Holiday Survival Guide

I once wanted to become an atheist, but I gave up - they have no holidays. ~ Henny Youngman      


        The holidays are finally here! This means the arrival of candy canes, holiday parties, and of course gift giving! While as wonderful as they are, the holiday season can bring stress and unforeseen complications.


         Different treats and goodies, especially if homemade, are difficult to adjust for in terms of insulin amounts.  I always try to adjust on the lower side if at a party or gathering, because I'd rather run a little high than low.  Carrying your carb counting book with you when you go out can be a good idea.  


         If you're hosting anything, tweaking recipes to reduce the carb or sugar count can be a good trick as well.  Even though diabetics can eat any kinds of food as long as they adjust for them, lower carb foods are easier to eat and help reduce sugar spikes.  Here's a recipe for a pumpkin cheesecake that's only 7 grams of carbs per slice! 


         In terms of holiday shopping, long lines and extensive wish lists can be draining for anyone, especially when lunch time rolls around and the food court is packed.  I always like to carry a few snacks like granola bars with me in addition to the usual glucose tablets. 


         The idea of navigating holiday parties reminds me of a concept I learned at the beginning of the semester, the idea of a public sphere.  This sphere is fostered by individuals who connect with one another separate from the greater forces of the government or public institutions.  Holiday gatherings are much like specialized public spheres: ideas are exchanged, connections are made, and individuals become part of a larger group.  This season, try using your public sphere to your advantage.  You never know what social capital you may gain!


Happy Holidays!

It's Finals Time!

         Who doesn't love finals?! Long, sleepless nights, stress eating in the dining hall, and cranky peers: what's not to love!  Dealing with the stress that final exams, presentations, and papers bring is hard enough, but being diabetic makes this time no easier to say the least.  

          I've found that stress usually drives my sugars up, although if I don't make an effort to eat enough before an exam I've fallen low during the middle of a class as well.  It's always important to test your blood sugar at least a couple hours or so before heading into an exam, so you'll have time to correct.  And then be sure to test again to make any other minor adjustments and avoid any surprises.

         It can sometimes be helpful to discuss your condition with your professors upfront.  That way, if an issue comes up during the middle of the exam there's a better chance they'll be more understanding.  However, when you're in a large lecture class it can be hard to feel like your condition will really matter that much.  But its important to remember you have every right to stand up for your health. 

         When studying, both high and low blood sugars can affect your concentration.  Difficultly reading, headaches, and blurred vision can all be signs that you're experiencing hyperglycemia.  It's easy to have several hours in the library pass by without stopping to test your sugar.  I'll sometimes set a timer on my cell phone or iPod to remind me. 

    

         Joseph Campbell is the creator of myth theory, which essentially states that all stories follow one standard outline.  The hero sets out on a journey with a set end goal, and along the way discovers something greater about themselves.  There are guides, challenges, danger, and elixirs that arise during the journey.  The journey that every student (hero) takes during finals week falls nicely into the theory.  A good grade on a finale exam (the goal) is met with the help of teachers, peers, and tutors (guides), and can be interfered with by exhaustion, parties, friends, and procrastination (challenges and dangers).  Perhaps energy drinks act as elixirs.  

         Whatever exam or challenge you are preparing yourself for, good luck, and stay healthy! 

Safety First

Beer is proof that God loves us and wants us to be happy~ Benjamin Franklin 

       A few days ago, I had an interesting talk with a friend from back home about her college experiences. After our discussion, I realized this blog wouldn't be complete without a post dedicated to  le booze.  

       Drinking is illegal for most college students.  But I really don't think that ever stopped anyone.  Sure, there are many people who choose not to drink while at school, and I don't mean to imply that there's a great pressure to do so.  Yet for those that do choose to indulge, its important to remember to do so responsibly.  Drinking too much for anyone is dangerous, but even more so when you're diabetic.

       First, always remember to eat while you're drinking.  Sugary alcoholic drinks may make your blood sugar spike up at first, but hours later will drive you low.  These later hours are usually when you're back in your dorm sleeping, so be careful to test before going to sleep to avoid overnight lows.  I usually aim to be in the 200 range before going to sleep just to be extra careful.

       While it may be cumbersome, always try to have a small bag with you when you go out, even if you're just headed to a friend's dorm room.  There's nothing worse than realizing a low is coming on and panicking because there's nothing for you to eat or drink.  I always like carrying a little cross body bag.  To fit my keys, lip gloss, glucose tabs, and tester in a small compartment, I'll take my tester out of its case and just slip the pieces in.  I usually throw a few extra lancets in too just in case.  

       It's always important to be sure the friends you're going out with know that you're diabetic.  This can be hard, especially if the friends you start off with at the beginning of the night end up being different than the friends you get back home with, which can happen at large events.  But the closer you get with people the easier it will be to inform the group as to what would be needed if case of an emergency.  And more than ever, its important to wear your medical i.d. 24/7.  

       B.F. Skinner is a well known psychologist, but has also done extensive work on verbal behavior. Skinner discussed in his studies "tacts and mands."  Tacts refers to making contact with, using words to connect with someone else in a social manner.  Mand refers to a command, which would hopefully result in a direct reward.  These tools are used by individuals to navigate interactions with others.  Just like being safe when you go out, tacts and mands can help you in informing a friend group about what you need to get home safely.  Dictating what others can do in case of an emergency are effective mands, and creating contacts with a group  of new people will only have benefits in the long run.

         Be safe, and have a great weekend!

We All Have Our Differences

      Most people who I discuss diabetes with very rarely know the differences between the two major types: Type 1 and Type 2.  Some people may not even realize there are multiple types.

      Type 1 diabetes, sometimes known as juvenile diabetes, can occur at any time in a person's life, but is usually diagnosed at infancy to age 30.  While the cause of Type 1 is not completely known yet, research indicates the body's immune system attacks and destroys the insulin-producing cells in the pancreas.  After a few years in a "honeymoon stage," where the pancreas is able to produce some insulin, patients need to deliver artificially produced insulin either through a syringe or pump.

      Type 2 diabetes usually develops in older patients, but has recently spiked in adolescent diagnoses.  The pancreas will still produce insulin, but does not produce enough or use it efficiently.  Type 2 diabetics can take additional insulin, but may be able to control their diabetes through diet and exercise alone.

      There are also lesser known forms of diabetes: monogenic and gestational diabetes. Monogenic diabetes is very rare, accounting for 1-2% of all cases.  Type 1 and Typ2 diabetes are polygenic, meaning the risk of developing them is related to multiple genes.  But in monogenic diabetes, the mutations occur in a single gene.  Mutations in monogenic diabetes reduce the body's ability to produce insulin and is often mistaken for Type 1 as a result.  Genetic testing can provide a proper diagnosis.

        Gestational diabetes affects 2-5% of all pregnant women.  During their pregnancies women will develop high blood sugars.  These usually go away after delivery, but those with gestational diabetes are at a greater risk for Type 2 later in life.

        Websites like the JDRF homepage and the American Diabetes Association website are additional tools and sources of information.  For a more in depth and scientific coverage, the convenient online edition of the Yale Diabetes Center's Facts and Guidelines is a great resource as well.  And this cute video gives a more personal explanation of life with diabetes:

      

         These informational websites serve as communities and support centers for those dealing with chronic illnesses.  Robert Putnam emphasizes the importance of such social capital and reciprocity in his book Bowling Alone. Through community involvement and charity, individuals can achieve greater societal goals, while receiving benefits on a personal level.  Websites and blogs dedicated to specific interests serve a similar purpose, in that they benefit those included in the interest with information and a support system, while also educating those outside the interest group.  The Internet simply creates a bigger community we can all be a part of. 

Privacy

Civilization is the progress toward a society of privacy. The savage's whole existence is public, ruled by the laws of his tribe. Civilization is the process of setting man free from men. ~ Ayn Rand

       Privacy is practically nonexistent in college.  Even if you're fortunate enough to not have a roommate, there are always people in the halls, people running in and out of your dorm room, and people up at all hours of the night.  Alone time is rare, but still very necessary.

       While there are things that are easy to be honest about when managing your diabetes, certain tasks require a great amount of privacy.  For example, I don't feel comfortable doing a site change in front of my roommates.  At home I was used to going into the bathroom and changing my site. Now in college though, I share a bathroom with four other girls and this is no longer as simple as it used to be.

      As I'm almost finished with the first semester of freshman year, I've been able to get a better schedule down and know when my roommates will either not be in the room or when the bathroom is usually available.  I still run into my fair share of uncomfortable moments, either when a suit-mate walks into the bathroom puzzled by the syringe I'm holding in my hand, or when one of my roommates comes back with a group of friends and my old inset has awkwardly stuck itself to my roomie's desk.

       I've found total honesty to be the best way when dealing with situations like these.  It can be very difficult, no doubt, especially when I'm startled myself by someone's unexpected entrance.  But there's no reason to feel embarrassed about what I'm doing and helping others understand life with diabetes can only be a good thing.

      I recently learned about Evgeny Morozov through his book The Net Delusion.  For those of you who have not read it, the book essentially critiques the Internet and mega search engines which allow personal information to be at anyone's disposal.  Morozov reflects on the Iranian protests in 2009, which at the time were said to be greatly aided by the online socializing network Twitter.  Morozov downplays Twitter's role however, and instead highlights the infringement on basic privacies that an online database of personal information creates.  Even if you seldom post personal information online, you can still exist in the online world.  In some ways, the social environment college creates is similar to the network of information found online.  When there are always other students around 24/7, your personal world unknown in high school can be exposed when others desire.  This is intimidating for many.  Yet, isn't learning about other's differences a major benefit of college itself?  While everyone deserves an appropriate amount of individual space, opening up can be a valuable learning experience for many.  The vast amount of knowledge available online was not open to the public before the Internet was created, and similarly, the wealth of college diversity is not available to most until the college years themselves.  

        Establishing a healthy balance between being open about personal matters and maintaining a proper level of privacy is important for everyone; those managing an illness like diabetes, and those who are not.

A Different Take on History Class...

History teaches everything including the future. ~ Lamartine

         While I created this blog out of a desire to share more information about life with Type 1 diabetes, I realized there are even fewer discussions about the progression that has been made in treatments and the history of diabetes in general.  My long train ride home from school turned out being a perfect research opportunity.

         Ancient carvings indicate diabetes has been around since 1500 B.C., and the term "diabetes" was coined by Aretaeus of Cappadocia, a Greek physician, in 200 A.D.  It was called diabetes mellitus, which means “flow,” referring to the flow through the urine, and “honey”, to imply the existence of sugar in the urine.  Indian physicians would see if ants were attracted to a person's urine as a method of diagnosis.  

        Flash forward to the late 1800’s, German physician Paul Langerhans found the part in the pancreas that later was discovered to be the place where insulin is formed, collected and then released.  

        Then in 1921 Frederick Banting and his assistant Charles Best kept a severely diabetic dog alive for 70 days by injecting it with a murky concoction of canine pancreas extract. With the help of Dr. Collip and Dr. Macleod, Banting and Best administered a more refined extract of insulin to Leonard Thompson, a young boy dying of diabetes. Within 24 hours, Leonard's dangerously high blood sugars had dropped to near normal levels. Until the discovery of insulin, most children diagnosed with diabetes were expected to live less than a year. In a matter of 24 hours the boy's life was changed forever. News of this new creation, insulin, spread across the world.

Frederick Banting with his invention of insulin

         In 1935 Roger Hinsworth discovered there were two types of diabetes: "insulin sensitive" (type I) and "insulin insensitive" (type II). By differentiating between the two types of diabetes, Hinsworth helped open up new avenues of treatment.

         In the 1960s urine strips were developed. Dorothy Frank, who has had type I diabetes since 1929, remembers, "In order to test your blood sugars there were these do-it-yourself urine kits. Blue meant there was no sugar present, and orange meant you were positive." With the invention of urine strips, patients were able to gain greater control over their management routines.  

          Becton-Dickinson introduced the single use syringe in 1961. This greatly reduced the amount of pain from injections as well as the time-consuming ritual of boiling needles and glass syringes. Diabetes Health board member Dr. Nancy Bohannon describes the early syringes as: "The needles were enormous, and they came with little pumice stones so that you could sharpen them. They often became dull and developed barbs on the end. And in order to sterilize them they had to be boiled for twenty minutes."

          The progress that has been made in diabetes management and treatment options over the last century alone has been incredible.  While receiving my diagnosis when I did was difficult, I had so many resources and options available to me that made the news much easier than it must have been for patients years ago.  I recently saw The Social Network again, and was reminded of how far technology has come.  Mark Zuckerberg's quest to create a whole new world which has never existed before is similar to the journey many scientists and doctors took and continue to take in efforts to ease the lives of those affected by diabetes.  Technological innovations have improved our lives so drastically, and its exciting to think about the improvements that will be discovered years to come. 

Fashion, Its A Way of Life

"I don't do fashion, I am fashion." ~ Coco Chanel 


       Let's be honest, being trendy and fashionable and put together at all times is not realistic, and certainly not easy.  But when you have a cell-phone-sized object strapped to you at all times, fitting this extra item into your fashion repertoire is a challenge at best.


       There are going to be some items that you'll never really be able to wear and fully disguise your insulin pump, if this is what makes you feel the most comfortable.  I know for me, while I have become more and more comfortable discussing my diabetes with others, I'm still not always ready for the looks and questions that accompany the display of my pump.  Maybe I'll feel better about it someday, but for now, not today.


       Over the years of pumpdome, I have acquired some basic skills and tips for disguising the little device.  Pashminas come in a whole rainbow of colors - I have everything from midnight blue to pink to purple.  They add a splash of color to an otherwise drab ensemble, and the fabric itself is soft and flawy.  But more importantly, the scarves, when draped casually in any way that falls past my hip, can cover the bulge of my pump.  


       But one of the best devices I've ever found is the leg cuff by t&j design.  I heard about this from my endocrinologist, and apparently one of the recent Miss America's uses it herself.  For prom, weddings, graduation, any event which requires a garment other than pants, I pull out my leg cuff.  My pump is securely tucked away from any questioning eyes, and I know it won't slip out at any time during the night.


     Yet there are certain events which I will always face with dread.  Ok, maybe thats a tad dramatic.  But still, when summer rolls around, and the bikinis come out, I'm always reminded there are no pockets, no scarves, no skirts that I can hide my pump under.  People are going to stare at the device clipped to my suit, simply because they've probably rarely seen one before, and it's hard to hide.  This is a time when its best to just remember this device is designed to manage my health, and it's nothing to be ashamed of.  
     
       When I began this blog, I can't say I was 100% confident and comfortable with discussing my diabetes.  But I soon realized the stories I share, in addition with those offered by others, can create a social network that will benefit anyone who chooses to join.  The web allows us to use one another as a social commodity, exchanging ideas, brands, connections, almost anything with one another.  So I'm here opening myself up to the World Wide Web to anyone who needs me.  

Let's Get Physical

There are really only two requirements when it comes to exercise.  One is that you do it.  The other is that you continue to do it. ~ The New Glucose Revolution for Diabetes by Jennie Brand-Miller, Kaye Foster-Powell, Stephen Colagiuri, Alan W. Barclay

       So after endless meals at the dining hall and weekends consisting of waking up far part noon to barely sneak in a shower before heading out again, you've probably started to feel like the textbook definition of a lazy ass (I know I'm not the only one).  Changing your diet will help some, but the only way to gain a complete revival of those energy levels is some good old fashioned exercise.

      Every college has at least a few exercise machines available to its students.  Take advantage of them! When else in your life will you have access to a free gym membership? Yet I do understand that having these machines at your advantage doesn't necessarily mean you'll automatically gain the motivation to use them.

       For those readers who are diabetic themselves, you probably already know the importance of exercise in terms of managing your blood sugars.  The effects of exercise on glucose levels are similar to those of insulin, making exercise another effective tool to use in terms of management.  Exercise helps enhance glucose's uptake to cells and counteracts high sugar levels often seen after eating.  In time, a frequent exercise routine will help reduce the amount of insulin needed daily, helping prevent insulin insensitivity from occurring.

      Be sure to test your blood sugar immediately before and after exercising, as well as a couple hours after.  If your sugar levels are low before exercise, correct appropriately by taking the proper amount of glucose.  However, if your sugars are too high, do not exercise until they come down as exercise will block the insulin's ability to bring these sugars down and can lead to ketoacidosis.

       Once you're ready to begin your new exercise regime, start by setting up an schedule that won't be too demanding.  Be honest with yourself--are you really going to wake up at 6:30 to run two miles before your 9 am class? I didn't think so. You don't need to plan to fit some exercise in every day either.  For those whose previous main form of exercise was a walk around the mall (aka me), planning to go down to the gym every other day is plenty.

      Yet say there's a night when its either too cold, too dark, or you're just too tired to walk down to your school's gym, but still want to feel good about getting some exercise in.  Fortunately, online resources and tools provided by the Internet will help you.  My favorite indoor workout is Pilates: you don't have to run or sweat too much, but still feel like you're really working out.  YouTube and iTunes are home to a wide selection of videos for a small routine.  Below is one of my favorites:

      While technology is a great tool to use to plan out exercise routines, working out with a group of friends is even better.  Staying inside and interacting with a computer screen is much less rewarding than interacting with others in person.  We often end up tethered to electronics and miss out on the experiences and friendships that are occurring in the present.  So take a break from the texting, IMing, and Facebooking to focus on your body and clear your mind.

Now go hit the gym!

Down with Dhall

Great food is like great sex.  The more you have the more you want.  ~Gael Greene


          For some, living with diabetes is much like living on a diet.  One must always be aware of the number of carbohydrates and amount of fat in each food or beverage, and properly deliver the corresponding dose of insulin to adjust.  Special meals, dining out, or snacking can make estimations difficult.  Packaged foods display the exact number of carbohydrates, but everyone enjoys a warm, prepared meal now and then.  Especially if your dorm is less than five minutes from a dining hall open for 16 hours a day.


        The wide selection, cozy setting, and of course delicious food itself make frequent trips an obvious necessity during those early days of freshman year.  But soon enough the pizza, prime rib, lo mein, and ice cream add up and leave you with blood sugars over 300 for the whole day.  You've eaten all these foods at home, but struggle to keep your scores in check now that you're away.


       The biggest change lies in portion sizes.  Unless you plan on carrying a plastic measuring cup with you around the dining hall, its difficult to determine if that pile of mashed potatoes is one, two, or maybe even three cups.


       Best way to master the dining hall is simply through practice.  Be careful of course, but overtime you will learn how to handle your favorite foods in any desired size.  About 15 minutes before heading to eat, deliver a bolus of half the normal number of carbs.  This will help prevent the severity of blood sugar spikes while also giving you a safety net in case you decide to eat less than normal.


       But one very helpful resource I can give you now is: Calorie King.  The nutrition fact counting monopoly has managed to track down the data for every major fast food chain, restaurant, grocery store, and major food producer.  Their small and handy comprehensive food guide also includes the average nutrition information for almost every prepared item imaginable.  I always get the newest edition every year, and it has helped my counting immensely.  Even more convenient is the company's mobile app for iPhone users, which directly connects you to the entire guide of 17, 000 foods (the same information can be accessed on other smart phones by typing www.calorieking.com into your browser).


       And I advise you to continue searching the web yourself! The beauty of blogs are their individual nature and the stories everyone has to tell.  As Justin Hall, freelance journalist himself once said: "The best content comes from people who love what they are doing."  Everyone will experience their own set of challenges, but by sharing part of our personal experiences through the freedom the Internet has to offer, we are able to begin a conversation that may have never taken place.


Be healthy, have fun, and enjoy tonight's supper!

Oh, Roomies

           Freshman year of college is alive with countless changes: both those good, and those bad.  But for most students, one of the most major changes becomes real even before stepping onto campus.  


Roommates. 


              There are those few lucky students who receive singles their first year, but the majority face sharing their space with at least one complete stranger, if not multiple. You know when to expect your older brother to stumble home on a Saturday night, or how long your sister takes in the shower.  But when the first day of orientation comes, you know very little about your new housemate. And like most aspects of life with Type 1 diabetes, managing these new changes is only more complicated with a chronic illness in tow.  


          Do you tell your roommate about your diabetes before you meet in person? How much insulin should you bring? Where are you going to store your supplies? Should your RA know? What about your professors?


         First, talk over how to manage things with your doctor or health care provider.  They will be able to give you advice in sync with how you've been managing your health for years.  Next, figure out how you will receive new supplies as those you bring from home run low.  If you use a mail order company, look into forwarding the supplies to your new address on campus.  Or, report to Mom and Dad your supply levels during those vital calls back home.  As for storage solutions, buy an under-the-bed container to keep everything together (if you have a fridge in your room, a small plastic notecard box is a great place to keep insulin cool and organized).  


But now back to the roommates.  


        Over the summer, I wrestled with the dilemma of if I should tell my roommates about my diabetes before we ever met or on the first day in person.  We had spoken some, and from what I could tell, they seemed nice enough, but I wondered how much they knew about Type 1 and what its like to live with.  I also wondered if when we did meet in person, my diabetes would be something they would use to identify me by, rather than knowing me for me.


       I ended up deciding to wait and tell my roommates in person about being diabetic.  Don't let first impressions be unfairly tainted by false information or assumptions people may have about diabetes.  Be honest and upfront immediately with those around you about what it takes to keep you happy and healthy.  


Love always,


Emily