Riva is finally doing what she set out to do in high school – writing her observations of life and human behavior - little did she know then that diabetes would be her muse. Riva has had type 1 since 18 and is the author of “50 Diabetes Myths That Can Ruin Your Life: and the 50 Diabetes Truths That Can Save It” and “The ABCs Of Loving Yourself With Diabetes.” Read full bio

Let’s Stop Lying About Diabetes

You can’t “control” diabetes. The very nature of blood sugar — whether you have diabetes or not — is to go up and down.

In a non-diabetic body, the pancreas sends out just the right amount of insulin to keep your blood sugar in a safe, normal range throughout the day.

In a diabetic body, you have to do this by guessing and calculating all day long the carbohydrates you eat, impact of any activity and medicine you take.

Every day it’s: How many grams of carbohydrate were in those 10 pretzels? Is my blood sugar still going up? Is my bike ride from yesterday still lowering it? Will half a unit of insulin cover that mini Reese’s peanut butter cup? S#&T! I should have remembered my insulin hasn’t peaked yet, why did I take another two units of insulin? Now I’m dropping and have to eat again!

Don’t even ask me about the angst I experienced last night over eating two-thirds of a sweet potato. Doing so at 10 p.m. I worried if I’d taken enough insulin so as not to wake up at 300 mg/dl (16.6 mmol/l) the next morning, yet not so much that I wouldn’t wake up at all.

Of course sleep, stress, sickness, meds and multiple other factors, including biomedical reactions rarely talked about, also impact blood sugar’s rise and fall.

This idea that diabetes can be “controlled” contributes to the general public’s ignorance. Too many people think, “Well, can’t you just avoid sweets?” It’s not their fault, they keep hearing we can “control” diabetes. This myth of control also keeps those of us who have diabetes frustrate because I’m sorry, but no we can’t “control” it.

Unfortunately too, many health professionals themselves don’t understand the complexity of managing blood sugar. Those who tell patients to eat healthy, drop weight start moving and take these meds, highly underestimate what goes into regulating blood sugar in the human body. A body that, by the way, gets weary of being on diabetes patrol 24/7, and happens to also have a life in which maybe that body just lost her job or her boyfriend.

I’d really like pharmaceutical companies to stop paying celebrities big bucks to tell me, “Diabetes doesn’t control me, I control it!” I know advertising has its own barometer for truthiness, but this is just a smear campaign against those of us who have diabetes.

That said, I’m not saying you can’t influence your blood sugar by your actions. You absolutely can. On a day where I do pretty much the same things I usually do, my influence is largely positive: routine being one of my most critical tools. On other days as hard as I try my influence is not as positive.

After bristling at the word “control” for years, in a recent issue of diaTribe, Adam Brown wrote a superb article highlighting 22 factors that impact blood sugar. He confirmed just how complex managing blood sugar is, and frankly, that you can only “get it” if you have it.

Adam went on to share his four game-changers that help him manage his diabetes, so I want to share five of mine.

Here are five things I’ve done over my 42 years living with Type 1 diabetes that have helped me significantly — not control my diabetes, but positively influence it.

1. Reading Dr. Bernstein’s book, Dr. Bernstein’s Diabetes Solution. While I didn’t go as low carb as he suggests, I did remove a great deal of the carbohydrates from my die Dting so stopped me from “riding the roller coaster” of high and low blood sugars. If you have Type 1, it’s required reading.

2. Going to health conferences. My first was TCOYD (Taking Control (yikes!) of Your Diabetes. There CDE/psychologist Bill Polonsky said 12 words that changed my diabetes life. He asked the 80 of us sitting in the room, “Who thinks diabetes is the leading cause of heart disease, blindness, amputation and kidney disease?” Everyone raised their hand, including me. Then he said, “You’re wrong. Poorly-controlled diabetes is the leading cause of these things.” In that moment 32 years of diabetes stress rolled off my shoulders and I knew, while I couldn’t control it, what I did to influence my health mattered.

3. Fix blood sugars in real time. When I used to check my blood sugar between meals and it was high, I would wait until the next meal to add a correction dose of insulin to my mealtime dose. Now I take a correction dose in real time.

4. Get some diabetes friends. One or two may do. Belonging to the A1C Champions peer-mentor group I have 79 and I’m grateful for each and every one. I said it before, no one “gets diabetes” like someone who has diabetes.

5. Portion control. I’ve lost 35 pounds and kept them off. I started by leaving two bites of food on my plate, every meal. Then I married a Dutch Indonesian man who is six feet tall and weighs 125 pounds. Truth is, while there’s nary an ounce of vanity in me, weighing more than him, well it’s a motivator.

I’d like everyone who has diabetes to stop suffering from this lie that we can control blood sugar. We can’t. And, I truly wish everyone diagnosed with diabetes from this day forward would hear this from their health care professional.

“Taking care of diabetes is hard, but doable. Forget the idea that you’re going to do this perfectly! You are now manually performing a bodily function that your pancreas use to do automatically. Your blood sugar will fluctuate.

“You won’t always get it right, but I will help you figure it out and know what to do. You’ll do well enough that you’ll have an excellent chance to live a healthy, full and happy life. I want to commend you for taking this on. Now let’s get started.”

I’d hire that doc in a minute.

Originally published in The Huffington Post.

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Simple Personal Systems for Big Health Benefits

Have you been trying to lose weight or start exercising and can’t get started or you’re failing?

Simple Personal Systems for Big Health Benefits

A typical breakfast meeting spread. Photo courtesy of Riva Greenberg

 

We like to think that our accomplishments are based on our merits, how strong and capable we are. And that what most influences our success is having enough smarts, money, motivation and/or willpower.

Yet we’re often unaware of a powerful influence on our success or failure — the “systems” we live within. This is the infrastructure that supports your behaviors — both wanted and unwanted.

For example, and I’ll take a wild guess but here goes, part of the reason you’re able to brush your teeth one or more times a day with ease is because of the system you created. Like keeping your toothbrush in the same place. Probably near a water source and within easy reach. It may also be in plain sight which acts as a visual cue. And you probably keep the toothpaste nearby.

When we try to make a change like losing weight or exercising, going back to school or advancing at work, to a large degree it’s the systems around us that either help ease us forward or hold us back — both our own personal systems and societal systems that we must navigate.

Ann Albright, director of the division of diabetes translation at the Centers for Disease Control and Prevention, confirmed the impact of our societal systems on diabetes management saying, “While we have to think about what the individual does and individual responsibility, the individual does not live in isolation. We all are influenced, and supported or undermined, by those other circles (societal systems).”

So when you come out of the doctor’s office and he’s just told you to lose 20 pounds and start exercising, you need an infrastructure that supports your behavior — both at home and outside your home — to achieve these goals. Otherwise, it’s easy to find yourself with your coat on racing to the car when a mouth-watering ad for hot, cheesy pizza comes on TV.

Luckily we can design personal systems that help support our desired actions wherever we are. With just a few simple steps you can greatly improve your health.

Broken Societal Systems
Unfortunately, many of our societal systems are not designed to support health. We have poor access to affordable healthy food, fertile soil to grow nutrient-rich food, fresh air and water, recreational space and family and community support.

Fast food restaurants are more plentiful than healthier ones, especially in small towns and cities across America. Agricultural policies and food subsidies support the overproduction of corn so metabolically unhealthy high fructose corn syrup now sweetens everything from crackers to ketchup.

Factory farming breeds profits and too often e coli. Saturday morning TV advertising to children is abundant and unlegislated. Schools needing to supplement their budgets have made Pizza Hut, Taco Bell and Burger King their primary lunch suppliers.

While people cried, “nanny state!” when Mayor Michael Bloomberg tried limiting the size of sugary sodas and drinks in NYC, we’re already living in a nanny country.

Regarding our health care system, doctors are incentivized and rewarded to perform costly tests and surgeries, not preventive care. Insurance companies limit blood sugar test strips, limiting people with diabetes’ ability to stay healthy. Many insurers don’t cover insulin pens, which among people with Type 2 diabetes particularly, foster more responsible insulin behaviors.

Of course some would say these systems aren’t broken; that they support the country’s chosen economic engines of capitalism and shareholder value.

That said, I hope we won’t have to wait until we are a nation of sick people to realize that healthy individuals are also an essential engine for economic growth and prosperity.

Certainly we can work on changing societal systems through political action and advocacy. More immediately we can design personal systems that support our own healthy behaviors.

Designing Systems

Over the years I’ve designed several systems that support my diabetes management. For instance, I keep glucose tablets under my pillow and in every coat and jacket pocket, purse and pouch, and I check my supply frequently and replenish it. I’m always prepared for low blood sugar.

I keep my meter always in the same place in my home so it’s easy and convenient to check my blood sugar. This helps me check frequently without the, “Where’s my meter?!” drama.

I’ve arranged my workday so that I can walk in the morning from 9:30 to 10:30 a.m. and I keep my walking gear in sight and accessible so it’s easy to grab and go.

I bring my own food to the airport because I never trust that I’ll find something healthy to eat there.

A few years ago I asked people what healthy habits they had created that helped their diabetes management. What they really told me was their systems. Like having three meters and keeping one at home, one at work and one at their parent’s house. Keeping cans of soda at work in a desk drawer for a low and informing one or two people at work about their diabetes and what to do in case of emergency. Simple steps that underlie success.

To design systems for diabetes health (or substitute “general health”) ask yourself:

1. What specific task in my diabetes management can I make handier, simpler, easier, less time consuming? How?

2. Where am I really falling down in my diabetes management? For instance, remembering to take my pills, checking my blood sugar, refilling my medications before I run out, preparing healthy meals? What steps can I put in place to make me more successful?

3. How can I manage the challenges to my diabetes management outside my home? For instance checking my blood sugar when I’m in a meeting, eating healthy at the airport, exercising when I’m away from home? What simple steps can help me overcome my challenge?

4. What can stop me while creating this healthier behavior and how can I prepare for that?

When my dear friend got a brain injury some years ago, her therapist focused on helping her create compensatory strategies — new ways (systems) to live a functional life on her own again. She did, and she’s succeeded beyond expectation. Designing systems for health is really no different.

While intention, motivation and desire may fuel our actions, it’s often our systems that determine whether or not they’ll be successful.

Originally published in The Huffington Post. 

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Would the Marlboro Man Get Diabetes Today?

I just returned from Findlay, Ohio where I addressed 25 people with Type 2 diabetes. Most of them use insulin and most rely on Medicaid for their insurance.

Yet Medicaid doesn’t cover the cost of enough test strips for them to use insulin responsibly — so their blood sugar and their health suffer. It’s harder for them to control their weight, and two had already had a heart attack.

Medicaid also, like many health insurance plans, doesn’t cover a simple device that makes taking insulin much easier, more convenient and less frightening: an insulin pen. Insulin pens replaced vial and syringe years ago in Europe.

I mention Europe because I’m married to a European. That causes me to see America a little differently. While we both admire America’s “can do” spirit and individualism, there is a downside.

Our cultural reverence for going it alone, making it on your own and pulling yourself up by your own bootstraps — think that great iconic Madison Avenue figure the Marlboro Man – often obstructs us from strength gained by working together.

Personal and social responsibility

It’s no surprise our beloved self-determination is expressed in chronic illness. In diabetes, we repeatedly talk about “self-care,” “self-management” and “self-efficacy.” It is the patient’s responsibility.

Certainly I believe people with any illness must take personal responsibility. But think how much stronger and capable we’d be if our environment supported our health.

What if in addition to “self-efficacy” there also existed “social-efficacy”?

That would cause healthy food to be widely available and affordable. Legislative policies would support big food manufacturers making a profit while making foods that actually nourish our kids.

You could walk and bicycle easily in towns and cities. People would gather in community squares, minimizing loneliness and increasing physical and mental well-being.

Health care providers would see their role as both expert and partner. Health insurance companies would see their mission as, and tie their financial targets to, keeping people well. Not earning their money charging customers exorbitant fees as their health erodes because they couldn’t get what they needed to stay healthy in the first place.

Tony Schwartz, CEO of The Energy Project and management guru, helps companies institute work policies and processes that first and foremost address employees’ needs and values. The result? Companies become more prosperous and workers become more productive, happier and able to consistently renew their energy.

Schwartz’ recent article, “Why You Hate Work,” is a business case for social-efficacy.

Getting back to the Marlboro Man
As I waited in the airport for my flight home from Ohio, I searched for something healthy for lunch. It didn’t exist.

The mantra in public health, “People will make the healthy choice when the healthy choice is the easy choice” is a clear cry for social-efficacy. Personal responsibility has not turned the tide on obesity, nor will it turn the tide of diabetes.

So, as I scraped the unidentifiable cheese-like sauce off my chicken breast and after paying an extra 99 cents for broccoli instead of fries, sitting in the Port Columbus International Airport, I wondered if the Marlboro Man existed today, would he get diabetes? I decided he would.

Walmart and a high end investor would have bought up the range, so Mr. Man was now living in town. With no job skills, his minimum wages from flipping burgers would have him dining nightly on the strip: Taco Bell, Kentucky Fried Chicken, Popeyes and Krispy Kreme. A dinner and a man-size Coke, $4.99. The same cost for a head of cauliflower and broccoli.

His diabetes, not to mention his high blood pressure from his salt-laden meals, means he’s twice as likely to get a heart attack or stroke as people without diabetes. 
The final irony? Because of his heart attack risk, Mr. Man’s physician takes away his cigarettes! Of course being a cynic he may have died years earlier from lung cancer.

What needs to happen
It took policy makers, agricultural people, big tobacco’s own workers and media — social efficacy — to make smoking uncool. Now we need politicians, food manufacturers, lobbyists, urban planners, marketers, health care professionals, dietitians, farmers and philanthropists to support our health.

To prevent diabetes we need to be able to feed our families healthy food and create more ways to move, not less. To stay healthy with diabetes and minimize complications, patients need access to essential medicine and tools.

Over the last few years cities like Cleveland and New York and states like Colorado, Pennsylvania and Delaware have been adding walking and biking paths. They know the power of social efficacy to create change. For while we may be strong alone, we are often stronger together.

Originally published in The Huffington Post. 

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The Factory Farming of Patients

When did we decide medicine was more about making money than making people well?

Yesterday I went for my annual mammogram. I go to the same medical imaging center each year. I know the drill — take off shirt and bra, put on a thin blue robe open to the front. Wait in the communal area with the brown vinyl overstuffed chairs.

But yesterday, this clinic’s core technical ability — imaging — was noticeably absent from the interactions between the staff and patients.

None of the receptionists and technicians actually saw me that day. Nor as I could tell did they see any of the other women who sat quietly, flipping magazine pages, hoping desperately to receive no bad news. 

The indifference began at the reception desk. A young girl sitting behind a high ledge asked for my birth date to identify me, never looking at my face. Unfortunately, on this day, that indifference culminated in what I now think of as an example of “exquisite awfulness” for one woman.

While waiting in the communal area, pale and frightened, almost hyperventilating, she beseeched me, “Do I have cancer? The girl told me to wait here. They have to look again. I must be sick, mustn’t I? Ay, Dios mio! Dios mio!” 

At this clinic, most women have a sonogram after their mammogram. When breast tissue is dense and fibrous a mammogram can’t clearly show the presence of calcified cells, tumors or cancer. 

Yet, the mammography technician did not tell this to the now hyperventilating woman. She told her only to sit down again in the waiting room for another test. 

Increasingly, I experience “care” being filtered out of health care.

We now revere technology and machines. Plus, institutional guidelines compel providers to push as many patients through their offices, in assembly line fashion, as quickly as possible.

This factory farming of patients – our focus on profit and efficiency at the expense of patients’ welfare — is soul-crushing, and not just for patients. Medical professionals have become disconnected from their own humanity and providers and patients have become disconnected from each other.

In providers’ hurriedness, the small kindnesses are falling away: a smile, a handshake, a few warm words, making connection. As care drops out of health care we are paying for it; we are sowing greater dis-ease. 

Hearing my name called by the technician for my mammogram, I clutched my flimsy gown to keep it from flapping open while I raced behind her; she was already 20 feet ahead of me down the corridor. 

When the procedure was over, I got a hand wave to the room I was to sit in next. The same hand wave stockboys use to indicate where the item you just asked for is. But, inevitably you are left to look for it yourself.

I am not suggesting, by any means, that we give up our medical and technological advances. I am suggesting that in our esteem for hardware, that we do not forfeit “heartware.” That we recognize tending to each other, particularly when we are at our most vulnerable, is the very meaning of care. And that care is, in and of itself, healing.

Bernard Lown, M.D., winner of the Nobel Peace Prize, writes in his book, The Lost Art of Healing:

A 3,000-year tradition, which bonded doctor and patient in a special affinity of trust, is being traded for a new type of relationship. Healing is replaced with treating, caring supplanted by managing, and the art of listening is taken over by technological procedures … Patients crave caring, which is dispensed largely with words.

 
 

If you doubt that just a few moments exchange with another person can raise one’s spirits, a behavioral experiment conducted on the Chicago subway confirmed this truth.

As reported in the New York Times article “Hello Stranger,” those people who engaged with their seatmate in a few minutes conversation on the subway — that bastion of don’t look at anyone and don’t under any circumstances talk to anyone — said it made the ride more positive and pleasant.

Further, while most people think our well-being is mostly dependent on our closest ties, the study reported that people felt happier on days when they had more interactions with simply anyone. 

Dr. Rachel Naomi Remen, who created The Healer’s Art, a national curriculum in 70 medical schools for students to explore service, compassion and healing writes how medicine has lost its heart.

In her book, My Grandfather’s Blessings, she tells a story of three stone cutters. Each day all they do is cut blocks into rocks. When someone asks the stone cutters, “What are you doing?” the first yells furiously, “You idiot, you see what I am doing! I am given a rock and I cut it into a block!”

The second says gently, “I am providing for my family, giving my wife and child a comfortable home and food to eat.” The third beams and says, “I am building a great cathedral where people who have gone adrift and are afraid will be able to put down their burden and let God shine into their souls.”

What we do matters and how we see our work matters. It guides how, and the spirit with which, we do it. The factory farming of patients is not medical professionals’ choice, it is the result of a health care system that too often values profit over people. Profit and care must not come at the expense of each other, they must be combined.

We must also train medical students that good medicine is both the result of modern technology and the simple exchange of comforting words or holding someone’s hand.

And we must help those who went into health care reconnect with, and reinvigorate, their original desire to help others. So that they can stitch back into their work the essential fabric of service that was once woven into health care.

After all, we know in our hearts that being seen by our fellow human beings is as necessary to good health as being seen by an expensive imaging machine.

Originally published in The Huffington Post.

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28-Year-Old Erin Little Is Changing Diabetes Care in India

“Every day I see children, 10 years old, going blind because their families can’t afford insulin. That is what inspires me to fight for them. Who will speak for them if no one shares their story?” 
– Erin Little

Diabetes Care in India

Erin Little on right.
Photos courtesy of Riva Greenberg.

 

Eighteen months ago, through a Skype conversation, I met a young American woman named Erin Little. In January, I spent 18 days in Bangalore, India because of her.

Erin has been living inside the Jnana Sanjeevini Medical Center for the poor in Bangalore. She is working tirelessly to better the health of people who live in India’s villages and have no access to health care.

What drives an American woman in her 20s to found a social enterprise company, Sucre Blue, dedicated to empowering community health leaders in India — and live inside a hospital?

Erin is my 19th interview with a change agent in diabetes.

RG: What is Sucre Blue’s mission?

EL: We are creating a chronic disease health model to bring affordable access to medical treatment to people who have diabetes, hypertension and cardiovascular disease.

The program is now training dozens of patients and caregivers in rural villages to be health leaders in their communities.

They literally go door to door surveying their villages’ residents’ health, checking who may have a chronic condition and be in need of treatment.

Diabetes Care in India - village visit

Bringing medical care and supplies to a village two hours from Bangalore city.

With the second fastest growth of diabetes (IDF Atlas 2013) and 70 percent of the population living in rural villages, India is struggling to provide medical access for chronic conditions.

Sucre Blue operates where the typical community has no doctor, hospital or medical treatment available within a 20-mile radius. Our typical patient household earns less than $2 a day. 

RG: What drives you to do this work in India?

EL: I was born in Kansas, raised in Missouri, and most of my relatives are from Louisiana and West Virginia. I grew up with strong roots to small, rural communities. India has a lot of similarities to America’s south in terms of hospitality, tradition, family and community. To me, it feels familiar despite the fact I was living in Chicago for almost 10 years before moving to Bombay in 2012.

I’ve also lived with Type 1 diabetes since the age of 11. I was diagnosed when attending a church camp in southern Missouri. There was no adequate medical care there, so I was life-flighted to the University of Missouri Columbia, where I was hospitalized for almost a month.

There is a phrase in Sankrit, “Vasudhaiva Kutumbakam.” It roughly translates into, “The world is a family.” For all of India’s traditions, which in some way make things here immovable, it is also a place constantly growing and open to change. Here I can have a true impact to make things better, and I can listen more easily to and hear more clearly what my heart is telling me.

Clinic visit - India

Clinic visit

RG: How will your project benefit people immediately and long term?

EL: Right now we provide screening, diagnosis, ongoing monitoring and free medicines. And, we are working at prevention through early detection, awareness and education.

Our long-term goal, and what we’re focused on at a policy level, is replicating and scaling this social enterprise model at an affordable cost and in a way that it’s sustainable and can provide continuity of care. Many of the patients with diabetes, for instance, will need care for complications. So we also want the presence of a clinical institution that actively invests in patients’ and the program’s success and growth. 

It’s challenging to understand the value of prevention services. But when you look at the cost difference between putting a diabetes patient, for instance, on dialysis versus managing their condition early through a community based intervention, a country like India can save potentially billions of dollars. 

RG: How does an American design a program for local Indian villagers?

EL: This program is designed to be patient-centric and led. Believe it or not, this is where living inside the hospital is a huge advantage. I’ve lived in India for almost three years, and as someone managing my own Type 1 diabetes in India, I understand how the system works here.

Our partners play a huge role in designing the program to local requirements, gathering feedback and harnessing the power of these communities. We do a lot of listening before we speak. 

Regarding culture, recently we had a big debate about whether the village women health leaders should wear white lab jackets when they conduct their door-to-door screenings.

Many were against it, thinking the health worker wouldn’t be let into homes; that people would think they were government officers. But the woman who tried it told us many patients came to her thinking she was a nurse which made her job easier!

RG: How are you able to finance this project?

EL: It hasn’t been easy. There are relatively few foundations and institutions that do diabetes development work. There’s little understanding that non-communicable diseases like diabetes, and getting care and medication, is a human rights issue. 

Initially we received an idea-stage grant from Ashoka in a competition called“Transforming Health Systems” supported by Boehringer Ingelheim. I raised some additional funds through friends and family to begin the pilot and I’ve been financing our work thus far with support from an organization called PAVE.

Just this month Sucre Blue received a large program grant through World Diabetes Foundation that may make it possible to reach 50,000 patients by 2015! That said, we still need support, now more than ever, since the grant doesn’t cover costs for myself or salaries.

Toward that end, on April 12, my 28th birthday, we launched a 28-day fundraising campaign (video in train station of campaign launch.) It ends May 10, although of course donations are always welcome. We want to ensure that those who’ve donated thus far will see the difference they’re making, that people who live in poverty will have access to affordable health care.

In India, unlike the West, many patients’ diabetes is caused by malnutrition. Less than 50 percent of cases are caused by lifestyle (Public Health Foundation of India Certificate Course in Diabetes Management). I am disappointed so many Westerners think diabetes is a rich man’s disease. Every day I see children, 10 years old, going blind because their families can’t afford insulin.

I hope and I believe chronic diseases will be the next priority to be addressed in Millenium Development goals, especially as global health challenges like polio and malaria are being eradicated. 

RG: What has been surprising thus far?

EL: I used to be surprised when I would hear mothers say they wanted to kill their child who has diabetes, and kill themselves, because they couldn’t afford the medicine. 

I was surprised to live inside a clinic and not earn a salary. But I am more surprised when people are more afraid for my livelihood than my character, of not doing what I know is right.

Frankly, I’ve been surprised by what we’ve achieved in less than a year even when what I have felt called to do seems impossible and have little to nothing materially to gain. 

The average Type 1 diabetic spends more than 25 percent of their income on their health (IDF Diabetes Atlas 4th Edition, Economic Costs of Diabetes Report). Many with Type 1 and Type 2 have dealt with extreme poverty caused by this disease.

Whether you are a family battling terminal cancer and foreclosing on your home in Ohio, or a man selling his last cow in the fields of Uttarkhand to manage his diabetes after contracting tuberculosis, Sucre Blue is trying to shift the same paradigm.

RG: What do you hope the future looks like?

EL: Having the capital required to replicate this model for care and give people back their lives without bankrupting them across the developing world.

No patient should feel like a beggar or live without dignity. We do not choose to have a disease, and we have the right to live fully. But in many parts of the world, like here, that luxury doesn’t exist.

Schoolchildren in a tiny, one street village minutes from the village visit

It has been humbling, and motivating, to live here and do this work. There are days I wonder how I can continue, the other days I know I cannot stop.

RG: What can someone do to help?

EL: Anyone can make a donation donate on our website. We are also actively recruiting board directors and advisors to help us grow and progress our mission, to support those with non-communicable diseases across the world.

We’re also in the process of building service trips to our villages. If interested, please contact us at info@sucreblue.org to find out more about coming to Bangalore, India.

I learned while in India, the region has the second highest number of deaths in the world due to diabetes. Erin’s work aims to change that, providing care for India’s poor, many of whom now travel up to half a day to reach the nearest clinic or doctor.

Originally published in The Huffington Post.

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Time for Your Type 1 Diabetes Medal?

Joslin Diabetes Center's 50-year type 1 diabetes medal.

Joslin Diabetes Center’s 50-year medal.
Photo credit ©Joslin Diabetes Center

In my last post, “Type 1 Diabetes Finally Explained,” I talked about the challenges and intense management one endures living with, and managing, Type 1 diabetes.

Thousands of people shared the post and hundreds wrote telling me that I had perfectly described their lives — how hard we work at every day, “staying between the lines.”

Joslin Diabetes Center, one of the world’s renowned diabetes clinics, knows how hard we work. They award people medals for living with Type 1 diabetes 50, 75, and as of last year, 80 years! The 25-year medal became a certificate as so many people are, as once unheard of, living with diabetes beyond 25 years.

Joslin 80 year Type 1 Diabetes Medal The 80-year medal

Dr. Elliott Joslin, founder of the Joslin center, believed that good self-management was key to reducing long-term complications.

Also, that recognizing patients for the care and attention they pay to their diabetes management would serve as motivation. It does.

“This is no less true today than when the first 25-year medal was awarded in 1948,” Stephanie Hastings, coordinator of the medals study, told me. “One of our 80-year recipients said he is now working toward his 100-year medal!”

Giving a medal for living with diabetes is remarkable in so many ways. Too often people with diabetes are scolded by their health professionals for “bad” blood sugar numbers or not working hard enough — as if managing diabetes was a perfect science.

Too often people with diabetes see themselves as failing for not being perfect in their care — which is all but impossible.

Joslin 75 Year type 1 diabetes MedalThe 75-year medal

The prescience of Joslin is very forward-thinking. While we recognize those who’ve lived through cancer as “survivors,” with the intention to honor them for their accomplishment, the word “survivor” actually focuses on the past and reminds one of the hardship.

Yet a Joslin medal is nothing but thunderous applause.

Joslin’s medals program is also more than merely motivation. Over 900 medalists are currently participating in Joslin’s medalist study launched in 2005.

Noticing that medalists were not just surviving, but thriving, Joslin is researching what genetic, environmental and physiological factors contribute to living long and well with Type 1 diabetes, with an aim to improve quality of life and move us closer to a cure.

Research Results To Date

These results were given to me by Ms. Hastings.

    • One big surprise so far is that a lower A1C does not always correlate with fewer complications.
    • Researchers think those with less glycemic control who are not developing complications have a protective factor.
    • Many who live 50 or more years with Type 1 diabetes don’t suffer from diabetes’ major micro-vasular complications — eye (retinopathy), kidney (nephropathy) and nerve-related (neuropathy) complications — or cardiovascular disease.
    • Close to 50 percent of medalists do not have serious complications. About 40 percent do not have retinopathy, even after 50 to 80 years living with the disease. And less than 10 percent have any kidney disease.
    • Over 66 percent of medalists who’ve had Type 1 diabetes for more than 50 years are still producing some insulin.

One might imagine that to live with Type 1 diabetes 50 years or more you must have a certain hardiness. Medalists appear to. They’ve managed their blood sugar levels well for most of their diabetes lives. They are physically active, have high HDL, low LDL and low to average weight.

Psychological Protective Factors
Medalists also have a certain heartiness. They tend to have a positive outlook, be socially connected and have a support system. They don’t feel sorry for themselves, let diabetes define them or beat themselves up for lapses.

Hastings says another prime ingredient for their success is knowing that they are responsible for their care. For the Medalists who got their initial diabetes education at the Joslin Center, they learned from Joslin’s two week educational program that it istheir responsibility, not their physician’s, to take care of their diabetes.

The study also researches protective factors for cognitive function, sexual dysfunction, stem cell and bone health and the impact of physical activity, now viewed as imperative, and nutrition.

What Medalists Say

I spoke with four medalists to hear their thoughts about the medal and living with diabetes.

Sixty-nine-year-old Don Francisco, who got Type 1 diabetes at 15, told me he knew a girl in college who had gotten it at age 9 and died at 25. “She didn’t take care of herself, and I knew I didn’t want that to be me. I’ve had hurdles along the way but I say to myself, ‘I’m going to go around them and go on.’ I heard a wise man say when obstacles are in our way, we go on. ‘Go on’ is what guides me.”

Cliff Bourie, diagnosed on his eighth birthday, told me opening his medal box he felt all those years he’d worked so hard to stay well overwhelm him. “This medal is just so personal and so big.”

John Landin’s major interest in the medalist program was contributing to the research. Having gotten Type 1 at age 3, and having had it now 59 years, he said, reflecting, “The medal doesn’t just belong to me. It belongs to my parents, educators and doctors who gave me the structure, confidence and support to succeed.” He also chided me several times to get my medal.

Deborah Langosch, who got diabetes at 4, also wanted to be part of the research. She described her contribution “as a way of giving back and paying forward.” I felt a small tingle when she described her feeling at the medalist ceremony last year. “To be standing in a roomful of more than two hundred people living with Type 1 diabetes who are healthy and committed to their care and their loved ones was unbelievably moving.”

Receiving a medal for living most of one’s life with diabetes is such a beautifully simple, deeply human way to acknowledge the hard work this illness demands — and those doing it.

As Don told me when he opened his medal box, “Wow, somebody recognized what I’ve been doing all these years. That feeling is amazing.”

So I’m now in the process of applying for my 50-year medal, still 8 years away. You can apply for your medal as early as you’d like but within 10 years, says Hastings, makes the most sense. Your application will be filed for your anniversary.

To apply you can e-mail: medals@joslin.harvard.edu or write to: Medalist Study Coordinator, One Joslin Place, Boston, MA 02215 or call 617-309-4532. To access an application packet click here. For the 25-Year Certificate, apply here.

If you’re nearing a medal anniversary, why not join me? Calling on family and friends to write letters documenting my diabetes-beginning has brought both bittersweet remembrances and deeper acknowledgement for what this is like to live with. And, personally, an appreciation for how hard I’ve worked at living with this all these years.

Now I just have to tell my husband where he’s taking me to celebrate Feb. 22, 2022!

Photo credit for 75 and 80-year medals John Soares ©Joslin Diabetes Center.

 
Originally published in The Huffington Post.

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Type 1 Diabetes Finally Explained

Let me say this with no exaggeration. My whole life, all day, all night, every day and each night is about keeping my blood sugar between the red and yellow lines. Whether I’m wearing, or not wearing, my continuous glucose monitor (CGM), screen pictured below.

 

(The little white dots between the red and yellow lines are my blood sugar levels every five minutes. The 99 mg/dl (5.4 mmol/l) was my blood sugar level the moment I took this photo. The larger white dots are glare from the camera.)

I just explained this “staying between the lines” to my mother, now being able to visibly show her on my monitor what I’ve long tried to tell her: Type 1 diabetes is a tightrope walk — all day and all night taking action to anticipate, prevent and recover from my blood sugar going too high and too low.

My life is, and will forever be, staying between the lines.

I got diabetes in February 1972 when I was 18 years old. I’m now 60. I’ve had diabetes more than four decades, more than two-thirds of my life. I have no memory of what life was like before “staying between the lines.”

Type 1 diabetes is the other diabetes. The one you don’t hear about on TV commercials — that’s Type 2 diabetes. People with Type 2 diabetes produce insulin but not enough or their body doesn’t use it effectively.

While people with Type 2 diabetes also must keep their blood sugar between the lines, it doesn’t require as intense effort. Even for those who take insulin, certain hormones they have that Type 1s lack, help to regulate their after meal blood sugars from rising too high and offset severe low blood sugar.

Type 1 diabetes is an autoimmune condition. Your body destroys your pancreas’ insulin-producing (beta) cells. You no longer produce insulin, or at most a trace amount. 

It’s not yet known what causes Type 1 diabetes. Most likely genetics and/or an insulting event like a virus. The only treatment is to replace the insulin your body no longer makes.

Some people wear an insulin pump that delivers a steady drip of insulin 24/7 into the body and larger amounts when you eat. Others, like me, take one or two daily injections of insulin for metabolic functions, plus injections before almost every meal and snack throughout the day. Food, most significantly carbohydrates, raises your blood sugar, insulin lowers it. Total, I take about six injections a day.

When your blood sugar drops below 70 mg/dl (3.8 mmol/l) as it did here at 6 p.m., you are in hypoglycemia. Your brain and muscles stop getting enough glucose (sugar) to function properly. You may tremble, sweat, have trouble catching your breath and your thoughts, feel ravenous, dizzy or tingly. My heart starts pounding in my chest.

If your blood sugar goes below 55 mg/dl (3 mmol/l), you have moderate hypoglycemia. You may slur and appear drunk, experience confusion, become irritable and spasmatic. If your blood sugar falls below 40 mg/dl (2.2 mmol/l), you are in a state of severe hypoglycemia. You may have convulsions or become unconscious. You may need someone to call 911. If a paramedic doesn’t show up and give you glucose, you can die.

Hypoglycemia is the personal boogeyman of people with Type 1 diabetes. Trying to stay between the lines doesn’t give you much cushion to stay away from hypoglycemia. The American Diabetes Association’s Clinical Diabetes reported that a person with Type 1 diabetes aiming for tight control can experience up to 10 episodesof hypoglycemia a week, and severe disabling hypoglycemia once a year.

Further, slightly under 20 percent of individuals with Type 1 diabetes have what’s called hypoglycemia unawareness. This means they don’t even feel the symptoms of their blood sugar dropping.

On the other hand, if you go above180 mg/dl (9.9 mmol/l) often over the years, you are prone todiabetes complications. They are the result of too much sugar in your blood which then damages your small and large blood vessels.

High blood sugar can damage almost every organ and system in your body: nervous and gastric systems, eyes, heart, kidneys, feet, hands and whatever I’ve left out.

180 is the recommendation of the American Diabetes Association. Yet, the American Association of Clinical Endocrinologists has long advised not going above 140 mg/dl (7.7 mmol/l). Drawing the lines yet closer together.

If you met me, you’d have no idea I spend a huge amount of my time managing this serious chronic illness. I look pretty good, I must say. I am generally happy and optimistic. I am active; I can be spotted walking around town when I’m not sitting behind this computer.

You would have no idea that half my mind space is not free, like yours. It’s busy doing what it needs to do to stay between the lines: guessing at the amount of carbohydrates in my meals, then checking my blood sugar to see how well I guessed. If not well, taking another injection or eating.

Or I’m preparing and drawing up my shot of insulin, also guessing at the dose, and remembering where on my body I took my last three injections so I don’t inject in the same place which can cause scar tissue.

Or I may be switching my syringes, checking my stock of pen needles, putting on a new sensor, ordering more supplies, and feeling my blood sugar plummet when I only meant to lower it a small amount. Then berating myself for over compensating.

There’s also time spent wiping residual blood from blood sugar checks off my kitchen cabinets, coffee table and keyboard.

That’s why the simplest I can put it is Type 1 diabetes is staying between the red and yellow lines all day and night, every day and every night. Oops, too high. Bring it down, now.

Oops, too low — below 50 as it was around 6 p.m. — get it up. Now!

My husband lovingly told me not long after we married that he wanted to know better what it’s like to live with Type 1 diabetes. He decided he would start with checking his blood sugar 10 times a day, as I often do, for three days in a row. He lasted one morning and afternoon. “It’s too painful,” he said, lowering his sad, guilty eyes.

Many people with Type 1 diabetes are annoyed we live in the shadow of Type 2, which gets all the attention. True, we do. 

Many people are irritated we get blamed and sneered at for causing our illness — some people think Type 1 is linked to being overweight and sedentary like Type 2. Not true.

But please, if you’re a sneerer, stop. Thin and normal weight people get Type 2 diabetes too, and there’s controversy whether weight is a cause or outcome of Type 2 diabetes.

The thing about living with Type 1 diabetes is it’s unrelenting.

While I don’t wake up throughout the night to check my blood sugar, many parents of children with Type 1 diabetes do check their child’s blood sugar during the night.

Yet every night before I go to bed, I have to bring my blood sugar to a level that gives me the greatest possibility of indeed waking up in the morning. A number of people don’t, suffering what’s called “dead-in-bed syndrome,” sudden death in people with Type 1 diabetes attributed to hypoglycemia.

I don’t know any other illness where so much work must be done by the patient on a daily basis.

On mornings I don’t finish my cereal, an evening I eat an extra piece of bread, the unexpected rain that foils my walk, traveling, eating at people’s homes, my insulin weakening, inserting my CGM sensor, walking an extra half hour, deciding to take the bus, deciding not to take the bus, the bus doesn’t come so I walk instead, the finger pricks, all day, all night, every day and every night all these things affect my ability to stay between the red and yellow lines.

Last month marked for me 42 years of living with Type 1 diabetes — 42 years of nonstop work to stay between the lines.

The number “42″ seems to have special powers. It’s featured in the classic book The Hitchhiker’s Guide to the Galaxy as the answer to the question of life, the universe and, well, everything.

I certainly don’t know everything. What I do know is even with its demands diabetes has bestowed blessings, and that those with Type 1, and parents of children and teens with Type 1, are working round the clock to delay the potential consequences of having a body that can’t regulate normal blood sugars.

Bottom line, Type 1 diabetes is all day, all night, every day and every night staying between the lines.

Originally published in The Huffington Post.

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Chronic Illness’ Opportunity for Patients and Providers

Typically, we don’t think about illness offering us anything positive. But it can, and it does for countless numbers of people.

After the initial stages of shock and grief, many people develop greater resilience and go on to what I call “flourish.” Live in a way that makes their life even more satisfying, full and compelling than it was before.

It has become my life’s work, helping patients with diabetes flourish: develop better health, along with emotional strength, confidence and happiness, and live more appreciatively and construct lives of greater meaning and purpose.

I also help health care professionals work with patients from an approach that fosters flourishing.

The power of not curing, but healing
When it comes to chronic illness, health care professionals focus almost solely on the medical issues, all but ignoring the person who lives with them.

Medical students receive little, if any, training how to help people with chronic illnesslive – exuberantly, healthfully and happily — with chronic illness.

Perhaps then it’s not surprising that seven out of 10 deaths in the U.S. are caused by chronic illness.

“Healing” is understood to pertain to acute injuries. Few health professionals think “healing” can also pertain to chronic illness. Yet it can; we heal a bit every time we are heard, seen and cared for.

Oddly, even psychologists don’t talk about healing in chronic illness, they talk about “coping.” Yet coping implies negativity, that you are somehow deficient, struggling to come up to “normal.”

There is an opportunity in chronic illness that most providers are missing — to help patients heal. How? By listening more and talking less. Praising more and scolding less. Looking for and acknowledging what we are doing well. Helping us discover our strengths. Inspiring confidence, providing support and holding a vision of our highest possibilities. This is what I teach.

 

Nature gave me this beautiful demonstration of resilience recently.

Over Christmas, I was walking on my friend’s property in the Blue Mountains of Australia. Four months earlier, the mountain had endured the worst fire in 50 years. My friend lost hundreds of trees yet, remarkably, those still standing, while burnt and hollowed, were also sprouting new leaves, new life.

Resilience is within each of us, as it is within nature.

What creates resilience?
In the Harvard Business Reviews’ “How Resilience Works,” author Diane Coutu says resilient people possess three common characteristics: ability to accept reality, a deep belief that life is meaningful and an ability to improvise, to create solutions.

Medical sociologist, Aaron Antonovsky discovered that when patients understand their condition, know how to manage it and find meaningfulness in it, they are far more capable of, and likely to, thrive

Having interviewed more than 150 people living with diabetes, I’ve heard numerous stories of resilience and flourishing. Common among the stories are integrating the tasks of diabetes into one’s life, seeing something positive in one’s condition and using it as a catalyst to eat healthier, lose weight, get active and help others.

Significantly, many people begin to live with more purpose after getting a chronic illness. The very thing that upends our lives in the first place causes us to realize what’s important and become more grounded.

Why is no one talking about post traumatic growth? 
While I’ve discovered many people create more satisfying, bigger and more vibrant lives after diagnosed with diabetes, the language of illness is dominantly “post traumatic stress” and rarely “post traumatic growth.” Why?

I believe a lot of it has to do with the fact that we live in a society focused on negativity. We are drawn to problems and problem-solving. It seems much harder to encourage hope, inspire confidence and envision possibilities.

We are afraid to be happy for fear it will go away.

We are afraid of seeming happier than others for fear they will ostracize us or shame us when our spirits falter.

In the absence of training, tools and knowledge how to help people with chronic illness flourish, health professionals focus on solving tactical problems.

In diabetes, you see it with the abundance of hardware to manage the disease — ever-new and improved meters, pumps, pens, apps, medicines and mobile devices.

You see little “heartware” — empathy, collaboration, interest, attentive listening, support and praise. Yet as providers embrace these, they and patients’ outcomes improve.

While I don’t think anyone with a chronic illness would chose it, many of us have found it has added something to our lives we’re not sure we want to give up. And in many ways, it has made us the best of ourselves.

I see the next leap in treating chronic illness as a shift in mindset and expanding skill sets for both patients and health professionals.

If you have a chronic illness and feel you flourish, I’d love to know how you do that and what it’s brought you?

If you are a health care professional and work from a flourishing approach, I’d love to hear what you do with your patients and what you’ve discovered in doing it?

Originally published in The Huffington Post.

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IDF World Congress in Melbourne: The IDF Takes New Steps to Stop Diabetes

IDF Melborn 2013

(The “Young Leaders in Diabetes.” Photo courtesy of Riva Greenberg.)

Last month I attended the International Diabetes Federation (IDF) World Congress in Melbourne. This was the largest diabetes conference ever held in Australia — with over10,000 clinicians, researchers, industry representatives and patients from 140 countries. And I felt a change in the air.

I sense this small, global, Belgium-based 40-staff member association that represents more than 200 member countries is outfitting itself to put speed and muscle behind halting diabetes’ ravage around the world.

From the formation of its “Young Leaders in Diabetes” (YLD) Programme to the hiring of its new CEO and president — both with decades experience in health care (yet outside of medicine, in technology and politics, respectively) — there seems a stronger focus on strategic leadership and more clear-cut goals to achieve.

First, the time is ripe. As I was told by Leonor Guariguata, IDF coordinator for the recently released Diabetes Atlas, diabetes is beginning to act like a contagious disease. As poorer nations’ populations of working age are falling under the diabetes-bus, so to speak, rising costs of care, decreasing productivity and the pricing and availability of food, medicine and health care for diabetes will affect all of us.

My introduction to the conference was participating in the Young Leaders in Diabetes Leadership Training. As YLD Leadership Training Faculty, under the sponsorship of Novo Nordisk, I and several noted diabetes experts helped these young people with diabetes be more effective advocates.

The Young Leaders in Diabetes Programme was formed by IDF two years ago as a voice for young people with diabetes and to strengthen their local diabetes associations. The group has already almost doubled in size from 68 to 132 and includes representation from 74 countries’ young leaders.

Alex Silverstein, outgoing president of the YLD, says much of the success of the group was learning from each other’s experience and being supported to work on a project relevant to their skills and country’s needs. Silverstein himself fundraised 100,000 pounds for three projects he manned for Diabetes UK.

Silverstein believes passionate and committed young people with diabetes can have great impact at the local level with their member associations, with health care professionals and the public worldwide.

The YLD’s new president, Keegan Hall from South Africa, told me in the past two years 50 Young Leaders have executed at least one project in their country. Keegan aims to create a stronger support structure and advocacy tools for the Young Leaders.

Lest you think these projects are insignificant, you’d be wrong. One Young Leader from Zimbabwe organized a group of volunteers for a diabetes awareness campaign. They distributed informational material about diabetes in the five largest shopping malls in Zimbabwe. More than a thousand people were reached, many said the information was entirely new to them and many got their blood sugar tested for the first time.

From young leaders to new leaders, IDF’s recently appointed CEO, Petra Wilson, begins her stewardship intent to expand e-health options as part of IDF’s objective to empower people with diabetes. “E-technologies will give patients critical information to make informed decisions, advance diabetes education and extend health care providers’ reach.” Wilson formerly led connected health teams at Cisco and the European Commission in Health.

Wilson also sees the potential for “big data,” huge volumes of data from thousands of sources, to be linked to lifestyle data to create health care policies that benefit those living with diabetes.

Sir Michael Hirst stepped into IDF as president 18 months ago and is drawing on his political career. He’s established the first Parliamentary Champions for Diabetes Forum.

One task of the Parliamentary Champions will be to working together to represent the interest of people with diabetes in policy making. Another will be to review and assess the commitments made by Heads of States and governments after the UN High Level summiton non-communicable diseases. Said Sir Michael, “This review provides an opportunity for stock-taking on progress, including sharing successes, lessons learned, opportunities, and recommendations to shape the future of diabetes and guide us forward.”

Sir Michael is also the father of a daughter with Type 1 diabetes and had no problem recently urging Secretary General Margaret Chan of the WHO that the resources dedicated to diabetes aren’t nearly enough.

I wait to see what this dynamic organization will accomplish going forward. Meanwhile I think of that refrain from the classic children’s book, The Little Engine That Could.

As the tiny locomotive chugged up the mountain saying, “I think I can, I think I can, I think I can,” personally, I think the IDF just might.

Originally published in The Huffington Post.

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The Antidote to Living With Diabetes

As Diabetes Month ends, I don’t know how much we’ve accomplished. I don’t know how many more people with diabetes will take better care of themselves. Or how many people realized they may have undiagnosed diabetes and went to get a fasting blood sugar test.

I do know that Nov. 14, World Diabetes Day, the International Diabetes Federation released the latest stats and projections on the rising incidence of diabetes around the world. The situation everywhere is getting worse.

Yet for me, having lived with Type 1 diabetes almost 42 years and with no end in sight, I have to find hope somewhere. So I take it in the attitude I’ve adopted: You can have a great life, not despite but because of diabetes.

Don’t get me wrong: I am not denying the work, the hardship and the fears diabetes brings or it’s potentially damaging consequences. I am suggesting what Randy Pausch told us in his “Last Lecture” and what Michael J. Fox has been telling us since he got Parkinson’s. That you can make meaning from tragedy and find not just a way to bear it, but joy in a meaningful life.

I have used diabetes as a catalyst to create a purposeful life: to become fitter, stronger, more compassionate, passionate, bolder, less fearful and help others. Many others have told me the same.

Looking for a way to cast light where things are dark, I believe pride can serve as an “antidote,” particularly for Type 1 diabetes, until there is a cure. I have found so in the passing decades. Perhaps there will be some light for you in my story.

Riva Greenberg

After three decades living with Type 1 diabetes, at the age of 48, I was laid off from my job, undergoing diabetic frozen shoulder surgery and getting married — for the first time.

There was another first. Not wanting to be a burden to my husband-to-be, I went to a diabetes educator for the first time in 32 years.

All these events provided the perfect midlife crisis — and the beginning of my second career — diabetes author, lecturer and coach.

I see diabetes management differently than most. I believe pride in how we live with diabetes can move people to manage their diabetes better than discipline, willpower and fear.

I am convinced that we need to inspire patients to better diabetes management, not through emphasizing target numbers, but the rewards of accomplishing those targets: good health, energy, spending time with loved ones and living our dreams.

Focusing on what gives life juice and what one loves is what motivates people to create health. Not surprisingly, those who use diabetes as a catalyst to create more meaningful and purposeful lives, live fuller, happier and healthier ones.

But pride cannot be taught, it can only be kindled. So we must shift our overwhelming focus on achieving numbers to bolstering pride. Pride creates its own closed loop system. Managing diabetes well you gain strength, courage, confidence, capability, and pride. Feeling proud, you are motivated to continue to manage your diabetes well.

Successful diabetes management requires both medical proficiency and emotional strength, and so we must look at people with diabetes as whole human beings. Sometimes I fear health professionals see us as levers to be pulled at appointments, and then sent home to get perfect numbers. 

I moved from a miserable beginning with diabetes: It was 1972 and I was 18 years old when diagnosed with Type 1. I spent a dozen years with no meter, the medical ignorance of the times and a physician who in trying to “scare me straight” scared me into denial. But through the years I learned more and shifted my goal from getting through the day to “flourishing” through the years.

Corny as it is, for me diabetes is in many ways a blessing in disguise. I believe I am healthier than I would be otherwise. I have used diabetes to lose 30 pounds and keep them off for 30 years. To walk three miles a day. To have a heart that makes cardiologists smile. To have tight blood sugar control, and to manage my tasks with gumption and grace, even with diabetes’ inconsistencies.

I also have a deeper appreciation for all that I have and a life now built around purpose and passion. I have lived and traveled around the world, in part due to diabetes, and accomplished things I never thought I could. Yes, I am proud.

Pride is an unquantifiable emotion; we cannot measure its power except in witnessing its results. I believe pride can transform the hopelessness, helplessness and notion of surviving diabetes into the strength, courage, character and determination of thriving with diabetes.

As Diabetes Month ends few people will stop to think that for those of us with diabetes, our diabetes life continues.

Be proud of what you do managing diabetes and let that pride help you ride the waves that will come and go each passing day.

Then, we will surely have accomplished something tremendous this Diabetes Month.

Originally published in The Huffington Post.

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