By the numbers.

I have been doing a great job with my sugars lately. But, I fear that I have been setting myself up for failure. Counting carbs is tedious. Going to lunch and sitting there for 10 minutes looking my food up in a carb guide gets pretty old. As a result, I find myself often eating the same selections. It's easy. Oh, that particular sandwich is 30g of carbs. That equals two units of insulin. Zing! Now, let's get on with the eatin'! Chain restaurants are the easiest because most of their nutrition info is available on the internet. Panera Cobb Salad with Avocado equals 8g of carbs. Easy, peasy, lemon squeezy (as my friend Mary likes to say).

Easy may bring efficiency, but it also ends up being pretty boring. So, today I ventured out of my comfort zone. My friend Lisa and I went to lunch. She was having a hectic day and didn't want to make decisions about where to go, so I suggested sushi.

I love maki rolls. I was introduced to them back in 2001 and my love for them has increased over the years. I have a few friends that will eat them with me, and one of them is Lisa. So off we went. Found the maki lunch special on the menu, ordered, and then made quick work of trying to figure out how many carbs I would be consuming. Maki is rolled in a white, sticky rice and is pretty starchy. The meal comes with two rolls (eight pieces per roll), a clear soup that has some sherry in it, and a salad with a ginger dressing. I searched through the nutrition database on my iphone and found another restaurant's version of the rolls I ordered. I added in the soup and the salad and the grand total was 68g of carbs. My sugar was 119, which is awesome, so all I had to do was divide 68 by 15 and administer that much insulin — 4.5 units. The insulin pen doesn't let you administer a half a unit, so I gave myself 4 and held back on the salad.

Two hours later I tested and my sugar was 325. Obviously all of that calculating went haywire somewhere. So I corrected and checked again an hour later. Still high. Finally around dinner time it was down to normal.

All of this is to say that the next time I eat sushi, I'll be a little more generous with the insulin.

Last night I made chili from a recipe I found on the internet a couple of years ago. Chili is one of those dishes that's pretty fattening, but surprisingly healthy for diabetics as long as you use beans that are high in fiber. Fiber is a diabetic's best friend. I sat and pondered the recipe and then got my computer out and did a quick internet search. I stumbled upon a website, www.myfitnesspal.com (you probably have already heard of it — I'm not usually spending my internet time looking for fitness plans, if you know what I mean). Anyway, on this site there is a recipe calculator. You add in all of the ingredients of your recipe and it tells you how many calories, fat grams, carbs and grams of protein are in your meal. You divide it by the number of servings and there's your nutrition info!

I am so happy with this little find. I may have mentioned that I regularly frequent a little deli that's a block away from where I work. The proprietress makes excellent soups. Now I can ask her for the ingredients of her soups (which I am hoping she will share) so I can calculate the nutrition information. Not just for me, but for all of her customers should they want to know.

Remember my most recent post about Halloween? Well, you might want to take a look at the carb counts of those fun-sized candies. You might reconsider how fun they are. You can find the American Diabetes Association's list by clicking here.





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Tricky Treats.

We are fast approaching that most dreaded of holidays for diabetics — Halloween. Candy is everywhere. On every shelf at every store. At every cash register. It taunts me with its come-hither chocolatey or sugar-coated goodness.

To buy, or not to buy — that is the question. Do I buy candy so I can pass it out to the gremlins who come calling and be remembered as the cool lady that hands out stellar goods? Or rather, do I refrain, turn off the porch light, draw the curtains and hunker down in front of the TV pretending not to be home (even though my car is in plain sight) leaving neighborhood children to brand me a Halloween Scrooge?

I tend to rest on the side of not indulging in candy purchases. I'm sure the munchkins will get plenty of treats. I know that if I buy candy, I'll have it left over and then will be tempted to eat it. I mean, who throws perfectly good candy away? I could buy healthy snacks (and those would be?) or pass out string cheese (my new protein-y snack of choice). Can you imagine the looks I would get if I passed out string cheese? I would be labeled some kind of sick-o. I'm sure of it. Plus, string cheese is not cheap.

And then there's the Halloween after-math. The bowls of Snickers and M&Ms that appear on the break-room table. The candy dish at the front counter. The desk drawers full of Twizzlers. Candy is so readily available in the Post-Halloween workplace that you almost trip over it on your way to the bathroom.

So, I'll abstain from candy this Halloween. I'm going to go hang out on the porch with my new great-nephew and help him pass out candy to his neighbors. He's only five months old and hasn't mastered Halloween candy distribution methods yet. He'll be dressed as a raccoon, and if you 've ever seen this little munchkin, you'll understand that hanging with him will be plenty enough treat for me.

One chip is too many, a thousand are not enough.

She walked into the Catina. It was dark inside and she had to wait for her eyes to adjust before heading toward a booth in the back. She took a seat, glancing furtively to see if she knew anyone in the restaurant. She didn't. And she was glad for that.

A waiter approached. "What can I get for you?" he asked.

"A diet, please. And chips," she replied. "keep them coming."

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This is how I feel at Mexican restaurants. At any restaurant really, where your meal is preceded by a basket of something. Bread, chips, peanuts -- It's all bad. Chips are especially enticing to me. They're small and thin. When accompanied by a hearty salsa, they're almost a health food, right? Yeah, not so much.

If I'm having an especially stressful day, and you're lunching with me, you'll know it if I suggest Mexican. Pay attention to the basket of chips and watch them disappear before your very eyes. My eyes will glaze over and I'll get into an eating zone. I can actually feel a sense of calm come over me. And then later the guilt (and the nap, as Mexican food makes me sleepy). I have eaten Mexican so often that the wait staff at one of our local eateries knows me by name.

It's what they call "Mindless eating." I've been a mindless eater all of my life. As a youngster I would come home from school, grab a bag of chips and a cola and plop in front of the TV to watch Gilligan's Island or The Brady Bunch or both. I'd sit there happily munching away, not realizing all of the calories I was consuming. Back in those days I was relatively active (my mom would yell, "it's too nice a day to be inside watching TV!") so somehow I managed not to weigh a ton. But, eventually all of those bad eating habits caught up with me. I started gaining weight. Then I'd diet and take it off. Then I'd gain it back. Take it off again. And so on, and so on.

Weight Watchers has always been my diet of choice. I still know the points value of many foods. I learned the tricks (small plates, eating slowly) to try to stop this pattern of behavior. A 3 oz. serving is approximately the size of the palm of your hand or a deck of cards. Twelve tortilla chips equals three points. I used to count out 12 chips and put them on my place mat. I'd break them into smaller pieces so it seemed like I was getting more. Salsa is free! You can eat as much as you like. But those darned chips. They are like a siren's song to me.

There's nothing inherently wrong with Mexican food. Or Italian food. Or any food for that matter. Really, it's not the food. It's the eating of the food. It's the shoveling in without tasting or appreciating the flavor. I can eat at any restaurant as long as I pay attention to the following:

• Portion size (just because they bring you a bucket of food doesn't mean you have to eat it)
• Carb count (how many carbs are in a portion and what exactly is a portion?)
• Protein (does it have any protein? It needs to have some to sustain my sugars until my next snack or meal)

It also helps to ask myself, "why am I eating this? Am I hungry?" Or am I instead stressed or sad or some other emotion that I medicate with food. It takes a discipline that I don't always have. But I'm working on it. Right now things are good. My sugars are normal. I'm not making daily visits to the company candy drawer. I didn't eat any of Tiffany's upside down pineapple cake that her mom brought in for her birthday.

Which is not to say that I won't be at a Mexican restaurant tomorrow. But for today, for this moment, I'm full.

Let's get physical.

You can run, but you can't hide. If you have diabetes, you need to exercise. Of course, everyone needs to exercise, but especially diabetics. When you exercise, your body needs less insulin. So, with proper diet and exercise, you decrease the need for medications. It doesn't matter if you are Type 1 or Type 2. It's a very important component for regulating blood sugars.

Last month I attended a diabetes management course. It met every Monday evening for three weeks. I went through a similar course when I was diagnosed, but my endocrinologist thought a refresher would be a good idea. I actually did get quite a bit of out of it. The first night was an overview, the second focused on medicines and the third on nutrition. They covered a ton of stuff. It made me realize how much there is to absorb when you are first diagnosed. At the end of the last session they had us fill out a form with our goals and made an appointment to meet again in a month.

Tonight was my appointment. I was anxious to go, as I have been diligent and have been having success at regulating my sugars. Plus, I wanted to share the news about my blog. I really feel like it is having a positive impact on my attitude.

We sat down and reviewed the goals I set for myself. Everything was great except for the exercise portion. I told Kate, the nurse who had facilitated the course, that I hate exercise. It's true. I hate it. There are very few things that I hate. I can count them on one hand — liver, Nancy Grace and exercise. Kate smiled at me and told me that I wasn't alone. She asked what I liked to do. She told me that had decided that she wanted to run. She thought running seemed like a cool thing to do, so she trained and has since run a couple of 5k races. You know, I think running is cool, too. I like the concept of running — out in the quiet, no need to converse, no need to wear a special outfit or spandex. It sounds good. In theory. In practice, I don't know so much. Yesterday my dog managed to get off of her lead and I had to chase her, which involved running. Horrible. I feel like the Abominable Snowman from Rudolph the Red-nosed Reindeer. Bumbles bounce, and so does Beth when she has to run.

So, here I go. I hope that by admitting this character flaw in front of you, my faithful readers, I might find the fortitude to get off the couch and do something. Maybe it isn't running. I'm not sure what it will be. Kate suggested I write about it — that maybe the answer is somewhere in the writing or in the comments. I welcome your suggestions.

Every mile starts with a first step. And then another, and another.

Diabesity part II.

A day or two ago I wrote a post about the shame I feel for having Type 2 diabetes. At least, that was what I thought it was about. What I intended it to be about. I'm not exactly sure that's what people took away from it, though.

The next morning after I posted it, I was preparing to go to a press event at a local elementary school. It's just down the street from where I live. My colleague suggested that we meet at the nearby McDonald's for breakfast. McDonald's is actually an easy place for me to eat. From all of my years at Weight Watchers I know that the Egg McMuffin sandwich is a relatively low-fat option there and I know that it has two carb exchanges (30 grams of carbohydrate), mostly from the English muffin. Because I am supposed to eat four exchanges at breakfast, I added a hash brown (15 grams of carb). Would I call it a healthy breakfast? No, of course not. Would I call it a terrible choice? No, I wouldn't call it that either.

During our meal I checked us in on Facebook with the words, "Breakfast of Champions!" I did not think a thing about doing this. I do it all the time from all types of restaurants.

So, after we finished I went over and photographed the event and then went in to work. I went on Facebook to find several comments chiding me about my breakfast choice, especially after the blog post from the night before. What did I eat? Why did I make this public?

This most recent blog post had been very cathartic for me. I woke up reinvigorated about my fight with diabetes. I really did. I checked my sugars that morning and they were normal. I ate a very reasonable meal, administered the proper dosage of insulin and took my Metformin. Just like I do almost every day. Breakfast is one of my good meals. My issues come later in the day and when I am stressed. My breakfasts are usually a good balance of carb and protein.

As the day wore on, I pondered this response to my check-in. I was frankly kind of surprised to see this kind of scolding reaction. I wondered, how can I make a point about this without making my friends feel bad for their concern. I know that these comments were coming from a place of love. It was the delivery that was problematic.

The next day I had an idea. I realized that Facebook lets you check-in from anywhere. You don't even need to be there. Early in the morning I checked in at a local bakery. Soon after a few comments appeared -- "what are you eating"? About 10 minutes later I checked in at iHop. All day long I checked in at fast-food places, bakeries, hamburger joints, ice cream factories, Chinese and Mexican and Greek restaurants, a local chocolatier and eventually a maker of Whoopie pies in Virginia and the Heart Attack Grill in Las Vegas.

Out of all of those check-ins, only one was authentic. I went to a local Mexican restaurant for lunch. Here is a photo of my meal, a chicken taco salad. I did not eat the shell. I did eat some chips, as I was actually a little low (The range is 80-120. I was around 74) when we arrived at the restaurant. Prior to eating the chips I had a couple of glucose tabs to bring up my sugar. The carbs in the chips are not fast-acting enough to work in that way. Mid-morning I had an apple and a piece of cheese. A carb and a protein to keep me satisfied until lunch. It did help. I didn't overeat.

I checked my sugars again an hour or so after eating. All good.

So, the point of this Facebook exercise I guess, is that even though I have diabetes, I still have a life. I will still be faced with the challenges of eating out and trying to find menu items that fit within my guidelines. I will succeed sometimes and I will fail sometimes. I hope you'll be with me along the way and have faith that I will make the right choices. If I don't I hope you'll understand and encourage me to do better next time.

I love you all, and thank you for your concern for me.

Diabesity.

There's a new word floating about. Perhaps you've heard it — "Diabesity." There have been several books written about it, it has been the topic of talk shows and columns in the New York Times and oodles of websites. Obesity is an epidemic and we have become a society of sedentary snackers who are just itching to get Type 2 diabetes.

According to the American Diabetes Association, "Type 1 diabetes is usually diagnosed in children and young adults, and was previously known as juvenile diabetes. In type 1 diabetes, the body does not produce insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. Only 5% of people with diabetes have this form of the disease. Type 1 and type 2 diabetes have different causes. Yet two factors are important in both. You inherit a predisposition to the disease then something in your environment triggers it."

This is good info to know, because there is much opportunity for shame with this disease.

I've had issues with my weight for all of my life. I've lost weight, and gained weight. I've been thin, I've been fat. I've eaten healthy foods and I've spent my share of money on junk food. I've exercised and I've laid around on the couch. But the truth of the matter is, I come from a family of substance abusers and my substance is food. My parents were both alcoholics. I knew at an early age that I did not want to become one. As a result I tend to find my comfort in food instead of a bottle. 

I don't say this to imply that one is worse than the other. It's just a sad fact. The older I become, the more I stew about things. The more I stew, the more I eat. The more I eat, the less I feel like exercising. And so the vicious cycle is born. And, you know what makes me stew the most? Having diabetes. So there you go.

This is one of the reasons I started this blog. I needed to get that off my chest. I feel guilty about developing diabetes and it keeps me in a rut. I am not a stupid person. I know that this disease can kill me. I know that if I take proper steps I can keep that from happening. But you know what else I know? Life happens. Stuff goes wrong. You have bad days. It gives me a tiny bit of comfort to know that I might have been given fast track to this and didn't just bring it on by mindlessly eating donuts.

What a crazy world in which we live, huh? Such mixed messages we are delivered all the time. If you smoke you are bad. If you drink too much you are bad. If you eat too much you are bad. But hey, at the same time, did you try that recipe for sinfully oozing molten chocolate bundt cake? I want bundt cake!

I quit caring about how I look awhile ago. That battle is behind me. What I worry about now is my A1C — the test you are given every three months to see you blood sugar averages. I worry about my eyesight. Diabetes can cause blindness. It can cause heart disease. Kidney problems. The list goes on.

So, I'm working on it. This blog is my journal. I'm sharing with you my demons. Be patient, please. I need to share my weaknesses, but I promise that I'll share my successes too.

The not-so-hidden cost of Diabetes

Type 2 Diabetes has been in the news quite a bit lately. We have an epidemic so it seems. It's all over the news -- surely you've heard. Obesity! Obesity! It's a scourge upon our society! Oh, wait, I digress. That's a topic for another post.

Whether you have Type 2 or Type 1 (insulin dependent) Diabetes there are some tools of the trade that you'll need to keep on hand:

A blood glucose monitor
Test strips
Lancets
Medication

These are the very basic items. The monitor itself is not that expensive. My first monitor was given to me by my doctor. It was a Freestyle. My insurance at the time wouldn't cover the strips that work with that meter, so I had to go buy a One Touch meter, the accompanying strips and lancets. The lancets are the little needles that poke your finger to draw your blood for testing. They need to be replaced often because when they are dull it hurts.

Those meters run anywhere between $20 and $80 depending on the type of meter. The test strips run $35.99 for 25 strips. That, my non-mathematical friends equals $1.44 (take or leave a half-penny) per strip. When I was first diagnosed I only had to test twice a day -- before breakfast (fasting reading) and two hours after my largest meal (usually after dinner). Now I test before I eat carbs — and that means a lot more testing. Type 1 diabetics have to test a ton.

When I increased my testing, I was running out of test strips faster than my insurance company would let me refill them. So, I switched meters and now don't run these purchases through insurance. Kroger has a $4 meter and 50 test strips only cost $20. My endocrinologist suggested this, and it works just peachy.

My sugars have always been wacky, and so quickly I went from just Metformin, which is the first drug you are put on when you're diagnosed as Type 2, to additional oral medications. For awhile I was on a drug called Byetta -- a twice a day injection from a pen. This drug costs around $230 a month. In 2008 I was unemployed and could no longer afford to take it. When I became employed again and had insurance, went on insulin (Lantus). I now take two types of insulin. At bedtime I take Lantus, a slow-acting insulin and during the day I take Novolog, a fast-acting insulin.

Both come in pen form and I use a little tiny needle and inject myself in my stomach. I know that sounds ooey, but it really doesn't hurt, nor is it difficult to do. They come in packs of five and both cost more than $200 per prescription. I have to refill them every couple of months or so.

My insurance does not have a co-pay. My company offers a Health Savings Account, where money is taken deducted out of my check, pre-tax and put into this account specifically for medical supplies. I did meet my deductible this year -- $5,600. Yikes!

So, there you go. This is not intended to be a tale of woe, as there are tons of diseases out there that cost much, much more. It's just that I went from a person who hated to take an aspirin, to a person that has one of those little pill dispenser things with the days of the week on them. I always made fun of my brother for having one of those and now look at me. I wear a medical alert bracelet, have a list of medications in my purse along with glucose tabs and a glucagon shot.

The whole thing just kind of makes me shake my head in disbelief.

The agony of the feet.

Any diabetic will tell you — your feet are a big deal. Prolonged elevated blood sugars damage your nerve endings and your circulatory system. Your feet, being located where they are on your body, are most vulnerable. Step on a crack and your momma's back is the least of your worries. A scrape, cut, corn and any number of maladies that you'd normally just ignore could pave the way to amputation.

Wow, that is a scary word, isn't it? Amputation. I always think of soldiers in the Civil War, where field doctors would say, "I cain't do nothing for you, son – Henry, git the saw!" It truly is serious stuff and one of the most common results of having diabetes. Because your nerve endings can be damaged, you can lose feeling in your extremities. An injury could go unnoticed because you don't feel it and can quickly become infected. Every visit to the doctor should be accompanied by a foot exam. Not only do they look for cuts and scrapes, they run a tiny plastic thing up and down the bottom of your foot to make sure you haven't lost any feeling there.

So, no more barefootin' it around in the grass. I always wear slippers or flip-flops around the house. I have dogs and they are notorious for leaving a chew toy in the hallway. A nighttime trip to the bathroom is like walking through a field of landmines, just waiting to be stepped upon. I may be lax about many things when it comes to managing my diabetes, but my feet are not one of them. I religiously use heel cream and wear shoes all of the time.

Here's my favorite foot story. It happened a couple of years ago.

I had two cats, Nip and Tuck. It was a warm summer evening and I had the front door  opened to let the breeze in. A neighborhood cat came and sat upon my stoop. Tuck, my female cat, went crazy. Shrieking and hissing as only cats do. Nip, the male, couldn't have cared less, but Tuck was having a fit. I went over to shut the front door and simultaneously reached out with my foot to shove her away. She, being not the brightest bulb, reached over and bit me. Sunk her teeth in to the meat of my right foot. Two puncture wounds right on the top. It hurt like crazy. She looked up at me as if to say, "hey — you're not that other cat..." I hopped around and went to the bathroom where I carefully cleaned the bite and put some anti-bacterial cream on it. It immediately started swelling and the next day I could barely get a shoe on. I called the doctor's office as soon as they opened and told the prescribing nurse what had happened. She said, "oh I'm sure that you've done the best thing, but let me ask doctor." By the way, when did they stop saying THE doctor? I hate it when things like this change and I have no idea why or when it happened.

Five minutes later she called me and told me that they had called in an anti-biotic. See, doctor knew. You don't mess around with the feet.

Feelin' low

Diabetes is a confusing disease. It sends missed messages to me. For instance, today before lunchtime.  I didn't pause for a mid-morning snack, as I should have. As a result, I dropped low. When you drop low, what does one do? Eat or drink sugar. So, I ate glucose tabs. These particular tabs are grape flavored. They're like a gigantic Sweet Tart. Each one contains 4g of carbs, so you eat about three of them to get your sugar up. Then you wait 15 minutes, test, and if all is well you go on your merry way.

"So, wait a minute. You get to eat candy when you're low?" you must be asking, because that is exactly what I think every time I go low and have to eat tabs, or drink juice or whatever. That seems like an incentive to stay low, don't you think? But it's not. Being low isn't fun. Not everyone has the same symptoms. Mine are sort of a quaky feeling -- jittery, especially in my hands. It makes it hard to test because my hands have a tremor kind of thing going on and I've dropped strips as a result. You don't want to do that because those pesky things are crazy expensive!

Plus, going low makes me tired. I kind of want to nap after a low. But then again, I kind of want to nap most of the time anyway.

Because I'm so inconsistent with managing my diabetes, I usually run high. I can't really tell you how that feels, because it's so normal to me that it doesn't feel weird at all. Every time I go to the doctor and my A1C is high (this is a test they run to get your 3 month blood glucose averages), they will change my dosages and say, "we'll get you feeling better." I want to say to them, "I feel fine!" I kind of wish I did feel crappy, as that would be more of an incentive to be diligent.

I could save myself from most of these highs and lows if I could just stick to a healthy diet. Which is not to say you never have wacky sugars when you eat healthy. All kinds of things affect (or is it effect? I can never remember) your sugars. Stress, infections, menstruation — any kind of sickness, really. And that opens a whole 'nother can of worms.

Here's one of my favorite stories of going low.

I was in Indy visiting a friend of mine. We were in a Marshalls and I was at a clothes rack when I felt myself going low — quickly. I actually felt like I had tunnel vision. I knew if I didn't treat it soon, I could pass out. I went to the restroom and tested. I was at 37 — which is pretty darned low. My niece had told me to carry one of those little gel tubes of cake icing. It is high in sugar and less expensive than the glucose drinks they sell at the drug store. I fished my hand around at the bottom of my purse and found the icing and unscrewed the top only to find that the thing needed to be snipped with scissors. I ran from the restroom, icing in hand. All of the scissors that were for sale were encased in plastic and were of no use to me. My friend saw me and said, "is everything okay?" I explained my dilemma and she said, "I just saw some tree trimmers!" I followed her over to the gardening section (I didn't even know they HAD a gardening section) and she pruned the top off of the icing. The tip went flying somewhere and I sucked the gel stuff out of the tube. Gross. I ended up buying a Coke and drinking it at the Homegoods store next door.

So, I try to always have a fast-acting sugary thing with me at all times. Now I have a glucagon syringe with me. I showed my friend Molly here at work how to administer it. She gave me that look like, "please don't ever make me do this." A glucagon syringe is only used when you pass out and can't ingest sugar on your own.

So, there you go. Highs vs. lows. It's all bad. Trying to get back on track is tricky, but considering the alternative helps. I really like my feet. And my eyesight.