I love starting new things. I am what I would describe as a starter. Maybe that’s why I haven’t been writing lately, because I’ve been engrossed in new projects. But I’m always grateful when I return to older interests and pursuits. It’s a relief knowing that although maybe it is a long arc, I do circle back around to what I’ve invested in previously.
The new thing that I have on my horizons is really a culmination of many elements that have flowed together in my life. In about three weeks, I’m beginning a Master of Clinical Mental Health Counseling Program. It’s a two year program, after which I hope to create a multidimensional counseling practice, that involves in-person, written, and audio support. My focus is, as it has been for the past 10+ years, supporting people with chronic conditions, especially individuals living through acute or chronic instability.
My mission, as far as I’ve defined it, is to help people with chronic conditions live healthier and more joyful lives. My vision is that people with chronic conditions, which is really, at one point or another, all of us, have the time, skills, and support they need to care for their health, pursue joy and creativity, and nurture meaningful relationships.
Care for their health – I used to have a more prescriptive idea about what this meant, but that’s no longer the way I see health with diabetes or other chronic conditions. Sometimes caring for our health means moving more, sometimes it means moving less. Sometimes caring for my health means having ice cream with people I love and bolusing for it and going high anyway. Sometimes that’s what health means for me. My New Years Resolution this year was to eat more cheese. I’ve accomplished it well so far.
Health is also an individually and culturally personal concept. I’ve been proud to work for a diabetes advocacy organization over the past two years that recognizes this and creates space for its volunteers and supporters to define individually what health means and pursue that ideal as their right.
More about the specifics of the vision coming later as I’m sure it will change anyway, but broadly I believe that finding health, joy, and meaning as a society requires deep respect and care for the Earth as our sustainer. In this next chapter, I am excited to weave my original passion for environmental connection and care with my less expected calling of health and well-being with chronic conditions.
My travels to Ohio last weekend were more exciting, but very related to, this post’s title. I have been less interested in travel over the past year, as the COVID overlay has made everything just a little bit more tiring, both in the lead up and the recovery. Wearing a mask all day in the airport, making sure I understand the ever-changing travel requirements, and just being worried in general about the virus has discouraged me. But this past weekend I was happy to be getting out of NC and headed to Columbus for a dear friend’s wedding.
I arrived at the airport a little less than 2 hrs early and made it through security in less than 15 minutes. I settled into the gate to wait for my departure, when it became clear that the flight would be slightly delayed. My connection would be tight, but I’ve made tighter, so it didn’t seem problematic. But then the flight was delayed further. Now we would be arriving at my connecting departure time. Obviously, this would not do.
Before learning that there was no way I would make my connection, I had been entertaining myself by scrolling through my mind to see if I could find something to worry about. I get this way on travel days. I think it comes from the necessary process of asking myself, “do I have everything I need to survive over the next X days?” I usually stick a post-it note inside my front door: “insulin; a way to get insulin into my body; test strips, poker (lancet device), and backup meter; charging cord; contacts; glasses.” If I’ve got this stuff, I’m gonna survive, so I’m good to go. Still, the packing and double-checking leaves me with this feeling of, I’ve surely forgotten something important and, subsequently, a vague sense of unease. But, what I love about travel is that it’s unpredictability almost always jolts me into the present.
This was true when I learned that I would not be making my connecting flight, and even truer when the agent on the phone said, “We’re going to do everything we can to help you,” followed by, “I’m sorry, but there’s really nothing we can do,” in the same conversation. There were no seats on later flights that day from Charlotte to Columbus. “Could I fly into Dayton, OH and rent a car?” the airline agent asked. “Only if the airline will pay for it,” I countered. “Oh, I’m not in charge of that, you can write to customer service.”
We all know that when a company that has its own app and operates giant flying machines wishes for you to write somewhere, this means they intend on doing everything they can to not give you any money.
So I declined Dayton and also declined the option of leaving Charlotte at 10:30 pm Friday and arriving in Columbus at 10:30 AM Saturday (“What? how could this even be possible?..” you ask. The layover would have been in Phoenix, AZ. Don’t fly to Phoenix from NC to get to Ohio. Just don’t do it.)
The point of this story isn’t the weird details of how I got to Ohio, although I did make it. Ultimately, I decided to take the risk of getting on the flight (inspired by my previous success) and making it standby for a later afternoon same-day flight. The point of the story though, is what happened to my blood sugar during this whole ordeal.
Graph 1 shows my blood sugar during the hours before and after finding out about the flight delay. Notice how I spike around 11:45 and stay above 200 for much of the afternoon.
Graph 2 shows that I had to take 41 units of insulin that day to keep my blood sugar in range. The other bars show a useful comparison of ‘typical’ days.
Now, don’t let me fool you, there are no truly ‘typical’ days with diabetes, but to give you a reference, my average short-acting insulin use per day has been about 25 units a day over the past few weeks. So, even allowing for the necessary amt. of typical variability, 41 units is an extreme anomaly. Graph 3 shows how many units I used on my return day, which went off without a hitch. Graph 4 shows my blood sugar on a more stable Friday, one week later.
What is it about stress that tends to make blood glucose spike and also makes us more resistant to insulin? Well, it comes down to a few things interacting together.
First, let’s disentangle the state of being stressed from various potential stressors. It’s the process of becoming and being stressed that raises blood sugar – aka the response. I like the definition of stress provided in here, “Essentially, stress can be considered as anything that tends to change the control that you have over our body and our emotions.”1 While I don’t much like this article’s terminology or conclusion, I do like this definition because there is a synthesis that has to happen between a stimulus and the stress response in our body. Some people are stressed by holidays – it’s not that holidays are inherently stressful – it’s our associations with them. When I heard that I would not make my connector, the associations I made were:
I’m going to miss the wedding
I’m going to let all my friends down
I’m going to lose the money I paid for this ticket
All of these thoughts were very paralyzing. I was also low at the time that I was trying to rebook my ticket and literally couldn’t figure out the order I needed to do things in. Interestingly, it was diabetes that got me back on track. Once I recognized that I was low, I stopped frantically flipping between my American Airlines app and my web browser, and hung up the call line I was waiting in. I ate some Annie’s gummy bunnies (sponsor me, Annie’s?) and took some deep breaths. I then realized that I would survive and everything would be fine.
But my blood glucose had already received the signal that it was go time. And in truth, it was. I had to make calls, decisions, perhaps hustle from one gate to the other, so it was great that my body was ready for that. When we get stressed, either physiologically or mentally/emotionally, the body releases certain chemical signals and hormones, namely epinephrine and norepinephrine, to prepare itself to take action.1,2
Brief aside – I hate the term ‘fight or flight.’ It’s overly binary and it leaves out freeze. Personally, I first exercised freeze, as previously described, and then I chose to fight respectfully on the phone with the first American Airlines rep who I talked to, before moving to schmooze, which is really another key omission in the term. After schmooze, I finally landed on plead, which was really the ticket.
Anyway back to stress hormones. So when the body releases these ‘stress’ hormones, they stimulate the liver to actually produce glucose (what, the liver can make glucose? Read about that here and see some cool diagrams).3 The liver releases that glucose into our blood stream, thus raising blood glucose levels.
So at this point, maybe you’re making some conclusions. Perhaps you’ve decided that stress is bad for blood sugar. This used to be my perspective too. Now, however, I would say that it depends. In truth, my body is doing what it’s supposed to do – preparing me to handle a situation. Wow, thank you, body. An important conclusion though, is that your response to stress really matters on a physiological level (I’m looking at you too, people without diabetes). There are a couple of ways I’ve learned to manage the effects of stress that I typically deploy with varying success. During my travel day, I tried to keep some perspective on the issue at hand. I had a support network to help me out if I was stranded, I had a cellphone to call customer service, and above all, I’ve been through things like this before and been just fine. So I reminded myself of that, did some deep breathing, and remembered quicker than I could have that I could handle the situation. The second thing, and this is the most important in my mind related to blood sugar, is that I no longer get as stressed about being stressed as I used to. Earlier on in my diabetes days, I would be watching my blood sugar climb over the course of the day and get so distressed about higher than normal levels. This would then perpetuate the stress cycle and I’d be left with higher than usual blood glucose levels for days. I think that over the course of my time with diabetes, I’ve lessened my expectations for consistency in how I feel day to day, moment to moment. I’ve also tried to let go of that idea of perfect, normal blood sugar, and employ more gratitude for my body’s efforts to get back to stability. I don’t always succeed, but it’s been a relief to try.
The sources linked here will provide you with more information, but remember that no source is perfect or absolutely complete and that no one person’s experience of diabetes is representative of the whole.
People with and people without diabetes, please let me know in the comments how your blood sugar/body reacts to stress and some of the ways you deal with it!
As I alluded to in a recent entry, open conversation, not being silent, is still key right now. In the spirit of embodying my 2017 theme, I’m going to string together a few pearls of wisdom I’ve picked up from the various people who inspire me every day. Then I’ll talk briefly about diabetes, too.
My head is brimming lately with all these phrases and metaphors that my friends have shared with me as the wisdom that guides them around their busy lives. One of my friends, as we were driving down a street full of piles of leaves and Christmas decorations that had been taken halfway down, shared a quote by Martin Niemoller, a Holocaust protester and survivor, which I had heard many years ago but had forgotten until then. It’s important, and I don’t want to forget it again:
First they came for the Socialists, and I did not speak out—
Because I was not a Socialist.
Then they came for the Trade Unionists, and I did not speak out— Because I was not a Trade Unionist.
Then they came for the Jews, and I did not speak out— Because I was not a Jew.
Then they came for me—and there was no one left to speak for me.
So much of what I have to be grateful for in my life comes from the friendships, like that I have with this friend, with wise women and men around the world who are searching for purpose and striving to be all they can be every day. Another friend of mine, who I’ve recently reconnected with, reminded me that we are never through becoming ourselves. And yet another, in a parallel conversation earlier this month, shared a favorite guiding quote of hers, “the most important thing in your life is…your life.”
Translating all that to diabetes management, as is the constant struggle, leaves me with some interesting reflections as well. In 2016 I left the pump and moved back to insulin injections. This was a really positive change for me. Interestingly though, so was the pump when I started with it. Which reminds me that diabetes management, like life, is not a static endeavor. Our needs change and being able and willing to adapt is a sign of healthy coping, not an indicator that we are failing or were wrong before.
Now I’m enjoying more fruit and less wheat, more cooked vegetables and spices and hopefully, just a little less hot sauce and salty condiments. I’m borrowing some wisdom from both my Southern mother and Chinese medicine, that cooking foods, especially in winter, makes the nutrients more accessible to the body and of course easier to digest.
And finally, my 2017 health resolution, both because it directly improves my blood sugar and because it makes me friendlier, is to prioritize sleep. I rang in the New Year with this theme last night. But I’m also hoping that regular sleep will also help me effectively abandon it when I have the chance to work on my last, little, other resolution, which is always my resolution, to dance more.
So in sum, may we never be done listening to each other, learning about life and ourselves, and resolving.
Solamente unas pocas horas mas en el dia Mundial de la Diabetes, y quisiera compartir este infografia que la organizacion JDRF me ayudo en crear sobre mis ultimos once anos con diabetes. Este es una pintura correcta, mas o menos, de las maneras en que diabetes tipo uno me afecta, pero hay algunas maneras mas en que me ha afectado, y quiero mencionarlas aqui tambien. Just a few more hours left in World Diabetes Day and I wanted to share this infographic that JDRF helped me create about my last 11 years with diabetes. It paints a pretty accurate picture of some of the ways Type 1 diabetes impacts my life, but it leaves out a few things, which I would like to mention as well.
Countless Friendships I have found through T1D/Sinnúmero Las amistades que he encontrado por medio de diabetes tipo 1
3000+ Hugs and words of encouragement I’ve received from friends living with T1D and friends and family who are not/3000+ Abrazos y palabras de aliento de amigos que tienen diabetes tipo uno y los que no la tienen
Endless inspiration, from my friends here and abroad, who are continually learning how to live with Type 1 Diabetes in each new day/Sin fin inspiracion, de mis amigos aqui y en otros paises, quienes estan continuamente aprendiendo como manejar diabetes tipo 1 en cada dia nuevo
Something caught my eye last night as I turned into my apartment complex. I was driving home from ‘helping a friend move’, which ended up just being eating popsicles with friends, and it was late when I returned. I’m not sure where the moon is in her cycle right now, so it was dark, and since the fireflies have been dwindling lately, even they were calm.
Then there she was, illuminated in the lamplight, a giant dark flyer against the blanket of beams. Maybe a Cecropia Moth, or an Imperial, I wasn’t close enough to tell.
And she was frantically trying to reach the source, although she seemed capped at her present height.
We’ve all seen beetles and moths swarming the porchlight at night. And there’s been a time when I remembered why they engage in this seemingly futile pursuit. But I don’t right now, and it’s not the point anyway.
She was all alone in the beam, or she at least was the star, because she was all I saw. And it made me think to myself, about the things we set ourselves towards, and fight for, and goals we accept without questioning.
And on the other side of that I thought about her perseverance, her unquestioning dedication to the task at hand. And about how at the same moment that the stresses and to-do lists of my life feel heavy on my shoulders, somewhere, everywhere, a Cecropia Moth is consumed with her all encompassing desire to reach the light.
The first thing I noticed after we pulled into town was the smell of smog. In Bolivia, on the weather report it is common to see ‘smoke’ listed as if it were a naturally occurring phenomenon like wind or rain. But smoke has been introduced into the nation, a byproduct of mining and concrete factories and the wood people burn in their homes to combat the dusty, dry, creeping cold of the Altiplano winter, which runs June through August.
After we’d checked into our hotel in the city center, we rode to the clinic in an ambulance that I’m still not sure the status of. It may currently be in operation, or it may just be the finest van in town. Upon entering the building we were greeted by immediate embraces and kisses from all who had come for the focus group. The first to hug me was a woman wearing a traditional pollera skirt and whose thick, jet-black braid ran far down her strong back. She kissed me solidly on either cheek and rubbed my shoulders vigorously, her eyes glistening with emotion.
That woman was the mother of Angela (name changed), a 19 year old girl who has had Type 1 Diabetes (T1D) since she was around 14. The next day we visited the whole family in their pueblito at the base of a giant tin mine where many of the residents, including Angela’s mother, work to collect minerals from inside the mountain or from the river bed that catches the heavy-metal runoff.
Earlier in the day we had boarded a dusty microbus on the side of the road next to women selling fried breads of all varieties and hot drinks in plastic bags with red straws sticking out of the tied ends. Maria bought one of each for the road. I poured hot water into my orange backpacking mug balanced on one knee and made a cup of instant coffee to sustain me through the morning van ride. We had three home visits ahead of us, separated by miles of pockmarked and potholed roads, and coffee was non-negotiable.
Each day from my time in Bolivia could stand alone as a life-changing experience based on the stories I heard and people I connected with, but this day in particular shines bright in my memory. Maybe it was the sun rising over the arid quinoa fields at the base of the Bolivian Andes, or talking with the teenage sisters who live with Type 1 Diabetes in temporary housing with no electricity or running water. But I suspect above all it was the immense kindness and generosity we encountered from the families we visited. Not only did they share their experiences living with Type 1 Diabetes and managing it in a country where finding supplies is hard and affording them is nearly impossible, but they also filled our stomachs with homemade breads, hot drinks, and even fresh sheep milk ice cream, frozen overnight in the rafters (that was breakfast).
All this social eating was a little tricky for a gal living with Type 1 Diabetes herself, but I came to realize just how immensely blessed I am to be able to manage my blood sugar with an insulin pump and to check my blood sugar anytime I want to. I already had some idea of this, which is part of why I wanted to go on the trip in the first place. I connected with the organization ‘Life For A Child’ (LFAC) because they provide test strips and insulin to children living with Type 1 Diabetes in low-resource nations who lack access to adequate medical supplies. I was hoping my practicum could translate to a learning experience for me and an immediate benefit for others living with Type 1 Diabetes who don’t enjoy the luxuries of management that we have here.My purpose on the ground in Bolivia became to interview, chat with, observe and learn from as many people living with Type 1 Diabetes or supporting those who do. Over the course of three weeks and five cities I got to do over 40 interviews and focus groups with nearly 100 participants made up of youth with T1D, their families, and the clinical staff and volunteers who support them. Everywhere I turned, a new element of life with diabetes in Bolivia jumped out at me. It became apparent that Bolivian cultural values were critical to consider when thinking about successful health outcomes for youth with T1D, especially the role of the family. One participant who volunteers as a leader for the group in Potosí and who has had T1D for 23 years himself, said that in all the situations he has observed, “La familia ha sido fundamental para poderlo apoyar..cree una necesidad, de, en todo diabético, de que la educación no sea sólo en el paciente diabético, pero sea también en su entorno. Ese apoyo a la familia, o esa educación a la familia, creo que también es muy importante, porque es un daño que afecta la familia” (“The family has been instrumental in that it can support…it creates a need, that, for all diabetics, the education not reach just the diabetic patient, but also their environment. This support for the family, or education for the family, I think it’s also really important, because it [diabetes} is an injury that affects the whole family”).
I’ve been marking through checklist after checklist for the last two weeks. The nice man who works at CVS doesn’t need to ask for my card number anymore, he just remembers it.
Today I went to the pharmacy twice, yesterday once, and the day before, yep, at least once.
The last time I traveled out of the country was in 2011. At that time I was preparing for a three month long trip. I quit my job, packed up a huge suitcase and my backpacking pack and filled a lunch box sized cooler full of insulin. This time it’s just a three week trip, and yet I feel like my wheels are spinning as I try to get organized with all these medical supplies.
It’s my first trip out of the country since getting the Omnipod insulin pump. I wore it when I flew to San Antonio for a business trip and to San Francisco to visit two great friends, but never on an overseas adventure and never to a place where I’m not sure what obtaining supplies will be like.
These are some of the diabetes-related supplies I have to carry, and yes, before you say anything, chocolate is a necessity. In the past, I’ve felt so burdened by all of this ‘stuff,’ but in this moment, embarking on this project, I feel so exceptionally lucky.
I am so lucky to be able to afford and obtain these supplies. I am so lucky that this technology is available in the U.S. and that my insurance covers at least a portion of it. And I’m lucky to have so many amazing friends and family supporting me.
When I was diagnosed with T1D 10.5 years ago, a doctor looked at me in my hospital bed and said, “You know, it could always be worse.” At the time, that was not the wisdom I was hoping to hear (actually I was hoping for, “most cases of diabetes clear up in two to three weeks…”). Yet, nearly a decade later I realize how right those words were, although maybe not in the way that doctor intended. I am so very lucky to have been born in this time, with these resources, and this support network, and have such a good starting point for managing diabetes. Not everyone is.
One more thing this time: if you enjoy my blog please go ahead and become an official follower (see the little button bottom right of the screen). It’d be a big help to me and I’d really appreciate it! You can always unfollow or change your email settings if you feel like you’re getting too many notifications from me, but I rarely write more than once a week.
Costa Rica right now. It’s cold here in North Carolina! Here are some pics now and then, side by side. It’s crazy how much our climate shapes us. Right now I’m going to the gym or bundling up for walks, down there I was rambling outside and running by the surf.
Diabetes was wild in Costa Rica. It was the first time I’d ever introduced myself to new people as a person with diabetes. Before that it was all about telling people who knew me that I’d been diagnosed. In some ways, it was sort of a relief to not have to explain how I got sick, stayed sick, and was finally diagnosed. To not have to fight people’s expectations of how I would be based on how they knew me before.
It’s nice to have better words to explain diabetes now. It’s taken me ten years – there have been a lot of hard emotions to sort through when it comes to how much to share, how much to ask for help. Being vulnerable with friends though, and there is a lot of interesting research right now about vulnerability that seems to confirm this, in my experience has blessed me with deeper relationships and more trust.
Even though I know it works, I forget that gratitude is a choice, like a lens you put into your camera to brighten the vibrancy. It always works, sometimes more than others, to heighten our focus on the present and make life something solid to hold on to.
During the two weeks I was traveling over my break between semesters, I slept on 2 different sofas and 6 different beds. The hospitality of my friends and family was heart rendering. I rolled in like a rambler and left full of good food, laughter, and strong coffee. I carried an increasingly buoyant load of love around with me from house to house. I am so exceedingly grateful that in my life I have people who I can feel connected to even when I’m miles away.
These are the people who bring a smile to my face as I’m falling asleep and whose very presence makes me feel healthy and whole. I just wanted to take a moment to celebrate the power of being present with each other, here at the start of this new year.
Twenty-eight years and I don’t think I’ve ever missed a Fall in the mountains – until now. The suburbs of Atlanta where I grew up never felt like home, but I still remember being instantly embraced by the mountains on family travels. When I was a little over a year old, my parents carried me up Mt. LeConte, swaddled against the misty cold in a trash-bag poncho. We spent weekends in our cabin in Toccoa, GA, nestled in a soft pine forest interspersed with tall poplars and beech trees.
During high school my dad and I traveled from Atlanta to Wesser, NC, on Friday afternoons so we could launch into the icy waters of the Nantahala and feel the crisp breezes that sweep through the gorge in early Fall. Needless to say, moving to Asheville a decade ago was more like coming home than leaving it.
In August of this year I loaded up my belongings and drove away from my rented bungalow, my roommate for the past four years, a street full of friends, my nephew who came into the world just a few months before, my job and my mountains. I’m pursuing an MPH at UNC Chapel Hill, so leaving my job felt like a natural progression. The telephone, email and even Facebook help me stay in touch with friends and family. But you can’t call the mountains. I’ve scrolled back through my photo reel, read my old poetry, and meditated with their image in my mind, but still my heart aches for them. Their support and unwavering presence has always inspired me to seek that sort of peace in myself.
Maybe it was an effort to be strong like the mountains, probably it was just self-protection, but I decided I needed to stay in the triangle over fall-break. I would never miss the woods in October, so a girlfriend and I decided to make our Piedmont backpacking dreams a reality.