Second D-versary

Today is (I think) the second anniversary of learning of my diagnosis as a Type Two diabetics.  (I told that story here.)

I can't say that I'm grateful to be diabetic, but I am grateful to have been diagnosed.  Many Type Two folks are only diagnosed only when they develop complications.  So, it's definitely a blessing to have the opportunity to minimize the likelihood of those complications.

Is my life different since diagnosis?  Well, I certainly eat better.  And I think I feel better physically than I did before, even if that's not true every day. I think my health future may be brighter, too: I was on a pretty bad path before I started making changes, so it's likely something would have come up even if diabetes didn't.  

Two years is just a beginning, I know: there's a lot of life to life yet.  I look forward to learning to live it ever more fully.

The Jelly Jar

I don't know if other people do this.  But for me, the strangest things can take on symbolic importance.

I have a cheap little plastic three-drawer storage unit in my bathroom.  One of the things that lives in the top drawer thereof is a glass pint jar.  I don't know what it originally held, but it LOOKS like a jelly jar, so I'll call it the jelly jar. The lid's been gone for years. It's functioned as my bathroom glass for when I need to brush my teeth, take pills, or just get a drink.

The jelly jar and I have been through a lot together.  The jelly jar did hard time in the months before my diagnosis, when I would drink it dry three or four times in a row, multiple times a day and sometimes multiple times a night.  So, the jelly jar has been my friend.

But the jelly jar has also been my enemy.  Well, not enemy, exactly, but a potential danger.  My bathroom floor is hard tile. I realized very shortly after my diagnosis two years ago that keeping a readily-breakable glass object in a room where I'm often barefoot was not a good plan, and that I should replace the jelly jar with something plastic.  It took me eighteen months (just how crazy does that sound?????), but I finally did get a small plastic container that works well.  But the jelly jar has remained in its drawer, both an old friend and a symbol of an extremely simple thing I could do for my health but which I haven't done. 

This morning, I threw away the jelly jar.

Greatest Doc Appointment EVAH

Three questions, two unanswered:


Question One: Where do I go to get a lab report framed?

I met with my doctor today to get lab results from last week's blood draw.  I was very anxious about this last night: I even tweeted about it.  (Bless those who responded.)  In conjunction with stress over some other issues, the worry was enough to keep me up most of the night.  The reason for the worry was that I was absolutely convinced that my A1c was going to be way up.  I even spent part of today's wait reading up on the meds used in conjunction with Metformin when the Met is no longer enough, assessed by their proclivities to produce weight gain or hypos.

Why was I so convinced of a bad result?  Well, DUH - my diet is horrible, and I don't exercise enough.

The results?  A1c 6.0, down .9 from a year ago.  Total cholesterol, LDL, and triglycerides within desirable ranges, HDL a wee bit low.  The most amazing part was my doctor telling me, "You're doing everything right.  Don't change a thing."

I have NEVER had a doctor tell me anything like that.  Not anything within a hundred miles of that.  The last doctor I saw more than once seemed to despair of my ever being able to make good choices.

Question Two: So why did my expectations very so far from reality?

Well, certainly my inborn tendency to expect disaster is part of it.  But I really, truly, believed that my choices, along with my upward-creeping fasting numbers, reasonably led me to expect a pretty big jump.

Here's what I think accounts for it:  I think of "perfect" diet and exercise as my goal, with suboptimal choices (and there are plenty of these, sometimes plenty bad) being viewed as damaging, moving me towards complications and heart disease.  Perhaps the reality is that good choices (and there are plenty of these as well) represent not a baseline but as actively moving me towards wellness.

Question Three: Is it really possibly that I'm not slowly getting ever sicker, day by day?

Boy, do I feel good.

I Want a New Feed

I've previously addressed various frustrations with health/diabetes news feeds -- you know, the ones that constantly tell me that something I've got probably caused something else I've got or puts me at dire risk for something I don't yet have.  There are other traps, too -- over the last couple of days, I've seen a number of things about the Dire Awfulness of something I do that I'd regarded as pretty dang benign.  Oh, joy.

I want a new feed -- a custom Bob Health News Service.

In order for this service to work, I'd daily post a few things that I did well in the health area, or at least failed to do wrong.  The service would respond with a drizzle of stories about the wonderful benefits of what I'd done.  For example, tonight I cooked unbreaded chicken wings, put about half of them away for tomorrow, and also had some spinach.  When I went to look at my feed, there would be stories proclaiming the virtues of small changes, how much fat is saved by not breading fried food, and the wonderous benefits of green leafy vegetables.  On a day when the best I can say is that I didn't eat barbecued ribs with my pizza, the stories would be along the lines of "Continued Respiration Proven to Delay Death!"

Doesn't that sound like fun?

Meet the New Doc

Today, I had an appointment with a doctor that I'd not seen before.  I was pretty nervous: I blogged about this last week, and last night asked on Twitter for thoughts and prayers about it.  (Many thanks for those of you who did this for me.)

Since arriving in Kansas City about 15 years ago, almost all of my doctors have been interns in Family Practice clinics.  I'd see the same intern as long as they were here, then they'd leave and I'd be assigned a new one.  This was okay, though I had anxieties each time I had a new one, but since my diagnosis I was coming to feel that I'd like a longer term relationship.  I decided to try a clinic that's so close to my work that I don't actually have to go outside to get there, although it's probably easier to do so.

I like her a lot.  She's somewhere in the 35-45 range, I'd guess, so at least we're approximately the same generation.  The phrase "efficient but unhurried" from my earlier post fits perfectly -- I certainly didn't feel invited to chat, but I also felt that I could ask my questions. 

One, thing, though -- she wants to schedule me for The Test Which Must Not Be Named.  Aaaaaauuuuugggghhhhh!!!!!  I have no desire to have any tubes put there! :)

I'll be meeting with her again in a week to go over test results.

Diabetes Blog Week: Sunday - If There Was A Cure

Today's topic was to discuss what I would do should there be a cure.

My first response, I confess, was silly.  Find a good Italian restaurant.  Order angel hair pasta with olive oil, garlic, and good parmesan.  Tell 'em to keep it coming until I cried "Uncle!".

But then I thought more about it.

If I could take a pill....

If I could take a pill that would not only make my insulin resistance go away but undo any damage that has been done to my pancreas....

If, further, this wonderful little pill also magically cured the whole cluster of maladies that like to hang out with Type 2, such as high cholesterol, hypertension, sleep apnea, and depression....

If all these things were true, if all these symptoms went away....

Wow.  What would it be like?

What it would be like to not worry every time I eat, every time I fail to exercise, every time I forget my meds, if I've just made the "last straw" mistake that will doom my pancreas, my feet, my kidneys, my heart, my ability to recognize my friends, or my ability to face the day?

That would be a new day, indeed.  And I'm unable to imagine what it would be like.

Diabetes Blog Week: Saturday -- Picture This

I've spent a fair amount of time thinking about what word I would use for the "Word in the Hand" project done over at Tudiabetes.org.  About a month ago, I came up with my word, and thought I would share it with you today.

My word is "waiting", and it seems to me to be a good word for my stage of Type 2 diabetes, at least as seen through my personality.  Right now, my health is okay.  My fasting BGs are normally pretty good, and beyond feet that sometimes tingle, no signs of any complications.  (As far as that goes, my circulation could be iffy for completely non-diabetes-related reasons. )

But, how long is that going to last?  I'm waiting for something to go wrong: a significant decrease in pancreatic function requiring more aggressive treatment, the onset of complications, maybe even a cardiovascular event.

Yes, I know: I should be optimistically and with self-empowerment and faith making those changes that might well help me prevent or long delay any of those things.  Yet one more healthy habit I don't seem able to pull off.

You can also see photos relevant to my diabetes life in this post and in this post.

Diabetes Blog Week: Friday - The E Word

Exercise.  It's important.  I know it is.

When I exercise regularly, my fasting numbers are lower and my post-meal numbers don't appear to go as high and come down faster.

Exercise is good for, well, everything.

I saw a headline on a podcast the other day (I haven't listened to it, yet) about how exercise may help prevent Alzheimer's disease.  My dad has Alzheimer's disease.

I walk to and from work essentially every weekday.  That forms a basis of about 25 minutes a day of moderate walking.

But more than that?  Well, crud.

My Eyebrows: A Chronological Outline

1960 -- I, and my eyebrows, are born.  Hordes of researchers have failed to produce any contemporary notice of my eyebrows whatsoever.  We must then assume that they differed in no way from the eyebrows one would expect on an infant that resembled Winston Churchill.

1960-1995 -- My eyebrows show no expansionist tendencies.  They lie waiting.  And plotting.

1995 -- I mention to my sister that I am on my way to get my haircut. She suggests I ask to have my eyebrows trimmed.  I shrug it off, deeming it ridiculous.  When I arrive for my haircut, I am asked if I would like my eyebrows trimmed.

2000 -- I begin trimming my own hair, doing so roughly monthly.  I trim my eyebrows first occasionally, then about every other time, then almost every time.

2010 -- Circa May 9 of this year, it becomes clear to me that my eyebrows require trimming, although my hair does not.

Where is this going?  Are my eyebrows in on Siah Sausage's plot for world domination?  I have fear.

What I Want From My Doctor

I'm seeing a new doctor on Monday, one I've never seen before.

Throughout my time in Kansas City, I've always gotten my medical care at Family Practice clinics, where I would be seen by interns.  They'd assign the same intern to see me every time, but after a year or two the intern would go on to the rest of their career.  Some of these folks I've liked, some I haven't. 

So, on Monday, I'm taking my care to a new clinic, one so near my workplace that I don't technically go outside if I don't want to. 

And, I'm feeling some anxiety.  So, I thought I'd summarize what I want from my new doctor:

• I want her to have experience with Type 2, but not the sort that leads her to think that we're hopeless.  
• I want her to be receptive, though not necessarily agree, when I ask about Byetta sometime in the next couple of appointments.
• If she needs to explain risks I face, she needn't phrase those risks as threats. ("If you don't lose weight, I'm going to raise your dosage.")
• I want her to be kind.
• I want her to be efficient but unrushed. I want to not have the feeling that her most important patient is the next one.
• I want her to check my feet.  They don't NEED checking, especially, but I need her to be attentive to the basics.  In the two years since diagnosis, my feet have never been checked, despite all appointments having taken place in rooms with posters reading "Diabetics - Show Us Your Feet!"
• Finally, if I like her, if she's what I need, I want her to be available to me for a long time.

Diabetes Blog Week: Thursday - The F Word

The "F-word".  Food.

Most folks with diabetes have complicated relationships with food.  Not only am I not an exception, I might be the poster child

At some point, I should try blogging about all the various ways I manage to screw up my food life, but I'm really not up to that.

So, here's what I TRY to do about food, without answering the touchy question of how often I pull it off.

Because I'm obese in addition to being diabetic, and because my risk of heart disease is huge, I try to eat reasonably low carb and reasonably low fat.  In practical terms, this means trying to focus on the veggies with enough protein and starch to make it to the next meal without discomfort.

Breakfast these days is half a cup of All-Bran with cinnamon, Splenda, skim milk, and sometimes flax meal.  (The cinnamon really helps the flavor.) I eat this out of a dixie cup both so that I don't have a bowl to wash and so that half a cup of cereal doesn't seem really small.  Supplemented with a string cheese, this gets me through to lunch.

On a good day, I take my lunch.  This will be some kind of vegetable entree (like the ratatouille stew I invented) with some chicken breast or something to fill it out.  The carb will be a sandwich thin, some brown rice, or a "variety grain" like quinoa or barley.  Sometimes I have a salad bar instead of the above, but I can't eat lettuce salad too often without risk of crankiness.

Supper (as I was raised to call the evening meal unless it's an event) is similar in concept to lunch except that the portions are larger.

That's the goal, anyway.

Diabetes Blog Week: Wednesday -- Sources of Support

My biggest source of support in my diabetes life is the Diabetes Online Community.  I do have one close T2 "in person" friend, but diabetes is not a big subject of conversation between us.  I rely on the DOC for friendship, information, and (above all) constant reminder that I have to take this diabetes thing seriously.  My approach to the Big D is certainly questionable, but I'm confident it's much, much, better than it would be without my daily DOC involvement. 

Beyond the DOC, it's a touch iffy.  Neither my family nor other close friends are really in a position to offer much diabetes-related support.  I do have a nurse and a life coach through my insurance company, each of whom I talk to by phone approximately monthly -- they have been significant help.  I'm starting with a new doctor later in the month, but none of my recent physicians have been much help beyond writing prescriptions.  (In nearly two years, nobody has yet looked at my feet.)

So, I'm very grateful to my friends at Diabetes Daily, my Twitter buds, and the authors of the blogs I read. 

Diabetes Blog Week: Tuesday - Hypoglycemia

As a Type 2 diabetic treated only with oral medication, there are some experiences common to other diabetics that I've not yet had.  Since my only diabetes medication is Metformin, there's one such experience that's huge:

To the best of my knowledge, I've never been hypoglycemic.

I hasten to add that I'm in no way deluded that this is evidence of sound diabetes management.  It's a function of my current disease state, my current therapy, and a certain amount of luck. 

Older medications used with T2 were more likely to produce lows: my dad used to have them regularly.  And a combination of metformin and the older meds can produce them: my neighbor lady goes low on occasion.  But for those of us on metformin only, I understand that my experience is common.

Because T2 is a progressive disease, I expect that my share of lows is coming.  At some point, as my pancreatic function diminishes, hypoglycemia awaits. 

I have discovered two things that have taken me to the bottom of the normal range, and therefore deserve some caution: heavy exercise and Kansas City summers.  So, I need to control the intensity of my exercise (not a huge problem anyway) and be careful about the heat of the day in July through September.

I do have glucose tabs at work, just in case, and my coworkers have been told where they are.  I also have some at home.  I'm familiar with the basic hypo treatment formula of test, eat 15 carbs, wait 15 minutes, retest.   For when my time arrives.

Diabetes Blog Week: Monday - My Type Two Day

(This is a lightly edited version of a post that first appeared 1/10/10.)

Here is what I do (or should do) about my T-2 diabetes on a daily basis.  I'll try to be pretty honest about what I actually manage to accomplish and what I don't.

Note: take NONE of this as advice.  My sole goal here is to give a picture of what I do (or try to do).   Go forth, and discover what works for you.

1.  Medication
It took me a long time to figure out how to be regular with my meds.  I now have one large 7-day pill sorter for morning pills and another for evening pills.  (I'd be a little better off by doing one for dinner time as well, since a couple of my bedtime pills would be better at that time, but I haven't implemented this yet.)  Using the pill sorters means I only have to think about the pills once a week.  This is a Good Thing.

I currently take prescription meds for diabetes, for blood pressure, for cholesterol, for glaucoma (not diabetes related), and for one or two other things.  I also take a number of over-the counter supplements which have been credibly (to my satisfaction, anyway) recommended at one time or another.

2.  Testing
Most Type 2s seem to be told to test once a day in the morning before eating.  That number is used as sort of the baseline for how your diabetes life is going.  I work at not letting myself be too up or down about a given day's number (unless it's way out of whack) but to watch the trend, expressed as "about how I've been running."  I think it's safe to say that I do this more often than not, but I go in spells of not testing several days in a row.

When I'm being conscientious, I test once or twice more during the day.  I don't have a set pattern for this: sometimes I'm checking on the effects of a particular food, if I've come down satisfactorily after a meal, etc.  If I feel weird physically or emotionally, I sometimes test to see if there's a blood sugar relationship.  (Usually, for me, there isn't.)

I'm not very good at all about testing my blood pressure, which I should also be doing on occasion.

3.  Food
Oh, boy, is there conflicting advice about optimal eating plans.  I try, when I'm doing well, to eat reasonably low carb AND reasonably low fat.  Eating this way, with exercise, helps me to lose weight.  But I'm not very good at it.  It's easy for me to feel discouraged about this area, but I have made progress in terms of laying off many of my worst choices or indulging only occasionally.

One thing that works very well when I do it is to plan a few days at a time, then hit the grocery store.  My basic approach for each meal is to plan for some veggies and/or fruit, a modest amount of carbs, and a lean protein source.  I try to lean in the direction of whole grain stuff for the carbs.  (In particular, I find that I do well on brown rice, while white rice is a spike food for me.)

4.  Exercise
I'm off-and-on here.  The exercise I most enjoy doing is walking, but iffy weather and tiny injuries don't always allow for this.  I'm experimenting with other things.  I recently got a Wii Fit, but am inconsistent.  Exercise videos tend to leave me feeling fat and clumsy.

I will tell you this: when I am exercising regularly, the effect on insulin resistance is very marked.  I not only see it in my morning numbers but think I have a much faster return to "normal" BG after eating.

That's my Type 2 Diabetes day.  (Sometimes.)

Depression and Lifestyle Change

In a recent post, I discussed my experience with depression.  Here I want to think about how depression may impact attempts to make the lifestyle changes appropriate to dealing with diabetes.

• When I'm depressed, I tend to feel a serious lack of energy.  Exercise seems like it requires an investment of "oomph" that I don't have, like asking a family in poverty to contribute to a savings account.  An excellent idea, but it just feels impossible.  (Ironically, research has shown - and my experience confirms - that exercise is a powerful treatment for depression.)
• When I'm depressed, the way I normally do things feels like survival strategy.  I suppose that most people have habits they fall back on during tough times.  For me, that involves climbing in bed and grabbing a crossword, a computer game, a favorite book -- anything that allows me to turn off my stupid brain. (I'm fortunate - no, make that blessed - that I never got into drugs or alcohol: I don't think it would be pretty.)  I'll hide away like that for the whole evening, or even the whole weekend.  This strategy does nothing to help me feel better, or to take care of my diabetes -- but the pull of this practice when things are crazy is very, very strong.  And the strong pull of the old tricks makes it that much harder to try out "new tricks" such as exercise, meditation, reading positive literature, and finding new activities.  
• When I'm depressed, medical appointments and even testing feel like judgments on my character, on my value as a person, that I just can't face.  (Yes, I know this is absurd.  That doesn't help.)  Not getting regular medical appointments means that I'm not getting the information I need, and maybe not even the tools I need, to better control my diabetes.

So, for me, part of lifestyle change includes learning some New Tricks when it comes to dealing with depression.  Not an easy thing.

Anatomy of an Evening

7:00 PM: "Man, I'm dragging...I don't dare go to bed too early, though....better wait until 9:30 or so."
8:00 PM: "Is 9:30 EVER going to come?  I can't keep my eyes open."
8:30 PM: "You know, I have an idea for a blog post....better make a few notes for it, since I can't go to bed yet anyway."
8:50 PM "I'm pretty happy with this draft...guess I'll post it.  Gee, I"m not quite as sleepy."
9:15 PM "I"ll just hang on Twitter for a while, then try to go to bed."
9:45 PM  "I don't think I can sleep quite yet...guess I'll watch something on DVR."
10:30 PM "Gosh, this is pleasant, just listening to the radio and playing Solitaire."
11:45 PM "Guess I'll do one last e-mail check."
12:00 PM "MIDNIGHT!  I gotta get up in six and a half hours!  What in the world happened to going to bed early??????"
6:30 AM "Bleeeeaaaaaaarrrrrrrrrgggghhhhh......"

Mr. Crankypants

I don’t know if this is true of others – barring reincarnations I’m unaware of, I’ve only been me, after all – but I am quite often a cranky person.

 

Because I know this about myself, and because I believe so strongly in treating people as well as I’m able, I’m able to keep this aspect of my personality subsumed most of the time.  If you follow me on Twitter, you may have noticed that I often joke about feeling cranky or grumpy.   But it’s not really joking – talking about feeling grumpy is part of how I keep from expressing it in more harmful ways.

 

To some extent, crankiness is a function of the depression I’ve written about previously.  But I think it’s also who I am.  So many things annoy me, and even I recognize that many of them are silly.  (The fellow in the next cubicle over likes to give his stapler a good firm thwack when he uses it – how dare he!.  C’mon, Bob, get a life!)

 

When I’m feeling cranky, I get irritated by loud noises, irregular noises, crowding, getting jostled, almost getting run over (wait, that one’s reasonable!), my phone ringing, stupid opinions, these kids today, and the prophecies of Nostradamus.  As I age, the word “curmudgeon” has been known to show up in descriptions of me.  Can I help it that I have Andy Rooney eyebrows?  Someday I’m going to have to get a place with a lawn just so that I can yell at little kids to get off of it.  (A corner lot is probably the best value in that respect.  Even when the kids aren’t actually ON my lawn, I could fume about the “cow path”.)  OK, I really wouldn't yell at little kids.  But apartment living might be a good plan anyway.  :)

But seriously, folks.

Is this a huge problem for me?  Well, no.  As I said, I'm pretty good at keeping it from showing, or at least from snapping at people.  But it is another way that a good day can go bad, creating a spiral that I don't often know how to turn around. 

 

I have, by the way, checked to see if there are weird blood sugars behind these moods.  Alas, there's no excuse in THAT area.

I do find that meditation (or focused breathing, as I sometimes call it) sometimes helps.  It would probably help a lot more if I practiced more regularly. 


Now, if you'll excuse me, I'll close this post -- that ice cream truck is making me NUTS!

Recipes and Cookbooks for Diabetics: Know Your Needs

I have no problem with the publication of cookbooks or recipes intended for diabetics. (Sometimes, collections of such recipes are called "diabetic cookbooks", but as my Twitter friend Tina pointed out, cookbooks can't get diabetes.)  Recipes like this can be very helpful for many, but as with so many issues with diabetes, we need to be thoughtful and informed in choosing what to cook and eat.

The issue is this: people with diabetes (PWDs) have a very wide range of dietary requirements, depending on treatment, other medical conditions, personal philosophy, and other factors.  Some folks on insulin require a small, tightly controlled portion of carbs, while others have more flexiblity as long as the carb content is known.   Because of the vastly increased risk of heart disease that diabetes brings, some folks may need to restrict saturated fat or total fat.  And, of course, many diabetics need to keep an eye on total calories.  Because of diabetes and conditions such as celiac disease can go together, some diabetics may need to avoid wheat flour or other conditions.  And, of course, some PWDs are choosing to avoid some or all animal products.

The key to finding recipes or recipe collections appropriate to you is to know what your needs are and to be able to recognize ingredients that may be a problem for you.  If you feel unsure about this, a visit with a dietician or diabetes educator might be helpful. 

To the Diabetes News Services

I lost my temper today.  I felt angry, frustrated, hurt, insulted.  Yes, I overreacted, but I think my complaint is legitimate.

This afternoon I visited one of the several web sites that provide summaries for and links to diabetes-related nes stories.  As near as I can tell, this site is intended for patients rather than physicians. Like others do, this site tags each of the stories so that you can click a link on the home page and find the stories you're interested in.  I clicked on "Type 2".

The first story that came up was about how moderate alcohol use might help prevent Type 2 diabetes.  That's great, and if the findings hold up, I hope they help some people.  BUT I ALREADY HAVE DIABETES.  THIS INFORMATION DOES NOT HELP ME.  IT CAN NOT HELP ME.

I have seen HUNDREDS of stories about the prevention of Type 2 in similar listings on similar sites or RSS feeds.  I have no complaint about the story itself.  And it would be perfectly appropriate to group such stories with Type 2 in services aimed at medical professionals or those interested in public health.  But not for patients.

You see, not only do stories like this not help me, they hurt me.  "Hey, Bob!" the (unintended) message is. "Not only did you eat too much and exercise too little, you didn't booze it up!  If you had just had some wine once in a while, you could be enjoying that pesto you made over a big steaming portion of white-flour linguini!  It bites to be you, huh?"

My plea to the news services is simple: come up with a new tag.  Call it "prevention" or "public health".  Call it "George" for all I care.  Just save the "Type 2" tag for stories actually aimed at me, on Type 2 care or treatment or whatever.

Please?