Thursday, March 24, 2011

Diabetes Terminology: It's Time for a Change [Awareness Series #1]

Words have the power to build people up or tear people down.  Unfortunately, a lot of people don't know how hurtful and harmful their words can be to others, especially when it comes to diseases or disabilities.  These are often sensitive subjects for people affected by them, and cause a lot of personal turmoil on their own.  This anxiety is compounded when others (either intentionally or not) use terminology that is at best politically incorrect and extremely hurtful at worst.

Before I was diagnosed with diabetes, I did not think twice when I referred to someone as "diabetic."  Even when my sister was diagnosed with type 1 diabetes at age 16, I didn't realize how some people are affected by the term.  My sister often complained about our family bringing up her diabetes to everyone, because it was something that she wanted to keep private at that age.  By describing her as "diabetic," we were defining her first and foremost by her disease.  I truly didn't understand how much that could hurt until I personally was diagnosed with type 1 diabetes in August. 

I've written several times about how being referred to as "a diabetic" (with a capital 'D') irritates me.  Some people, especially those who have been dealing with the disease for many years, aren't bothered by this term.  However, a lot of people (myself and my sister included) would rather be referred to as PWD.  In the DOC (diabetes online community), this abbreviation is used to refer to "a person/people with diabetes."  This may seem like an argument of semantics, but it's really an important distinction for those of us that are affected by the term.  The reason being that this distinguishes us as people first...people who happen to have diabetes. 

I would almost guarantee that anyone who has any form of disease or disability does not want it to define their lives or who they are.  Yes, many times these things do tend to take over a large percentage of our time and attention, but we still don't like to be defined by them.  These terms put our diseases or disabilities (which, by the way, no one asks for) at the forefront, while most would prefer they be left as part of the background of our lives.  I am very open and forthcoming about my diabetes with those who are genuinely interested in learning more about the disease, but I get frustrated with people who assume they know everything about my life just because they know someone who is "a diabetic". 

For example, I was at a fundraiser meal with my husband one Sunday a few weeks ago and was wearing my insulin pump on a belt over my skirt suit.  When we got to the end of the line, a lady I used to go to church with asked me, "What is that on your belt?" I told her it was my insulin pump, and she replied, "Oh, I didn't know you were A DIABETIC."  I let that one slide, and told her that I was diagnosed as type 1 six months before.  She said, "Oh, I didn't know that.  I guess you can't have dessert then, huh?!"  I informed her that since I was on insulin, I had more flexibility with my diet and could simply cover the occasional dessert with insulin.  I'm almost positive, though, that she was thinking I didn't know what I was talking about, and that I should only be eating sugar-free desserts.  When I told my sister about our conversation, she said that lady had given her a lot of grief in the past as well over what she ate. (Also see: "the D-Police" in this post)

Then, just the other day, my mom and I were talking to another lady who seemed to believe she knew it all about diabetes because her neighbor and preacher (and her grandmother and son, who had both passed away) were "bad diabetics."  She told me she would bring me some sugar-free (but not carb free, of course) cookies next time she made some.  Obviously, she meant well; however, it is difficult to explain to people like this who have long-standing beliefs about the disease that what they think they know is oftentimes incorrect.  Clearly, the only way to fix this problem is to raise awareness and educate people at every opportunity.

"Bad Diabetics"
What's almost as bad (and just as frustrating) as people referring to me as "A Diabetic" is to hear people talk about others they know who are "[a] bad diabetic[s]" when diabetes comes up in the conversation.  This bothers me for two reasons: first, what in the world is a "bad diabetic"? (and would that person enjoy being called that to their face?).  Is it someone who truly doesn't take care of themselves, or just that diabetes is something they have to give a lot of attention to?  In the first case, you would be better off giving them some much-needed encouragement and support to take care of themselves better rather than discussing their bad health with others.  In the latter case, of course diabetes takes a lot of time and attention to control.  I suppose in that case I have it really "bad", because managing it often feels like another full-time job.  Furthermore, in some people's eyes, the fact that I use an insulin pump must mean that my diabetes is really bad, because otherwise I would just be able to diet and exercise or use pills like the other "Diabetics" they know. 

They often don't realize that the two types of diabetes are very different in terms of cause and treatment, and that just because I'll have to use insulin for the rest of my life doesn't mean I have the disease any "worse" than someone who is able to manage it with diet and's just a difference in type.  In fact, it's important to point out that the two types of diabetes are actually two very different diseases even though the end result (high blood sugar) is the same.  Type 2 is caused by insulin resistence (a condition in which your body doesn't use the insulin it makes efficiently), while type 1 is an autoimmune disease in which your own body attacks your pancreas (which it sees as a foreign body), causing it to stop producing insulin.

Secondly, talking about "bad diabetics" further reinforces the notion that we're all condemned to this one big category of people who don't take care of themselves and are destined for horrible health.  I don't know about you, but I try my best to have a positive outlook on life (including my diabetes management), and work very hard to keep my blood sugars within normal range.  Just because I have this disease doesn't mean that I'm automatically resigned to having amputations or other health issues in the future.  In fact, many people don't know that with tight control, your risk for having any diabetes-related complications is greatly reduced or can sometimes be eliminated. 

Furthermore, I believe that referring to people as "bad diabetics" may lead to situations of self-fulfilling prophecies in people who do not have the social support they need to manage their disease.  After all, if you always heard what horrible health you were in and already had problems with your disease, what motivation would there be to make the effort needed to change your situation?  I am a very motivated person when it comes to managing my diabetes, but a lot of people have trouble finding the desire or getting the help they need to adequately manage their health.  These are the people that are often referred to as "bad diabetics," and they're the ones that stand to be hurt the most by the term.

This phrase may seem harmless enough to people without diabetes, but it hurts every time I have to hear it.  It underlines the perception that diabetes is something you somehow caused or brought upon yourself for not living a healthy lifestyle, and that you can "cure" it by becoming more healthy.  Very few people know that type 1 is actually an autoimmune disorder, for which the causes are largely unknown at this point.  Type 2 has a huge genetic component, so even though lifestyle choices can affect its prevention/development or prognosis, it still isn't the person's "fault" for having it.

The notion of fault in diabetes is sad and hugely detrimental for several reasons.  First, it contributes to the general apathy towards diabetes and people who have it, which in turn prevents people from donating to diabetes research.  After all, why contribute money to research for a disease that (they think) people could prevent if only they'd lose weight/eat healthier/exercise more?  It's a vicious circle: lack of research and awareness, more people with diabetes, apathy towards the needs to stop, but how?  I certainly don't have the answer, but I do believe that more could be done in the area of awareness at very least.  If we could educate the general public on the realities of the disease and combat the common myths surrounding it, there might be more interest in funding diabetes research.

The idea of fault also makes it harder for those of us living with the disease to cope with the realities of having a chronic illness.  Having diabetes is hard enough to deal with without having to feel guilty for having it.  As I've already mentioned, it often feels like a second (or third, or fourth) job; and it's draining physically, emotionally, psychologically, and financially.  It's no surprise, then, that depression has a high comorbidity rate in people with diabetes.  It's obviously a challenging disease to deal with even under the best and most supportive situations, so it can be downright impossible to manage for those who receive little or no support.  The bottom line is that the perception of fault associated with diabetes is clearly detrimental to the people that have it and to the research that could possibly find a cure someday.  It's not fair, but it's part of our collective reality.

"The Cure"
The issue of a cure is also a controversial one.  I've had some heated exchanges with people over the subject, and it just goes to show how hard it is to educate people on a disease that is surrounded by so many myths.  Despite what you may hear from people or in the media, there is currently no cure for either type 1 or type 2 diabetes.  Even with cases of type 2 diabetes, in which many people are able to control the disease through diet and exercise alone, the underlying disease is still there; and since insulin resistence gets worse with age, it will become progressively harder to control for many people over the years. 
The belief that diabetes has a cure is obviously another hit for diabetes research funding, and sadly it's a common one.  One of my next diabetes awareness posts focuses on the need for diabetes education, and will provide some startling statistics on the general public's knowledge of the disease.  The study featured in my future post found that of the people surveyed:
  • 67% believed (mistakenly) that there is a cure for type 1 diabetes
  • 25% believed that the proper diet could "cure" the disease
  • 32% believed that exercise could be a "cure"
Just as insulin is not truly a "cure" for type 1 (it's more like life support, really), diet and exercise and/or pills treat the symptoms of the disease (high blood sugar), not the root of the disease itself.  Therefore, I am extremely hesitant to call them a "cure".  For me, a cure is something that completely and permanently erradicates a disease, not a temporary elimination of symptoms.

The bottom line...
Clearly, the words we use in relation to diabetes (and other disease/disabilities) can have an immense impact on both the people affected by it and the funding for research to find a cure.  Each of us has the power to change this, at least in our own families and communities.  Next time you hear someone use these words, please take the opportunity to educate them in a way that is firm, but not rude or defensive.  Some of these ideas and terms have been around for decades, so it's not going to be an easy or quick change, but it can happen. 

In addition, I've posted this "Diabetes Etiquette [for people who DON'T have diabetes]" handout before, but I thought it appropriate to share it with you again.  I first came across it in my diabetes education class, and think it's a great collection of advice for anyone who doesn't have diabetes on how to treat those they know who are affected by the disease.

Tuesday, March 22, 2011

Challenges in My D-Life

Help! I'm on the D-Rollercoaster again and I can't get off...
The last couple of days have been pretty tough for me.  I've had some ups and downs with my numbers, and my after-breakfast BGs have still not improved.  It seems like no matter what I do, they're always in the 140-200 range while my lunch and supper postprandials are perfect.  It's frustrating simply because I've tried so many things in an effort to change the trend, but haven't succeeded yet.  Actually, I was following my CGM pretty closely yesterday morning and bolusing accordingly as my BG went up...and up, and up.  I bolused about 8.0 units to cover 24 grams of carbohydrate (a Glucerna mini snack bar and a SF Jello Pudding snack) and ended up at 119 at the two hour a success, but wow.  Will I really have to take that much insulin every morning?  Today I thought I did everything right--I ate a Jimmy Dean D-lights whole grain bagel w/turkey sausage, egg whites, and cheese.  31g carbohydrate, 18g protein, bolused with ~40% given immediately and the other 60% over 30 minutes (to accommodate the protein content), and no caffeine.  Then an hour and a half later, I was at 192.  Ugh...So. Incredibly. Frustrating.

In Other Not-So-Great D-News...
Other than those post-breakfast highs, I also had to deal with one of the other challenging aspects of diabetes again yesterday.  Over the course of conversations with people about my diabetes, I encounter a lot of frustrating ignorance about the disease.  The way a lot of people perceive those of us with diabetes is often hurtful, and leaves me feeling helpless as to how to correct them in a way that will change their way of thinking without pushing them away or letting my feelings get the best of me. 

I have a lot to say on the subject, so I've decided to break it down into a serious of posts focused on raising diabetes awareness and correcting the common myths and misperceptions associated with the disease.  I completely realize that most people don't mean to be hurtful with their comments, and that they simply come from a place of ignorance regarding the disease.  I'll be the first to admit that I had some of the same ideas before I was diagnosed, even though my sister had been diagnosed with type 1 about four years before me and my dad had had type 2 for a couple of years before.  I've been on both sides of the fence and know that the general public just has very little accurate information when it comes to diabetes, and it's natural for people to want to relate to one another.  For this reason, I think a lot of people are simply trying to empathyze with you and show you that they know there are things that are more difficult for a person with diabetes when they bring these things up in conversation...At least that's what the optimist in me wants to believe.  Some people, though, can be downright rude and mean when it comes down to it.

What is it about diabetes that makes people feel like it's their personal responsibility to make sure you know everything they think they know about your disease?  When people find out you have diabetes, they almost automatically tend to comment on, instruct you, or judge you when it comes to your disease, and they don't always have to use words to do it.  I've come to the conclusion that pregnant women and new mothers must feel the same way, because having that belly or baby somehow makes people believe that you're somehow public property open for comment.  (Not that I am or have been pregnant, but I've had plenty of friends that this has happened to!)  Whatever the reason for this, it happens; and it happens often.  I don't understand it, mainly because you wouldn't tell someone who has cancer or some other disease that they should just "____[insert genius medical advice here]" and all their problems would be solved, so why is it people feel they have the right to do this when it comes to diabetes?

In the end, the only solution is to raise awareness and educate people on the subject.  I'm tempted to create a brochure or booklet on diabetes that I can hand to the people I have these conversations with.  It would make things a lot simpler, and maybe then the information would stick.  I've also thought about writing a column for our local newspaper to raise awareness on a bigger scale and educate people that I may not reach otherwise.  Stay tuned for developments in that area, and for future posts in my awareness series!

Friday, March 18, 2011

The CGM...It's (Unfortunately) Infectious

I'm so glad it's Friday!  I look forward to the weekends so much...even though Saturday is mainly a catch-up day (laundry, housework, yard/garden stuff, etc.) since I work full-time during the week.  Then, of course, there's my other job: the 24/7 management of my diabetes.  Someone without the disease may think I'm being over dramatic, but any PWD knows I'm not...It takes A LOT of time, effort, and energy on a daily (and sometimes hourly or minute-to-minute) basis to keep your numbers under control.  It's something that I honestly think no one understands until they've walked a mile in those shoes.  I'm not complaining (well, maybe just a little bit), though, because the alternatives (complications, death) aren't so attractive.

I mentioned in my last post that my CGM has brought my attention to overnight lows that I've been unknowingly experiencing, probably since I started insulin therapy.  My CDE and I were both surprised, and were able to fix the problem almost immediately with a couple of basal rate changes.  Now I'm hoping that I'll actually have energy during the day, and be able to get out of bed at a decent time in the mornings...those nighttime lows have a tendency to drain all of your energy without you even being aware of it.  I haven't had many low alerts from my CGM since we made the basal rate changes, so I'm going to file that away as a success!

In other CGM news, I removed my first sensor on Wednesday night (I'd had it in since last Friday, so for about five days), and noticed that the site looked like it might be infected...It was red, puffy, and painful.  I took a picture of it and emailed it to my CDE (who is also an RN), and she called me back last night saying it could just be irritation from having a foreign object in my body or a staph infection...yuck.  Today it looked better, but it still hurts.  I could tell last night that the path of the sensor probe under my skin is puffy, and that's the part that is most painful.  My CDE called my endocrinologist, and he wrote a prescription for Bactraban for this and possibly for future infections (although I hope that isn't the case!). 

She also told me to only insert sensors after taking a bath and using Dial antibacterial body wash to make sure the area is 100% clean.  Medtronic specifically says not to use any sort of skin prep before inserting sensors due to possible interference with proper functioning of the sensor probe itself, so the only option for skin prep other than a good wash in the shower/tub is swabbing the area with an alcohol pad.  I've also read online that it helps to keep the sensor site dry after showers and not completely sealing off the IV tape to allow the site to "breathe".  Anyway, I figure that if I try all of these things, maybe I can prevent future Ben Franklin said, "An ounce of prevention is worth a pound of cure."  Not so helpful when it comes to Type 1 diabetes, but great advice for site management.

Other than those issues, having the CGM is (somewhat literally, apparently) infectious.  Yesterday I felt lost without it...It's so nice to be able to push a button and have more than just an educated guess of where you're at.  More than that, it helps you better tailor your treatment to how your blood sugar responds to different things.  For example, I've been consistently having after-breakfast highs.  On my CGM, I can see my BG climbing and "head it off", so to speak, before I hit that high point, either with exercise or an extra dose of insulin.  I can also see how specific foods affect my blood sugar, and bolus accordingly.  The thing about this (and every other diabetes managment tool out there) is that it's only that-a tool.  You still have to use it appropriately and understand its limitations to get the most out of it.  I wasn't sure if I would like the CGM or not after all the negative stuff I'd heard about it, but I'm only on my second sensor and I'm already sold.  And the pain factor?  Well, the first one didn't hurt at all, and the second one wasn't bad either.  I don't know if I've just lucked out, or if it really isn't as bad as some people make it out to be.

I hope you all have a wonderful weekend, and here's to hoping for a healed site by Monday!

Wednesday, March 16, 2011

CGMs & Gazelles

As many of you know, I went for CGM training on Friday.  Since then, my experience with it has been great overall--aside from the incessant alarms the first day or two (I stopped counting at 36 on Saturday afternoon)!  The CGM has already proved its worth for me simply because it alerted me (over and over again) of the nightime lows I've probably been experiencing since I started insulin and the pump.  That first night, I chalked all the alarms up to the CGM not being calibrated correctly with the meter...But then night after night, I've consistently been running in the 60's & 70's-or lower.  The lowest reading I've had on my CGM was 40 in the middle of one night-the lowest # I've ever had.

Here are a couple of graphs of my CareLink data:

I can't even begin to tell you how ecstatic I am to see 114 as my BG average since I've been on the pump...Well within the range I need to get that 6.0% A1C (which corresponds to an average of about 120-126, depending on which source you read).  And the last few days have been awesome...My sensor glucose average is 93, so I'm super excited about that too.  What's more, my average curve falls (mostly) within the normal range we've set (70-120).  Now if I can just get most of my readings in that range and smooth out my curves even more...And there's that perfectionist coming out in me again!  My CDE said my graphs were laying on her desk while she was meeting with another patient who's been chasing highs and lows for the last six months, and that the lady told her, "Whoever that is, I hate them.  I didn't know curves could be that smooth!"  Every time I talk to my CDE about numbers that I perceive as out-of-whack, she tells me that I'm actually doing great..."probably the best I've ever had one of my pump patients do," she says.  I told her yesterday that it's probably easier for me too since I'm still most likely in the honeymoon stage (and still producing some insulin of my own), but she reminded me that even if that's the case, the experience I'm getting will help me with my control if my numbers do start to creep up.

All of this makes me realize how great technology is...If it weren't for the CGM, I would probably never have known about my nighttime lows.  Even if I tested again at night like I do periodically, I would set my alarm for 3:00AM, before the lows I've been having even set in.  My CDE called yesterday after reviewing my data on CareLink (the Medtronic software for the pump & CGM), and we made some changes to my basal rates.  She told me I was doing very well, but that we needed to take care of those lows simply because once I am pregnant, I don't need to be running in that lower range (where the baby doesn't get the nutrition it needs). 

I've had to remind myself, though, that I shouldn't bolus based on the CGM readings...I've done that a couple of times to catch the highs showing up on my graph, only to end up low later on.  In fact, I did that just today at lunch, so I'll probably end up low again at the two hour mark.  It's hard not to correct those vertical lines when you can see them happening, though!  On the bright side, seeing those jumps definitely gets me up and moving, whether it's running back and forth in the office (I work with my parents) or out in the parking lot with our dog...Whatever it takes to get those double upward-pointing arrows off the screen!  Those little bursts of movement can add up, so I'm getting a little more activity on top of the purposeful exercise I get everyday after work. 

Speaking of exercise, since I've been working out consistently, I've felt so much better.  I wouldn't say I've had a huge increase in energy, but I feel less stressed throughout the day...And call me crazy, but it's seemed to have an impact on my BG numbers, which have been consistently lower since I've started.  I don't know if it's from the activity itself or the decrease in stress (or both), but I like it.  And although I haven't experienced that huge increase in energy that everyone talks about in regards to exercise, I think I'll get there once my numbers are more level (especially during the night).

In my last post on exercise, I wrote about my favorite form of exercise, the Gazelle.  I bought it in January on Amazon (they had the best price and free shipping) after doing some research into different exercise machines and their reviews.  The Gazelle fit the bill for me due to its relatively low price (good ellipticals are $500+) and an overall high level of customer satisfaction.  Plus, it just looked fun.  I remember seeing the infomercials for it back in the day (who hasn't?!), and even though they're cheesy, I thought the actual movement would be a fun (and low-impact) form of exercise...And I was right!  I recently ordered another four workout DVDs to go with it (the Gazelle itself comes with one).  Yes, the cheese factor is definitely there (mainly due to Tony Little himself, I think...I mean, come on! A hugely muscular dude with a curly blond ponytail?), but it's honestly a good, fun workout.  I love it, therefore it's not hard for me to use it everyday...In fact, I actually look forward to it

Well, I've got to go...I was just alerted that I'm low again (surprise, surprise), so I have to take care of that!

Saturday, March 12, 2011

CGM Training & Other Changes

Change has always made me anxious (at best).  At worst, it makes me feel like my world is crashing down.  Six months ago, though, my world did turn upside down thanks to diabetes...And you know what?  I came out on the other side just fine.  A little shell-shocked, but fine.

I wrote last month about what I've learned since the day of my diagnosis.  It's taken six months, but my life has regained some semblance of "normal" (whatever that is!).  In the past month or so, I also feel like I've finally come into my own in regards to my diabetes.  The first month I was on the pump was largely a time of trial and error.  I had to learn in real-time what effect certain foods have on my blood sugar, and how to correct for them with insulin.  For example, pizza, ice cream, and hot dogs all require a dual-wave bolus for me...If I do it all at once, I end up with a postprandial high, but if I do some immediately and the rest over 30 minutes or so, I'm fairly reliably within my normal range two hours after the meal.  That may seem insignificant or irrelevant to PWOD (a person/people without diabetes), but as anyone dealing with this disease knows, it's huge...Normal is always wonderful when it comes to your blood sugar.

Each time I have one of these breakthroughs, I gain some more confidence in my ability to deal with diabetes.  On those rollercoaster days when you devote most of your energy to chasing highs and lows, this confidence takes a hit, so even the smallest "light bulb moments"  are more precious than diamonds to me.  After all, this is my life that we're talking about, and all I want is to live a long, fulfilling one in good health.

With this in mind, I want to come back to the concept of change...and fear.  Aside from the pump, the most amazing technology we have in managing diabetes today is the Continuous Glucose Monitor (CGM).  I've written in previous posts about the fears I had about the CGM.  After seeing the sensors in person and reading horror stories about their insertion online, I was understandably anxious about actually using them, despite the amazing asset they are to diabetes management.  However, as Rosanne Cash's quote above makes clear, you have to overcome fear in order to be successful with change.  I finally decided that the benefit I would get from using the CGM far outweighed any (hopefully) momentary pain or fear I might experience.  In short, I made the decision to "suck it up" and deal with the pain when I got to it, because the entire reason I'm making such an effort to control this disease is definitely worth it.

I tell you all of this to give you some hint as to my mindset yesterday when I went for CGM training.  Determined, (finally) not anxious (well, maybe a just a's a huge needle), and excited about the opportunity to use such amazing technology.  My mom came with me to meet my CDE at a coffee shop, and we got down to business.  It turns out I had to get the scary part over with in the beginning, because the sensor takes 5-15 minutes to wet with interstitial fluid.  I picked my spot (lower right abdomen), swabbed it with an alcohol pad, and took a deep breath (along with a couple of glucose tabs, because I didn't need to be shaking for two reasons).  My CDE showed me how to use the inserter, then handed it to me for the big moment.  She helped me place the inserter at the correct angle at my stomach, then told me to press the button.  I did (a little nervously), but nothing happened. 

My CDE checked to make sure everything was in place, then had me try again.  I didn't realize it until it was done, but as I was pressing the button the second time, I wasn't looking at the insertion site...I don't really remember where I was looking, but all I know is that it finally went off, and then it was done.  I vividly recall going, "Oh"...Not a huge "OH!", just "Oh."  I was pleasantly surprised at the virtually pain-free insertion, and the relative lack of bleeding at the site.  We had some issues with sticking the adhesive down, but the sensor magically stayed in its place, so we connected the transmitter and the rest is history.

Seven hours after inserting the sensor, my CGM was reading within 1 pt of my meter.  No, I don't have one of those nifty pictures for proof, because it was dark and we were in the car on the way home, but I promise you, it happened!  My meter was reading 126, and the CGM 127.  I wasn't so lucky through the night, though.  My alarm went off 9 times between 1:00AM and 6:00AM, when I finally silenced the alarms.  It's been better since I calibrated it upon getting up this morning and again before eating, but I've still had quite a few alarms today.  I'm going to email my CDE and see if she'll let me change the lower limit on the sensor alarms so that maybe I won't have a constant beeping at my side!  Other than that, everything is going great.  My BGs haven't topped 162 in five days, and my average is steadily coming down.  I'm hoping that by using the CGM, I'll be able to bring it down even more.

Thursday, March 3, 2011

Exercise Does a Body Good

Exercise.  It's a word that can strike fear and anxiety into the hearts of even the most well-intentioned people.  It's your body's best friend and a couch potato's worst enemy.  Even so, we are all aware of its many benefits (According to a Mayo Clinic article on the subject):
  • Improved mood
  • Disease prevention
  • Weight management
  • Increased energy
  • Better sleep
  • Improved sex life (*Ahem*)
Then, of course, there's the diabetes-specific benefit of exercise lowering your blood glucose levels and increasing the effectiveness of insulin in doing the same.

And yet, despite its many advantages, for many of us exercise is like doing your taxes: you know it needs to be done, but there's always tomorrow (and the next day, and the next); and after all, you're busy enough today.  You put it off until you absolutely have to do it-which many times, isn't until the event of an acute or chronic illness.  You just can't fit it into your hectic schedule, and even if you could, you wouldn't have the energy to so much as think about exercising.

I know because I've been there.  I've been there so often I should have a Frequent Exercise-Avoider's Rewards Card...In fact, I'm pretty sure I could have cashed in my points for one of those nifty logo-branded shirts by now.  The thing is, while many exercise-avoiders would tell you they don't like exercise at all, most of us actually just don't enjoy starting to exercise.  In reality, once we get going it's not so bad; it's getting started that's the problem.  Whether it's truly a scheduling issue (because who really has much if any spare time to do anything during the average day?) or a general lack of energy (when I get off work, I'm collapse-on-the-couch-and-don't-wanna-move-beat), all of us have a plethora of great (and oftentimes valid) excuses not to exercise.  Often, the want-to is there, but the motivation to actually do it is lacking.

What I'm about to tell you is going to sound annoyingly cliche and upbeat and you'll probably hate me for it.  But I started working out a few weeks ago for just 30 minutes at a time after I got home from work, and now I can't imagine not doing it.  It's truly become part of my daily routine, and it feels weird to miss a workout.  As for all of the exercise-inspiring benefits? Well, many of them aren't exactly measurable or even tangible, but the main benefit I've experienced is knowing that I'm doing something good for my health.

And you know what?  I'll be honest: it took a life-changing diagnosis to motivate me to get moving.  If not for my Type 1 diagnosis six months ago, I would most likely still be generally inactive.  I was overweight as a child, but lost around 40 lbs at 12 years old when I did Weight Watchers and played basketball.  I continued to play basketball and tennis and did cross country and track through junior high and part of high school, but as soon as the structured physical-activity time was taken out of my day, exercise became sporadic at best and completely nonexistent at worst.  I continued to eat a healthier diet right up until the day I was diagnosed, and maintained my weight fairly easily.  In fact, I have improved that area of my well-being even more in the past six months and have lost another 13-14 lbs after learning to count carbs through diabetes education. 

However, I was so overwhelmed for the first five months after my diagnosis that exercise still wasn't a big part of my life.  Up until about a month ago, I was too focused on getting my blood glucose numbers closer to my target range and learning as much as I could that (paradoxically), I continued to be fairly inactive.  I have a desk job, so I don't get much physical activity in during the day, so any exercise I do get has to be purposeful.  That's it: purposeful.  You have to purposefully make an effort to get some extra movement in your day, and have to be downright committed to accomplish an actual workout for any given time.  I'm not going to lie; sometimes it's hard not to revert back to the ever-so-familiar couch potato position on those days that I'm super tired after work. 

Sometimes exercise is the last thing on my list of things I want to do.  And on those horrible D-days when you're on the rollercoaster of highs and lows, it's hard not to give in to the feeling that everything is screwed up anyway, so why bother?  Quite honestly, the only thing that gets me on my Gazelle those days is sucking it up and faking it.  When the motivation just plain isn't there, that's what you do: fake it and do it anyway.

The good news: Once you start, there's a chain reaction of awesomeness that tends to follow.  When you feel like you're doing something good for you and your health, you feel better about yourself.  You start to make better choices in your diet and subsequently pull yourself out of the rut of out-of-range BG numbers and general D-apathy.  Big change doesn't happen overnight; it's all of those small changes that add up over time and lead to success in whatever you're trying to achieve.  It's much easier to commit to (and stick to) small changes anyway...And once you do them so often that they become habit, you realize that getting from A to B wasn't as hard as you thought it was going to be.

Moral of the story?  Just try.  I'm serious.  Really, truly try (I'm talking honest effort, no excuses) to get some exercise today-any exercise, whatever you enjoy-and try to do it again tomorrow.  It's really that simple.  Take it one day at a time, do a little more each day, and before you know it, you'll be a habitual exerciser.  I think the most important thing is doing something you really enjoy rather than something you consider EXERCISE in the traditional sense of the word and hating it.  If you hate it, you're not going to stick with it, bottom line.  For example, I loathe treadmills.  I hate the feeling of running and getting nowhere.  But give me an elliptical (or, if you have my budget, a Gazelle) and I'm happy as a jaybird.  A walk or bike ride around the neighborhood on a nice day? I'm you're girl.  I just hate treadmills, and knowing this, I avoid them if there's any possible alternative.  After all, common sense will tell you that you'll put more effort into doing something you like, so why waste your time and energy on anything you truly hate doing?

Try and I can almost guarantee that something good will come of it.  It may be that you have more energy, or that you feel better about yourself, or maybe even that you see a difference in your BG numbers.  Any which way you look at it, exercise does everybody--and your body--good.

This post is my March entry in the DSMA Blog Carnival.  If you’d like to participate too, you can get all of the information at