Riding Alone…with Type 1 Diabetes

I love to ride my bicycle and do so whenever I can. More often than not this means riding alone. Being a type 1 diabetic, riding alone presents several challenges.

A little background on me: I’m 54 years young. I’m 6’1, 200 lbs, and I’ve lived with type 1 for over 25 years. I use a Medtronic pump and wear a CGM. My last HbA1c was 6.6 percent.

Here are a few tips, from one lone-rider to another, on diabetes management when you’re out on the road:

There are several great tools at your disposal to assist in mapping out a route. I like MapMyRide.com because I can upload data from my bike computer, it’s free and you can share your rides on social media. Give a friend or loved one a briefing on your route and the expected timetable.

I drink at least one 20oz bottle for every hour that I ride. I carry two, one with H2O, one with electrolytes. Rides of more than two hours require waterholes on the route. Don’t get left high and dry!? For electrolytes I like Nuun tablets. As the package states they are “electrolyte enhanced drink tabs” and come in a variety of flavors. ?Two tabs have about 180mg of sodium and other good stuff. REI and Sprouts have a good selection.

For rides of one hour or less concentrate on hydration, but also carry 25 to 30 grams of carbs and 200mg of sodium in case you need it. I prefer Clif Bars, gels and Shot Bloks. One Clif Bar has about 40g, a pack of 6 Clif Shot Bloks has 48g, and one pack of gel has about 25g. I usually stock up on Clif Bar products when I visit REI. They give you a discount when you by 12 or more. Most bike shops have a good selection as well.

For rides over 1 hour, carry 1 bottle of water and 1 bottle of sports drink or electrolytes. Drink 20 to 30 oz per hour. You will need to consume 30 to 60 grams or more of carbs per hour. These can come from bars, gels, sport drinks, etc. I prefer Clif Bars, gels and Shot Bloks for carbs and Nuun tablets for electrolytes.

To determine how many carbs per hour you need use this formula I learned from the diabetes educators at TeamWILD:

Pounds/2.2 = kg, kg * .7 = carbs per hour needed to fuel your ride
For me… 200 lbs/2.2 = 91 kg, 91 * .7 = 63 carbs per hour

Carry a glucose test kit with extra test strips. Always carry enough fast acting carbs to recover from low blood sugars. I prefer glucose tablets, raspberry is my favorite, and always carry 1 or two tubes depending on the length of the ride. I never ride without them.

At least have your ID and something to let whoever responds knows you are diabetic. I have a RoadID bracelet so I don’t bother carrying my wallet and I always wear one of my Red Rider jerseys. A few dollars in case you need to buy more food or water. A cell phone if you have one.?A flat repair kit with enough supplies for two tires. A multi-tool in case minor repairs or adjustments are needed

This may seem like a lot of work just to go for a bike ride but you will find that it becomes routine if you ride frequently. Stay safe. Stay hydrated. Stay fueled. Have fun!

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Alas, Poor Twinkie. Ahoy, Brussels Sprouts.

I was speaking with my cousin Dean over the weekend. He and his two employers in Washington DC are regular followers of my website. Dean asked if I was going to do an article about the demise of the Twinkie.

I suddenly realized, to the best of my recollection, that I had never had a Twinkie in my face. I will admit to having one or more of those seemingly-chocolate cupcakes with the swirl on the top, but my sole relationship to the Twinkie was stories of them being able survive the destruction of the world, and of course the infamous “Twinkie”??defense for the murder in San Francisco of Harvey Milk.??Neither event have encouraged me to try one of these treats. Nor have I ever been tempted to try a deep fried Twinkie.??A deep fried Snickers bar is a totally different story, although I have never tried that either. I am tempted though.

However, this brings me to the interesting way some people see diabetics. The assumption is that outside of those living with type 1 diabetes, diabetics (the type 2s) have “brought this disease upon themselves” by lack of control and poor eating habits. Even the nurse practitioner I meet at the diabetes clinic seemed to look down on me as someone who has caused my own disease by shoving bad foods into my face. While not a health nut, I have always eaten rather well. When the world said to eat according to the food triangle, I did for the most part. I admit to eating more protein and fats than suggested, but made sure that whole grains and green leafy vegetables were a major art of my diet.

I would tease Dr. Dan that I was getting a green tinge from all of the broccoli I consumed. I am not saying that some of us diabetics don’t assist the progress of this disease, but to assume that fact is as much of an error as assuming that you just have to stop eating sweets to control diabetes.

The evidence is certainly there suggesting we are leading our future generation down a path toward multiple illnesses with poor diets, but those diets are not sweets alone. Fast foods are just that, fast and easy. I am as guilty as the next person for proclaiming that pizza is the perfect food with it crust for grain, sauce for vegetable, and cheese for protein. As those of you that follow me regularly know I still eat pizza. I just use a low carbohydrate Josephs’s pita for the crust. Hey, it may not be a “perfect” food, but I have made it much better. Step by step, piece by piece. It is all part of the journey.

Back to the Twinkie.

My recipe suggestion, to any of you who still have a Twinkie on hand and are searching for the willpower to not eat it, is to slice it in half lengthwise, spread it with??softened peanut butter and using a large star tube, pipe some of that blue marshmallow stuff (for color). Place the two halves together, Drizzle it with chocolate syrup from the bottle, dot it with stars of the blue marshmallow. Place in the freezer to set. When set, sprinkle with crushed potato chips. Photograph it and hang it on your fridge.

If that image does not assist you in controlling what you eat, here’s another thought: since the cold-weather holidays are upon us, have some turkey instead. If you don’t hate the idea of brussels sprouts give the recipe below a try.

Happy Holidays to all of you.?Enjoy, be healthy, be decadent.

2 servings
Net Carbohydrates: 10?grams

? pound fresh Brussels sprouts1 medium shallot, sliced1 clove garlic, grated3-4 sundried tomato halves thinly sliced3 Tbsp. butterSalt and pepper to taste3 Tbsp. grated Parmesan cheese

Instructions:

Remove the outer leaves from the sprouts. Cut a shallow cross in the stem end of each sprout. Blanch in sweetened water (water with salt and 2 teaspoons sweetener) for 4 minutes. Immediately shock in iced water. Cut each sprout in half lengthwise. You can stop here and continue the recipe later.

Melt the butter in a skillet. Add the shallots sundried tomato and garlic and cook until just fragrant, about 1 minute. Add the Brussels sprouts the salt and pepper. Cook over medium high heat until the sprouts start to caramelize. Plate and dust with grated Parmesan cheese. For an extra golden color, run under the broiler for just a minute or so. If you are trying to get people who think they hate this vegetable to change their mind, sprinkle with some crushed cooked bacon.

Enjoy.

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Don’t Believe the Diet Hype

How many diet programs have you seen over the years? Hundreds? Thousands? They are all packed with prescriptions for how you should eat, usually backed up by copious footnotes.

But whom do you believe?

It turns out that we know a lot less than most of us think we know.

 

Let’s say we want to know how something effects a group.

It’s easy to find out. We have one group continue doing things the normal way – we’ll call them the “control group” – and have another group do something new, like take a new drug. We check back in three months and compare the results. Piece of cake.

But this doesn’t work so well with diets. Changes from diet may take place over very long periods of time, sometimes even decades. People are terrible at sticking to prescribed diets, especially for the long periods of time. It’s extraordinarily difficult to assemble a large group of people, control what they eat, and measure the results over years. Even if you manage to do it, there are a lot of confounding factors:

How closely did participants follow the diet? Was the diet so broad as to make comparisons impossible?How often did they cheat?How well did they measure calories?What actual components of the diet accounts for the change in results? Is it the presence of a nutrient or a specific set of foods?Do a diet’s benefits or downsides vary by gender, age, genetics, weight or other factors?

As you can see, these answers are hard to identify in studies of thousands of people. Most diet studies enroll merely dozens. Big studies enroll hundreds. Over time, you end up with what we have: thousands of small studies that say lots of contradictory things.

If you have a diet to peddle, you can dig up a study that says almost anything. And people do.

Because creating experiments is so difficult, many researchers look at broad populations of people and examine their diets. Researchers have done careful examinations of the?Chinese,?Inuits, Japanese,?French, Mediterranean dwellers, vegans, and many others.

In these studies, we can find examples of large groups of people eating differently and achieving healthy outcomes, whether eating diets ?full of proteins, carbohydrates or fat. No single groups of foods seem to lead to consistently better outcomes than others.

Of course, there are likely many foods that are healthy and others that are not. But the sad truth is that the evidence for those types of statements tends to be very weak and circumstantial. The positive outcomes are extremely difficult to attribute to something specific.

There are some trends that do appear across groups.

Eating more many calories than one’s metabolism can process leads to weight gain.Processed foods, particularly processed carbs, do not satisfy hunger as ?well and lead to over-eating.There are examples of people who follow carbohydrate heavy, protein-heavy, and fat-heavy diets with good results.Michael Pollan has a famous quote summarizing his Food Rules:?“Eat food. Not too much. Mostly plants.” Based on all of the diet research, this seems like one valid approach. Perhaps it could even be simplified and broadened to include all that we truly know:

“Eat whole foods. Not too much.”

(Those with certain medical issues often do have more specific needs. For example, those with diabetes need to be sensitive to carbohydrate intake. Someone with kidney issues may need to limit protein consumption. Etc.)

At Diabetes Daily, we believe that the most effective approach to managing diabetes is to eat to your meter. A meal can become a little science experiment: check your blood sugar, eat a meal, and a check your blood sugar two hours later. If you’re back in target range, then as far as diabetes is concerned, that meal is diabetes-approved. If it spikes your blood sugars, you can either eat fewer carbs, take more insulin/medication, or exercise after eating. (These are medical decisions and should be made in consultation with your doctor.)

The best diabetes diet is one that works for our diabetes. The broader question of which diet works best for weight loss and long-term health is different. But as the major food studies show, there are a lot of different ways to get there. So understand what works for your diabetes and work with your health care team to find a way of eating that leaves you healthy, fit and happy.

(In 2009, a study put over 800 obese individuals on four popular diets. The result??They all lost the same amount of weight.)

Photo Credit: L@mie

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“Coming out of the closet” with Your Diabetes

In this article from Diabetes Mine’s writer and video-blogger, Mike Lawson, a young woman shares her story about finally telling the people in her life that she was diagnosed with type 2 diabetes. Having worked very hard to keep her diagnosis a secret out of fear of being judged and the overall shame that comes along with type 2 diabetes in today’s society, Kellie was surprised to find compassion and support from her peers. She compares her experience within diabetes to a different time in her life when she told people she was a lesbian.

In your own life, is diabetes a secret?

For me, sharing my life with type 1 diabetes has been empowering. Yes, I’ve had strangers say rather lame things that are purely the result of ignorance and lack of education, but for the most part, I present my diabetes as something I proud of myself for managing every day. And the people around me see it not as a reason to pity me, but to say, “Hey, that’s pretty cool you do that every day. It clearly hasn’t stopped you from anything in your life.”

Of course, there are certain times or places when I try to be very discreet about my diabetes, largely because I know I might be surrounded by people who don’t know me well, who may try to micromanage or tell me what to do and how to eat.?(I have, indeed, had complete strangers catch me giving myself an injection or checking my blood sugar, and they began to tell me how I ought to be living my life…but this is rare.)

But for the most part, my diabetes is a very public thing that I do very little to ever hide.

If you are hiding your diabetes from the people in your life, consider these questions:

Is there at least one person you might feel comfortable sharing your diagnosis with?What are you most afraid will happen if you reveal you have diabetes?What are the positives to sharing your diabetes diagnosis with the people around you?

Living with diabetes, type 1 or type 2, can feel like a very large burden for some people. Being able to talk about that burden, and most importantly, being able to ask for help in an emergency (like a low blood sugar), is important. You are not alone in your life with diabetes.

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Joys & Perils of Traveling with Diabetes

I hate to complain but it’s 3 a.m. and your alarm just went off. Time to get up and get ready to travel. Really? You shower, go into your kitchen and make your usual and perhaps last decent (read: healthful) breakfast at this most unusual hour. But it is also time to plan ahead. Because the airlines no longer feed you on the plane you make yourself a cheese sandwich on a whole wheat Arnold Sandwich Thins. The airlines have all but eliminated peanuts from their flights and offer you cookies or pretzels with your sugar free soda. Oops!

You arrive at the airport an hour and a half before your flight. Besides showing the airport security (TSA) your liquids and gels, you show them your lunch. They look at you as if they think your original plan was to bring a live chicken with you.

In the terminal, at last you find the Starbucks is charging an additional 50% over the already high price for a cup of coffee. The only other alternative is the Burger King and it looks like the coffee there has aged since it was made. Oh well.

At 3 p.m., we arrive at our hotel. Call our family and let them know we have arrived safely and make plans for dinner. For the most part, if you have all intentions of keeping to your dietary needs, your choices become protein and salad. The vegetable medley that the restaurants offer has long since lost its tune. The fries are seldom a good choice, nor are the mounds of mashed potatoes, macaroni and cheese or the coleslaw laced with sugar. Two whole cuisines are eliminated from your planning. Italian, with all the pasta and Asian with all the rice and corn starch. At home you can easily substitute wilted spinach or spaghetti squash for the pasta and rice, but most Italian and Asian restaurants do not offer those alternatives.?

This year I found a very pleasant surprise at a chain called Ruby Tuesday. We chose it because it was quieter than the other places and my aunt (95 years old) could hear us over the table. Along with your protein and a fairly decent salad bar, the chain offers us some interesting vegetable choices. Snap peas, roasted spaghetti squash, and mashed cauliflower, and the ordinary green bean. Other than in a vegetarian place, I have never seen such an extensive selection.

Kudos to them.

The offerings are just there. There is no suggestion that they are for diabetics, they are just the chain’s usual offerings. They saved me from asking for double veg instead of rice or potato. I am not hesitant to make the request, nor have I ever run into a restaurant that was annoyed to do that substitution for me. But it was just plain nice not to have to ask. We went back there a few times, in part because of the sound and lighting levels, but also for joy of having choices. Before I go any further, the mashed cauliflower was really tasty as were the snap peas. Although the roasted spaghetti squash sounded good it need some help. In this case, again, I really hate to complain.

Breakfast is always the hardest for me. The hotels have these spreads of fake eggs and fatty meats combined with white bread disguised as bagels and high carbohydrate cereals. I found that if I hit the local “stupidmarkets” when I land and pick up some Trop 50, Dannon Light & Fit Greek yogurt, Thomas’?Light?English muffins and some Arnold Sandwich Things, I can do pretty well using the cream cheese and butter supplied by the hotels and still have a dessert of yogurt in the evening..

My trip took us to Florida. In southern Florida there is a pretty heavy New York Jewish population. I almost started to salivate upon landing at the thought of real corned beef and New York pickles. While corned beef on rye may be the ideal, I brought my bread to the deli and had my sandwich on a Joseph’s Oat, flax Whole wheat pita. It took the mounds of meat very well for only 4 grams of net carbohydrates. And oh that brown deli mustard and the pickles, heaven!

My pet peeve about restaurants is that there is seldom a fresh fruit choice for dessert. Others at the table often feel uncomfortable having a dessert if I have to just sit there and spoon my coffee. They have berries and pineapple as a garnish for beverages and cheese cake. How difficult is it to take a few fresh strawberries and put them on a plate with a sprig of mint and some fresh cream? Or even some melon slices?

After a week of travel, and always having to turn away offerings, I really missed being in my own kitchen.

At the Atlanta airport, the food choices were maddening. If I did not want (and believe me, I did) fried chicken or even a fried chicken salad or a burger, or a prepackaged salad, I was left with the choice of coffee.

Home at last. Strawberries and sweetened sour cream with almonds abound! JOY!

Read Elizabeth’s tips for traveling with diabetes!

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A Long-Acting Form of Byetta for Treating Diabetes

The latest medication for people with type 2 diabetes is Bydureon, revealed early this year 2012. For more information on Bydureon, I highly recommend reading?Diabetes Mine?and?David Mendosas take on the new drug.

Let me start by telling you the basics:

It is made from the same medication as Byetta, but in long-acting form.It is taken once per week in the form of an injection (Byetta is an injection, taken daily before meals.)Like Byetta, it has shown to decrease your appetite which leads to weight loss as well.

How does it work?

Bydureon basically improves your blood sugar levels by sensing when your blood sugar level is rising, and telling your body to produce more insulin at that time.Slows down how quickly food is digested to prevent large spikes in your blood sugar after eating.Works hand-in-hand with your own efforts to exercise more, eat well, and lose weight for better blood sugars.

Now, let me tell you what Bydureon is?not:?

It does not replace insulin.It should not be taken with Byetta, because it is a different form of the exact same medication.It is not for people with type 1 diabetes or children.It is not ideal for people pancreatitis or severe kidney problems.

In the safety information, it does state that during clinical trials in rats, some of the rats developed cancerous tumors in their thyroid. It is not known?if it causes this type of cancer in humans, and the same can be said about Byetta. In humans, this form of cancer is referred to as Medullary Thyroid Cancer (MTC). If you have a history of MTC, you should definitely not take Bydureon.

If you’d like to know if this drug is a good fit for you and your goals in diabetes, talk to your health care team. Depending on your medical history, it may or may not be a great fit for you.

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Raw Food Does NOT Cure Diabetes

The month of November, Diabetes Awareness Month, brings out tons of information on diabetes management. Pharmacies open their doors to testing people for diabetes and communities around the world show solidarity for the cause. This is all for the good, right?

As with any good and worthy cause, there are a few individuals who also take advantage and promote inaccurate information about diabetes. What wrinkles my nose is the concept that nature has a cure for diabetes. Why is this a myth? Let me explain.

First, which diabetes are they talking about that has a natural cure? Type 1 diabetes does not have a cure, nor a natural cure!?Type 1?is an autoimmune disease, which attacks the insulin forming cells, called beta cells, leaving as little as 10% of the total amount needed to keep the body alive. The only way to treat type 1 is injected insulin; you can’t eat better, take supplements, or drink medicinal teas to “reverse” it. The digestive system of someone with type 1 can take a pounding from the nature of the disease, so eating well, taking antioxidants and adding acupuncture can help tremendously, in beefing up the weakened immune system and aid in better digestion. Additionally, cutting down carbohydrates helps to manage blood sugar levels and because of the way type 1 diabetes affects the metabolism, lower carb intake also helps the stomach and small intestine digest food and absorb nutrients better.

For type 2 diabetes natural is better, because learning to eat well and living a healthier life will decrease the risk for complications. But type 2 diabetes has a definition problem. For years, type 2 was categorized as a form of?metabolic syndrome, primarily insulin resistance. But in recent years,?type 2 is being studied to determine if it really belongs in the autoimmune category, right along side type 1 diabetes. The reason is that when people are diagnosed with type 2 diabetes, they also show a decreased number of beta cells (the insulin producing cells) approximately 50% less then normal. For many, the beta cells replenish to about 80% of their total mass after a few changes are made to eating and health habits. (To me this is similar to the?honeymoon period that happens with type 1) What is not expressed well, even by the medical community is that for many with type 2, their beta cells may eventually die off again, reducing the overall number of beta cells back to 50% or less permanently; and therein lies the problem with telling patients they can reverse their type 2 diabetes.

A well educated diabetes doctor (called an endocrinologist) should then say to his patients, “This is managing diabetes, not reversing it and it’s the most proven method to avoiding the need for pharmaceutical medication.”

For the alternative medicine groups, when trying to sell a product to help type 2 patients, they should never stake the claim that they can reverse, or cure diabetes, no supplement will ever cure diabetes.

Let me give you an example of the kind of advertising that hurts people. I got an email from Kris Carr of Crazy Sexy Kitchen, who sent out?this ad?for buying a “captivating documentary film, Simply Raw: Reversing Diabetes in 30 days…” Carr goes on to say, “The ?lm follows the healing journeys of six beautiful souls who reverse their diabetes naturally by eating only organic, vegan, uncooked, raw foods. Brava! If you’ve been embracing the Crazy Sexy lifestyle for any time now, you can imagine the incredible transformations these courageous life changers go through.”

I’m so annoyed on so many levels. Raw foods is not reversing diabetes, it is simply a way to manage type 2. Raw is also very extreme and not everyone is at their optimal health by living on a raw diet. The real truth is, for people with weight and health issues, a healthier diet with lots of veggies and balanced amounts of protein will help manage diabetes by decreasing blood sugar and weight. If you choose to eat raw, do it because it feels good to your body and gives you energy, then it’s the right fit for you. If you have never done raw, don’t start there. A diet low in processed foods and high in natural sources of fiber will be a great start to managing diabetes and helping your body help itself!

The second rub is Dr. Gabriel Cousens, who is used as the expert doctor in the video.?Dr. Cousens is an MD who had his license to practice medicine revoked in AZ and censured in NY. And to think, you can buy this video at 50% off, because Kris Carr knows how tight budgets are. Really? You give viewers an expert doctor with a revoked medical license, and you want them to pay $161.20!?

I have loved using integrated medicine for a very long time, but there are alternative practitioners, who are not familiar with chronic illness, who profess to understand a health condition and advocate that they have the universal path to success. Know this: each body is individual and it’s cellular make up is also unique. Integrated approaches to a health problem can be unbelievable helpful and I am a testament to that, but it will not be successful if you listen to alternative vs. conventional. In most cases, it takes both. So experiment with integrated medicine, study it and keep working at it, until you feel amazing and health glows in your skin, your eyes and your smile!

In the meantime, if you see ads for reversing diabetes, do your homework and research the sources making the recommendations. Talk with your doctor, CDE (certified diabetes educator) or nutritionist, because that is healthy and safe for you!

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