Diabetes and exercise: A powerful combination

The biggest factor for me in taking control of my Type 2 diabetes has been making moderate physical exercise – primarily walking – a part of my daily life. While changing what I eat has certainly helped that effort along – it takes less effort for my body to burn off smaller amounts of food than it did when I used to binge eat with every meal – it’s the regular exercise that has made the biggest difference. Alongside eating less, getting exercise in daily makes it easier for my body to metabolize food without boosting my blood glucose levels in response.

This video describes an annual public service campaign aimed at increasing both blood glucose testing and short amounts of daily activity for diabetics of all kinds, including Type 2. Next month, November, is National Diabetes Month and diabetics of all kinds, from all around the world will participate in the Big Blue Test to prove – to themselves, their followers, and the folks who love them.

If you or a loved one are diabetic, please see this link for more information about how you can take part.

Living With Diabetes: Remembering to take medication

I was approached by The American Recall Center to participate in “Talk About Your Medicines” month, a public service effort during the month of October. I received no compensation nor other consideration for this post and the ideas expressed are entirely my own.

talk about diabetes medication Living With Diabetes: Remembering to take medication

For several years, I took between five and nine different medications at a time as part of my Type 2 diabetes treatment plan. While I am currently able to control my diabetes with careful attention to what I eat and a physically active lifestyle, I know how vital it is to take medications as directed for effective diabetes self management.

I used several key strategies that helped me remember to take my medication:

  • Some of my medications – including Metformin, one of the most common medications for treatment of Type 2 diabetes – were to be taken twice daily, with food, so I purchased a small container with 14 separate compartments, to allow me to see at a glance if I’d taken my breakfast and dinner medications.
  • For my injectable medications – including Victoza and, later, insulin – I used a small, pre-filled pen device to inject myself once a day. The easiest time for me to remember to inject myself was at night, as part of my bedtime routine: I washed my face, brushed my teeth, moisturized my skin, and gave myself an injection in my abdomen, all before I went to bed.
  • My husband usually ate dinner with me and, if he didn’t see me take my pills, he’d ask if I’d forgotten about them. (This one can be touchy, depending on how you feel about others being involved in your diabetes treatment plan, but it worked well for us.)
  • I couldn’t take my medications as prescribed if I didn’t have them available, so I took advantage of my pharmacy’s automatic renewal service, which not only filled the orders before I ran out but also called our house phone with an automated reminder when it was time to pick them up. Combine that with the convenient Pharmacy drive-through window and it was nearly impossible for me to run out of my medications.

Living with Type 2 diabetes is stressful, regardless of whether or not you are taking medications as part of your treatment plan, and having strategies that work for you is critical to achieving control of your diabetes symptoms. Do you have techniques you’ve incorporated into your diabetes self management plan to remind you to take your medications as prescribed?

Diabetes & Depression: All in your head

It’s estimated that as many as 30% of diabetics also suffer from clinical depression. While the “which came first”/”which causes which” argument hasn’t been settled at this point, it’s clear that treatment and care plans for diabetes should make provision for the complicating factor of doing what needs to be done to avoid diabetic complications while simultaneously managing a serious mental illness.

For me, I believe the depression came first although the very nature of that disease – the distorted thinking, the lack of desire to do much of anything, the belief that I’m not worth the effort it will take to keep me happy and healthy – make it difficult to say for sure. I’m pretty sure that I was depressed in college, possibly even as early as my teens, and I wasn’t diagnosed with diabetes until age 29, so it’s likely that the depression pre-dates the diabetes for me. Given that I use(d) food to soothe myself when l’m in the middle of a bout with depression and that nearly all physical activity other than chewing and breathing used to stop when I was depressed, I would even call depression out as one of the “causes” of my diabetes.

Regardless of how and when they started, I deal with both diseases regularly: diabetes every minute of every day, depression at least once a month – every month – without fail. As exhausting as it is to keep my diabetes management mojo going on a good day, when I’m depressed it’s a whole lot tougher.

bigstock Sadness And Happiness 50402351 300x200 Diabetes & Depression: All in your head

Over the last 19 months, as I’ve focused on Project: Happy/Healthy Me, I’ve learned a few things that help me deal with my depression more effectively. Tactics that work for me include:

  • Recognizing that it’s back and that I’m depressed again is a great first step. When it’s really bad, this can take me anywhere from a few days to a week or more. If you have never experienced it, it’s tough to explain how that happens but remember that depression means that my own brain is working against me, creating thoughts that aren’t true but feel completely valid. Once some part of my brain breaks free to see that it’s just the disease talking, I can implement better coping techniques.
  • Keeping up my healthy daily routines as much as possible. I get quite a lot of physical activity and track my food intake every day, so I try to keep those habits going even when I’m dealing with the crazy thoughts that would have me stay in bed and eat simple, starchy carbohydrates for the rest of my life. That’s not nearly as simple as it sounds but it’s easier now that I make natural and planned physical activity so much a part of my everyday life. When the depression hits, I still go out before work each day but I might take a simple walk instead of incorporating jog/walk intervals. Both diabetes and depression benefit from exercise and walking is such an easy way to get my day off to a healthy start. Once I have a walk under my belt, it’s much easier to continue making good choices for my health even as I put up with my depression symptoms.
  • Calling myself out when I start giving small things more importance than they deserve. I overreact on a good, non-depressed day and it only gets worse when you add in the disordered thinking that accompanies depression. Suddenly, the fact that I haven’t completed any of my duathlon training planned workouts in a week means that I’m a terrible person and am destined to re-gain every pound I’ve worked so hard to lose. The truth is that I’ve been very active in ways other than running or biking and my fitness level will carry me through the event next month even if I never follow through on another workout from the training plan. (Not that I plan to skip another month of workouts, but with depression, anything is possible.)
  • Treating myself kindly, as I would a friend who was suffering with a chronic illness; skip the self-abuse. While it’s easier said than done, taking excellent care of myself while I’m depressed pays off almost immediately with improved mood and cognitive function. For me, this could mean going to bed a little early, using a favorite body wash with my shower, or scheduling a massage. If I pretend that it’s a friend who is suffering, this becomes more natural and less awkward.
  • Incorporating more mindfulness into my daily activities. Whether it’s yoga, quiet meditation, focused breathing, or simply focusing intently on my surroundings with each of my senses, the more I am present in the here and now, the easier it is to keep an even keel.

Even with these strategies, there is no “cure” for depression. Some months the symptoms are worse than others and at those times I call my therapist for a check in – somehow just talking with her brings a better focus on what’s real and what is not.

If you suffer from depression, know that you’re never alone, no matter what your brain might be telling you to the contrary. You are lovable and loved more than you know, so when things get scary, reach out and find help.

  • To find a therapist in your area, use this helpful website
  • Psych Central hosts an online depression support group which includes both message boards and weekly chat sessions. Depression tries to isolate us so being around others – even virtually – is a great way to put the disease back in its bottle
  • If it’s all too much and you just can’t bear another minute of feeling this way, please call the National Suicide Prevention Hotline at 1-800-273-TALK (8255) – it’s staffed 24/7/365 with trained professionals who will help you. Nothing – absolutely nothing! – gets better if you hurt yourself so don’t let this stupid disease win!

Just as with my diabetes, I know I’ll need to continue refining my depression self management plan for the rest of my life. There is no cure for my diseases but with careful planning, strong partnerships with medical professionals, and a little bit of luck, I’m confident I will live a long, healthy life.

Happy Veterans Day & Diabetes Awareness Month

Veterans Day Happy Veterans Day & Diabetes Awareness Month

I borrowed this from the Lilly Pulitzer blog – it perfectly blends my love of all things bright and floral with my patriotic spirit!

Today I’d like to thank every member of the United States armed services for their service and sacrifice. Similarly, I would also like to acknowledge and thank the sacrifices made by the families of service members, too. (Believe me, they also serve.) Less than 1% of the families in this country have a member currently serving in the military. Less than 1%. Please take time every day to thank those in your life who put service ahead of self.

November is National Diabetes Awareness Month, the aim of which is to increase knowledge and understanding of this disease. Most of you know that I am diabetic, as are about 26 million other Americans. The type of diabetes that I have is called Type II – which used to be called “adult onset” until children under 18 began being diagnosed, too – and I am fortunate that my condition is currently well controlled with diet, exercise, and oral medication (Metformin). At the beginning of the year, I was injecting the maximum dose of long-acting insulin, a non-insulin injectible medication (Victoza), taking a pill to make my body produce more insulin on its own (Glipizide) plus a prescription-strength Omega-3 pill (Lovaza) and cholesterol medication (Tricor) to lower my triglycerides, AND double my current dose of Metformin – to absolutely no avail. I was a virtual walking pharmacy and none of it could get my numbers (blood sugar and triglycerides) into the recommended ranges.

I have made a lot of changes to my eating and exercise routines since then and have been fortunate to see drastic, positive changes in my health, but lifestyle changes such as the ones I’ve made this year don’t work for everyone – certainly not for Type I diabetics, who must inject insulin with every meal in order to allow their bodies to process the food that they eat – and so more must be done to spread awareness of ways to avoid diabetes as well as funding critical research to find new and better medical therapies for both Type I and Type II diabetics.

Last month, I was approached to participate in an online diabetes awareness-raising activity. The results of the project can be seen here and I’m very proud to be part of such a great group of bloggers with diabetes. Please take a moment to check it out and let me know if you have any questions about diabetes that I can help with. Knowledge is always powerful and it’s one of the best weapons against diabetes, too.

Doing my bit for Science

Having diabetes stinks. No really, it does. It’s not the dread Death Sentence some media outlets like to make it out to be but it definitely does stink.

(Did you know that insulin can make you gain weight? Insulin which most Type 2 diabetics will end up needing at some point in their lives? Basically, you need to lose weight to help control your blood sugar but the drug that you need to help you manage your blood sugar will make it tougher to lose weight. Just one of the special little gifts that come with your diabetes diagnosis – yay!)

Then you’ve got the stigma attached to being a person with Type 2 diabetes. Because one of the risk factors for Type 2 is being overweight, there’s a perception that we “deserve” this disease because we wouldn’t be here if we weren’t fat. Seriously, I’ve had people tell me that to my face. Whether that’s true or not, no one deserves diabetes and I wouldn’t wish it on my worst enemy. Three times yearly visits to the endocrinologist (diabetes doctor). Keeping track of what you eat versus your pre- and post-meal blood sugar readings so that you can try to figure out which foods don’t send your body into orbit with extra sugar. Finding it harder to lose weight even as your doctor tells you that you “really ought to” focus on losing some weight. Is it any wonder that so many diabetics also battle depression? And of course, depression can make getting out of bed a huge accomplishment, much less exercising and planning nutritious, low calorie meals. It’s all much easier with support from friends and family but the depression and shame can make it tough to reach out.

Enter Ginger.io, a company dedicated to using big data to help make new discoveries for treating chronic diseases like diabetes. I recently signed up for a pilot they are running to gather passive data about activity levels among Type 2 diabetics that can be used for several purposes.

sanofi landing page 122712 c 300x232 Doing my bit for Science

In essence, each of the participants downloads an application to their smart phone and then just goes about their daily business. Every day I receive a one-question survey about my mood the day prior, and once weekly I answer a survey about how I’m doing with my diabetes tasks and another about how my quality of life has been for the past week. Simple Simon. The application then tracks how active I’ve been – not with steps or calories burned or anything like that, but how many miles I’ve traveled, text messages I’ve sent, and phone calls I’ve made. Right now the application just gives me interesting tidbits about how my activity this week compares to what I did last week or today’s travels versus yesterday’s, but the plan is that in the future, if I specify people in my support circle, the application will track how I’m doing and alert those that I specify when my activity drops and my survey results show I’m not doing well.

Imagine that: I’m dealing with depression and struggling with my diabetes, and then TCB will just know as if by magic that I need help. Wow.

In addition to the selfish part of this exercise, the application is also gathering important behavioral information about a group of folks with Type II diabetes that can then be used to help create new methods for treating diabetes and those suffering from the disease.

If you or someone you know has been diagnosed with Type II diabetes and this program sounds like something you’d like to hear more about, click here to find out more or to sign up for the on-going pilot today.

…and then I had a completely crazy thought

Updates since last time:

  • Went to the gym all seven days last week
  • Tracked every morsel of food that went into my mouth using MyFitnessPal
  • Made it through a mild episode of depression without turning to food. I wanted to eat, I thought a lot about eating, but instead of eating I tried to figure out what it was that I really wanted and how to get there without food. Very interesting
  • I tested my blood sugar seven times in less than a week including my pre-breakfast blood sugars every day. I haven’t tested my blood sugar since I started on insulin injections and the readings were so high that they upset me, so I put my meter away. I committed to my Making Peace With Food group – all Type 1 and Type 2 diabetics – that I would test at least once before our next class, and then when the number wasn’t too bad, I just kept going. I’m treating it like an experiment: “if it’s this number now, what will it look like right after I finish on the treadmill?” or “I wonder what my blood sugar is this morning after I had more carbs for dinner than usual?”
129419999 1947747739 ...and then I had a completely crazy thought

Peonies by Linda N. via Flickr

So many good things are going on in my life right now and it’s wonderful but also scary. Scary because I remember what it feels like when it all goes sideways, so I’m putting in the effort now, while it’s all good, to learn how to be OK with not being 100% perfect all the time – basically learning to fail and bounce back.

Part of my strategy is to not let the scale be the sole determinant of whether or not I’m “successful”. I need to lose a LOT of weight just to be considered “overweight” (as opposed to Morbidly Obese, my current designation based on BMI) but I can’t focus on that because it’s too overwhelming, so I’m staying focused on what’s really important – my blood sugar. Good things are happening on that front, friends, and it’s very exciting! When I took my blood sugar for the first time in months last week it was 171 mg/dL which was about 40 points less than my fasting test last time I saw my endocrinologist two months ago. Target ranges for diabetics with good control are between 70 and 130 mg/dl before meals, and less than 180 two hours after starting a meal, so I knew I was a little high but was heading in the right direction. And I’ll be darned if my reading this morning before breakfast wasn’t 131 mg/dL – down 40 points in less than a week!

I also lost seven pounds this week.

And I had this crazy thought about what I can use for my long-term motivation but that will have to wait until next time. In the meantime, though, tell me how you deal with the “all or nothing”/”must be perfect in all ways” syndrome of healthy eating and exercise? Am I the only one who feels like there’s a light switch somewhere that controls my desire to eat well and exercise every day???  

Put One Foot In Front of the Other

Song PutOneFootInFront 300x228 Put One Foot In Front of the Other

(from Santa Claus is Coming to Town)

I don’t know what to think. I’ve gotten so used to failure and disappointment when it comes to making good choices about my eating and exercise habits that I’m scared. Scared because it’s all coming together so seemingly easily. And I remember when it used to be easy but then one day it wasn’t any more. So I don’t want to relax and enjoy the feeling because if I stop being scared maybe it will all evaporate and I’ll be back where I started, disappointed and sad. And hopeless.

But I have hope now – I’m letting myself feel just the faintest glimmer of hope again – and that is everything.

Little, tiny, baby steps

I started nightly injections of insulin a few days ago and have already had to increase the dose by 50% because the lowest dose isn’t effective. I could cry about that fact and beat myself up about my unwillingness to make the lifestyle changes that would make my own insulin effective enough to control my blood sugar, but the fact is that neither of those actions will take me in a positive direction. Once I find the right dosage, insulin will absolutely help get my blood sugar levels back where they belong and that’s just a simple truth.

At the appointment with my doctor where he prescribed the insulin, we talked about increasing my dosage of a non-insulin oral medication I’ve been taking for months, or going back to the Weight Loss clinic so they can prescribe a combo anti-seizure/amphetamine drug that’s supposed to make you forget to eat (the amphetamine option has already not worked for me), or changing up one of the six other medications I take on a daily basis. And a little voice inside my head started to scream, “Stop playing around with your health, Denise. Do what needs to be done and get on with it!” (It might have been my grandma’s voice I was hearing, to be honest, since that’s definitely what she would have told me had she been alive and in the room with me.) and so I stopped the doctor mid-sentence and told him that I’d like to start taking insulin.

5552023473 5ca5d3b410 z Little, tiny, baby steps

Wintersteps into the unknown by Stefán Freyr | Skyzography, on Flickr

Insulin isn’t the cure-all super-duper fixer-upper for my problems but it will get my blood sugar under control almost immediately (once I get to the right dosage) and that’s the big thing right now. Stop the damage that high blood sugar is doing to my body first then focus on making the rest of the changes that I need to make – eat better, exercise daily, control my stress.

As we sat in the car in the line at the pharmacy drive-through, I thought about what I need to do in order to get my diabetes under control: I just have to put my big girl panties on, take my insulin, and start making small changes for the better.

Small steps, people. Small steps.

Stuck

44863659 5dbfa1d48b Stuck

QUICKSAND!!! by Mickie Quick on Flickr

I feel so STUCK.

Every evening I tell myself that tomorrow will be better, that I’ll get some exercise and eat something with good nutritional value, but I don’t do it.

I get lots of really helpful advice from real-life friends, blog friends, doctors, parents, and random folks on the street. These are well-meaning people for the most part and their advice usually has at least a kernel of usefulness, but change isn’t happening.

Today I have an appointment with my endocrinologist (diabetes doctor, for those not in the know) and I will ask him to start me on an insulin regimen to get my blood sugar into acceptable ranges; I feel like such a waste of space.

Why don’t I control my eating? Why don’t I get any exercise at all??? I haven’t even made it on my yoga mat once and my 30 Days of Curvy Yoga class ends on Saturday. What will it take for me to change???

Eating well for diabetics: Six things NOT to eat

Just as there are guidelines about how to eat for diabetics, there are also recommendations about what not to eat if you’re diabetic. (I’d like to point out that non-diabetics probably wouldn’t be hurt by following these “don’t eat” commandments, too.) I found these from Everyday Health:

  1. Donuts.Whether glazed or jelly-filled, these little gems are full of saturated fat, tons of sugar, and not a single positive nutritional contribution to your diet. Just say no! Substitute a piece of low-glycemic fruit
    snacks to skip on diabetes diet 03 pg full 300x300 Eating well for diabetics: Six things NOT to eat

    My nemesis (from EverydayHealth.com)

    (apple slices, half a banana) with organic peanut butter.

  2. Cheese. Oh man, this one kills me! I love cheese so much that it hurts, but it’s just chock-full of saturated fat and we already know that’s a no-no. I don’t know of a really good substitute but the article mentions Greek yogurt which might work if you like Greek yogurt (it’s not a favorite of mine yet but I’m still trying).
  3. Anything breaded and fried, including chicken fingers and fish sticks. Not only are these saturated fat bombs, they generally have way too much salt, too, which can contribute to high blood pressure. Substitute an ounce of nuts, just be careful to portion it out because if you’re anything like me, nuts can lead to overindulging.
  4. Potato chips, crackers, and tortilla/corn chips. Wow, this is another tough one. I love chips and salsa SO MUCH. These nutritional miscreants not only raise your bad cholesterol and add too many calories to your diet, they are also a “gateway” to high fat dips or other enhancers. Le sigh. Substitute baked whole-grain crackers with salsa instead.
  5. Packaged baked goods, like cookies. High in sugar, fat, and calories, they also fall into the bucket of carbohydrate sources that are quickly converted to sugar because they have absolutely no fiber to slow digestion. Good substitutes include baked whole grain crackers or fruit. I sometimes find that a hot cup of tea with non-fat milk and sugar substitute will satiate my craving for sweet junk food, too!
  6. Processed cereals. I am lucky that I don’t like, and never eat, sugary cereals. As a matter of fact, I rarely eat cereal of any kind. These diet demons are packed so full of sugar that there’s no room for any fiber – a bad combination. A better option for breakfast would be non-fat Greek yogurt with fresh fruit and just a light sprinkling of a cereal that has whole grain listed as the first ingredient.

There are a few of my all-time favorites on that list, so I’d better get to the store tonight to stock up on some alternate snack ideas. I know what to do, now it’s time to actually do it.

What are some of your “no-no” food items and what strategies do you employ to avoid them? Or do you include them in your daily life in moderation? Do tell!