Dogs and diabetes

Hi Friends,

I’m writing to share a piece I submitted to Diabetes Daily as part of an effort to promote the new fundraising campaign by Life for a Child (LFAC) that features stories from kids with T1D in Bolivia.

Check it out here: Profiles in Strength: A Story of Type 1 Diabetes in Bolivia

One more thing – I suspect I’ll stop posting my blog on Facebook soon, so if this is the way you find out about new entries, please follow me so that you’ll be notified in your inbox. You can always unfollow or adjust email settings if it becomes too much! And please feel free to share this blog with anyone who you think might enjoy it.

Thank you,
Katie

131(?) mg/dl

Yesterday was a wash.

Literally, it was gray and pouring out. I stood by my window at work and felt dampened by the weather.

Figuratively it was one of those rare days when I forget my meter at home – and this left me unmoored, confused, uncertain.

I do this, I would say, about twice a year. I realized it after walking and busing almost all the way to work. I can’t park at my work, so the thought of going back home felt to my maximum-productivity brain like a real waste of time.

In truth though, not having my meter really isn’t safe – I typically can feel my low blood sugar coming on, but I learned yesterday that I really overestimate my ability to feel where I am – so much of that ‘feeling’ is really a complex set of predictions based on my last reading, which ideally is no more than 2 hours ago. And about the safety thing – my rational brain knows that taking the two hours of sick leave it would have cost to go back home for my meter, is a lot less than the amount I would have had to take if I’d had a real problem (read: very low or high blood sugar) because of it.

Every time this happens I think of the kids with T1D who I met in Bolivia who can only test two to three times a day, max. Checking infrequently is their norm. I think of them and wonder how they manage when I feel so utterly lost.

A friend asked me how I was yesterday – I said I don’t know. I didn’t know. How I’m doing is very tied to my blood sugar, I realized anew.

Realizing anew is frustrating isn’t it? We realize, we forget, we tell ourselves it doesn’t matter, and then we have to realize anew!

Anyway, I ultimately did decide to leave work early. When I got home I was in the low 200’s. I took some insulin, did some yoga and then, as a reader so keenly pointed out in yesterday’s comments, of course went low before dinner. About 2 hours after dinner I was 130, an hour later I was 175…can I explain that? Nope. Not even a guess. Too few data points to guess. Correction dose, bed. I woke up at 3:51 AM at 150 mg/dl; at 7 AM at 131 mg/dl. Grateful to know.

“So what’s the plan?” I ask myself, because after forgetting my insulin pen one day, I installed an extra labeled in a plastic bag in our shared fridge. The plan is definitely, as of today, to store a backup meter at work. I have several from years past on different insurance plans, and I still have enough test strips left to get me through a mess up day.

*Reminder about the big, giant disclaimer: I do not have medical expertise and this is not an advice blog. I’m not saying that the way I manage is the right/safe way, or that my goals and targets are right/safe for anyone else, but rather I am simply recounting my experiences as a person living with Type 1 diabetes. 

Diabetes Resolutions

I’m a person who loves resolutions. I love the celebration of shedding old parts of ourselves and adopting new habits built on all of the tremendous self-growth of the past year. That’s what the New Year symbolizes for me. Whereas other times of the year we resist change, both in the external world and the internal world, right around 12/31 we start to act like we think it’s the greatest thing ever.

So I was asking myself, in addition to my all of the resolutions I’d like to make in every other realm of my life, should I have a diabetes resolution? And then I decided, no. Basic diabetes management is a big enough resolution. It’s like asking your friend without diabetes what their health goal for the coming year would be and them saying, “Well, I’d like to start pricking my finger 8 times a day and counting all the carbs I eat and explaining very intimate details about my body to both my closest friends and to complete strangers multiple times a day. I’d also like to introduce a lot of self-shaming and restraint into my eating, exercise, and general lifestyle habits.”

I mean that’s big enough right?

But I was writing in my journal this morning and as I always do I made a note of my morning bg (this is not a ‘health journal’, just my journal journal), and I was moved to also note that the elevated number was likely due to late-night snacking. Now here, I want to make a critical explanation, because I hate overly simplified diabetes rhetoric. It makes it seem like, “Well, if those people with diabetes could just do what they were supposed to do, it’d all be fine!” No! my blood glucose could just as easily sneak high in the night without me having a late-night snack, if I didn’t have enough insulin in my system to cover the sugars my liver is naturally pumping out all the time (just like everybody’s is). And sometimes, not eating after dinner makes this more likely to happen – especially if I finished dinner early and had less insulin in my system overall, perhaps because it was a dinner particularly low in carbs.

The complexity of diabetes is what originally inspired me to write a blog. It’s like being part of a secret world – the ins and outs of blood sugar. I imagine myself like Mrs. Frizzle. taking her class to the pancreas for a day. So I thought, why not make a diabetes resolution and a.) use my blog for accountability, and b.) take you all along on the complicated journey that is every blood sugar reading.

I realize this plan has some flaws. People with T1D are gonna be like – “why would I want to read about her blood sugar when I have to manage my own?” And people without T1D are gonna be like – “why would I want to read about her blood sugar when I don’t have to manage my own?” But whatever, this is my resolution.

So here it is, stated clearly, my small diabetes resolution-experiment:

  • 4 out of seven days of the week, I will cease eating by 8 pm unless I have a low blood sugar and have to treat it (treating it means eating something, FYI).

What this really means for me is that I’ll be prompted to eat dinner earlier and eliminate post-dinner snacking on those days.

I’ll post my BG every morning along with a brief explanation of my theories behind the number. I could be right, I could be wrong, and we’ll literally never know!

Cauliflower is the new steak

Because steak will never be the new cauliflower, I’ve been making this recipe for cauliflower steaks out of Bon Appetit magazine, as often as possible lately.

Often I tell people that, while I can eat anything with diabetes that I want as long as I cover it with insulin and exercise, etc., I generally avoid white foods, as these tend to be laden with quick-burning, simple carbs.

Of course the cauliflower stands in stark defiance of this rule. For example, if you eat a whole head of cauliflower* you have consumed only 146 calories. That is crazy. Also only 29 grams of carbs and a whopping 12 grams of fiber. For reference, one Clif bar has roughly 250 calories, 42 grams of carbs, and 5 grams of fiber.* As you can see, raw cauliflower is clearly the better cross-country road trip snack.

That’s a joke, but the cauli steak recipe really has changed the way I think about this Brassica. It’s buttery, rich, and delicious, and goes great underneath sauteed ground pork with sage, and I imagine underneath many other meat and vegetarian-based proteins. Plus, diabetically* speaking, the steaks and the accompanying puree both have an almost potato-like heartiness that I often miss, without delivering a big punch of carbs. And also it’s totally beautiful to look at before you eat it or serve it to your loved ones. Let me know your thoughts and variations if you try it out!

img_1139

*https://www.nutritionix.com/i/clif-bar/cool-mint-chocolate/5b4f8589a9db904b1fcf24f1

*USDA, google sidebar

*As always, this is a made up word (but aren’t they all?) that you shouldn’t use in scientific papers or elsewhere.

Does diabetes limit your life?

My dad came to visit me for Father’s Day this past weekend. After dinner one night we got to talking about my work and about how the landscape of diabetes and its management has changed over the years. He asked about my experience of living with diabetes and how it had changed over the past 12 years or so. Dad, who I probably haven’t ever talked as openly about diabetes with, was more willing to be curious than I previously remembered. He asked me: “So – do you find that it (diabetes) limits your life?”

What an interesting question.

If you had asked me two days after diagnosis, I would have started bawling and talked about all of the dreams I had that I could never do now that I had to tote diabetes around with me. Dreams like: hiking the AT, kayaking in a remote jungle, abandoning society with no cellphone or attachment to the outside world…

If you had asked me two weeks after diagnosis I would have given some sort of manic response cloaked in coping positivity, like, “No! It has made me stronger, more organized, and more appreciative of life!”

If you had asked me two years after diagnosis I would have probably given you some more truthful examples, like how hard it was to be a summer camp counselor only 5 months after I’d been diagnosed; to be chipper and on full-time, while trying to give myself shots, check my blood sugar, eat someone else’s cooking, sleep in a cabin full of 8-year-olds, and otherwise make sure everyone was safe and entertained.

And then there have been other moments when the thought of doing it and doing diabetes, was just too much. I’ve said no to weekend plans and trips with friends, stayed in at night because I didn’t want to have to keep strategizing about my blood sugar so that I made sure to be at a good level to drive a car.

But – and I may be conveniently forgetting something – I’ve never not done anything I really wanted to do because of diabetes. Maybe I’ve been more exhausted before, during, and after it, maybe it’s made me ask myself how important something was to me before committing, but I’ve kayaked in a jungle, have gone on long trips, and have otherwise lived the life that I wanted to.

And – what’s interesting is how the “life that I wanted” has changed. My desires seem to be increasingly able to co-exist with a life that gives me space for diabetes management.

Natalie Goldberg says our obsessions can be our inspiration – and I’d be lying if I said I wasn’t obsessed with diabetes. But I’d also be lying if I pretended that obsessions wasn’t a prerequisite of diabetes; either you’re obsessed with it upfront in order to manage the moment to moment decisions and tasks, or you end up obsessed with the symptoms of high or low blood sugar, and other short and long-term complications. And to say I’m obsessed with diabetes is really barely scratching the surface – what I’m obsessed with is what diabetes represents – the interaction between our bodies and our environments. Between the internal and external world. Diabetes gives you a front row seat to watch the effects of every bite of food, every step you take, every bit of anxiety you hold on to, minute of sleep you get, sunburn, bug bite, cold, allergy, all of it – it’s all a weird dance. Or orchestra. Or rowdy old-time band (represented by featured image taken at Shakori Hills music festival, 2018).

So, after traveling a long and winding mental road to an answer, I replied to Dad that the question didn’t quite fit for me anymore. It was the first time I’d realized this, that the answer required a reimagining of the question. Deciphering whether diabetes limits my life, or impacts it in positive or negative ways doesn’t make sense anymore, because it’s an inseparable part of my life and experience. And letting go of that qualifying, deciphering, and even meaning making, feels like a relief.

Waffle Fries and Celery Root

February can be rough. The days are short, the weather is temperamental, winter closes us inside of its blue shutters…

But luckily, we have created several traditions to get us through, one of my favorite being, in atypical fashion, SUPERBOWL SUNDAY!

I, like many of you, went to a Superbowl party a couple weeks back and found myself so INSPIRED. Let me preface this by saying that in between the 2017 and 2018 Superbowls, I watched 0 minutes of football. So, it’s always a fresh experience for me. I couldn’t believe how physically strong the players were. I was also very captivated by how delicious the various party foods involving potatoes were. There were waffle fries (not from Chick-fil-A!), homemade potato chips (in three varieties!), and baked potatoes with gruyere. So, based on these two observations, I added two resolutions to my list for this year: 1) workout more; 2) eat more potatoes.

When I got home from the party, my blood sugar, despite a lot of extra insulin and monitoring, was above 200 mg/dl. I don’t like this – I don’t feel good when my bg is high and taking extra insulin before bed is a little frightening because of aforementioned nighttime lows. So I put the potatoes on the back burner, so to speak.

I did start moving more though. Yoga and walking have been good, along with a class or two at the student rec center. So with goal #1 underway, I got back to the potatoes.

Recently, I ordered a dish with shaved celery root when out at a restaurant. Between ordering and receiving my food, I forgot about this, and when it came I thought I was eating hashbrowns. Fancy hashbrowns, but still. So this weekend at the grocery store, remembering my positive celery root experience, I decided to branch out of my cooking rut.

If you’ve ever bought a celery root (also known as Celeriac), you know just how unappetizing it looks in its natural form. Celery root is, in fact, so ugly that I can’t believe we discovered it was edible. I can’t imagine being that first person to look at it and think, “I’m gonna eat that.”

But someone did and I’m glad.

It’s really a vegetable that you have to tackle – which goes well with the general metaphor of this post. I used this recipe from Bon Appetit for Celery Root Steaks with Tomatillo Salsa Verde as a basis.

Except I didn’t make the salsa because I planned to just pile my other food on top of the steaks.

Here’s a detailed play-by-play:

  1. Scrub that thing! – I took my veggie brush and I scrubbed the root thoroughly, rinsing under cool water.
  2. Peel it! – I took a carrot peeler and shaved off the rough skin (yes, even though I’d just scrubbed it), until it had a mostly smooth texture. Then I used the scooped end of the peeler to get out the fuzzy, radish like whiskers (ugh) near the end and smoothed once again over the top and bottom.
  3. Preheat it! – I was already baking brussels sprouts, so my oven was on 450 degrees.
  4. Slice it! – I sliced it into rounds, about a 1/2 inch in thickness, until I’d cut up about half of it. Then I cut it in half so I could lay it flat and cut half-moons of the same thickness.
  5. Sauté it! – I added quite a bit of olive oil to a big cast iron skillet, set this to heating on the stove, and laid the slices down into it, turning it down to about 6. I let them sizzle on each side for about 5 minutes total, flipping impatiently. I think the recipe is correct – 4 minutes each side with only one flip would have given a better, golden brown to each.
  6. Bake it! – About 10 minutes on high heat for a nice, tender texture (recipe says until it can be easily pierced with a fork or butter knife).

Pro tip: if the steaks are tender but you want more of a golden brown look, flip them over to serve; most likely they are browned on the pan side.

So, how do celery steaks stack up to potatoes, ounce for ounce?

1 cup celery root weighs in at 66 calories, 14 grams of carbs, and packs a powerful punch of 2.8 grams fiber, according to google.

Potato comes in at nearly double all of the above (except fiber): 116 calories, 26 grams carbs, 3.4 grams fiber, per cup.

So to me, diabetically speaking, Celeriac is the clear winner!

Oh and finally, Happy Valentine’s Day.

 

 

 

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.