando, que me transformó en otro cuerpo temporalmente. Este viaje, pienso que es valioso, porque permite empatía. Esto, empatía, pienso que es el ingrediente clave (para mi) de ser una buena prójima. Obviamente, hay otra moral aquí también para mis amigos que tienen diabetes tipo 1 (o 2 realmente), que es, por favor, mide tus niveles de azúcar frequentemente y cuídate cuando tienen bajos. Ahora mi pierna se siente mucho mejor y estoy otra vez pensando en como podemos usar la palabra gratitud como un verbo. Tal vez, si estamos luchando por encontrar empatía, podemos pensar en todas las cosas en nuestras vidas por lo que deberíamos tener gratitud.

H2O

10 things you can do with water (that are great for diabetes):

Brush your teeth – People with diabetes are at an increased risk of periodontal disease and oral health issues

Drink until you’re hydrated – Dehydration can lead quickly to an emergency situation during ketoacidosis

Make hummus (soak chick peas, cook them, achieve desired consistency) – The fiber, protein, and other nutrients in hummus make it one of my favorite diabetes power foods

Wash your hands – When you have diabetes, infections can cause inflammation in the body that elevates blood sugar levels, which in turn makes it even harder to get well

Mop the floor – Clean floors are a vital part of happiness

Flush the toilet – Sanitation, obviously important

Wash your clothes – Although, I read on a tag of one of my ‘Toad&Co’ shirts that ‘clean is the new dirty’ and we should wash our clothes less often

Wash your dishes – Along with the next one, cooked meals are typically healthier than meals out. Keeping your kitchen free of foodborne bacteria is important to avoiding gastrointestinal illness

Clean your (non-starchy) veggies – My favorite diabetes superfood group!

Take your Vitamin D – there’s some promising research out about the importance of maintaining healthy Vitamin D levels for people with diabetes (and all people)

Interestingly enough, this is also a list of 10 things you can’t do without water. In my town this past weekend we were under a state of emergency for over 24 hours because of over-fluoridation and a water main break (two separate incidences). I had a friend visiting for the weekend, so she and I went to stay at another friend’s house in a neighboring county. We all had a great slumber party and then the ban was lifted.

It worked out so well for me that it was particularly sobering to realize how blessed/privileged I am – in terms of this country and internationally. I was able to afford bottles, access them, and also have a nice place to stay because of my social network. Then too, thinking about the world, how bizarre that we declare a crisis and state of emergency after an hour of reduced water when in some countries people live every day with no expectation of running water in their homes. Why don’t we think about how lucky we are to have clean water that we can access almost anywhere by turning on a tap? If clean drinking water is something you don’t think about every day, chances are you’re privileged in comparison to many people in the world. Worldwide, more than 1 billion people still lack access to improved drinking water. And in many places, global warming and industry is causing water sources that entire communities depended on to dry up completely: Climate Change Claims a Lake, and an Identity (this is a great NY Times article about Lago Poopó in Bolivia).

So I know you may be wondering, what’s the call to action here? Well I’ve got two for you. The first one is to sign up for your town’s Public Health Reserve Corps (PHRC) or another similar organization that will alert you to volunteer opportunities during crises like the water shortage we experienced. The second is to challenge yourself to discover one thing that you take for granted in your day-to-day and learn about what life is like in regards to this element, whether it be water, clean air, reliable transportation, or something else, for people living in another part of our world. Please feel free to add your thoughts, experiences and/or calls to action in the comments below!