Jessica Apple grew up in Houston. She studied Bible and Ancient Near Eastern Studies at the University of Michigan, and completed an MA in the same field at the Hebrew University. She began to write and publish short stories while a student, and has continued to write essays and fiction while raising her three sons (and many pets). Read full bio

S**T Happens, So Does Hypoglycemia

That awkward moment when someone asks a (seemingly) innocent question about your diabetes and all you can do is shrug, because if you open your mouth obscenities will fly out of it…

Okay, I’ll admit it: I’m on edge.  The last few days have been rough on my family.  My youngest son, Adam, became quite sick on Tuesday.  And on Thursday night, things took a turn for the worse.  On both Friday and Saturday, Mike and I took Adam to urgent care.  Luckily, he was treated there and we did not have to go to the hospital.  Unluckily, the treatment involved big injections into his butt. Adam was brave, but it was a painful ordeal.  For him, though, it came and went. He mentioned a few times that his butt was sore, otherwise, he’s mostly himself again. For me, seeing him so sick ripped up my heart.

Adam had improved enough by Saturday night that Mike felt it was fine to go out with his running buddies to celebrate completing the Tiberias Marathon.  I  stayed home, and got the kids to bed.  I could have easily gone to sleep at the same time as the kids, but I knew I should stay awake to catch up on the laundry and email I’d neglected for several days.  It turns out to have been an excellent decision.  Here’s why:

1. I had turned the ringer off on my phone when I was getting the kids to bed, and forgot to put it back on.

2. Mike forgot to take his keys when he went out.

3. On his way home from dinner, Mike started to feel really bad: disoriented and shaky.

4. In the elevator in our building, he texted to me, “please open.”

5. My phone didn’t make a sound, so I didn’t know to run to the door. But I was working at my computer, near the front door so I heard the scuffle of Mike’s arrival.  

6. Mike was pale.  ”I think I’m low,” he said.

7. Yes, 35 is definitely low.

8. Mike ate voraciously.  Anything his hand could reach went into his mouth.  Then he collapsed on the couch and the roller coaster began.

I went back and forth between checking Adam and checking Mike for the next several hours.  When all seemed okay, I allowed myself to fall asleep for a few hours.  You might expect that I will now tell you how fragile everything felt over the weekend.  It did.  It was miserable.  I’m so grateful that things are better right now. But, no, I’m not going that route. Instead, I’m going to talk about how pissed off I got when I relayed the story of the “35″ to some friends.  They all responded in the exact same way, by asking the innocent questions – what happened? or how did that happen?  

You know what guys, hypoglycemia happens.  

Hypoglycemia is part of life with diabetes.  When you ask why it happened, the answers we can give you are that we took too much insulin or didn’t eat enough.  We don’t really know how all of the other factors, like the ebb and flow of hormones, play in. But that doesn’t mean we’ve done something wrong, and those innocent questions of how and why  leave us no choice but to answer that we’ve fucked up.  So, yes, that’s the truth.  But imagine if someone told you that you had to drive across the country without a map and predetermine the precise amount of gas it would take to do so, not to the gallon, but to the drop. There’s a good chance you’d run out of fuel on the way because you got lost and drove extra miles, and there’s a good chance you’d overestimate your needs, assuming traffic and detours, and have some to spare. 

Next time I mention hypoglycemia, if I don’t offer up a reason, don’t ask me what happened.  Just agree with me that it sucks.  Blaming the unpredictability of diabetes is much kinder than blaming the person with diabetes. 

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Raise Your Pants, Raise Diabetes Awareness

Raise Your Pants, Raise Diabetes AwarenessHappy Diabetes Awareness Month!  Mike and I had the wonderful opportunity to partner with Novo Nordisk to create a video about diabetes.  I’m very grateful to Novo Nordisk for playing along with my silly side and to Catherine Price for her stellar interviews (and for wearing those pants in public). 

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Also check out videos by our friends Kerri Sparling and Manny Hernandez!

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Cronuts, the New Carb on the Block

cronuts - dominiqueansel.com

cronuts – dominiqueansel.com

I’m a little late in learning about the cronut craze, but now that I know about cronuts, I hate diabetes a little more than usual. 

If you haven’t been following, in May the Dominique Ansel Bakery in NYC created a pastry that is part croissant and part doughnut.  The Cronut.  The bakery produces 200 cronuts a day, and sells out immediately.  Fans line up as much as two hours before opening in order to get a cronut.  There is even a cronut blackmarket.  Yep, cronut scalpers.  

In this day and age of obesity and epidemic levels of diabetes, we should all be cringing about the fact that there’s a new carb on the block and it’s considerably more popular than spinach.  And this carb is not just on the block anymore.  Dunkin Donuts has launched its own version of the cronut in South Korea .  

Cronuts - Dunkin' Donuts's Photos

Cronuts – From Dunkin’ Donuts’s Photos on FaceBook

 

But, I’m having a hard time getting upset about the cronut.  It sounds like the most delicious combination of carbs and I can’t help but admire the genius of Dominique Ansel.  Out of curiosity, I visited Ansel’s website and checked out his online store (boutique, I mean).  There’s a special joke in there for people with diabetes – a baked good aptly named DKA.  There’s even an Extra Large DKA in case you want to die twice.  The cronut, thankfully, lacks the initials that spell out death to diabetics.  I might be reading too much into the cronut craze, but its popularity seems to represent a sort of rebellion, a broccoli backlash.  After years of being bombarded with top ten lists exalting kale, the stress of the NYC soda ban, and those preachy Meatless Mondays folks, someone has finally given us what we want: really sweet carbs. 

Though I haven’t tasted a cronut, I’m guessing it’s the best new carb since Cinnamon Toast Crunch cereal. What I’m saying is, although I’m against the cronut in principle, if you offered me one I wouldn’t say no thanks.  I’d smile and bolus. 

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The “No’s” of Hypoglycemia

I woke up at 3:00 a.m. to the rustle of the plastic bag that Mike was trying to open.  “Are you okay?” I asked.

“Yes,” Mike said.  “My blood sugar is 44.  I’m dropping.  I’m going to eat these Chomps.”

“I have glucose tablets,” I said.  “Do you want one?”

“I want the Chomps,” Mike said, but he was still struggling to open the bag. 

“Want me to open it for you?”

“No,” Mike said.

“Are you sure?”

“Yes.”

I didn’t want to be annoying, but I offered my glucose tablets to Mike again.  He refused them. 

“Can I get you something else?  Food?”

“No,” Mike said.  Then he got the Chomps bag open and chewed four little candies.

I should know by now not to listen to the “no’s” of hypoglycemia.  I should not try to be respectful of Mike’s pride.  I should have stuck a glucose tablet in his mouth and told him to chew.  I should have grabbed the Chomps bag and opened it for him. 

“You okay?” I asked Mike.  I wanted to hear a “yes” and go back to sleep.

“Yes.”

Just as I drifted back into sleep, I heard the thumps of heavy, clumsy footsteps on the steep stairway.  Mike was stumbling to the kitchen for food.  His way down was dangerous and something I could have prevented if I’d been more aggressive about treating his hypoglycemia.  

The line between helping and offending is so fine. There is no set number to go by.  Sometimes a 45 comes up in no time.  Other times a 70 drops to 50 even after the glucose tablet.  And it’s always so much worse at night, trying to snap out of dreams and into the unpredictable reality of hypoglycemia.

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Have a Donut with Your Donation to the American Diabetes Association

Just before I turned 14, in the middle of my eighth grade school year, my father, brother, and I left Houston and moved to NYC.  We moved into a sublet on 108th Street and Riverside Drive.  In contrast to sunny Houston, NYC was gray.  Our building was dreary, and the wind off the river was so bitter it stung my face.  But that was all tolerable because it was above ground.   The most shocking hardship I faced in NYC was the subway ride to my school, Friends Seminary, on East 16th Street.  The underground world was different – especially when we changed trains in Times Square.  The stench of urine was so overpowering I had to hold my breath.  And there was no escape from the devotees of L. Ron Hubbard, and their aggressive attempts to sell me copies of Dianetics

Every ride to and from school felt like the journey in The Way Back.  The one respite after a crowded subway ride home from school with my face stuck in the armpits of the passengers around me was a little shop called Happy Donuts down the street from my building.  After we exited the subway station, my brother and I made a daily stop at Happy Donuts, and carried our treats home in a little white paper bag so we could eat them while we played Nintendo.  (Looking back with the eyes of a mother, I can’t imagine allowing my sons to eat donuts every day nor can I imagine letting them eat them on the couch while playing a video game: crumbs and sticky fingers!  My father, though, never told us not to buy donuts.  I suppose he was just relieved we made it home.  And, hey, the donuts were Happy and I wasn’t.  Maybe he thought some of the donuts’ joy would rub off on me.) 

The point of this story, I suppose, is to tell you that I am a big fan of donuts.  But I have diabetes, so I don’t eat them.  Now, I’d like to ask you to refrain from telling me that people with diabetes can eat anything they want.  Sure, we can.  But the consequences of donut-eating in a diabetic are harsh.  It’s an almost guaranteed blood sugar disaster.  Everyone with diabetes knows how difficult it is to bolus for a combination of sugar, wheat flour, and fat.  But apparently the organizations and companies that represent people with diabetes and produce products for us, haven’t yet wrapped their brains around a very simple concept: junk food screws us over. Every. Single. Time. 

I’m really not the type to throw out conspiracy theories.  Really not.  But when I attended a Dexcom party in Chicago a few days ago (which I was told by unofficial sources was a fundraiser for the American Diabetes Association (ADA)) and saw the biggest donut spread in the history of the world, my first thought was: Are they fucking kidding me?  My second thought was: these guys are making sure they profit off our diabetes.  How many blood glucose test strips will I use while I try to cover my donut?  How badly will I wish I had a continuous glucose monitor while I’m pricking my finger every ten minutes to see the donut damage? 

I wish I’d taken a picture of the make-your-own-donut spread.  There was a long, long table with naked glazed donuts and beside them all sorts of add-ons, like chocolate syrup, sprinkles, etc.  It was tortuous to be so close to those drool-worthy donuts.   But never mind that it was insensitive to put a donut spread in front of diabetics.  Where are your PR people, Dexcom?  All you smart people taking care of diabetics – don’t you realize that serving donuts at a party to raise money for the American Diabetes Association – or any other diabetes-related organization – is like having a smoking party to raise money for lung cancer patients?  It’s begging for ridicule.  You’re giving the Onion free headlines.

So, at the party I had a little chat with an ADA person.  “What’s with the donuts?” I asked. He shrugged, looked a bit embarrassed and told me it was an “after party” and “ a dessert party.”

Quick facts for the party planners: Diabetes doesn’t go away after dinner.  And while the ADA suggests 45-60 grams of carb per meal is about right for most people (I disagree), a donut with toppings would likely run  somewhere between 50-80 grams of carb.

But what’s really at stake here is not one party, one carb count, or one day of highs and lows, but rather, it’s the message you’re sending.  In a country with soaring levels of diabetes and obesity, when you serve donuts, you’re saying, “We don’t care.”  When you set piles of donuts out to tempt those of us who can’t secrete insulin, you’re not cool, you’re cruel. 

You can’t work in diabetes and ignore the food issue.  It’s true that having diabetes doesn’t mean you can’t have dessert.  But dessert can be dark chocolate covered almonds, small truffles, cherries, berries with cream, bite-sized sweets.  There are many options that aren’t over-the-top.  And it’s also okay to tell people – loudly and clearly – that one of the best ways to keep blood glucose levels in range is to avoid eating things like donuts.  In fact, I’d argue that it’s part of your job.  

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Spread the Love: Diabetes Blogs

Unfortunately, I missed a few days of Diabetes Blog Week.  But I really loved participating. I especially loved discovering new diabetes blogs and catching up on blogs I haven’t visited in a while.  What struck me as I went through the blogs was how many amazing people there are in our diabetes community – so many kind and sensitive D-people.  And they’re good writers, too!  I really thank Karen Graffeo for organizing Diabetes Blog Week.  It’s great to take a time out and focus on our community. 

Today’s prompt:

As another Diabetes Blog Week draws to a close, let’s reflect on some of the great bloggers we’ve found this week. Give some love to three blog posts you’ve read and loved during Diabetes Blog Week, and tell us why they’re worth reading. Or share three blogs you’ve found this week that are new to you. (Thanks to Pearlsa of A Girl’s Reflections for inspiring this topic.)

1.  I loved a post called Seasons of Love by Melissa Lee.  Check out the video of her beautiful singing.

2. Jenn at SweetZoo wrote about her dream diabetes device.

3. There’s a nice post on Naturally Sweet Sisters on the topic Diabetes Accomplishments, with this advice,“Whatever your plans were for your child, don’t let type 1 diabetes stop you from doing them.”

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Diabetes and Marijuana: Marijuana Users Could Have Better Blood Sugar

A study that might answer some questions about diabetes and marijuana appeared online  this week in the American Journal of Medicine:  The Impact of Marijuana Use on Glucose, Insulin, and Insulin Resistance among US Adults.  The study is the first to investigate the relationship between marijuana use and fasting insulin, glucose, and insulin resistance.

Marijuana-Cannabis_sativa_(Köhler)

Cannabis as illustrated in Köhler’s Medicinal Plants book from 1897

The American Journal of Medicine’s blog reports, “Participants who reported using marijuana in the past month had lower levels of fasting insulin and HOMA-IR [insulin resistance] and higher levels of high-density lipoprotein cholesterol (HDL-C). These associations were weaker among those who reported using marijuana at least once, but not in the past thirty days, suggesting that the impact of marijuana use on insulin and insulin resistance exists during periods of recent use. Current users had 16% lower fasting insulin levels than participants who reported never having used marijuana in their lifetimes.

Large waist circumference is linked to diabetes risk. In the current study there were also significant associations between marijuana use and smaller waist circumferences.”

The blog also quotes an author of the study, Elizabeth Penner, MD, MPH, who said that after subjects with a diagnosis of diabetes were excluded, the associations between marijuana use and insulin levels, HOMA-IR, waist circumference, and HDL-C were similar and remained statistically significant.

In summary, the study concludes three things about marijuana use:  It was associated with lower levels of fasting insulin and insulin resistance, and smaller waist circumference.  So marijuana users could have better blood sugar levels.

Does this study mean marijuana is safe for people with diabetes?  No.  This study is not a green light to pass the dutchie.  There’s not enough evidence here to conclude that marijuana and diabetes are a good combination.   But the study is significant because it’s a first, and it suggests that more research is needed to explore future treatments using the marijuana plant’s compound active ingredient, tetrahydrocannabinol, or THC.  

For more see Can a Diabetic Smoke Marijuana?

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Failing the Oral Glucose Tolerance Test: (Bad) Diabetes Memories

I lived in Jerusalem when I pregnant with my first son, and though my doctor wasn’t concerned about gestational diabetes, she sent me to do the oral glucose tolerance test given to most pregnant women in the second trimester.  “You’re young, thin, with no first-degree diabetic relatives,” the doctor said.  “Don’t worry.  It’s routine.”

While it might have been routine for the doctor, for me there was nothing routine about being pregnant, and extra-nothing routine about drinking 50 grams of sugar on a fasting stomach.  I must have looked upset.  “It’s just like drinking cola,” the doctor said.   “The nurse will take your fasting blood sugar and then, one hour after you drink, she’ll take blood again.”

I had a lot of questions at that time, but no one to ask. None of my friends had been pregnant yet, and there was basically nothing in the way of diabetes blogs, and I didn’t know a thing about gestational diabetes.  All I had a copy of “What to Expect” and the comfort of knowing that Jerusalem was a city where everyone gave you advice and shared their opinions whether or not you requested.  And so it went – when I sat down in the lab, in a special room for pregnant women drinking glucose, everyone began to give me advice.  I was the only woman there who was pregnant for the first time.  Most of the other women in the room were religious – Jews and Muslims.  They were covered head to toe, a few of them had small children with them, and many read from prayer books.  And then there was me: long, free hair, and totally clueless.   A nurse whipped up a concoction of powered glucose and water.  She handed it over to me and told me to drink it quickly.  As I brought the cup to my lips I felt a wave of nausea.  After one sip I gagged. 

“I’m sorry,” I told the nurse.   “I don’t think I can drink this.”

“Everybody drinks it,” she said and walked away.

“It’s true,” said a women in thick black stockings despite the warm weather.  “You’re not special.”

“You need lemons,” another woman said.  “It’s better with lemons.”

“Do they have lemons here?” I asked.

“Why didn’t you bring lemons?” several women said at the same time. 

A few minutes later the nurse returned.  “Why aren’t you drinking?” she asked.  “You’re ruining the test.  Hurry!”

I took another sip and gagged again.

“Go to the bathroom if you’re sick,” the woman in the stockings said. 

I took a deep breath and two gulps of glucose.  I was about halfway done. 

I felt intense nausea and when I stood to walk toward the bathroom I felt dizzy so I sat back down.  I began to sweat. 

“You should have brought lemons,” someone said.

It took me about 15 minutes of baby sips, but I managed to finish the cup of sugar.  The nurse drew my blood and I went home, relieved to have the oral glucose tolerance test behind me.

The next day my doctor called to say my blood glucose results were in, and they weren’t good.  I would have to do another test.  This time I would do the 100 gram oral glucose tolerance test and the nurse would draw my blood four times: fasting, 60 minutes, 120 minutes, and 180 minutes. 

Double the sugar.  Triple the time in that room.  I cried a bit and then I told Mike I needed to get some lemons.

Mike took me to the lab for my three-hour oral glucose tolerance test and said he’d stay with me until I finished drinking.  I felt like a pro.  I showed him where the glucose room was, but realized that he couldn’t really sit there with me.  It wasn’t strictly women-only, but it was.  We’d have to sit in the general waiting area.

I held out my bag of lemons to the nurse, who was not impressed.  “Here you go,” I said. 

“You didn’t squeeze them,” she said.  “What am I going to do with a bag of lemons?  This isn’t a restaurant.”  She handed me two cups, each one with 50 grams of sugar and water. 

I felt nauseated just from looking at the cups.

“It’ll be fine,” Mike said.  “Just drink.”

I drank, one little sip at a time.  The nurse and Mike told me to hurry.  I couldn’t.  I sweated.  I cried a bit.  But, finally, I finished both cups of glucose.  I was proud and relieved.   And I’d done it all without any lemons!  Before I had a chance to revel in my glory, though, I was overwhelmed by intense nausea, as if I’d just guzzled a bottle of tequila. 

“Are you okay?” Mike asked.

I couldn’t answer.  I ran as fast as my big belly allowed, pushed my way into the restroom, and puked 100 grams of glucose into a toilet bowl. 

I came out teary and told the nurse what had happened.

“Don’t worry,” she said.  “Just come back tomorrow and do it again.”

As I turned to walk away, thinking that this glucose test should be illegal and that there had to be a better way, a woman in a floor-length navy skirt who’d overheard our conversation called me over with a word of advice.  “Next time bring some lemons,” she said.

This post is part of Diabetes Blog Week.

 

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Diabetes Petition: Blue M&M’s for the Treatment of Hypoglycemia

Dear Mars, Inc., Manufacturer of M&M’s,

In the 90s, when I came of voting age, I experienced the joy of voting for President Clinton.  I felt as though I were making a difference in the world.  I was proud of myself and my contribution to the United States of America as I cast my vote in favor of gun control, higher taxes for the wealthy, a woman’s right to abortion without exception, and so on.  Then, just a few years later, in 1995, thanks to you, I had the opportunity to cast my vote on a matter, unlike all that other stuff I mentioned, that truly defined basic American values: the color of our M&M’s. You gave me the power to oust the tan M&M, a color so putrid it was only in dark movie theaters that we could eat it without thinking of baby diarrhea.

I was not alone in my desire for change. 10 million Americans raised their phone receivers to vote on the future color of M&M’s. More than 50% of us chose blue. 

Blue m&m

At the time I based my vote on a several things: First, I was a student at the University of Michigan and “Go Blue!” was one of my regular cheers.  Second, I truly believed the world was in need of more blue food. Now, however, as I have become a person with diabetes, blue has a whole new meaning to me. Blue is the color of diabetes awareness. A blue circle is the international symbol of diabetes.  I write to you today to ask you to become a diabetes advocate. Help me and my community raise diabetes awareness by declaring the blue M&M the international symbol for the treatment of hypoglycemia.

I propose the following: Create a blue M&M that contains one gram of carbohydrate per button.  Sell in packages of 15 M&M’s per pack.  In order to differentiate between regular packages of M&M’s, I suggest you add to your label “for the treatment of hypoglyceM&Mia”.  (Mars Pharmaceuticals could be your future!) If you agree to do this, and dedicate all of your profits to diabetes research and charities, I will write another petition asking my community to change the O in DOC to a blue M&M.

Now is the time.  It’s been 18 years since the blue M&M came to life.  Since then diabetes rates have doubled or tripled, or quadrupled!  All around the world people are sweating and shaking from hypoglycemia with nothing but barfy, chalky glucose tablets (exception: Glucolift) to save them from fainting.  Blue M&M’s (1g of carb per button) could change the face (and taste) of hypoglycemia.  Think of the testimonials you’d get:

Jess Apple: I used to dread hypoglycemia.  I ran my blood sugar high all of the time just to avoid going low.  Now that I know I can treat accurately with M&M’s, I smile at the thought of hypoglycemia.  The days of forgetting to take my insulin are long gone.

Mike Aviad: Some people think Mars and their products are responsible for the rising obesity and diabetes epidemic in America.  I say, who cares?  Unlike all of the other food companies selling crap, Mars is making a difference with Blue M&M’s (1g of carb per button) for the treatment of hypoglyceM&Mia.  When I am low, Mars brings me up.  Mars cares about people with diabetes.  They might be killing us, but they’re also saving our lives.

Anonymous: I love how small and discreet Blue M&M’s (1g of carb per button) are.   I used to feel ashamed of pulling out bulky glucose tablets in public.  Not so with my baby Blues! People think I’m just snacking. No one ever suspects I’m about to pass out.

Mars, Inc, you have the opportunity to change history again.   We’re all grateful (and alive) because of insulin.  But insulin is not a cure.  So take this slogan and run with my idea: Until there’s a cure, there’s blue M&M’s (1g of carb per button).

Yours Sincerely,

Jessica Apple

(Please leave a comment if you support this petition!)

This post is part of Diabetes Blog Week.  Today’s topic: We the undersigned.  Write a petition.

 

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