The Breast Exam and Fragmentation of the Patient

Today I went for my annual mammogram. It is probably the only non-diabetes related medical procedure I experience.

I find mammograms interesting because they say a lot about medicine. The breast, as the object of examination, is manipulated as if it were an independent part of the woman's body. This fragmentation is accentuated by the fact that the surface where the breast is placed is usually cold. The woman is placed in a position relative to the x-ray machine which is tantamount to contortion, as the breast, the focus of the procedure, is pulled away from the body and placed rather aggressively on the cold, hard surface. Finally, the breast is compressed between two plates up to the point of discomfort, which the technician asks about in an effort to get the most squish up to the point of the victim's tolerance.

Thus, the breast almost behaves as an independent entity during the test. The woman is separated from the breast. That is what fragmentation is in medicine. Another example is a Pap Smear, in which the focus becomes the uterus. In this vaginal exam, the woman is even shielded from that part of her body when a drape is laid over her knees. I had a gynecologist once who seemed to recognize me, finally, when he got down in front of my uterus, as though my cervix had my name on it. Once, as I was getting ready to leave, he quipped, "She stands up. She wears clothes." A patient not laying on a table with feet up in stirrups was something remarkable to him.

There is an obvious effort to make the mammography procedure more comfortable. At my "Breast Clinic," the waiting room is decorated with homey brightly colored furniture, almost cushy. There is a valence across the top of the window which faces the hall. In one corner (much to my delight) is a real desk with a computer on it, with Microsoft Explorer up and ready to go. A couple of times in the past, there has been a stuffed dog laying on the cold surface where the breast is compressed, in an attempt to warm it up. I have since learned that there is a market for mammogram warmers -- an attempt to make the experience more comfortable.

Perhaps these measures are meant to encourage women to have their breasts examined every year. It sure beats a cold waiting room, but the comfy waiting room environment ends when the woman enters the examining room. There, everything is functional, and there is no doubt that the breast at the "Breast Clinic" is an entity unto itself. "It stands up. It wears clothes."

Continuous Improvement in Diabetes Care

It seems that hospitals and HMOs can improve outcomes for diabetics by focusing on improvement of care.

An article about my health care provider, ThedaCare, give results of a continuous improvement program in diabetes care. The following are some of the results for diabetes care:

...through a combination of strategies aimed at improving care for patients with diabetes, ThedaCare has:

Increased the number of diabetic patients receiving a yearly eye exam from 65 percent to 85 percent

Increased the number of diabetic patients with HemoglobinA1c (HbA1c) levels below 8.0 from 43 percent to 60 percent

Reduced the average HemoglobinA1c (HbA1c) level among its diabetic patients from 8.7 to 7.6

It isn't surprising to me that there has been a focus on diabetes at ThedaCare, since the head of ThedaCare is Dr. John Toussaint, an endocrinologist who was my first diabetes doctor in the area.

I am in control!

I have been in control for two days now! I have been testing several times a day, and only once had a value over 200. I am counting carbohydrates and taking only the amount of insulin needed to cover those carbs. It feels great!

I ate a Sees Chocolate...

I just ate a Sees chocolate. Daniel brought them home. I try not to eat them unless I have hypoglycemia. I don't have hypoglycemia. Okay, so how much damage did I do?

There is an insert in the Sees boxes listing the nutritional facts, as they call them. I have a box of assorted chocolates. There are six charts in the little insert. Find the right one! A serving size for the assorted chocolates is two pieces, calories 160, fat 9 g, carbohydrates 20 g. Those chocolates are expensive luxuries in a diet, with all that fat and carbs! Okay, so I only ate one. One little chocolate -- 10 g of carbohydrate, 4.5 g of fat. Very expensive in the diet.

A cure for hypoglycemia is only the two chocolate serving. If it weren't for my kids, those chocolates would be around for a while!

Am I being studied? Nobody asked ME!

I am feeling annoyed today. I went to see the dietitian and diabetes educator, and although things went great with them, I have been wondering about something written at the bottom of my forms. There is a line on the bottom of the form that says "Special Status," and next to that, "Publish." I have seen this before, and in the past it has said, "Study." I have asked what this is about, and I get no answers. It seems nobody knows -- or else I am being put off.

As a social scientist, and a person accustomed to collecting data, it sounds to me as if I were in a study, or being studied, and that the results are going to be published. In anthropology we have a tradition. It's called, "full disclosure." It means that the people who are being studied consent to being studied, that I have told them what the true goals of my research are, and that I protect their identities. I have not consented to being studied nor published. Nothing has been disclosed to me.

UPDATE: I sent an email to my PCP's office, and received back some emails from the nurse (not the person I sent the emails to) giving me the run-around again. At first she didn't understand what I was talking about, and now she is telling me it's probably nothing and not to worry about it. I wrote back and told her to ask and find out. I am not going to accept "don't worry about it." If it's in my file, it's my business.

ANOTHER UPDATE (August 17): I again contacted the nurse at my PCP's office. I told her I was not yet satisfied. She responded that their "MyThedaCare expert" (MyThedaCare is the patient access website) couldn't reproduce the results. She said I need to bring in the form showing the word "Publish" at the bottom. I don't have the form because the diabetes educator took it. I have now sent the diabetes educator an email (also through MyThedaCare) asking her if I could have a copy of the form.

My Syringes

I know the Blogathon is over, but I had to add one more picture: my syringes. These are ultra fine syringes made by BD. They are subcutaneous. I use 1/3 cc and 1/2 cc. The needles are so skinny and small that you can hardly see them unless you're up close. For anyone who is afraid of needles, the truth is, these don't hurt. You don't even feel them.

The Boys Say Thanks!!!

Much thanks also from Ace and Henry, who were underfoot much of the time during the Blogathon, and especially Ace, who demanded constantly I play with his toy. I wish I could have gotten a picture of them both with a ball in their mouths -- a usually pose.

The Venus of Willendorf takes the last shot...

Okay, I promised one more picture of me shooting up. Here I am taking morning dose of Lantus, rounding out where I started my first shot yesterday morning. I do look like the Venus of Willendorf!!! Oh geesh, to lose that weight...

Luv Ya for all the support during the Blogathon!!!!

To Lei, Patty, Sennoma, Terrilynn, Sheana, and everyone else who followed my blog during the Blogathon! Thank you so much for the support for my efforts and for the Juvenile Diabetes Research Foundation! Thanks to the two friends who donated to my campaign and my mom, whose arm I had to twist but who finally came through.

No thanks to the rest of my relatives, those executives and doctors and lawyers and engineers, who did not come through with a dollar. Not even a penny.

I just want to tell everyone how much I got out of this Blogathon for myself. I never realized how all-consuming my life with diabetes is. To have it all down in words and pictures is pretty amazing. I really learned something from this experience. Plus, I had fun!

And it was great getting to know all of you! Let's stay in touch! xoxoxoxo

Candice

Berries

Here I am eating blackberries, and the Blogathon is almost over. I should post myself taking insulin one more time. Shouldn't I?

I'm Awake! I Swear!

It's my medication, I know it is. If I just weren't taking so much medication, I wouldn't fall asleep! It's that bipolar disorder. I have an excuse!

I feel as fat as...

...the Venus of Willendorf. I suppose it's one of those female self-image things, but since I quit smoking and gained weight, I feel pretty rotten about the way I look. I bet she had Type 2 diabets.

Polypharmacy

It's now 2:16 am. I didn't take my pills last night. I have a stack of them for my "head." They call it "polypharmacy." I guess the moral here is that if you have one affliction (say, diabetes) it doesn't mean you aren't going to get another one (say, bipolar disorder). One of my friends once commented, after she was diagnosed with ovarian cancer, that she had been thinking that this was her "big disease." Then she added, "You can think something is your big disease, but then it might not be." Interesting.

Off to take the meds.

Diabetes and the "Art" of Healing

I am a big fan of the NYU Medical Humanities, Literature, Art, and Medicine Database. This wonderful resource indexes medically-related film, poems, works of art and literature by topic, disease, affliction -- whatever topic you might want to find related to medicine.

There are several medically-related topics I enjoy looking up in this database, but of course diabetes is relevant here. The list for diabetes isn't that long, and oddly, "Steel Magnolias" is not listed under film. There is also no diabetes art listed -- but is there any? Hard to know (maybe I will invent some, ala Judy Chicago...I've got some ideas!).

Still, there are 17 works listed under literature that I haven't read. I am especially attracted to the W.H. Auden poem, "The Art of Healing." I know I must have read this recently. Yes I have read it. Here is a quote:

From "The Art of Healing"
by W.H. Auden

Most patients believe
Dying is something they do.
Not their physician,
That white-coated sage,
Never to be imagined
Naked or married.
Begotten by one,
I should know better. “Healing,”
Papa would tell me,
“is not a science,
but the intuitive art
of wooing Nature.”

Uh oh!

Uh oh! I crashed out there for a little while. Maybe I can use my diabetes as an excuse? Uh...I had low blood sugar...no, I had high blood sugar...

Thank God, I'm still here!

"Steel Magnolias" and My Pregnancy

I'm starting to struggle with staying awake. I nearly fell asleep thinking about the movie, Steel Magnolias, in which Shelby, played by Julia Roberts, dies of complications of diabetes brought on by pregnancy. Shelby gets pregnant against her doctor's advice and goes on kidney dialysis after the birth of a healthy baby boy.

This film was released in 1989. Camille was born in 1991. I was haunted by the film during my pregnancy, because people (especially my mother) thought my pregancy would harm me like Shelby's harmed her. I hated having to explain that I had consulted with doctors before becomming pregnant, and had been given the go-ahead. I like that movie, but it made me crazy at the time.

BB King and the One-Touch Ultra

BB King is the spokesperson for One-Touch Ultra, which is the meter I have. Apparently he likes being able to get blood for his tests from his arm, so he won't have to prick his fingers which he needs for playing. I haven't really understood the relationship between the brand of meter and where you can get blood. It would seem that multiple sites would have been available all along. If less blood is necessary for testing (if that is indeed the argument One-Touch is making) you would think all the new meters would provide the same benefits. The logic of the argument just doesn't follow. I guess some people buy it, and that's why One-Touch uses that commercial.

I've Blogged 12 Hours of My Diabetes Routine So Far

It's almost 12 hours since the Blogathon began. I have gone through an entire day of sharing my routine. When I started this, I wasn't sure what I was going to blog about. I had ideas. For example, I thought I would talk about going to Africa with diabetes, or how I was diagnosed. But something slightly different happened naturally; I wrote about my day-to-day, hour-to-hour triumphs and trials with my diabetes. I wrote about the basics. I took pictures. I shared what it is like being an insulin-dependent diabetic.

Now that we are coming up on the second half of the Blogathon, I again have little idea where my writing will take me. I am not worried, though. There is still plenty to say about diabetes and how it has affected my life. Now on to the next 12 hours!

Dinner -- The Same Routine, AGAIN

Here is my dinner. A piece of steak and some corn on the cob, no butter or margarine. Total: 25 grams of carbohydrate, 29 grams of fat (3/4 of my fat allowance for the day).

My blood sugar was 286 when I tested it before dinner. It should have been between 80 and 120. Here is how I calculate how much insulin to take: 1 units per 15 grams of carbohydrate from dinner, plus 1 unit for each 50 points above 120. Total insulin: 5 units. I inject myself ONE MORE TIME.

I'm Diabetic, and This is My Meter

I haven't gone through the finger pricking and blood sugar testing on here yet. Well, this is my meter, a One-Touch Ultra. It's half the size of my cell phone and gives results in five seconds. It also stores (I think) 100 blood sugar values.
The meter uses a small drop of blood on a test strip. To get the blood, you need a finger pricker. I really don't understand what all the fuss is about on TV, with people talking about finger pricking hurting. I never found it painful, but I think you have to adjust the pricker to the right depth. Besides, you prick your finger so many times calouses develop. It really is no big deal.
Final picture: the tiny drop of blood to put on the test strip. With the new meters, you need less and less blood, so that is an improvement. I'm sure it helps a lot of people, especially children. It has just never bothered me to prick my finger.

Nearest Distant Shore

Terri-Lynn, who has a 6 year old with diabetes, is one of my sponsors. She has a very nice blog called Nearest Distant Shore. There are some lovely photographs, and a whole lot of music! Visit it.

What they said about my blog

This is what Sennoma said about my blog on the front page of Blogathon this evening:

Candice is blogging for Juvenile Diabetes Research Foundation; she has had Type I diabetes for 19 years. It’s quite an eye-opener to see what she goes through every single day — in fact, every time she eats. Sponsor Candice here.

Very cool! Thank you Sennoma.

"One" Magazine and Crock Pot Recipes

I received a magazine in the mail today from Penzeys Spices. It is the first issue of a magazine called "one." It is an absolutely beautiful magazine filled with incredible recipes -- from regular folks, but totally slicked-out in large magazine format. Unfortunately, there is no dietary information. One would need to sit and figure it out.

One of my favorite cooking websites, Southern Us Cuisine has hundreds of crock pot recipes. I've cooked some great Hungarian goulash from one of the recipes here. I also had to go to Penzeys and buy the sweet Hungarian paprica first. Thus, my crock pot led to receiving the magazine, "one." Funny, huh?

A1c?

This diabetes joke and many others are from the Defeat Diabetes: Islets of Humor website.

I was bad again...

Oh dear. This time I binged on cookies, and topped it off with two slices of bakery French bread loaded with margarine. I have yet to figure out what this cost me in terms of units of insulin. I think I need to take nine units.

I have had trouble controlling my appetite since I quit smoking a few months ago. I just need to cover everything with insulin. My A1cs have been really bad.

In case you don't know, an A1c is a measure of blood glucose control over the past three months. A good A1c is between 4.8 and 7.0. A1cs at this level reduce or prevent complications. My A1c this last time was 8.9. Scary. This is the reason the doctor thinks I should go on a pump. It seems that my diabetes has become harder to control, even covering for the food. I am doing my best.

These factors are exactly the reason I started Diabetes Buddies. I thought, that with some support, I could conquer some of my demons. Namely, the food demon.

It is so hard to maintain control.

Going Through the Routine AGAIN

Okay, this time I needed to take two units of Humalog insulin, after eating the yogurt and berries. The first pictures is drawing up two units (see how little that is?).

The second picture is me injecting AGAIN.

I'm sure you're getting the point by now. "Tight control" means taking multiple injections of insulin every day. You are watching my routine.

My Lunch -- I do it right

This is my lunch of plain low-fat yogurt and blueberries. It is about a cup of yogurt and half a cup of berries. It has 3.5 grams of fat and about 30 grams of carbohydrate. A very safe choice. Plus, it tastes good. Tastes like ice cream to me. I do like it better with blackberries or raspberries though. I need to take 2 units of insulin to cover it. (Back to the insulin.)

Have I made up for the two cinnabuns yet?

Servings Sizes as Sports Equipment?

I found this on the American Diabetes Association website. It's a guide to portion sizes using, of all things, sports and game metaphors. Makes me want to eat a cup of pasta.

A serving of… Measures… And is about as big as….
Cheese - 1 ounce - Four dice.
Rice - ½ cup - Half a baseball.
Bagel - 4 ounces - A hockey puck.
Meat - 3 ounces - A deck of cards.
Peanut butter - 2 Tablespoons - A ping-pong ball.
Pasta - 1 cup - A tennis ball.

Dogs and Cats with Diabetes

When Daniel and I were living in our first house, a little condo in Irvine, California, the lady upstairs had a cat that took insulin. She faithfully injected it with insulin subcutaneously every day, lifting up its skin. She also had to leave food around for it because a cat can't tell you when it has hypoglycemia and needs to eat.

This was the first time I heard of a cat with diabetes. Since then, I've heard of it a lot. Apparently up to 1% of dogs and cats get diabetes. That's a lot of pets on insulin, and a lot of obsessive pet owners. There are also a lot of websites about diabetes in pets, both about individual animals and about dog and cat diabetes in general. That tells you how common it is.

My friend Chrissy told me just this morning about a lady she knew who had a cat with diabetes. The cat was about 20 years old and the lady had it on an insulin pump. An insulin pump costs about $5,000 nowadays. I wonder how the lady justified that. I guess some people leave their estates to their animals too.

Diabetes Monitor, a e-magazine, has an entire web page of links for diabetes in dogs and cats. It's the best resource I've seen on the subject, although a google of cat diabetes or dog diabetes will bring up all sorts of links.

While we're talking about types of insulin, I should point out that there is special insulin for dogs and cats called Caninsulin. It is a pork insulin.

I don't think I could stand injecting an animal with insulin. I think it would irritate me having to spend my time doing that. It is enough of a hassle injecting yourself with insulin

Insulin for the Cinnabuns

This is my shot to cover the cinnamon buns. The FitDay data says 60 grams of carbohydrate for two medium buns. That would have been four units, but I didn't believe it and took six. I will have to check my blood sugar in a little while. Something else to post!

Eating Bad Stuff -- Again

Check out my FitDay record for today. I have already gone off my diet today. I had two cinnamon rolls with that sugar icing. Daniel made them. I just couldn't resist. I have no will power at all when the food is sitting there on the stove, hot and sticky and ready to be eaten.

Interesting, when I went looking for pictures of Cinnabuns, I found lots of pictures of rabbits. I guess a lot of rabbits are named Cinnabun.

Now to go take some more insulin to cover the cinnamon rolls.

Lantus Insulin and other Insulins

This is Lantus insulin, which is also known as insulin glargine. Who knows what that means. It is recombinant DNA human insulin -- synthetic insulin. Not everyone likes human insulin, by the way. Some argue that it causes hypoglycemia and prefer animal insulins such as pork or beef. Unfortunately for these people, Eli Lilly doesn't make animal insulins any more. I am happy with my Lantus, although I never took animal insulins. Eli Lilly has half the insulin market.

There is a nice webpage comparing insulin types at Drug Digest. I am also including a picture here of the difference between NPH insulin and Lantus insulin. Before there was Lantus, there was always some slope in the way the insulin affected blood sugar. That's the sharp peak. Now that we have Lantus insulin, we have an insulin that provides a steady background dose and the result is less fluctuation in blood sugars. The Lantus is the straight line. Lantus insulin is as much like a pump as possible without being on a pump.

The Genetics of Type 1 Diabetes, by Hsien Hsien Lei

Lei has kindly written this article for the blogathon. She has also written a post on her blog about me, my diabetes related activities and my struggle with diabetes. Lei's blogs include her Genetics and Public Health Blog (where the posts about diabetes are) and her Cotton Pickin' Days personal blog. If you go by her Genetics blog, be sure to check out the article on how humans are genetically similar to pigs!

The Genetics of Type 1 Diabetes
by Hsien Hsein Lei

Type 1 diabetes occurs when the insulin-producing cells of the pancreas are destroyed by the body's own immune system. About 18 regions of the genome, labeled IDDM1 to IDDM18, have been associated with an increase in type 1 diabetes risk.

• IDDM1 - HLA genes that encode immune response proteins


• IDDM2 - insulin gene


• IDDM4 - genes for ZFM1 (zinc finger protein 162), FADD (Fas-associated death protein), and LRP5


• IDDM5 - SOD2 gene


• IDDM6 - gene associated with colorectal cancer (DCC), gene that encodes a zinc finger DNA binding domain (ZNF236), and a molecule that opposes apoptosis (bcl-2)


• IDDM7 - genes for NEUROD1, IGRP


• IDDM10 - GAD2 gene


• IDDM11 - genes for ENSA and SEL1L


• IDDM16 - gene that encodes for immunoglobulin heavy chain


• IDDM18 - ILB12 gene


• CTLA4 gene - regulates immune system


• CD28 gene


• ICOS gene

Despite these and other candidate genes that have been associated with increased risk of type 1 diabetes, no gene therapy or gene-targeted drugs have been developed thus far. As more genes are discovered and their functions better understood, it will become possible to figure out exactly why some people have type 1 diabetes and to provide them a cure, as well as prevent others from developing it in the first place.

For more detailed information, see The Genetic Landscape of Diabetes, NCBI

Now to "Inject" a Little Humor!

Four Europeans go hiking together, and get frightfully lost. First they run out of food, then they run out of water.

“I’m so thirsty,” says the Englishman. “I must have tea.”

“I’m so thirsty, says the Frenchman. “I must have wine.”

“I’m so thirsty,” says the German. “I must have beer.”

“I’m so thirsty,” says the Jew. “I must have diabetes.”

Will I survive the Blogathon Quiz???

40 %

There's a 40 % chance that I'll survive the 'thon.
Will you survive the Blogathon?
Oh Geesh. It looks like I'm in trouble.

Shootin' Up

Okay I took this picture myself and I sorta missed. I meant to get the syringe in there. What I got was my hand, my belly and a couple of bruises. The bruises are from needles. I don't get a lot of those, but when I do, they stick around for a while. I will have to catch a better picture the next time around.

Drawing up the Syringe

I took this one a little while ago drawing up my dose of Lantus. I take my Lantus in the morning, but that's a different story and another post. In case you don't know, Lantus is a long-acting insulin, supposedly 24 hours, and is a kind of background dose. Anyway, here I am drawing up my Lantus. I took the picture myself, so my other hand is missing, but I think you get the idea.

The Injecting Stuff

This is my current injecting equipment. I've had that pounch with that cooling insert for about 15 years I think. It's filthy. I need to get a new one, or at least wash this one. But maybe I won't need it much longer. I am supposed to get a pump, whenever the diabetes educator decides that I am "ready." As far as I am concerned, I am ready NOW!

The Blogathon Begins!

It's 8:00 am. I am up and raring to go. Gotta go downstairs and take my insulin though. Maybe I'll take a picture and post it!

A1c Testing at Home?

Brystol-Myers Squibb has a machine that allows you to test your homoglobin A1c levels at home. The device is called Choice DM A1c Home Test. The test is disposable and the results come in about 8 minutes. I found it online for about $19.00. Click here for a news release dated December 2004. It appears this little device has only been on the market for seven months.

I don't need a home A1c because I get it tested regularly at my doctor's office. It might be great for people who can't afford to go to the doctor or don't have insurance. Would have been a great thing to have taken to Africa too, hmmm!

Link Between Diabetes and Alzheimer's?

There have been some studies of the relationship between Diabetes and Alzheimer's disease. The latest study, coming out of Kyushu University, Japan, found that diabetics were 3.1 times more likely to develop Alzeimer's disease than non-diabetics.

This number far exceeds the proportion found in studies in the US. One US study of more than 2,500 people found the ratio to be 1.8 times. A study in the Netherlands of more than 6,000 people found that diabetics were 1.9 times more likely to develop Alzheimer's.

Hiroshi Kiyohara, who leads the Kyushu University team, said, "Prevention of diabetes and proper control of blood-sugar levels will become an important issue for society as it continues to age."

These findings are scary for me, because there is a history of Alzheimer's in my family. As far as I know, I am the only one with type 1 diabetes. My uncle, who is not related to me by blood, had diabetes for years before he was diagnosed recently with Alzheimer's. My grandfather was type 2 diabetes when he developed a form of dementia at age 80. We don't really know whether this this was Alzheimer's. It was 1966.

New Yahoo Group! Diabetes Buddies

I have started a new Yahoo Group, Diabetes Buddies. The goal of the group is to provide a place for diabetics to link up with other diabetics -- to provide regular, email support for each other on a one-to-one basis, with the goal of improving control! In other words, people will go to Diabetes Buddies to find an email buddy.

I am the first and only member so far. I am an adult female looking for a buddy with type 1 diabetes, preferably an insulin pumper. (Now doesn't that sound like a dating ad?)

If you're interested in joining, go to the Diabetes Buddies website, tell me why you want to be a member, and I'll sign you up!

Looking for a diabetes buddy

I decided I need a diabetes buddy -- someone to link up with over the internet. I want somebody to check in with about how I'm doing with my diabetes control, on a day-to-day basis. And in return, I would do the same for the other person. It seems relatively obvious. But when I went looking on the internet, I didn't find anything here in the US. There are diabetes buddy programs in Australia and the UK, but I don't think they are focused on the internet. Am I missing something, or is this kind of program just not available?

Yesterday I talked to my friend John in California about being my diabetes buddy. He said he could do it, but he's Type 2, and I'm Type 1. He doesn't take insulin and only has to check his blood sugars twice a week. He says he doesn't think he'd have much to offer. After some thought, I figured he was right.

I think it would be cool to start an internet diabetes buddy program. I wonder how that would work. There would need to be a central meeting point, like a Yahoo group for example, where people could post looking for a buddy. It would be a place where people could match themselves up. And a place for information about what it takes to be a good buddy. I don't think I have the time to achieve such a thing...but maybe somebody else does.

FitDay -- a public food log! (Yikes!)

Through ReneeGetsFit, I have discovered FitDay, an online food journal that can be made public. Actually, that there is my first FitDay record. More than 3000 calories and 160 grams of fat. Gotta do better than that. Okay, so I'm letting it all hang out here. Thanks again, Renee!

To Eat or to Smoke: That is the Question

I called LeAnn, my diabetes educator today. I got desperate. I can't seem to follow the diet. It's not because I don't know what I should be doing. I do. That part is easy. The complicated part is controlling the eating. I have been having trouble controlling my eating ever since I quit smoking.

It turns out that she is the one who has delayed my receiving the pump. Just because it was approved by the insurance company doesn't mean they are going to let me have it right now. She says she hasn't worked with me long enough. She is the one who needs to teach me to use it. So I am unhappy about this. At least I will get it eventually.

But back to the diet issues.

I told LeAnn that I don't know what to do. I am even considering starting smoking again, so I can control my eating and take off the weight I gained. Of course she doesn't want me to do that. What she wants me to do is to count the carbohydrates and cover them with insulin. The last thing I need is to go into ketoacidosis again. So the goal is to keep the blood sugars down even if I can't stop myself from eating.

This is a drag.

Renee's 5 lb Labor Day Challenge

I found Reneegetsfit through BlogExplosion. Truthfully, I haven't found many on that website that impress me, but Renee's did. She has actual polaroids of herself at stage one (in skimpy bathingsuit top, with fat hanging over waistband of jeans) and stage two (remarkable improvement, but more to go). Girl, does it take commitment and daring to put up those pictures! I can't even look at myself in the mirror since I quit smoking a few months ago.

So, anyway, Renee has posted a five-pounds-by-Labor-Day challenge. Since I'm supposed to be following an obcenely skimpy, disgustingly tasteless diabetic diet (which I am trying to transform into something tolerable), I figure I could use a little motivation from Renee. It will be interesting to see how many pounds the horrid diabetic diet will take off by Labor Day.

(See my earlier post, The Horrid Proposed Diet.)

I will get weighed on Wednesday, August 3, at my physical. Dread and loathing.

Blogathon for Juvenile Diabetes Research Foundation!

I have signed up to participate in Blogathon! When I found Blogathon, I realized it would be a really cool thing to do: Blog for a charity. I chose the JDRF, of course. Nobody else on Blogathon was blogging for JDRF.

I would love if you would sponsor me! All you need to do is go to Blogathon and register, and then sign up to sponsor me. You can sponsor me here:

My JDRF sponsor link at Blogathon

If you choose to sponsor me, the link will take you DIRECTLY to the JDRF webpage, where you make your pledge. No money goes through me or through Blogathon. So you know your money is going straight to the charity. Isn't that cool?

Then, on August 6, starting at 9:00 eastern time, I'll be posting on this blog about every 30 minutes! And I'll be staying up all night to do it. Come in and see how I'm doing and what I'm writing! You don't need to stay up all night though, LOL!

My blog needs to bring in at least $5.00. All you need to do is pledge at least $1.00.

Hope you can participate!

My insulin pump is approved!

I got a call from Animas yesterday. My pump has been approved by United Healthcare, our insurance company! I will probably have it on Friday. I am so excited!

"Sugar": The first part of poem, "Diabetes," by James Dickey

One night I thirsted like a prince
Then like a king
Then like an empire like a world
On fire. I rose and flowed away and fell
Once more to sleep. In an hour I was back
In the kingdom staggering, my belly going round with self-
Made night-water, wondering what
The hell. Months of having a tongue
Of flame convinced me: I had better not go
On this way. The doctor was young

And nice. He said, I must tell you,
My friend, that it is needless moderation
And exercise. You don’t want to look forward
To gangrene and kidney

Failure boils blindness infection skin trouble falling
Teeth coma and death

O.K.

In sleep my mouth went dry
With my answer and in it burned the sands
Of time with new fury. Sleep could give me no water
But my own. Gangrene in white
Was in my wife’s hand at breakfast
Heaped like a mountain. Moderation, moderation,

My friend, and exercise. Each time the barbell
Rose each time a foot fell
Jogging, it counted itself
One death two death three death and resurrection
For a little while. Not bad! I always knew it would have to be
somewhere around

The house: the real
Symbol of Time I could eat
And live with, coming true when I opened my mouth:
True in the coffee and the child’s birthday
Cake helping sickness be fire-
tongued, sleepless and water-
logged but not bad, sweet sand
Of time, my friend, an everyday –
A livable death at least.

"Walking the Dog," a poem by John Wright

She weighed
three hundred pounds.
Fat and high sugars
were killing her
I thought.

So,
I thought.
So,

I gave her a puppy
with dark curly hair,
nothing else had worked.

Walking the dog
twice a day
I thought
might persuade,
might motivate.

She was pleased with my prescription,
she laughed,
she rocked
from side to side.

She lived
for twelve years
hugging
that little black dog
while her lean husband
walked it faithfully,
twice a day.

by James Wright (1927-1980)

The Dietitian, Yogurt, and Yoplait Thick & Creamy

To me, good food is a quality of life issue. This also applies to yogurt. My favorite yogurt is Yoplait Thick and Creamy vanilla.

The dietitian had shown me cartons of nonfat yogurt with fruit on the bottom. I told her I eat Yoplait Thick and Creamy. She said these were high in fat, and I have a "fat tooth"! She also told me that I could eat two cartons of nonfat yogurt for one carton of the Thick and Creamy. I happen not to like yogurt with fruit on the bottom. I want to stay with my Yoplait.

As with everything else, I decided to do my own research on nonfat yogurt versus Yoplait Thick and Creamy. It turns out that the Yoplait is low fat yogurt with live or active cultures. Here are the facts for 8 ounce containers:

• Nonfat yogurt has zero grams of fat. Yoplait yogurt has 3.5 grams of fat. Whole milk yogurts have 7-8 grams of fat. If I were to have a 1200 calorie diet, one carton of Yoplait Thick and Creamy would make up less than ten percent of my daily fat allowance. I wouldn't say Yoplait is high in fat.
  
  
• Nonfat yogurt with fruit on the bottom has about 19 grams of carbohydrate per carton. Yoplait yogurt has 31 grams of carbohydrate. The dietitian told me I could eat two cartons of the nonfat yogurt for one carton of the Yoplait. That isn't exactly true. Even nonfat yogurt without fruit at the bottom has about 18 grams of carbohydrate.
  

Actually, the best yogurt is nonfat plain yogurt with active cultures. This I like, with my own fresh fruit or wheat germ mixed in. But the dietitian didn't offer me this choice. Her repertoire included mostly processed foods low on quality and flavor. I feel the dietitian mislead me about the fat content of my yogurt, making it seem as though I would be making poor choices going with lowfat yogurt.

I think what irks me the most is the dietitians's condenscencion toward me. It is true that I am more educated than the average patient, capable of doing my own research (after all, I am a social scientist). Why is it, though, that my doctors are not condescending and the dietitian is?

Finally, dietitians should consider the lifestyle and preferences of their patients in helping them plan a diet. For one person, packaged and processed foods (like packaged cheese), or foods low on flavor, are perfectly acceptable. For people like me, however, the thought of that kind of diet depresses me. I consider eating good food a quality of life issue, and I am going to find a way to do it within the limits of my diet.

Diabetes in Postage Stamps

In 2001, the U.S. Postal Service issued a diabetes awareness stamp. According to Diabetes Monitor, the stamp was designed by artist James Steinberg. That same year, Dr. Lee J. Sanders published The Philatelic History of Diabetes: In Search of a Cure, a book which tells the history of diabetes through 30 international postage stamps. The book is available at Amazon.com for $14.95.

There is a lecture by Dr. Standers on the internet called From Thebes to Toronto and the 21st Century: An Incredible Journey. It gives a nice overview of this topic, along with pictures of a lot of lovely stamps. Dr. Sanders is a podiatrist at the VA Medical Center in Lebanon, Pennsylvania.

My favorite stamp is a 1999 Canadian stamp of Frederick G. Banting and Charles H. Best, the discoverers of insulin. Shortly after I was diagnosed with diabetes, I read The Discovery of Insulin by Michael Bliss. I was in graduate school at the time, and deeply involved in research myself, so the book was an eye-opener in terms of medical ethics, animal research, the real "messiness" of research that can be made to appear neat and clean after the fact, and (last but not least) professional rivalry. I would love to have this stamp, put it in a frame with a wide white mat, and hang it in my office.

The Eleven-Pound Baby: Pregnancy with Diabetes

If I'd had another child, I would have named her Isabella. I knew a little girl in Africa named Isabella, the daughter of a Kenyan doctor. She was called Bella for short. I think it is a beautiful name.

I had wanted four children. As it turned out, I had three. Diabetes made my third pregnancy difficult. Neither Daniel nor I were ready to go through it again.

Camille was born when I was 39. She weighed 11 pounds 3 ounces. There was extra amniotic fluid in my uterus, and I had braxton-hicks contractions for most of the pregnancy. My doctor didn't want me climbing stairs, but my office -- in an old building on the Lawrence University campus -- was on the third floor and the elevator only went to the second. I had to stop every so often as I climbed the stairs, because the contractions grew stronger.

My doctors were a high-risk neonatologist and an endocrinologist. I went to the hospital twice a week for a checkup, blood glucose monitoring, sonograms and whatever else they threw at me. This I had to do early in the morning so I could make it to my anthropology lectures on time. I drove back and forth between Appleton and Neenah at 7:00 am. It was very cold that winter.

The neonatologist was a sexist creep who told blonde jokes. He later lost his license. I think he was an alcoholic, because one of the nurses told me he had liver disease. He was often not there.

Labor was induced the day after Christmas in 1991. Nobody knew the baby was so big -- nor that she had such a large head that she would never drop down into my pelvis. I didn't even dilate. Daniel told the doctor that if he put me through labor and then did a c-section, he would have to buy us dinner. Camille was born they evening of the 27th, by c-section.

What I resent the most are the cracks the doctor made while delivering Camille, implying (while I was laying on the table in the operating room with my arms tied down) that I was dominating Daniel. That memory pollutes the experience of her birth. But he was the only game in town, as high-risk doctors went. Maybe I should be grateful he was there for me, but I have nothing but bad memories of him.

The worst was what he said after Camille was born. He said that because she weighed so much, the pregnancy had been "considered a failure." He said I must have cheated somehow. I tried to protest, but he walked away. My A1c's had been quite low, and my records were accurate. I met often with the endocrinologist, and (despite the fact that I claimed my morning blood sugars were too high) she felt I was doing great. The worst thing I did was eat muffins every once in a while. I was so good. I don't know why she weighed 11 pounds 3 ounces.

I held up my baby and said to him, "She is perfect. How can she be considered a failure?"

Sometimes I wonder what happened, why she was so big. I wonder why, because I had excellent control during my pregnancy. I wonder if there aren't factors we don't yet understand.

The best moments of my pregnancy were when I was in Kenya that summer. I was in my second trimester and just starting to show. I would walk all over Nairobi, and I felt so good and so healthy. The people out in the village told me that this one was going to be my daughter. One woman said, "We cursed you to have a girl." Some curse!

But it was a difficult pregnancy. And so there was going to be no Isabella.

What is appropriate fat consumption per day?

I found the following on a website called Ask the Dietitian. In this case, the dietitian argues that there is such a thing as too little fat. Given the following guidelines, fat consumption should make up 450 calories of an 1800 calorie diet.

If your diet has less than 1 teaspoon of soybean oil (linoleic and linolenic fatty acids) per day you could develop a fatty acid deficiency. Symptoms are red, irritated skin , infections and dehydration. Also, the liver processes food fat and may develop abnormalities if fatty acids are deficient.

Your body uses fat to synthesize hormones and regulate blood pressure as well. Dietary fat also carries fat soluble vitamins A, D, E and K which could also become deficient if fat is too restricted.

Diets of less than 25% fat tend to reduce feeling satisfied after a meal. Bulimics tend to binge on carbohydrates when fat falls below 20%. The current recommendations are 25 to 30% calories from fat.

On the same website, there is a "Healthy Body Calculator". Here are the results for me:

If I want to lose 2 pounds per week, I should eat a 1200 calorie diet which would be 360 calories from fat, a total of 40g of fat with 13g of that saturated fat. To lose one pound per week, total calories should be 1,760, with 530 calories from fat (59g of fat with saturated fat 19g).

How to argue with the dietitian about cheese!

Laurie, the dietitian, told me that cheese was cheese and it didn't matter what color it is. I recalled that white cheese had less fat than yellow cheese, but Laurie argued that it was because the yellow cheese was dyed. I said, "I don't eat that kind of cheese, I eat cheese from the deli counter." I tried to picture myself eating that horrible lowfat cheese in those packages. So I decided to find out for myself.

All cheese is not alike in terms of fat content. Fresh cheese, or curd style cheese, is lower in fat. That includes cottage cheese, feta cheese and mozarella. I knew mozarella was lower in fat than other cheeses, and I've been eating it for years. The quantity of cheese used in a dish is very important. A lot of low-fat cheese is worse than a small amount of higher fat cheese. That seems obvious, but at the moment it really hadn't occurred to me.

This information comes from the National Heart Foundation. See Fresh Cheeses.

Another source of information about cheeses comes from Dr. Christine Fenn. She writes:

All hard and cream cheeses are high-fat foods. Reduce the amount of cheese in sauces and dishes by using smaller amounts of strongly flavoured cheese or adding the cheese to the top of the dish instead of in the dish. Try lower-fat cheeses such as Edam, Gouda and Jarlsberg cheese as well as cottage cheese. They make great sandwich or baked potato fillings mixed with chopped spring onion, watercress, pickles or chutneys.

One UK website states that any cheese with 27g of fat per 100g can be offered as a "healthy choice," but warns to watch the quantities. Note: mozarella cheese has 18 g., feta has 16 g, and regular cottage cheese has 4 g.

Soy cheeses, by the way, have 7g fat.

Now I have the real information and am able to make cheese choices on my own. You know, I wish health care workers wouldn't try to simplify so much.

Lowfat salad dressings

Okay, I admit it. I went looking in my American Diabetes Association and American Heart Association cookbooks for lowfat salad dressings. There are actually some lowfat and nonfat dressings to make. The ADA dressings are lower in fat than the AHA dressings.

I wish the dietitian had given me a fat guideline of some sort -- how many fat exchanges per day for example. That would really have helped me.

Here's one from the internet:

Diabetic, Low-Fat Creamy Ranch Salad Dressing
1 cup low fat cottage cheese
2/3 cup low-fat plain yogurt
2 green onions, chopped
1 teaspoon Dijon mustard
1/2 teaspoon garlic powder
1/2 teaspoon dried basil
1/4 teaspoon dried oregano

In food processor or blender, process cottage cheese and yogurt until smooth. Pour into bowl and stir in onions and seasonings. Cover and refrigerate for at least 30 minutes so flavours develop. Store for up to one week. Stir before serving.

This has 3.8 g fat.

Okay, so a lowfat dressing is possible. Maybe I'm not going to suffer so much.

John Neale...

...has published all of the data on his diabetes since 1994. This is a fascinating website. Visit at: http://www.webshowcase.net/diabetes/archive/

Photographing food as an aid in improving control

I found an interesting thesis online: Visualizing Health: Imagery for data in changing personal practice by Jeana Frost. It appears to be from MIT Department of Media Arts and Sciences.

http://web.media.mit.edu/~frost/Thesis/FrostThesis.pdf

The thesis is about taking photographs as part of a diabetes care program, with the goal of improving how diabetics see their behavior. The author had diabetics take pictures of such things as their meals, inside their refridgerators, tables with food on it, food on the stove, etc. The photographs were then shown in front of other diabetics in a classroom situation, for feedback and critique. This helped the participants see their habits more honestly, and provided a tool to see what was actually happening with their diets.

Today, my photographs would consist of a series of Diet Pepsis, two cans of Slim Fast, and two oranges. Actually, I'm downright starving, and I'm thinking about a to-go order from the Korean restaurant of sashimi and rice, of course watching the quantities. I would have to think about the vegetable. I wonder if they have anything that's not fried. Hmmm. Should I take a picture of it?

The idea of taking pictures of diabetics' food is pretty brilliant. I would never have thought of that. I'm considering it as a supplement to my food records.

AFTERTHOUGHT: Here's how my head works. I pictured photographing everything I ate every day for a couple of weeks, and posting it on the web, along with my diet, for the dieticians to see. Or, alternatively, attaching the photographs to the charts where I'm supposed to keep track of my food. Then I realized that this could actually be performance art -- everything I put into my mouth photographed, and assembled into an installation or display of some kind. The ideal, though, would be to get hold of some of that plastic food, and actually show full size versions of everything I eat. Diabetic artwork, sort of. What do you think?

"Doing Fieldwork with Diabetes"

I just remembered something. I wrote an article for an anthropology research methods journal (Field Methods, formerly CAM: Cultural Anthropology Methods) entitled "Doing Fieldwork with Diabetes."* I need to retrieve that article from somewhere and post it so it can be read here. The article is rather long, so I would need to put it on a separate web page.

It's a good article. I considered publishing it in one of the diabetes magazines. I even queried the magazine editor at the American Diabetes Association about it, and he said he would want it. But I never did it. That's what I was like back then.

I think I could still rewrite the article for a diabetes magazine. It wouldn't focus on field methods. It would focus on getting by in Africa with type 1 diabetes.

(*Vol 9, Issue 2, 1997)

The horrid proposed diet: Visiting the nutritionist

This week I saw Laurie, the nutritionist. This is the first time I have seen a nutritionist or dietitian in years. I needed to go because my diabetes has been so out of control. I also gained wieght after I quit smoking. So I needed to look at my diet.

We did the usual -- looking at plastic slabs of meat and pizza and rubber glasses of juice. I remember the servings of meat and bread. Easy. Then she showed me the starches. How could I eat so little? I'm always hungry.

She went after my fat intake too. What the heck is lowfat salad dressing? I don't eat bottled dressing, I make my own! Bottled dressing tastes terrible. Or fat free yogurt with fruit at the bottom? I hate both fat free yogurt and fruit at the bottom! I like Yoplait Thick and Creamy. And she showed me slabs of lowfat cheeses! Yuck! I don't even buy package cheese. I buy it from the deli counter. I like real cheese, not processed cheese.

Quantities? Can I eat so little starch and fat?

I was almost in tears. Is it worth living longer if you can't eat decent food? Or of you have to be hungry all the time? I am so discouraged.

I now have sheets of paper I have to fill out with my food intake for all my meals and snacks every day. So far I haven't done it and I saw her on Tuesday. It's because I haven't eaten regular meals, so I don't know what to write down. I haven't even been to the grocery store.

What a hassle. What a hassle. I am so discouraged.

I am getting an insulin pump

After 19 years with diabetes, I am getting an insulin pump. The paperwork has gone to the company for the pump I want, Animas, and supposedly they are clearing it with my insurance. It has been about three weeks; I expect to hear something soon. I chose the Animas IR 1250 insulin pump because of the software available, the lithium battery, and the fact that it doesn't lose all the data right away if the battery dies.

My doctor says programming an insulin pump is like programming a VCR.

I am looking forward to the day when the pump will measure your blood sugar in real time along with infusing insulin.

Why am I getting a pump? Because my diabetes has suddenly become very hard to control. In the last few months, I have had blood sugars ranging from 30 to 600. What I used to do no longer works. I was in the hospital three times with ketoacidosis. The doctor tried increasing my Lantus, but then my family ended up calling an ambulance on me because of severe hypoglycemia. I now know what ketoacidosis and severe hypoglycemia feel like, and I don't want to go there again.