Invasion of the baked goods

We have been a very bad household of diabetics this past week.

Okay. I admit it. I started it. I bought the chocolate cake.

But he went to the bakery and bought the filled buns. Coconut filled buns. Cheesecake filled buns. And chocolate croissants. En francais, s'il vous plait, pain au chocolate. One for each of us.

Have I mentioned that I've been a little down this week? In mood, not in numbers. Numbers, I haven't been checking. That means my numbers have been just fine, right?

Yeah, yeah. I know better.

I let one of my meds run out, and went two days before the mail-order refill arrived. Sloppy. I'm likely to run out of glucophage and have to 'borrow' pills from Dr. Parts. Tsk, tsk, tsk.

I'm slipping on control - in many areas of my life - and it's time to stop the slide. If I find more baked goods in the kitchen, I may have to call Allison and ask her to come over and do an intervention for us. If she has time.

The new meds continue good for me. The foot pain is down to a dull roar. I must still curtail my steps and standing time. I must still wear the dorky supportive shoes all the time.

I must buy additional test strips and restart my daily testing habits.

I must find a way to build exercise into my life, without injuring my feet any further.

Dr. Parts and I re-negotiated the household budget and made a plan to shift some debts around, so I'm feeling less stress in that area. And we have a weekend off. Meaning, no plans for either of us to go into the office. No need to travel to support some relative's need. I can sleep in my own bed, and, if I'm lucky, sleep in a little.

This health thing, with or without diabetes, I know that it's a daily choice, and the long-term accumulation of many small choices. I haven't been making good choices this week.

But I can make better choices now. And this evening. And tomorrow. And the next day. And the day after that. And the day after that.....

Tootsie Roll Trap

We went up and visited my maternal grandparents for the day on Saturday. I helped Nana sort through her Christmas decorations, in preparation for the move to a retirement community apartment. Dr. Parts got roped into some outdoor clean-up work by the team of cousins who were there. They have a much higher energy level than I do. I also felt like I was getting some dirty looks from them, because I wasn’t out there helping to move the woodpile. Well, they don’t know about my foot condition, and I wasn’t in any mood to explain myself. I was doing what I could do, given my physical condition, and I am not required to justify my actions to them. I did tell my grandparents, however. The feet were pretty painful this weekend.

While we were there, the kitchen sink started leaking, and Dr. Parts was able to do some simple repairs that would have been a big project to my grandfather. Dr. Parts gets a gold star for service above and beyond the call of duty. The faucet hasn’t given them any problems for years, but now, after the house has closed, and they have 60 days to live in it, now it starts leaking. Alas. The repairs kept us there for an extra two hours or so.

I’ve been thinking about being food-centric.

My grandparents have chosen their retirement community based largely on the quality and type of food offered. They're entitled to do this. When I was writing about the diabetic who just loved to cook and bake, and made a career change to become a pastry chef (!), I thought about saying that a diabetic should not make food the center, the focus, of her life.

Well, that’s silly, I thought. We diabetics have to focus on food. It’s hard for a diabetic to avoid being food-centric. What we eat is an important part of managing our disease. There must be a better way to phrase the concept that I have in mind.

Maybe what I want to say is that we should not be food worshippers. We must not be gluttons. We must not be gourmands. (A gourmand is a person who really likes good food and drink but tends to eat and drink too much.)

We can be gourmets, that is, we can appreciate excellent flavor and preparation in food and drink, but diabetics, especially type 2s, cannot eat to excess without damaging our bodies and sending our disease into overdrive. We seem to treat it as an addictive substance, a can’t-live-without-it.

Gosh, surely I can live without Tootsie Rolls. And yet, I still eat them to excess if I purchase them. How puzzling that I would do this to myself. I had a reading of 257 this week, post-Tootsie Rolls. Shame on me! And in the grand scheme of things, are Tootsie Rolls really that much a taste treat for me? They'd hardly qualify as 'gourmet'. What a thing it is to be human.

I know that one of the physicians associated with Dr. McDougall’s program speaks to this point. I want to order this DVD of his presentation on The Pleasure Trap. And a trap it is!

I am always learning and growing. I still have much to do.

Power Struggles

My AM BG reading today was 95. That's down a little bit. Dr. Parts and I have been pigging out on cake & cookies in the evening. (By pigging out, I mean eating some, especially after dinner.)

I visited my physician this week. She prescribed Effexor and gave me samples to last 6 weeks. We'll re-assess my mood then. I forgot to mention the restless leg thing to her. I "forgot" to schedule my follow up appointment. I went to the lab for the blood draw. They politely explained, that, as it was a Friday, and one of the tests ordered was one that required immediate processing of the sample and no lab performed that test on the weekend, I would have to come back on a day next week. No problem, I said. I'd be happy to go away.

Ah, but will you come back, asked the wiley phlebotomist. No fool, that one.

I've been thinking about the relationships between persons with diabetes and their physicians. I'm not always sure who's in charge of that relationship, or who's in charge of the diabetes. It probably goes back and forth.

I strongly believe that a person with diabetes needs allopathic medical care as part of their regimin. (That means, in the USA, IMHO, a treating MD or DO, or maybe an ND. You know, someone who knows the western European scientific tradition and can write prescriptions for you.) I also believe that the physician needs to be your partner, and you need to be their partner, in order for the diabetes management to work in your life.

The doc can order labs and tests to help you get numbers to know more about how your body's doing. The doc can order medications to help you manage and alter your body's processes, not just with diabetes, but with all the other things that go along with living in a human body. (Yes, diabetes will not be the only thing that goes wrong with your body as the years go by. Sorry, but I believe that to be true.) The doc can also help diagnosis things, putting the symptoms together in a way that us non-trained personnel cannot do.

As an aside, I also must say that anything I say here in the blog, should not be taken as medical advice. I have attended the Johns Hopkins University. I have not attended nor graduated from the Johns Hopkins School of Medicine. I am not trained or qualified to give medical advice.

The diabetic, however, is the one in charge of implementing the plan. You're the one who has to exercise. You're the one who chooses to take the meds or not take them. You're the one who chooses whether to eat broccoli or cheescake for dinner. You're the one who has to test daily to get those daily BG numbers.

The patient has to trust the doc. The patient has to be sure that the doc has her best interests in mind. You have to trust that the doc is not going to over-intervene, medically. You have to trust that the doc is going to listen.

The doc has to also trust the patient, that the patient knows whats going on in his own body. The doc has to trust that the patient, if the patient says he will take a certain course to correct a medical problem, that the patient will do it. And that if the patient fails, or the course of action fails, that the patient will report it and, together, you can make a different plan to tackle that medical problem.

Of course, that's how it would work in ideal circumstances.

I have known at least one diabetic who, whenever a physician would say to her something along the lines of "your diabetes and your health is out of control and we need to do more to bring it under control," her response would be to fire the physician. She was a mentally unhealthy person, IMHO, always with the excuses, for her eating, for her inactivity, for not testing. She went on insulin, gained a lot of weight (because the insulin allowed her to eat as much as she wished-that's my guess), was unhappy with the weight gain, and went off the insulin without telling her doctor. She refused to go to counseling, to exercise, to go to diabetes education classes.

Last I heard, she had enrolled in a training class to become a pastry chef. Yes, an obese, diabetic pastry chef, making desserts for a living. I don't know whether to laugh or cry. It's close to suicidal. Hey, maybe by now, she's had gastric bypass surgery.

Sometimes, it's the doctor's job to give you bad news. Sometimes, it's her job to bring you back to reality. Sometimes, it's her job to lecture you and to stimulate you to change your habits or your diabetes management plan. Yes, even the kick-in-the-pants, figurative of course. Okay, so it's better if you learn to give yourself the lecture and the kick-in-the-pants when you need it.

So, find a physician who will be a good partner to you. But don't break up with them if they say things that make you uncomfortable. Sometimes a diabetic does have to fire a physician.

But if you have to fire several physicians in a row, all for saying the same thing to you, maybe it's time to fire the patient. Maybe it's time to listen to the things the physician is saying to you. Sometimes, when the universe is trying to talk to you, it will use many different mouths to speak the same message to you, because it is the message that you need to hear. Listen for that message.

Collection

I wanted to add a few notes and things

1. I went to the dentist's office on Wednesday for my dental cleaning. It's very important for a person with diabetes to keep up on oral health. I hope you do it. I have to go more often than I would like, 3-4 times per year, but I'm much happier, and my diabetes numbers behave better when my oral health is good. That means flossing, often, and using my sonicare toothbrush, twice a day.

2. My Nana would want to tell you that going on insulin to help control your Type 2 diabetes is not an indicator of failure. Using insulin does not mean that you're a bad diabetic. It means that insulin is the best way to keep you healthy at this time. Sometimes, diabetes follows a progression, in us Type 2s, and that often will include using insulin.

Even Dr. McDougall believes that, if you need medication to help control diabetes, insulin is probably the very best medication to do that. (He's not a big fan of oral hypoglycemic agents in type 2 diabetics, other than following his diet. He's got some very big reasons for his opinions and I respect him highly. I suspect he's right, or at least, he's more right than he is wrong.)

3. Speaking of Nana, I want to meet Becky who is a CDE in the Pierce County, Washington, area. At least, I think she's a CDE-I don't really know for sure. Becky has been my grandparents' diabetes consultant for many years now. I want to meet her and give her a hug, because she recommended and wrote a prescription for therapeutic massage for my Nana. (Nana & G'pa are selling their home, liquidating a lifetime of possessions, and moving into an assisted living facility. It's a little stressful.) I think Becky is way-cool. I wish more diabetes medical professionals wrote 'scripts for therapeutic massage. I hope she also sends Grandpa for the same treatment. In fact, if Becky could just call my physician, I've got the number right here...

4. Foot pain. It continues, but is down to background noise. I'm not going to be able to run and walk and dance like I used to. But I may be able to load and unload my own dishwasher without bracing myself or finding a stool to sit on. I still have doctor's appointments related to this.

More later....

I love my grouchy podiatrist!

I think my grouchy podiatrist got the medication right! I have now taken two doses of this NSAID. He prescribed Voltaren, which they filled with the generic diclofenac. He told me to stop taking the OTC naproxen sodium, which I did.

My feet feel better already. I hope this trend continues. I don't know if I'll have to take this med forever or what. I'm enjoying feeling pain-free or 'normal' for these hours. The med does not make me feel loopy or fuzzy, which the percocet definitely did. We'll see how it goes in the days and weeks ahead.

I have nothing good to say about my local Walgreens pharmacy and their process, though. They bobbled the pick-up time and then failed to communicate that to me when I came to the counter three times to pick it up.

Grouchy Podiatrist

My podiatrist was grouchy today, and admitted it, brave fellow, because he was using a new piece of technology to help record the medical records. It looked like one of those StarTrek devices, about the size of a legal pad, and less than an inch thick. He wrote, and it typed, although sometimes it asked him what exactly that particular scrawl meant.

I'm encouraged, that he did not recommend surgery or casting or steroid injections, nor did he poo-poo my foot pain. He's taking me off the naproxen sodium and prescribed a non-OTC NSAID. He also wonders whether I have some other condition either contributing to the pain I'm experiencing or else reducing my ability to deal with it.

In other words, I could be developing some rheumatoid-related disorder, which could be increasing the pain. (Yuck. In my studies, those would be lupus, polymyalgia rheumatica, or rheumatoid arthritis, or something else. I wouldn't sign up for those voluntarily, you understand. ) The other factor that may be reducing my pain threshold could be either depression or insomnia. Blecch. He ordered blood tests which may show some markers to suggest sending me to a rheumatologist for a work-up.

So, we'll ask the internal medicine doctor about all that on Friday. And let her prescribe some anti-depressants and/or sleeping meds.

I don't want to get a diagnosis of depression again. I don't want to live in depression again.

But, I gotta say, it is better than scheduling bilateral foot surgeries. And recovering from them in my two-story house.

And depression and diabetes go hand-in-hand. Many of us experience depression. It's not that abnormal. And I know the signs and signals that I see when I go through that.

We're continuing the investigation. I'm hopeful that there could be some future resolution for the foot pain. Which could mean that I could resume walking and other types of exercise that I enjoy, at least on a limited basis. Cool!

Blog Therapy & Family

Okay, I'm now addicted to blogging. I love it. I can't stop doing it.

I love the chance to write. I love the chance to talk about the things that I think about all the time. I do find it therapeutic. If I had a therapist right now, many of the things that I say in the blog are things I'd be saying to the therapist. However, there would be many things I might say to the therapist that I would not say in the blog.

Part of my experience with diabetes is my relatives' experiences with diabetes. It's tough to write about them here, because 1) many of them read this, 2) they are real people with real feelings and real struggles, and 3) because I've recently realized, that I don't know them very well at all. Certainly not well enough to pass judgment on them in any particular aspect of their lives.

(Well, okay, I might be willing do claim that I know my mother well enough to do that, but would it be true? I don't think so. I generally have only positive things to say about my mom, so I'm not even sure if that applies.)

So, I wish that I were talking about made-up persons, but I'm not. I have met these people. We share genes. I do love them, even those who I don't spend a lot of time with. I don't wish to tear them down in public. I apologize in advance for any offensive thing that I might say about you, if you are one of those poor souls unlucky enough to be related to me and mentioned here. Please let me know and I will issue a more direct and personalized apology. Again, I have recently become aware of how little I really know about my extended family. Life is hard enough without someone saying stupid hurtful things about you or your life. And what do I know anyway?

Are the things I think I know about you true, or are they just the family fiction that I've been told? And how would I be able to know the difference?

I think my paternal grandfather was the first relative in my direct line to be diagnosed with diabetes that I knew of.

The next was my maternal grandmother. Nana grew up in a rural area of Wyoming, complete with blizzards and wind and all. Her mother's family had moved there, a generation before, to be part of a Christian utopian movement, associated with Jireh College. She married my grandfather in the 1930s. Nana and her husband had continued to be part of a fairly conservative, evangelical, Pentecostal Christian churches and lived simple, healthy lives. No smoking. No drinking. No gambling (no games played with standard deck of cards, even).

She was careful with her money and creative with her cooking. (I gotta mention the Mayonnaise Cupcakes, Choco-Nuggets, and Thin Pancakes. I loved them as a kid, but rarely make or eat them anymore. ) There were not a lot of extras in her household. My mom recalls that they got homemade cake on a fairly regular basis, but only got frosting on the cake if it was to celebrate a birthday.

Nana got her diagnosis shortly after my aunt Orlene died of lung cancer, which was prior to 1983. Nana has expressed that she believes that the stress of Orlene's illness and death contributed to her development of diabetes. Nana is now in her middle eighties.

She immediately joined Weight Watchers and kept herself much slimmer for the next several decades. I don't know what drugs she was on after her diagnosis. I don't know when she got her first in-home meter. She has had a diagnosis of intermittent claudication affecting her legs, and stopping her from going on daily walks at least a decade ago. She went through a period of believing that consumption of cow's milk directly contributed to heart disease, so was the first person who's fridge contained soy or rice milk that I ever saw. (Yes, that was before mine did.) She started using tofu and yogurt when I was still turning up my nose at them. (Perhaps I should post her A-Z dip, which is something she developed as an alternative to sour cream based dips.)

She has had clogged carotid arteries and has had them cleaned out, leaving nasty ropy scars on her neck. This problem probably contributed to her hearing loss. She is now seemingly in the early stages of some kind of dementia or, in the least offensive language, cognitive changes.

She has encouraged me, and I would pass this on to you, to not be afraid to go on insulin when the doctors suggest it. Her experience with using insulin for diabetes control has been a good one. The injections of insulin are not as painful as one imagines beforehand, she reports, and not nearly as painful as the fingersticks we all do. (You are testing, aren't you?)

So she has been a type 2 diabetic for over 20 years now, without any significant diabetes complications. She does not have diabetic retinopathy. She does not require dialysis. She does not have neuropathy. She does have significant circulatory issues, which may be contributing to her cognitive decline. And, diabetes probably contributes to her circulation troubles, or her heart troubles contribute to her diabetes. I'm kinda of the opinion that the heart & circulation vs. diabetes issue is sort of a chicken-or-the-egg debate. They go along.

She's had doctors retire on her. Many of her brothers have died, some of diabetes-related problems. Three of her four children have pre-deceased her. And she has still gone on. She is my example of love and service. She is my mother's example of love and service. I hope to be as good a woman as she is. And I hope that I get to reach my middle-eighties with diabetes.

Nana is not one of the relatives who reads this blog regularly. But I sincerely hope that she would not be offended by anything that I have written about her in this post.

She would probably want me to talk more about her faith in Jesus Christ, and about mine, and to urge you to find salvation as she has found it. I find her faith to be inspiring. I aspire to such faith. I also find her experience with diabetes to be inspiring. I shared it, because I hope it also inspires you.

Expand the Clubhouse

I've seen several news stories recently, about type 2 diabetes, which make me wince and cringe, for a variety of reasons.

This one, about treating post-prandials highs with Precose and that treatment not preventing the progression of diabetes, makes me want to go back and study more science. I wish I understood that more. It does seem to support Dr. McDougall's contention that a few high readings after meals may not be as worrisome as the whole diabetes establishment seems to think. Or perhaps I'm reading that wrong. I understand that I don't get that article well. Consult your local medical team.

This one, about tai chi and calisthenics exercise still having benefit to diabetics, I find very encouraging. I love tai chi, and since I may be off my feet for a while, some other calisthenic type exercise may be all that is available to me. Exercise is required, ladies & gentlemen!

This one and the other one, about diabetes control & treatment for differing racial groups, elicited another well-duh! reaction from me. One of the black persons who I know with diabetes (type 2), was so sick at the time of his diagnosis, that his physicians told him, "You either have AIDS or you have diabetes." Imagine his relief at getting his diagnosis of diabetes. And it's such a simple test, to test for blood sugar levels, which should point to diabetes. Why these racial disparities exist is something others have discussed at length. That they continue to exist is part of the shame of the USA. I wish these two stories were not true, but I have no trouble believing that they are true.

This one, about preventing pre-diabetes from becoming diabetes by prescribing metformin, is more complicated for me. It makes me wonder if we need a new term for diabetes type 2. And, are we going toward a "Prescribe metformin for every pudgy person" diabetes prevention policy? I'm all for lifestyle changes to prevent diabetes. If they're on a drug for diabetes, can't we call them 'diabetics?' I don't know. Is every north American (with health insurance) going to be on ACE inhibitors and metformin to stave off high blood pressure and diabetes, just as a matter of course? This is scary to me. And, not everybody can take metformin (yucky digestive side effects-eeeww).

I'm not even going to give you the link to the stories about Korean pine-nuts and pomegranates. If you want to believe in one or two magic foods, go ahead. I believe in large categories of health-supporting foods and large categories of non-health-supporting foods. Choose what you believe to be your best nutritional and dietary approach to your life, listen (somewhat) to your tastes & preferences, check your numbers, and go from there.

But this one, about the expected 45+ million persons who will likely have diabetes in the USA by the year 2050, just makes me want to cry. (I'm assuming the majority of these new diagnoses will be for type 2 diabetes. I'm hoping by 2050, there's a cure or prevention for type 1.) How will there possibly be enough resources for all of us?

I welcome every new diabetic. Your diagnosis is an opportunity for you to change the course of your life and your health. Welcome to the diabetes club!

Embrace your diabetes. Wrestle with it. Master it. Roll with it. Let it influence and improve you.

I just wish, that there were fewer new members. It is a terrible disease, which can produce a lifetime of losses. It requires so much focus, so much management, so much change. Any secondary diagnosis or increased health risk (for instance, smoking) can make it unmanageable.

This outlook, for our numbers to grow so much, is sad. I do not wish to be so discouraged.

Big fat, little fat

So far this year, I have lost weight. I have moved from a BMI of 30.4 to one of 27.1. This means that my label has changed from 'obese' to 'marginally overweight.'

So what?

I've moved from a big fat category to a little fat category. I'm still diabetic. I'm still on two oral meds to keep my numbers under control. My feet still hurt. I still have to be very careful what I eat, in order to keep both my weight and my BG numbers to behave. I'll still have to work hard at maintaining the weight lose for the next several years.

How have I done it? I think the best term for my eating habits this year is portion control, or perhaps, partial anorexia. (Can I be an anorexic at a weight exceeding 160 lbs? I don't think so.) I've substituted a meal replacement bar for the greasy breakfast burrito from the catering truck that appears at our worksite at 8:30 am each day. I try to choose a small lunch, often a salad, or broth-based soup. I try to listen to my body and stop eating when my appetite is satisfied. I often leave food on the plate. I don't have to finish it just because I served it up. I eat more often, but smaller, snack-type meals. I do not count carbs. I do not follow an exchange diet. I don't even follow the McDougall diet, which I would like to be doing. I'm sure I'm a nutritionist's nightmare.

I once read a magazine story-and I believe this to be true-that the psychological effect of excess weight is the same, whether the amount one carries is small, say 10 pounds, or large, 50-200 pounds. In other words, losing weight is just as hard, no matter what the amount of weight one has in mind to lose.

I don't think people in the big-fat categories are going to believe that. I know they're not going to believe that I understand what they're going through, especially at my current weight, or if I continue to lose weight. It is still my goal to lose another 8-18 lbs.

I don't know whether the foot pain has reduced my appetite. That could be. I do know that my foot pain is not an acceptable excuse for weight gain.

I'm all for fat acceptance. I'm all for good self image, no matter what one's size. Love your body, whatever it's size and shape. Your body supports your life. It deserves to be honored and supported for that role. I'm never going to look like Tyra Banks or Paris Hilton or any tall slim actor. (Thanks goodness I don't have to live their lives, either.) That's okay. I'm happy to look like me, with all my lumps, scars, and bulges.

However, I am not content to be complacent about weight. Excess fat is dangerous to my health. I believe it's dangerous to yours. You, especially if you have diabetes (type 2) or are at risk for diabetes, must lose weight, if you're overfat. Losing that extra fat is not optional for you. You must pursue health, with your whole heart, with both hands and feet, with your mouth and your eyes and every fiber of your being.

So what weight is OK? I don't know. I think you should work toward getting your weight to a normal or near normal level. The experts say, if you can lose about 10% of the weight you carried at your diagnosis, your blood sugar levels should improve. So, at the very least, you should weigh less than your lifetime maximum weight number.

I've heard it said, that for every extra pound of weight, the body has to grow a mile of blood vessels to support those extra cells. What a stress on your circulatory system!

I do know that if you're over 600 lbs, your life is very difficult, for many reasons. The Americans With Disabilities Act sets up 600 lbs as the weight limit which must be accommodated. In other words, if you weigh 601, you may not be able to get transportation, depending on where you live, or other accommodation, even if you claim your weight or obesity as a disability.

In reality, a weight of about 350 lbs, male or female, can put you close enough to that limit, especially if you need help to get around. If you are over 300 lbs, and need a motorized mobility device (and I won't push you at that weight in a manual chair, sweetums), the weight of the device and its machinery and batteries can quickly send you over the 600 lb mark. Please don't go there.

Lose weight. Pursue health. Acknowlege the reality of your life, both your eating and your movement habits. See what you can do to improve them. You're capable of making powerful changes, even more so than you realize.

Changing the channel

My recent posts seem overly serious and somber to me. Maybe it's my foot pain. That's been rough this weekend. So, let's change the channel.

I don't like to admit how much TV I watch. So, admitting that I really like VH1's Celebrity Fit Club, that's a stretch for me. But I do like it. And I do watch it. Watching TV does not create foot pain for me.

I have to admit, it's encouraging to see real people go through this same issues that we do, when we're thinking about our weight and our health and getting fit. I like seeing what real people at different heights weigh, and how they look, and what goal weight those trainers set for their 100-day program.

I like seeing them offer the same lame excuses we use: "I have big bones." "I'm too busy." "I hate exercise." "I just had a baby." "I'm an Italian." "I had to eat M & Ms to put myself to sleep last night." "I couldn't do it, because of my heart." (when her cardiologist wants her to do all this activity.)

With Season 4, it's interesting to me to hear the stories from Tina Yothers, regarding her mother, and from Carnie Wilson, regarding herself, about the weight loss and weight gain following gastric bypass surgery. (I'm highly opinionated regarding surgery for weight loss, and I'm sure I'll offend people later by offering my thoughts on that in a post all of its own.)

I'm also a fan of several of the Season 4 contestants, specifically Nick Turturro, from NYPD Blue, which I watched obsessively, at least, once that little red-headed boy was gone, and Vincent Pastore, who played Big Pussy, in the first season(s?) of The Sopranos. (I know, I could link to all those folks and their shows. I'm too lazy today.) I find Bone Crusher appealing and amusing. I hope he finds a way to cut through all that jokester nonsense layer and get real about his health and his family. I hope he's there for wife and their five children as they grow, and to meet their children as they arrive.

Hmm. None of these fat people have diabetes, or if they do, nobody's talking about it. Does that seem odd to you?

It's encouraging to see their same reactions to the weigh-ins, including joy at a low number, and frustration at a high number. They've got the same disconnect between behavior and the weight numbers as do people in my lunchroom at work. When the trainers point out their observations of behavior, both eating and exercise, the contestants still insist that they followed the diet faithfully or that they worked as hard as they could physically. Ha! I know how much I lie to myself on that point.

It's interesting to see the different styles of encouragement offered to the contestants, and their willingness and unwillingness to accept different styles of encouragement. I know it is not my favorite thing to have teammates screaming, "COME ON!" at me if I really think that I'm doing my best. I don't respond well to public shaming, although I didn't think that there was a lot of public shaming going on there during the last episode. That was the big blow-up episode.

Geeze, it's not like the contestants didn't sign up for this. They did, they did sign up for this.

At some point, whether you're famous, infamous, semi-famous, or famous in your own mind, you have to find a place of acceptance, that this is the reality of your life, this is how fat you are today, this is your diagnosis, this is how you look, this is the size you wear, this is your prognosis if you're unwilling to make any lifestyle changes. And that this is the cost of making a lifestyle change.

I'd love to see a three or four year follow-up with these contestants, and with the contestants featured on the other big weight loss shows. I'm interested in long-term success, not just short-term weight loss. And I hope to see all of those contestants lose weight and keep it off and keep up a regular exercise program. I don't like seeing how much they're trying to sell the books of the expert panelists.

PS. I have an appointment with my podiatrist for Monday, 9/11. I'm wearing a pedometer today so I can gather information on approximately how many steps per day I'm doing. I'm hoping the podiatrist has some options, and that I'll be able to accept that this is the reality of my feet right now.

A lot of living

I had to bring you this link to Gretchen Rubin's blog entitled The Happiness Project. This link is a post she wrote about tips she's gotten from reading memoirs about illness. I like Gretchen. I love her blog. I find it inspiring and interesting. (Plus, I think she's gorgeous, although I remind myself that she probably doesn't look that glamorous every minute of every day.) I think that many of her tips from that post apply to diabetes, although diabetes doesn't kill many of us as quickly as the diseases in the books she read.

Hey, does anybody know of a good memoir of living with diabetes? Either type?

I loved the third tip, which reads, in part, "A lot of living goes on in the course of dying." This is very true.

I think I learned this way back when I was in high school when my aunt Orlene, my mother's older sister, died of lung cancer. I don't know whether my mom said it to Orlene or whether Orlene said to mom, or whether my mixed up memory just attributes it to them, but one of them said that you LIVE until you die. You live with cancer for a long time before it kills you. You only actually die in that last moment when you die.

Orlene was a bright and loving woman. She did not smoke. She died around 1980 or 1981, or maybe 1982. She set aside a lovely ring to give to me at my high school graduation. I wear it on my left hand now. Orlene never had diabetes, since the cancer killed her while she was in her 40s. The death of Dana Reeve, with a similar quick fight, brought back a lot of memories about her and her illness for me this year. We miss Orlene. I wonder what marvelous things she would have done by now.

My mother's second husband also died of lung cancer. We miss Cliff.

My husband's mother died of ALS (Lou Gehrig's disease) in June 2005. She was diagnosed in the spring of 2003. She had bulbar onset ALS and it affected both her speech, her swallowing, and her cognition. We got to spend a lot of time with her, as she spent her last years. And yes, there is a lot of living to do in the process of dying. Or, perhaps, in the process of living with a terminal illness. We both got to be there as she breathed her last. We miss Karen.

And even if you're a health perfectionist, a marathoner who eats a raw organic vegan diet, everyone who is born and lives will die. Even if you took perfect care of your diabetes, you will not avoid death. I hope to avoid pain. I hope to avoid disability. I hope to extend useful, joyful life, for myself, and for others, right up until the moment that I die, no matter what the cause.

So, whether your diagnosis is diabetes or something more horrible, I urge you to do all the living you can, right up until you die. That's a lot of living. Don't miss a minute of it.

Dr. Parts Rocks!

Dr. Parts, my sweet and talented husband, replaced the starter in my vehicle last night. I am free again! It only took him about an hour, I think, unless the clock played tricks on me.

He came in with grease splattered all over his face. He looked dangerous and wicked and sexy.

He requested some public praise, here on the blog. Here it is. He's the best, the very best.

I'd offer to loan him out, but I don't think I could bear to part with him.

Exercise Helps

I found this news story today, with the headline "Exercise cuts diabetes risk in people with big waists."

I'm having another well-duh moment. Please excuse me, it will pass.

The big news in this story is that they found reduced risk regardless of the BMI. So, even for persons whose BMI may not indicate a risk, if the waist size is big, they should exercise, and that exercise will help reduce their risk of developing diabetes. For this study, exercise meant five 30-minute periods of exercise per week.

Will this be the study that gets you off the couch? Will this be the one that convinces the next door neighbor to build exercise into her life?

If you're already a diabetic, or if you're at risk of becoming a diabetic, you must exercise. I know I sound like an overzealous P.E. teacher, but you must still exercise. Exercise is like magic for the body. It does such good work, even down at the cellular level.

You must exercise, even if it's uncomfortable.

You must exercise, even if it's inconvenient.

You must exercise, even if you don't like how you look in the exercise gear.

You must exercise, even if you think everybody's looking at you funny when you exercise.

We, meaning persons with diabetes, and people at risk of diabetes, must reconnect with our bodies. We must find a way to love the bodies that support our lives and find ways to make those bodies more healthy than they were before.

We modern folk often use so many labor saving devices that we don't even know what kind of physical work our bodies are capable of. Get out, walk a mile. See for yourself how short a mile is. Most healthy adults, even without training, can walk a mile in 20 minutes.

You can do more exercise than you think you are capable of. You can find great satisfaction in athletic accomplishments.

I have to give a nod to a few people here, one is Ellie Hodder. I participated in her Women Walk the Marathon training clinics for two years in the middle 90s. I'd love for you to go to that website and see all the photos of fat women sucessfully FINISHING the marathon and other ultra-long walk events. Ellie's phrase of "I am an athlete!" still rings in my ears.

I gotta say, barring injury, walking a marathon is not hard. It requires training, which means that you plan the time to train in the months leading up to your event. You walk 4 miles at a time, then 6 miles, then 8 miles, then 10 miles. This is not hard, but it does require determination and stick-to-it-iveness. It requires commitment. You have to do the training, and you have to keep going when you'd rather sit down and have a mocha frappuccino. It requires time. It does not require being a gifted athlete who might qualify for the Olympics. (You learned to walk when you were how old, remember?)

I had planned to walk on a walk relay team for the Portland To Coast relay this year, but my foot injury (sesamoiditis) caused me to withdraw. My team still finished. Twelve amazing interesting women, with widely varying athletic capacities. Some did 12 minute miles, some did 20 minute miles. They came back with blisters and minor injuries (jammed toes) and a lot of soreness, but they are so jazzed to do this again next year. I cannot believe it, and I am so proud of them. Each walker walked about 10 miles, in two different legs of the race. I'm so jealous that they can do this, and that they DID do this. They gave me a team photo, which is up on my desk right now.

This team has several XL t-shirts and even one or two 2x t-shirts. And these were not the largest women who I saw on the course this year. Do not let your size right now stop you from increasing your exercise. You're living in YOUR body. Don't let what other people think, or the bodies other people have, stop you from working to improve your body and your health. Your diabetes numbers will likely improve very quickly if you can exercise, even 30 minutes, even only five days a week.

I'm struggling with switching from walking as my exercise. This is a tough transition for me. But I'm committed to seeking physical health, including regular exercise, as part of my life. I'll let you know how it goes.

I'd like a double-foot transplant, or even a transplant of my four broken sesamoid bones, but I don't think that's in the near future of medicine.

I have to get creative and find solutions that will work for me, with the body that I have now.

So do you!