The Diabetic Ice Cream Social has been my baby for a few years now. It�s really been everyone�s baby. It�s been a special thing for me to fight misconceptions, and to spread a little bit of change in everyone�s mindsets as to what a person with diabetes can and cannot eat � as well as what moderation looks like. The idea that a person with diabetes gave themselves a disease is repulsive to me, as well as the idea that foods are �bad� or �off limits.� As a person with an eating disorder, as well as diabetes, I feel that moderation (and not deprivation) are key to managing our daily lives with a modicum of enjoyment and success.

So, in 2011, when a local Indiana chef wrote a poorly educated column on type 2 diabetes, he stopped my world. In his misguided crusade against people with type 2 diabetes, he sought to attack the local Diabetes Youth Foundation of Indiana for holding an ice cream fund raiser in order to help children with type 1 diabetes go to diabetes camp.  There isn�t just something wrong with attacking children with type 1 diabetes trying to enjoy life as any other child � there is also something wrong with someone who tries to shame our food choices, and create food militancy. Food militancy is something we don�t need in our body image obsessed society. Food militancy is one of the triggers for disordered eating, and many of the common eating disorders affecting our current society � including diabulimia.

Food militancy is also creating a lot of shaming of people with type 2 diabetes and this has got to stop. NO ONE gave themselves diabetes � not a type 1 and not a type 2. People with diabetes are people who were predisposed to developing the disease, for one reason or another. No one knows what triggers type 1, and though obesity may trigger type 2, the fact is that millions of obese people will never develop type 2 diabetes. We all struggle making the healthiest choices for ourselves, and we all need to learn moderation� and we all suffer from bad luck. Life just happens. The #1 risk factor for developing illness is living. Being alive. But one thing is for sure: none of us need deprivation and shaming.

This is what we seek to spread with the Diabetic Ice Cream Social. We seek to spread a renewed view of the person with diabetes; a renewed perspective, as well as a healthier attitude toward food. I have had some pushback from a few folks with different perspectives � and that�s fine. I respect their life path for managing their conditions. But at the same time, I have had thousands of partners in this crusade � the crusade for freedom to make the best choices we know we can make in order to manage diabetes, without fear or shame from others.

The Diabetic Ice Cream Social is a celebration of life � and you may choose to celebrate it any way you want. You can have an ice cream scoop in any way you please: make it lactose free, fat free, sugar free, make it sorbet, make it wine. Make it whatever you prefer � but make it a statement that says you love life, and you appreciate living it, even with diabetes. Make it with family, with friends� or toast the full moon. Make it your own.

This year, 2014, I am very busy with many life challenges and responsibilities � so I won�t be able to lead the crusade as I always do. I won�t be too far from the fray, though. I will be right here, having my scoop, and cheering it on. My friends at The Blue Heel Society have agreed to take on the Social for me� perhaps for a year or so, we�ll see. But they are just as gung-ho about diabetes awareness as I am, so please know this event will keep going. Give them your full support, as I know I will.

This year, while you have your favorite treat� have it will wearing your favorite pair of blues: blue shoes, that is.  

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Life has a funny sense of humor, sometimes... A funny way of testing our wits.

I have a lot of jobs. One of my jobs is for a local church, as their Administrative Assistant. This is a job in which I am transitioning, and their old Administrative Assistant trained me last week, and suggested if I had any questions at all, I could call her. She gives me her business card, and I take it. Later, I'm looking at it, and I find it a bit unusual, as she's labeled herself as a 'Certified Hypnotist and EFT Practitioner,' whatever EFT is. 'Call Your Power Back' it says, under the main header. Under her picture, she claims 'Empowerment and Nutritional Cleansing.' -- Now, this is where I give you guys the disclaimer that I am a skeptic, and I am not fond of new age methods and things. I really like science a lot. I don't believe in cleanses and other kinds of 'fasts' people do to get 'clean' or whatever -- because science doesn't back them up (they can also be dangerous).

I flip the card over -- and what do you know... before and after pictures of people at the worst of their weight gain, and then ripped to no end with muscle, and 'in shape.' I feel the sudden judgmental thoughts going through me -- the sudden comparisons of 'I'm not as good as these people.' Then I'm reminded this person just wants to make a compelling case to get my dollars. I'm reminded that she has confessed to me that she has a lot of health issues herself, and from her appearance is not in what one could term as 'ripped' or in as 'excellent' shape as the people on the back of her business card, and that she's just another human being. I tell myself I have a binging problem, not a weight problem. That I need love, and not a carrot on a stick. I don't need to be Mrs. Olympia 2015.

I will write her numbers down -- and just throw the card away.

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So, recently I was given the chance to try out a ton of Level Life Products and tell you folks what I thought about them. I've been offered other products to try and review before, and I am careful about what I would recommend to anyone: there are many, many, MANY products out there on the market claiming to understand the needs of persons with diabetes, and selling all manner of things, particularly shakes and meal replacement bars. I hate most of them, and tend to not endorse many. They tend to have a lot of sugar, or be a lot higher in carbohydrates than I would personally want. 

Enter Level Life. 

Level Life started out as a company that makes glucose products to help treat hypoglycemia, in more delicious flavors than just chalky orange... So when Level Life contacted me, stating they now had shakes and bars and the like, for me try out, I perked up. You see, Level Life is a company that was founded by a young man who lives with type 1 diabetes. A person with diabetes who couldn't find what he needed out there -- and knew the rest of us probably couldn't, either. 

Finally, a diabetes management product by someone who gets it! 

I am always in the market for the best shake, or meal replacement bar -- one with not a lot of carbs, that won't make me feel sick later... and let me tell you, this is it. I lead a pretty fast paced life these days, since I have two jobs, and often have to squeeze a meal or a snack wherever I can get it. 

These products are fantastic. The bars have around 140 calories, with 14 grams of carbohydrate per bar, and the shakes have around 170 calories, and 10 grams of carbohydrate per shake. They are rich in protein and fiber. I tended to feel satisfied for long stretches, and my blood glucose remained nice and level. Many of us do not want to exceed 140 mg/dL wherever possible, and most shakes and bars can quickly put me at 180 mg/dL. I tested regularly while trying these out, and I feel confident that I can trust Level Life to help me keep my blood glucose goals, and to keep a level lower than 140 most of the time. These products are also gluten free for those of you suffering from any form of gluten intolerance.

I have to admit that I am pretty biased and my favorite flavor is the Rich Caramel Shake. I just grew up with too many vanilla, strawberry and chocolate diet products, or glucose management products... and well. Yuck. lol While ALL of these were actually good tasting compared to other products, I'll stick with Caramel. :-D Thanks. But if you miss strawberry flavored milk, though, you will like the Strawberry Creme shake. It's just yummy!

Level Life has been very generous in their efforts to try to get the word out about their great product, and have given me the opportunity to give away a generous package to one of my lucky readers! You too could win a premier bundle of bars and shakes valued at $60.

To enter, you just have to do three things:

• Follow/subscribe to this blog;
• Like us on Facebook; and
• Leave a comment below about what you're looking for in a meal replacement bar, or what you like about Level Life if you've tried them in the past. 

A winner will be chosen at random and will be announced Saturday, July 12th.  Good luck!!

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I've had type 2 diabetes for nearly 4 � years. Though not a very long period of time, it's still been very challenging...

I've lost weight, gained weight, lost weight; I've low carbed, extremely low carbed, and eaten intuitively; I've exercised myself to death, been a couch potato, and a simple walk around the block lover; I've quit soda, drank only water, and then gotten on diet soda, again... I've had highs and lows, and lows, and highs. I've been proud of myself, and disappointed in myself -- and I've learned just how HARD it is to change myself -- all willpower aside. I've even dealt with some very angry type 1 diabetics and some very unhealthy diabetes forums and communities.

All of these challenges aside, none of these compare to the one big challenge I've had to face while living with type 2 diabetes... keeping my dignity as a patient.

I'm no stranger to the discussion of keeping the patient dignity. I've challenged various prominent diabetes writers on their own biases and deliberate fact twisting, I've written various letters to television programs, to diabetes programs like Take Care of Your Diabetes, to celebrities like Conan O'Brien, and have even hosted an online Diabetes Ice Cream Social event to get people thinking differently (and been skewered for it). My most famous of these discussions on patient dignity, however, happened as an ePatient Scholarship recipient, when I attended Stanford University's Medical School, for their 2012 Medicine X conference. (For that little escapade, I got editorialized by Esther Dyson as someone who was wanting to pass the buck for being fat.) 

And therein lies the rub. We want to find people to punish and blame. We want to skewer people for "giving themselves" type 2 diabetes. 

This is not an abnormal thing. It's actually a part of human nature to want to find vindication for issues -- it's a form of 'negative altruism.' The problem is that the social dialogue that has been crafted in the media, and in part thanks to illness advocacy organizations like the ADA, various medical groups, and those who want to exploit the obesity and diabetes medical communities -- has been centered on discussing obesity and diabetes as though they were a crime against society (i.e., obesity and diabetes are going to bankrupt the economy, destroy the healthcare system, our children, bring governments to their knees, destroy third world countries, bring a second coming of Christ, etc.) So, people with either obesity or type 2 diabetes, are not seen as persons struggling to take ownership of their health issues -- but as people failing to take accountability for a crime against society. "Be accountable for your health," they say. Obesity and diabetes are not seen as personal struggles for personal health ownership -- but as a moral failing of the individual, a crime against society, and as a justification for social outcasting.

This is a HUGE undercurrent in the diabetes dialogue at large! 

It colors the mindsets of many an educator, clinician, registered dietitian, media or TV personality, people trying to sell us goods and services, and of course... persons presenting new technology at a conference like Medicine X. It's a problem. It's a HUGE problem. And when one addresses such a problem, one is portrayed as though one were trying to pass the buck for being obese, or having diabetes. There's a certain self important arrogance about it all... If I point out your moral failing for having 'given yourself diabetes,' then I must be a more moral, and worthier, contributing citizen to the society at large. 

Now, this blog post is not about whether or not one can 'give oneself' diabetes. That would be an entirely new blog post -- and I think I've spoken on that before... My overall view on whether one 'gave oneself' diabetes, however, is that it's IRRELEVANT. Yes, it's irrelevant. Once a person has diabetes, whether or not they 'gave' themselves diabetes is, quite frankly, irrelevant. One can analyze a person's decisions and life style choices till the cows come home... but once that person has AIDS, cancer, diabetes, heart disease, etc... is it now time to start treating them without respect, or dignity? Should we spit on their faces, and socially mock them while at the same time claiming to try to help them? "I'm going to help you, fatty, because you can't help yourself! You have no self control, and you can't stop eating!" 

I think many misunderstand my words here, when I speak of patient dignity. Patient dignity is NOT a patient passing the buck; it is not a patient not taking ownership of their health... Dignity simply means treating someone with a certain basic level of respect for being a human being in the midst of a trying, and challenging situation -- whether of their own doing, or not. We are all human; none of us is above the struggle to make the best choices. Though this is another topic worthy of further exploration in a different blog post, the food choices many of us make day in, and day out, cannot be completely and genuinely labeled as 'mistakes,' for they are the product of our programming as children, as members of some particular society, and as mammals evolved (thanks to natural selection) to prefer more nutritionally dense foods, especially in order to better face periods of famine. While many have had the blessings of genetics, and a healthier food environment overall (familially and culturally), it takes enormous effort to change oneself as an individual, because it is not simply a product of will -- it is a product of reprograming, and reprogramming is HARD. You aren't just fighting your family's bad eating choices, you are also fighting millions of years of evolution! So it is thus, unfair to treat these issues as though they were black and white, and as a people's moral failings, or as a crime against society. Also -- the person with type 2 diabetes is NOT accountable for their health to you -- so get over yourself. Type 2 diabetes has many different triggers (not causes), of which obesity is just one of them, and the others are not quite as uncommon as people want to think. The scientific and peer reviewed studies showing this are there -- but they seldom get public light, because they are NOT media-attention worthy. Sensationalism is simply what sells. 

All of these things aside -- the overall goal of ANY health initiative by any group is to make positive change. But if we want to help a patient community to make positive changes toward a general health improvement, what we want to do is focus on that 'positive' word. Putting the word "skinny" in front of your company's marketing, cracking jokes about a community's obesity or bad eating habits, how they gave themselves diabetes, stereotyping, claiming diabetes can be cured (or blaming people for not curing themselves), turning them into a 'meme' or down talking to them is NOT going to make positive change. Instead, all it will create is an underculture of social pariahs who are not just denied services and tools, but who do not seek the necessary medical attention they need, the tools and education they deserve, or the new lease on life that they could have. In other words, the culture we have NOW.  

If you make it too embarrassing and shameful to have diabetes -- people aren't going to work toward not getting diabetes... People are still going to get diabetes, and they are going to die in silence, from diabetes. 

In the end, the person who'll end up costing more to a society is not the person with diabetes: it is the diabetes bully. 

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Two years ago, I wrote a blog post about diabetes and anger. In that post, I explored a lot of the day to day reasons why a person with diabetes might feel anger, and frustration. In fact, there are many reasons why a person with diabetes would, indeed, become angry. Those reasons can be varied, including anger at oneself for 'failing' to prevent the disease, to anger at family for not understanding or patrolling/policing the person with diabetes' behavior, etc. These are common types of anger: the anger that results from struggling to cope with a new and changing environment, for which we might have little control. (You can check out that blog post link, above, for a more in depth look at that topic.)

However, little did I realize that I was going to get such a huge response from the public -- but not about anger in this usual, common sense -- but anger in the chronic and mental health sense. Folks from all over the country have poured out their hearts to me in sheer frustration and worry over their loved ones, from sons to spouses, to friends. From lay people, to mental health professionals as well.

I must emphasize here, that I am NOT a mental health professional. I am not a medical expert of any kind, or a scientist. I am just a person with diabetes, with a blog. A person who loves learning every day, researching my own condition, and learning how to live and cope with it. Anything I say here is information you must take to your own clinician, or consult with your own mental health professional. It is also information that anyone can research on their own: never take my word for anything. Always be a skeptic.

Now that we have gotten that out of the way, let's start with the ways in which diabetes can clinically affect our moods.

Day to Day Blood Glucose Swings

When our blood sugars are not within normal or euglycemic boundaries (i.e., between 70-120 mg/dL, or 3.9-6.7 mmol/L), our mood and emotions will be altered. In some extreme cases, a person who, for example, experiences severe low blood sugar may become angry and even combative, or violent, or may seem 'drunk.' A person who experiences high blood sugar may experience sadness and depression, inability to concentrate, fatigue, etc. The root of all these glucose related mood swings has to deal with their association with the neurotransmitters in our brains, and how those in turn, communicate messages to our nerve cells about mood, appetite, and even sleep. Dealing with these states of mind is challenging, and can be tiring for the person with diabetes, as well as bring on a short temper. To top it off, having a negative disposition may also bring on bad blood glucose numbers, creating a vicious cycle that feeds off itself.

Chronic Mood Swings

The problem with being on this persistent 'roller coaster' of high and low blood glucose swings is that it can be bring about permanent, and chronic, mental health problems. Problems such as clinical depression, anxiety, anger, and a whole host of mental health conditions, like bipolar disorder.

According to a study on "Diabetes and Psychiatric Disorders," by the Indian Journal of Endocrinology and Metabolism, "Diabetes and psychiatric disorders share a bidirectional association -- both influencing each other in multiple ways." So much so, that apparently scientists back in the late 1800s found diabetes to be a disease which had been present in families with a pronounced history of mental health problems, so that insulin shock therapy was used as a treatment for mental health disorders even as shortly as insulin was isolated for the first time.  (Yes, insulin has a role in mental health, and even in the development of such diseases as Alzheimer's.)

This study further points out that there are several ways in which both diabetes and mental health problems can show up:

• As two parallel conditions, which developed independently of each other, with no apparent connection;
• As a complication of the diabetes, or as a complication of the mental health problem: type 2 diabetes may lead to depression, as well as depression may lead to type 2 diabetes, for example;
• As a product of hypoglycemia or hyperglycemia (and ketoacidosis), such as the development of chronic anxiety;
• And as a result of taking various medications for treating mental health -- many of these medications can lead to a triggering of a type 2 diabetes diagnosis. 

In my personal and anecdotal experience, I am a person who suffers from dysthymia. Dysthymia is a type of low grade, long term depression, which can subside and be in the background, for much of one's life. It is much milder than regular depression. However, in situations in which I have had an undiagnosed, and chronic health condition, such as hypothyroidism, or type 2 diabetes -- the imbalances in health provoked episodes of severe depression. The conditions influenced my depression and worsened it. In this way, uncontrolled diabetes can worsen or complicate a mental health condition that is already present, making overcoming of both conditions a challenge. 

It could very well be that the sudden and deep mood changes many persons with diabetes have experienced were the result of these drastic, and long term changes in blood glucose influencing an already underlying mental health problem -- especially if the diabetes was left undiagnosed or untreated for an extended period of time. It is particularly difficult for a person with diabetes that is weighed down by these mood changes, to find the motivation and positive inclination to manage their health condition. Quality of life tends to be reduced, and so does optimism, which can lead to development of unsavory habits, such as uncontrolled diet, smoking and drinking -- habits which can exacerbate mental health problems and lack of control, to an already breaking point. 

How Do We Help? 

In my previous blog post on anger, I noted several ways in which we could be of support to a person who was being burdened every day by the management of their diabetes. Being a good listener, helping a person cook meals, and being empathetic, are all proper ways in which we can deal with a loved one's chronic health condition. The Behavioral Diabetes Institute provides resources for us to utilize when we are overcome by our day to day emotions when managing diabetes, and may feel burnt out, or depressed. 

However, there are situations in which we need to be more proactive in identifying the mental state of our loved ones. Understand that, outside of a rare and severe hypoglycemic event, violent and aggressive behaviors are NOT standard complications of diabetes. These are not typical or normal behaviors for a person with diabetes. (Grouchiness is.) If a person you love is experiencing warning signs of serious mental health problems, you might need to have a conversation with them about visiting a mental health professional. This is an intimidating task, and there are suggestions out there, on how to broach the subject. 

The National Alliance on Mental Illness (NAMI) has a good Resource Guide for Families Dealing with Mental Illness. In it, they address what to do for 'crisis intervention,' when a person's behavior is particularly violent, or out of control:

If the individual with mental illness is in danger of physical injury, if his or her behavior is out of control or others are in danger, it is important to know what steps to take. Plan ahead by locating available sources for help: your emergency phone number (911), police or sheriff department number, Community Mental Health crisis or emergency number, name and phone number of a mental health professional, friends or neighbors who may be of help, and the nearest NAMI affiliate. Keep these numbers posted by the telephone. 

Any behavior such as this, that falls outside of both a mental health disorder, or a severe hypoglycemic episode, is unjustified violence, and should never be tolerated. Do not put up with it. 

. . .

Mood swings can be a standard part of diabetes mellitus and its attendant blood glucose fluctuations. However, when chronically unregulated, these blood glucose fluctuations can bring about more serious mood disorders. These mood disorders are NOT a standard symptom of day to day diabetes management, and will usually not ameliorate on their own. If you are living with a person who has become unpredictable, or violent, due to a potential mental health disorder, please seek help from your local community mental health centers, a mental health professional, or from your family physician.

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His foot was black and woody; gnarled, like dirt covered ginger. I will never forget the terror in my mother's eyes as she fruitlessly tended to its bandaging, and yelled at him for letting things get to this point. It was a shocking state of affairs. My father was now blind, bedridden, undergoing dialysis, and at the verge of needing his foot amputated.

My old childhood home had changed from whatever it was in my memories and into a hospital. Dad's room was an intensive care unit; my sister's old room was storage for the massive amounts of dialysis fluid boxes he would be needing.

I knew that dad was struggling... but I didn't know the extent. I had been gone from home for far too long, I guess, where at least reality wouldn't have denied me the right to know the truth. My parents, however, were the kind of people that lie by omission -- never telling their youngest daughter whatever might have worried her, or troubled her; never keeping her up to date with issues such as this. It was their way of protecting me... but it was far less protective than the truth. On May 5th, 2003, dad passed away. I only got to spend one last weekend with him the previous March... where he couldn't see me, couldn't go on walks with me, and had the beginning stages of dementia.

For the longest time I was very angry at my dad. To be and feel desperate at the healing of the unhealable is one of the most impotent feelings a loved one can experience. You are overcome with anger at the selfishness of the 'uncompliant' diabetic, not thinking how this would impact family; not thinking of the burdens of family having to be nurses, diaper changers, dialysis providers, and well... at the other end of helplessly watching them rot.

It has taken me years to deal and cope with these feelings; to come to terms with acceptance and forgiveness, and understanding that although complications happen, they are not always due to our choices as people with diabetes. That sometimes, the long ride is just too much -- and the genetic deck is not stacked in our favor.

Except on December 20th, 2013...

A desperate message was posted in a large online community to which I belong by a young man seeking advise about his father's infected wound, how it was not healing, and asking about what all that needed to be done. Someone -- knowing about me and my advocacy -- gave him my name. Then the desperation began anew... this unreasonable feeling of 'how can I save this person's loved one?' What all can I do to turn back the hands of time? I answered as best I could... with all the information I knew.

But information is cold, and stiff. It doesn't change his lack of access to resources, to well educated medical professionals, to the state of the art facilities we enjoy here in the states. It doesn't change that he knew not much about neuropathy, how to care for poor circulation, how to effectively and diligently monitor blood glucose levels, let alone what healthy blood glucose levels were, that Indian food is not exactly diabetic friendly, and that years and years of this status quo would likely not be undone.

Every day, the young man messaged me. "What can be done?" Sometimes, a few times a day. I could see the desperation of his situation -- I could see in my mind's eye, the terror on his face. At some point, I had to say "I am sorry. I am not a medical professional. These are the best guidelines I can give you... and to urge you to seek a wound care specialist." I wish I could have done more. I felt like I was needing to save my own father all over again.

I heard little from the young man, after that... But I had my suspicions. My gut feelings. On December 31st, he wished me a Happy New Year, perhaps in the most somber of ways one could wish it. Just words on a page... not even capitalized. Then by January 5th, he finally mustered the courage to tell me that on the 2nd, his father passed away. And it all came back around, home for me...

I mustered an "I'm so sorry,"  in the best way that I knew how, never once telling him about my own pain. My own loss. "It's fine," he replied.

Perhaps not so, today... and that's just fine, as well.

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