Yoga with a Purpose: Life for a Child

Think back to ten years ago today. It’s hard to do. If you managed it, can you imagine your then self ever guessing what you’d be doing (and why) ten years later? Yesterday I could remember back to a Halloween a decade ago when I was too sick to carve pumpkins with the new friends I’d met just a few months before. It was my first semester of college. I had undiagnosed Type 1 diabetes and would have ever imagined why I felt so very miserable (and worse everyday).

I also would have never guessed that ten years later I would be lucky enough to be teaching a yoga class as a mini-fundraiser for “Life for a Child,” an amazing program of the International Diabetes Federation. “Life for a Child” provides insulin, test strips and trains teaching teams in clinics around the world to support children living with Type 1 diabetes who might otherwise die from lack of access to diabetes supplies and care.

The day meant so much to me, not just because “Life for a Child” is an amazing organization, but because of how much my own journey with diabetes has taught me and the twists and turns it’s taken me on. Because of diabetes I began to rely more heavily on yoga as a coping strategy and eventually got my yoga teacher certification. Because of diabetes I find myself pursuing a master’s in public health and meeting people that are all so dedicated to their causes and their passions and it’s so inspiring. And those are the people who were sitting on their mats on a crisp Halloween afternoon to do inner and outer work together. I am so grateful to them. The hour long class raised $112.00 to be donated to Life for a Child.

I am also so grateful to Loving Kindness Yoga School in Carrboro for allowing us to use the space.

Finally I’m grateful that “Life for a Child” is working tirelessly to literally make it possible for children to live, to grow and flourish with this condition instead of living in fear. Their work is essential. http://www.idf.org/lifeforachild

When Insurance and Supply Companies Get You Down

Strap on your skates and get ready for a ride round and round the insurance-supply company roller rink! It’s a place full of big ups and downs, of enthralling personal emergencies, of fantastic defeats that you have to pick yourself up from so you can try, try again, because next month, you’ll still have a chronic condition and you’ll still need those supplies, gosh darnit!

A couple weeks back I’d just walked in the door of my little sagging bungalow and was headed for the fridge to make myself a cheese plate and celebrate Friday afternoon on the porch. As I was taking the insulin for my appetizer, my pod suddenly alarmed, a long high pitched drone, that was clearly not going away. The pdm said “remove pod and call customer service.” I was very distressed to be interrupted on the way to cheese, but I called the number, because I had to. You can’t choose to do diabetes later. After a long conversation and being instructed to stick my pdm with a paper clip numerous times, it was determined that my pdm, still under warranty, would need to be replaced. The company rep was very helpful and friendly and the whole thing went pretty smoothly, considering the way it interrupted my vision of an afternoon. She asked me that thing that supply company and pump reps ask when you have diabetes and some part of their process or technology screws up, “Do you have a backup method of insulin delivery?” One time a customer service person went so far as to say to me, “I recommend that you use a backup method of insulin delivery.” Well I guess she did! Luckily I always have novolog and lantus in the fridge and plenty of syringes. The fact that anyone would present it like there was another answer besides “Of course I do!” that would work is laughable to me. But I started thinking, what if I was in the woods? On a plane? What if I had packed enough novolog and pods for any pod malfunction, but hadn’t considered that at a normal moment the whole system could crash?

It made me think too about kids with type 1 who wear systems like this, or even those who just use injections, who do not have a lot (and I mean a LOT) of parent support. The following week my saga continued. I called my pod supply company no less than 6 times, because over the course of the past three weeks I’d been waiting on pods that never arrived, and each time I spoke with someone they assured me something like, “We have to wait on approval from your doctor, they usually get back to us in two to three days.” I had to give them my endo’s number at that point, then call my doctor and confirm they received the request, then call the supply company back to notify them that the approval was in, and they still did not automatically request reauthorization from my insurance co. Every year, EVERY YEAR, my doctor and insurance company have to re-authorize that I do in fact still have Type 1 diabetes. Why would common sense and accepted medical knowledge not trump procedure here? If I am requesting pods to deliver insulin, obviously I need it. And type 1 diabetes, unless you’re in a swanky new clinical trial that I don’t know about, does not go away. We know that, or at least it’s very commonly accepted in the medical world, so can we please give those of us who live with these conditions a break and let them just manage their blood sugars and lives, instead of spend the majority of their self-care time on the phone trying to determine if their pods are on the way or if the approval has even yet been requested.

And that is all I better say about that, except that I am lucky enough to be able to take time off work to make these calls, have a cell phone with unlimited minutes, and have the awareness that you must be a strong self-advocate every step of the way. I can’t imagine what a parent would do if their child was just diagnosed with type 1 and they did not have this flexibility in their work schedule, they were trying to learn about the condition itself and navigate the slippery world of insurance policies and secure their child’s supplies each month. I don’t know how a parent of or someone with type 1 would do it if they only had a limited number of minutes on their phone or if they didn’t know that you have to have backup for your backup. Or if they didn’t have the support of family and friends with type 1 and without like I have been lucky enough to find.

On the Road with Diabetes

Lately I’ve been on the road a lot. Which is a way I love to be! I love the adventure of navigating a new place. I like to go at it without a GPS (which is good since I don’t own one) and ask for directions as many times as possible from as many different people as I can. This seems strange, I know, but it is a fabulous way to discover the hidden nooks of a place and to get a sense of the general friendliness and openness of a community.

When you ask a local for directions, you can often tell right away how they feel about that place. People will light up when describing a route to you through a town or countryside that they love. They will shake their heads and look down and make scoffing, grunting sounds, or else, like when I landed in the worst neighborhood in San Francisco dragging my big red suitcase, with no cash, they will make purse-lipped, “Mhmm,” sounds with a furrowed brow and tell you not to make eye contact and to just keep moving. That’s not my style, so I asked a cop for directions further down the road hoping he might offer to transport me in his squad car. He didn’t, he just made more, “Mhmm,” sounds of worry and confusion for me.

When I’m traveling half of my mind is engrossed in the outer landscape and the other half is engrossed in my inner physiological landscape. I simultaneously hate and appreciate this. As much as I try to tell myself beforehand, “I’m going to just not care what my blood sugar is on this trip,” I always still do! When I have high blood sugar and have an hour or two of a drive yet, I feel like frustration is swelling inside of my heart. Having high blood sugar already makes me feel like a caged animal, and having it while being in a car is like that feeling times two. I can’t even (quite literally) shake it off, by going for a walk, or jog, etc. And I’m always puzzled between the fine dance of ‘conservative’ bolusing, so that I don’t go low if I’m driving, and extra bolusing or increased basal for the more sedentary time of travel.

Diabetes management thrives on routine or else requires the operator (me) to become a lot more involved. Which is the opposite of what I want to do on vacation. I want to say to my friends, “I don’t care where we go to dinner, take me to your favorite place!” Or, “Yeah, cheesecake sounds great!” Sometimes, I have an impulse to do that thing called…relaxing, where your mind sort of goes blank and you stop strategizing for the best possible way to achieve balance and you just sort of…veg.

But instead I pack a rigorous cooler full of literal veggies and nut butters, snack foods of all kinds, instant coffee (can’t really attribute that to diabetes, but it helps), and try to picnic as much as possible. The picnic is key because usually a good spot for picnicking is also a good spot for walking, which is a really useful tool on car trips. Often I park far from my ultimate destination and play the ‘ask for directions’ game on the way to wherever I’m going, which usually helps me get a good walk in. But I think the best outcome for me on the road comes from that good cache of snacks that I can use to fill-up a little before and meal at a restaurant that might not have as much to offer in the way of non-spiking foods or to munch on in the morning before my companions wake up. I would recommend the noble avocado, as the perfect snack for morning, afternoon, or night, compatible with sweet and savory, filling, and rich in happy making omega-3’s. I have more to say on this topic, but for now I’ve got to move.

A Change-Up

So I’m pretty excited about this. A few days ago I wrote about my recent disgust with my own optimistic attitude about diabetes, even though that attitude is what has pulled me through over the past nine years. I’m happy to announce, I can feel it coming back! Largely because diabetes does teach me some strange and interesting things.

For the past few days I haven’t been sleeping well at all. I’ll feel tired, reading my book wrapped up in an afghan in a cozy chair, spits of snow coming down outside. Then I’ll lay down in my cozy bed, warm and tired. And then…

I’ll get this feeling like my bones are hollow and I’m a little bird on a windy branch and I could just blow away, and the feeling is sort of in my heart and mind too, like I’m a reed humming in the wind.

Being low around bedtime often feels to me like I’m vibrating slightly, but lately that feeling has extended to include a low-grade but constant mental agitation. Even when my blood sugar has been elevated, I’ve been edgier. The only and best way I can describe it at this point is a swirling feeling of being unsettled.

A couple of weeks ago I was craving more carbs and food in general at the same time that it felt like my blood sugar was frequently stuck. I wasn’t receptive to insulin like usual. I would hit 250 and stay there on and off for hours. I woke up one morning, mouth dry, feeling like I’d been on a long road trip with no water, and I could tell I hadn’t been getting the insulin I needed from my pod.

So I switched from my usual sight on my upper glute to my belly. I don’t really like having the pod on my belly because I’m more aware of it and it gets in the way of yoga, but immediately my insulin needs and the time it took for insulin to start working went down.

Unfortunately these benefits came at the same time as my sleep troubles. At first I thought I wasn’t sleeping well because the different site was less comfortable to me, but I sensed that there was something beyond that at work.

For two pod changes I kept the pod on my belly. For nearly a week I slept like a guard dog, waking up at every creak and rattle in our albeit pretty noisy house.

Then, suddenly it hit me. That swirling unsettledness was centered around my navel.

Yesterday I changed my pod back to its old favorite spot.

Last night I slept like a champ.

Now the good news is I’m back to better responsiveness to my insulin with the pod in that old spot. I suspect that area did need a break; maybe I had hit some scar tissue or my bun muscles of steel were bending the cannulas. Who knows, maybe I’ll have to eat some more of these truffles from the Chocolate Lounge where I’m writing this.

It’s snowy out today, but not icy, so we spent all morning building snowball players. The title of this post comes from the lady pitcher who’s about to throw a change-up. It’s a pretty weak pun, but she is very strong, so I wanted to put in a picture of her.

So I’m curious to know what other people’s experiences have been with how their blood sugars, emotions, and sleep patterns respond to varying pod or infusion sites. Any feedback or comments are welcome.

Kayakin’ with Diabetes

October 2013

Omnipod on the water, a success. As a paddler I try to be more minimalistic than other times, which can be a challenge with diabetes. But my boat is a Wavesport XXX, an old model from 99’, with no foot space, no cockpit, not much space period. I fill the back with a throw rope, a big yellow sponge, and two pelican cases full of snacks and supplies. In one case I keep a quick dry cloth for blood sugar checks, my ‘river meter,’ a novolog and lantus pen, 3 pen needles, 4 alcohol swabs (never know when somebody’s gonna scrape a knuckle), and some glucose tabs. In the other I keep my glucagon kit, a granola bar, 2 disposable eye drops, and some other snack; today it was beef jerky. I leave my pdm in the car, maybe in a cooler away from the freezer pack itself, because if you’re swimming, you want to worry about your boat, your paddle, and yourself, not your $1000 piece of durable medical equipment!

Then there are my water shoes attached with a carabener, a water bottle, and extra dry layers. That leaves barely enough space for me. Despite being strapped into a tiny container, half boat, half woman, there is something incredibly freeing about being one with the boat. Couple that with finding the river’s line of least resistance and surging down a rapid – blissful and riveting.

Paddling is always a great reset for me, giving me that experience of being absorbed in the present by its very nature. Holding that feeling all day and using my body to accomplish a goal helps me remember what it is like to be fully present, not puzzling or planning. Diabetes sometimes can be a hard balance between planning ahead, reflecting back (often analyzing and criticizing), and going with the flow of the moment (with all of its unexpected holes, strainers, and whirlpools). More and more I’m learning that both are necessary to be healthy, happy, and move forward. For me a successful day on the river means advanced planning for blood sugar management so that I can focus my attention on the river and not on diabetes.

I use checklists. It’s taken me a long time to realize that I just can’t keep everything I need to have organized in my head, much less my home, without real, printed-on-paper checklists. When going out on the river I use the five finger test: boat is your thumb, then each finger is helmet, life jacket, paddle, and skirt. It doesn’t matter the order though because basically if you miss any one of those you’ve got to borrow or go back. Now layer onto that all there is to keep up with diabetes on land: meter, test strips, insulin, extra pods, batteries, glucagon, glucose, alcohol swabs, etc. Maybe you’re paddling the Nantahala, one of Western North Carolina’s icy beauties, so you need to have warm layers, a dry top, extra dry clothes in the car. Perhaps you’re like me and you’re always voraciously hungry, especially after being a little cold and using your muscles all day. That means snacks in the car for your return. My favorite river snacks are beef or turkey jerky sticks, nut butter packets (try ‘Jason’s’ almond butter, peanut butter, and chocolate hazelnut butter in single serving packets), and celery, apple, and carrot for dipping. Today I made a sandwich on ‘Farm and Sparrow’ bread from the local tailgate market spread with sunflower butter, layered with avocado slices, and splashed with balsamic vinegar. I’m an exploratory eater. Nothing to spoil and the river keeps it pretty cold anyway. I like to eat relatively low-carb on the river but have back up carbs in case I go low. I find that the less fast-acting insulin I can take the better to minimize the risk of lows. That being said my basal needs seem to go up from both the cold water and the muscular exertion. My big safety trick is keeping a honey zinger packet in the front pouch of my life jacket. They can get pricey at $1.25 a piece, but the bulk packs are available at a lower cost from multiple sellers on Amazon. I definitely have glucose tabs in my boat but the zingers are packaged in waterproof plastic (nothing worse than a soggy luna bar), easy to eat fast and you don’t even have to chew. That’s helpful if you have to get your blood sugar up and can’t find a place to eddy out. Of course trying to paddle, tear open a packet, and eat honey, is not ideal, but with diabetes you’ve always got to be prepared with the back-up that will let you do what you got to do, if you’re going to do it at all.

One of the last two check-boxes on the list is a great group of friends with some experienced paddlers in it, at least one or two. And let them know you have diabetes. Be that girl who introduces herself with, “I’m Katie (insert your name, don’t steal mine), I love to get outside, meet new people, and I have type 1 diabetes!!” And give your glucagon kit to that seasoned paddler who has a dry bag. Don’t keep it in your boat – because if you flip over and your boat is one place and you are another, well, what good is it going to do you then?

Final check-box: plunge in. Check that sugar thirty minutes before you get on, check it two minutes before you get on. Check over what you need to have with you all day in your boat, check it over again. Flex those muscles, stretch the skirt with all your might over the cockpit, and launch into the rapids. Now you’re a boater as much as your a diabetic. We become whatever identity we embrace.

I am a boater.

I am a diabetic.

I am a planner.

I am an adventurer.

A friend I met on the river who organizes trips for a WNC paddlers meet-up group got me in touch with a friend of hers who is getting into paddling now that she is landlocked and her first love, scuba diving, isn’t easily accessible. Her friend has lived with type 1 for forty two years. Now that’s inspiring! When we were getting to know each other over email she wrote me, “I love the water because it fills up what life drains from me.” Type 1 diabetes can drain out quite a bit. The background stress, the wondering, checking, assessing, judging, criticizing – all of that takes something from the rawness of our experience. Like my new friend, the river rehydrates my soul as well. I have found no faster way to feel the pulse of nature than to be taken in by the current of a wave train and merge with the force of the water.

On the RUUUNNNNNN!!!

January 2011

My motivation for running has finally picked back up after the first real visit from winter this season. As a comfortably warm-natured person for the first eighteen years of my life, I have struggled with the effort it now takes me to achieve and maintain warmth since becoming diabetic. My creativity and motivation wanes in the winter time for outdoor activities, so this year I am exercising at the YMCA and planning for outdoor warmth through layering and the right gear. Later this month I will run the Hot Chocolate 10k and I expect I will need that hot cocoa not only to bring up my blood sugar after 6 miles but also to warm my blood back up.
I ran my first (and only so far) 10k this summer with my father who has just become a runner now in his late fifties. It was a trail run through the mountainous Dupont State Forest and the longest distance I’d run before was maybe 4 miles, so I knew I would have to train. This summer I followed the plan suggested by my most fit friend, Alison, running 2 miles one day, 3 the next, then 4, then five. I would rest a day and run 2 again the day after, just about twenty minutes. Sometimes I would throw in some sprint work or hills, although not as much as I probably should have. The day before the race I took a short two mile run through the campsite in Brevard where my parents had a pop-up camper set up for the weekend. I was terrified. My run was slow but my mind raced over the possibilities. What if I get two miles into the woods and my blood sugar plummets? – how do you ask competitive runners for help? – would I even be able to make myself ask? It couldn’t come to that. Well it could have…and if it had I would have had to make my situation known to someone so they could run on to a water station and inform the staff. I’m sure my instincts would have conquered my embarassment. But my anxiety produced sufficient planning to rise over hills and low blood sugar.
The morning of the race I awoke to percolating coffee and whole wheat toast with spun honey. I cut my normal dose of insulin in half and packed a banana for the car ride to the race site. Belly in knots, Dad and I stretched before the final line up. I checked my blood sugar…160…a little low to start a 6 mile run with. I ate the banana. Surely that would last me. We lined up, a pack of about 70 runners in the cool, foggy air of a mountain morning. The long grass was dewey and I was eager to get running and warm up my body. The whistle blew, the pack took off. There were old and young, men and women, even a high school track team and some ten year old kids weaving around the taller legs. Mile one and two were shaky, but then I saw a girl down in the trail up ahead. She was with a friend – it was two of the runners from the track team. Her ankle was hurt in someway and the friend would stay with her and help, so I decided to run on to the water station to tell the staff there was a runner injured. It was the motivation I needed to forget about my blood sugar fears and book it. Farther than I thought, I reached the station a mile and half later. I let the staff know and they attended to the downed runner – after the race it seemed like it had been only a twist – and I ran on towards the finish with renewed energy.
That energy quickly dissipated in mile four when I met the hill so steep that even the fastest finishing woman later reported that she power walked. There was just no way to run it without gravity taking you back down, so I moved my upper body like I was running and firmly planted my feet with each step. In 0.4 mile it was over though and on the 0.6 steep downhill I let go of the brakes and struggled to keep up with my churning legs as gravity really did rush me down the hill. The last mile was a test of my mantra which had moved from “walking is not an option” to “stopping is not an option.” I ran deliberately, then strongly as I neared a runner about 30 years my senior and another maybe 4 years my junior. I passed the younger runner and tailed the man who was now setting my finishing pace. We both heard shouts and cowbells as we navigated the narrow trail and approaced a blind curve up ahead. I had paced him once but he had overtaken me again and was pulling away. I was letting him go, resolving to finish but not magnificently, when rounding the corner I heard very familiar shouts and then saw my mother standing there, right before the final straightaway, shouting for me to run just like Forrest Gump. I gave her a little shout back and felt myself take off, loving the finish, sailing through the field, forgetting my exhaustion and all the fears I had gone into the race with about blood sugar, about stamina, about making it. The man led me and the young girl behind me by seconds but we all raced through strongly, motivated to better finishing times by the final mile competition. If I’d had wings I would have flown, but instead I just collapsed to a seat on the grass before regaining my strength with a juice bottle waiting for me at the finish line while we watched other runners pushing to the end.

Tags: 10K running