Hello sweet peeps! It's about that time of the year again! Diabetes awareness month is fast approaching... and with it will come another year of living with diabetes, for me. November 17th will mark my four year anniversary of living with this insidious disease.

What will you do for diabetes awareness month? Will you wear a diabetes awareness pin? Will you hand out fliers, or educational materials? Will you donate money to the cause, or participate in a walk? Will you help the International Diabetes Federation light up a building blue? There are so many things we could do. I was considering making little educational booklets for the recently diagnosed type 2 diabetic, being as there is often so little information given to patients. This might take me a little time, and expense... but it's a goal I have. 

November is also a month in which I contemplate my life with diabetes: Where am I? Where am I going? Am I where I want to be? What have I learned about myself. 

Through my four years of living with diabetes, I've gone through several approaches as to how to manage and cope. From stricter, to less so, to more of a balanced and moderate approach. I've had to sit down and think long and hard about my attitudes toward food, weight loss, and how I was emotionally comforting myself. For a while, I practiced extreme low carbing, and realized it was not the best approach for me: it was not financially doable, plus it was also not realistic as to enjoying life with others in social situations. And well... I just dislike almond flour and excess fat. Now, I love the approach of eating with awareness, or intuitive eating, but I must be aware that as a person with diabetes, I must mind my level of carbohydrate consumption, as well as some of my calories, so I still needed to put some limitations on myself. 

So far, I've come to a place where I practice a sort of hybrid of both: I try not to eat more than 400 calories per main meal (I'm only 4'9... I really don't need that many calories), and then I eat my meals with awareness, so I may not end up eating that whole meal, if I don't feel like it. I can be one of those people who eat distractedly, or emotionally, so if I 'fail' to stop where I want, at least I won't have eaten a lot more than 400 calories in one sitting meal. If I am physically hungry and need more food than this, I'll eat it. I try to do this approach of mindful eating when I'm in restaurants, too. If I can, I will order less of the regular portion, or box away half of the portion, etc., adding veggies or side salads, helping to balance things out, as well. I generally don't like to take portions home.  

I've started trying to cut ties with certain foods, not because I can't have them, but to reduce my cravings for them, while increasing my appetite for others. It has given me quite a bit of freedom in my walk with diabetes... leaving some foods to rare occasions. I won't say what these foods are: I think that's irrelevant, really. What those foods are, could be different for everyone. It's the concept that matters. 

I am fortunate right now, that I have a very physical job at a restaurant, and I get quite a bit of exercise running around a busy dining room all day, and often lifting heavy things. I should add more physical activity to my life, though, as I go along. And this won't be too difficult to do. I just need to schedule it in, and go do it. 

Pacing myself with weight loss has also been another big lesson. When I first was diagnosed with diabetes, I was in such a hurry to lose weight and be healthy -- I was so scared of this disease. I did manage to go from 243 lbs down to 170, which was a great accomplishment, but it left me feeling tired, deprived and trapped by having diabetes. It made me burnt out. Eventually, I yo-yo'ed a lot with my weight, gaining and losing weight quite a few times, up to reaching 226 lbs again. I am now, presently at 183 lbs... and losing slowly, and as peacefully as possible. Even us advocates need to be reminded that this is not a sprint, but a marathon; that we need to pace ourselves along the way. Love ourselves along the way. It is hard to feel much love for life, ourselves, or any peace with diabetes, when one is pursuing strict, short term solutions, to long term problems. This rocky relationship brings moodiness as well; depression, anger, eventual high blood sugars, and further uncontrolled emotions.  

Diabetes has been for me then, a deep exercise in introspection: a deep learning to pay attention to my needs, to want those things I'm doing for myself, to love and desire to be healthy, and in good spirits. It is the courage to look at what we want in the face, versus what we need... and to turn what we need into what we want.  

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Every November is sort of bittersweet, for me.  In one way, I am very excited -- the unity, love and compassion of many, just pours over in our communities.  It is a huge opportunity to spread a bright blue beacon of awareness across the world. It's almost like Christmas time... Diabetes style.

In another way, Diabetes Awareness Month is very frustrating to me... because it is, in many ways, National Recrimination Month.  I can conspiracy-theory-spin this all the way to the bank, but I won't... Instead, I'll just share a few simple truths with you:

1. Type 2 Diabetes Awareness, largely focuses on telling people that their Diabetes is preventable, and that 80-90% of the cases could have been avoided.  Now, I'm curious... did anyone send you a survey, or knock on your door asking you how you got your diabetes? Did they ask you what medications you take, what other illnesses you have, or come over and take blood samples from you? No? Oh. Well... That's because when people are throwing that statistic around, they are usually mentioning either of these two studies... (Most people, or organizations, WON'T EVEN REFERENCE THEM. I had to dig DEEP just to find these two.)
• Diet, Lifestyle, and the Risk of Type 2 Diabetes Mellitus in Women: Frank B. Hu, M.D., JoAnn E. Manson, M.D., Meir J. Stampfer, M.D., Graham Colditz, M.D., Simin Liu, M.D., Caren G. Solomon, M.D., and Walter C. Willett, M.D. N Engl J Med 2001; 345:790-797. September 13, 2001. http://www.nejm.org/doi/full/10.1056/NEJMoa010492#t=articleDiscussion
• Lifestyle Factors and Risk for New-Onset Diabetes: A Population-Based Cohort Study. Jared P. Reis, PhD; Catherine M. Loria, PhD; Paul D. Sorlie, PhD; Yikyung Park, PhD; Albert Hollenbeck, PhD; and Arthur Schatzkin, MD, PhD�. http://www.annals.org/content/155/5/292.abstract 

Now... what's wrong with using this to badger people with diabetes? Well, for starters, these types of studies are OBSERVATIONAL studies.  Meaning a.) they rely largely on demographic data from participants, and not on laboratory studied, measured, clinical data,  b.) they make assumptions on what a healthy diet means, b.) they rely on anecdotal testimony on what participants may claim are their risk markers for a family history, c.) they do not account for racial, or ethnic risk markers, d.) they use limited populations of people that may or may not represent the overall population, in certain circumstances (like ALL nurses, which their occupation already may put STRESS as a HUGE factor in diagnosis.), e.) they don't tell how many of the total participants in the studies were actually overweight or obese, regardless of diabetes development, f.) they control for common things, like metabolic syndrome, but not for other critical factors, such as different illnesses, medications, pollution, toxins, etc., g.) They assume things like high triglycerides, high cholesterol, and high blood pressure, are ALL preventable things (completely ignoring their genetic components), and what's worse... h.) These studies assume that because the rest of the people were able to, somehow, avoid getting Type 2 Diabetes... that those people who did get it, should have been able to avoid it, too! I think that it's very evident that we are all UNIQUE, as our fingerprints, and that unless we were able to magically step back in time, and redirect those people who got Type 2 diabetes, we will never truly be able to tell if they could have prevented their illness just by comparing them to other strangers! That's like saying I could have avoided getting late to work, like 'Jenny did,' without taking into account a.) my car breaking down, b.) people having an accident and blocking the main roadways, c.) tornado warnings being issued, etc., etc. These studies tell you NOTHING about these people other than many of them have a poor diet, like MOST Americans do.  Yet MOST Americans will NOT develop Diabetes.  These studies will NOT tell you anything about the chemistry inside these people's bodies, or even WHY they might be overeating, or addicted to nicotine, or alcohol.  As discussed in my About Diabetes post, Type 2 Diabetes is a HELL of a lot more complicated than these simplistic studies.  

I am SICK and TIRED of hearing this old line used to badger poor people who got a disease they DIDN'T WANT.  NO ONE wants Diabetes.  NO ONE. While I can't say that there aren't folks out there, in the world, who love food... or love to pig out, or drink, or smoke, for the sake of doing these things... I can tell you that that is HARDLY an excuse to say everyone else who developed a disease was EXACTLY LIKE THAT. What's worse are the George Burns of the world who smoked till they were 100, and had NO PROBLEMS ever with lung cancer, or the Manuel Uribe's of the world, who weigh in around 1,000 lbs, and have no high blood pressure, no high cholesterol, no triglycerides, and no diabetes. Healthy eating and exercising can benefit EVERYONE, and they are ways to help us EXTEND our chances for good, overall health, and have more energy for life... but they are not a passport to a disease free life.  I recall a next door neighbor, from my childhood... Jogged every day, very fit, and thin... Died at 42, from a sudden heart attack. No family history.  His dad, by contrast, smoked like a chimney ALL HIS LIFE and didn't die until well into his old age, when he actually presented complications. Diet and exercise will NOT 100% prevent anyone from getting Type 2 Diabetes, nor should it be presented that way.  Am I saying we should push the lottery of life? NO.  No way in hell.  But what I AM saying is that telling people they could have avoided giving themselves a disease is a.) Unhelpful, and b.) Not the complete picture of things, and probably, very untruthful.  
2. Awareness focuses on telling people THEY need to take action in getting tested, and finding out that they have this chronic condition. Now, don't get me wrong... I agree with this.  I agree that we need to take action, and we need to get a hold of our health... but I agree with it, mostly because doctors are NOT doing their part.  And this is where awareness fails.  Awareness should not rely on going around, scaring people, telling them they need to get tested. (Many people won't... they don't want to know... hey, it's scary... I don't blame them!) Awareness should rely on empowering doctors, urging them to continuously educate themselves about Diabetes, and giving them the tools to help, and empower persons with Diabetes, in a welcoming, and nonjudgmental environment. If this is such a dangerous disease, why aren't doctors being sent to more intensive training to learn, and deal with this condition? Why is my PCP so ignorant that she had to go get herself on the ADA website to find out information to "give me," on what to do?! I can do that myself, thank you very much! (And it sure as hell WON'T be from the ADA site!) If this is such a dangerous disease, why is a fasting blood glucose, or even an OGTT for those at high risk, NOT part of an annual physical? Why do people need to know that they need that, in order to demand it? Why can't a doctor know? 
What's worse is HOW a diabetes diagnosis just keeps getting delayed, and delayed because of old, and tacky, ADA guidelines. Patients are not given proper follow up testing, told they have "pre-diabetes," not told they need to make any changes, not referred to any certified diabetes educators, or registered dietitians, and not given tools to monitor their condition.  In short, they are told they have NOTHING to worry about.  To just lose some weight, and they will be fine.  Most of these people are ALREADY diabetic, and don't know it.  By the time the average person gets diagnosed with "Pre-Diabetes," they've already reached a 40% loss in beta cell function. (http://diabetes.diabetesjournals.org/content/52/1/102.full) By the time they are diagnosed with Type 2, an 80% loss in beta cell function. (http://www.dlife.com/diabetes/type-2/diabetes-causes/garnero_0608)
3. Awareness focuses mainly on telling people with Type 2 Diabetes that they need to take care of themselves, and they need to test.  I couldn't agree more! *clap* *clap* This is the truest thing that anyone can say about Diabetes (of any type), really.  It might seem hard to imagine that I, or anyone else, would have a problem with this... what could possibly be wrong? Well, the problem is similar to telling your spouse they need to go do the grocery shopping (for the week), and giving them only $20 to do it with. Huh? I'll spell it out for you... :)  Insurance companies will NOT HELP people with Type 2 Diabetes; they are of the view, and the assumption that because most of us will not immediately die from high blood sugar, that we do not need to test as often. This means that if you have "Pre-Diabetes," you are likely to be given 0-1 test strips (a day!) to test with; if you have Type 2 (anywhere from 2-4), depending on what medications you use... with 1 generally used for those not on medications, and 4 being used for those on insulin.  If you are a newly diagnosed person with diabetes who does NOT know how their diet affects them, 1 strip isn't going to be of much help.  Much less 0. You have to know at least two parts of a mathematical equation, to be able to come up with a conclusion of some sort (ie, because my fasting blood glucose before a meal was X, and my postprandial was Y, then I know the amount of carbohydrates I had raised me Z glucose points.) But if you only have X, or Y, by themselves, that doesn't tell you much of anything.  And if you have nothing, you're pretty much going on exactly that... nothing. Almost every informational pamphlet out there, on Type 2 Diabetes, urges people to test before and after every meal, at rising, before going to bed, and before or during exercise, and at times of illness.  Now, do the math with me... how many strips does that add to? ... Yeah, a heck of a lot more than 1. Insurance companies claim that the costs of covering these strips is too much, yet... they do not factor in the costs of complications from poorly controlled blood glucose, nor do they seem to want to listen to how much money they could actually save if they actually taught people how to monitor their blood glucose and make meal decisions based on their numbers.
4. Awareness focuses on telling people they need to go talk to a Certified Diabetes Educator, Registered Dietitian, or Endocrinologist.  Yet, for a Type 2 Diabetic, insurance will SELDOM cover these specialists as they deem them unnecessary, and unjustifiable.  Diabetics are left to the care of very many ignorant PCPs, APs, and even RNs, or LNs, with their OWN ideas of what diabetes is.  What's worse, is that NONE of these people seem to understand that Type 2 Diabetes is a progressive illness in which our bodies will not be able to metabolize carbohydrates properly... We are ALL different in our progression (and the damage in our systems), and telling a person to eat X amount of carbohydrates, at meal times, without instead... letting them learn what number is appropriate for them based on their glucose responses, their overall health feeling, and appropriate medication levels, is setting up MANY people for failure.  This is where the conspiracy theorist in many wakes up, because keeping people on so many carbohydrates with the excuse of "your brain will starve," keeps a lot of diabetics on MANY medications, some very dangerous, bringing about many unnecessary complications at an early period of progression.  What's worse is that doctors not up to par with the latest in medical research will keep Type 2 Diabetics from access to insulin, sometimes until terrible, and unnecessary damage has occurred, from the complications of high blood glucose. Studies have shown that early insulin intervention is NECESSARY in Type 2 Diabetics. (http://clinical.diabetesjournals.org/content/27/2/60.full)  
5. Awareness focuses on telling Diabetics they need to keep their blood glucose numbers steady. Yet another gem of wisdom here.  I couldn't agree more, again, frankly... "But why is this so wrong, Liz? You must be off your rocker..."  The problem here is that Diabetes advisory organizations do NOT agree on blood glucose target goals, and often use poorly done studies (like the ACCORD study) to justify that diabetics (of all types, without respect to good health), stick to higher blood glucose numbers that can lead to complications later down the road.  Frankly, the American Diabetes Association is the ONLY organization recommending such high blood glucose goals as being at 180 or lower, 2 hours after a meal! Everyone else recommends around 140 mg/dL.  Why are we relying on these people, and not on the American Association of Clinical Endocrinologists, for example? I can't tell you the answer to that one... I can surmise they channel most of the research funding money, and think many of us can't do it. We can't and won't take care of ourselves, to better levels... It's too hard.  While some, may, indeed have health challenges keeping them from tighter goals, I do think those are personal decisions that need to be made with one's medical team, and not as general blanket goals espoused by guideline organizations.  Again, the conspiracy theorist in me, would tell you that because the ADA has a LOT of conflicts of interest with big pharma (and this was documented through a recent Mount Sinai research study), then they get some type of financial, monetary kick back from many of us being on pills.   (http://www.ama-assn.org/amednews/2011/10/24/prsc1025.htm) 
6. By far... what I dislike the most about Type 2 Diabetes, in regard to Diabetes Awareness  Month... is that they NEVER talk about finding a cure.  This hurts me deeply... because NO, diet and exercise won't make this thing go away, and for many of us... like my father... they are not even guarantees of having good control. My father lost his battle to Type 2 Diabetes on 05/05/2003. During the last few years of his life, he endured kidney failure (we dialysed him at home), blindness, neuropathy (both peripheral and autonomic), coronary heart disease, dementia, stroke, and gangrene. He passed away at the operating table, from respiratory failure, as he was awaiting surgery for a leg amputation.  His diabetes simply took a very brittle turn for the worst... I've never known someone that took better care of themselves.... He was President of the Puerto Rican Olympic Cycling Federation and Skating Federations, as well as President of the Puerto Rican BMX Associations.  A coach, and a huge supporter of active youth, and athletics.  He got me my first BMX bike when I was just 5 years old. 

My father, near diagnosis.

My father, 10+ years after diagnosis 

My father in his last years.

EVERYONE deserves a cure.  Everyone deserves a dad, or a loved one, to come home to... Spend Christmases with... and walk them down the isle. Everyone.  You owe it to me, ADA.  You owe it to EVERY person with Diabetes, of EVERY type.  

It's time you get off your sofa, stop pigging out on chips and soda bought with big pharma money.. AND FIND A CURE. 

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