JDRF 2013 Children's Congress

As a former middle and high school teacher, I was always well aware of how most of my students chose to spend their summers: lots of late nights, sleeping in until noon, hanging out with friends during the day, and maybe the occasional summer job. But, this is not how 150 children with diabetes are choosing to spend their time this week. These children, who are from the United States and abroad, are united together in Washington, D.C. to encourage Congress to continue funding research initiatives aimed at preventing, curing, and treating type 1 diabetes. This event, called Children's Congress,  is organized by the Juvenile Diabetes Research Foundation (JDRF) and has been an effective advocacy tool.

A past Children's Congress testifying at a U.S.
Senate committee hearing. Source: JDRF

JDRF Children's Congress will convene July 8-10 in Washington, D.C. During these three days, children will meet with their elected officials and even testify before a Senate committee. I have watched several videos of this year's delegates (The Wyoming delegate is my favorite) and am very happy to be represented by so many wonderful and ambitious children. They are very articulate, and I am confident that they will tell their stories eloquently when given the chance.

If you would like to learn more about the Children's Congress, visit the link here. You can show your support for the Children's Congress by following the JDRF on twitter @JDRF and by tweeting your support using the hashtag #JDRFcc2013.

A Bag of Gold

In five weeks, I will begin medical school at the University of Mississippi Medical Center (UMMC) in Jackson. In preparation for the semester, UMMC sent all of the soon-to-be M1 students the book Kitchen Table Wisdom by Dr. Rachel Naomi Remen. Dr. Remen began her career as a pediatrician, but eventually became a pioneer of holistic and integrative medicine. Her biography on the back cover of the book explains that she has "trained many thousands of physicians to practice medicine from the heart." The book is compilation of short stories from her career counseling a myriad of patients suffering from chronic and terminal illness.

One short story that stood out to me was titled Grace. One of Dr. Remen's patients, a physician with cancer, told Dr. Remen a parable of a miserably poor man walking down a road. Shiva and Shakti, the Divine Couple of Hinduism, were watching the man from their heavenly abode. Shakti turned to her husband and begged him to give the man gold. Shiva explained to his wife that he could not do that because the man was not ready to receive it. Shakti continued to beg her husband to help the man, so Shiva eventually dropped a bag of gold in the poor man's path. As the poor man got closer to the gold, he thought to himself, "Look there, a large rock. How fortunate that I have seen it. I might have torn these poor sandals of mine even further." He carefully stepped over the bag of gold and went on his way.

Dr. Remen explains that life often drops bags of gold in our path, but they rarely look like what they are. When she asked her patient if life had ever given him an unrecognizable bag of gold that he had used to enrich his life he smiled and said, "Cancer."

Like cancer for Dr. Remen's patient, diabetes has been a bag of gold that has enriched my life. As a teenager, I learned discipline from the disease, which translated into academic and personal success that continues today. My diagnosis also provided me the opportunity to learn from an early age how precious the gift of life really is. Our days on Earth are numbered and we do not know how many we will get. Therefore, I try to live in the present. When I hear music, I dance. When I hear a song, I sing. I try to tell the people whom I love that I love them. I smile and laugh often and don't sweat the small things. I also know that my daily struggle with diabetes will make me a compassionate and empathetic physician. I will be able to relate to patients who live with pain, fatigue, or some other ailment. Diabetes has taken things away from me -- money, a few nights of good sleep, and the ability to eat foods without thinking how it will disrupt my body -- but it has given me so much more. It has been a bag of gold that has enriched my life.

Going "Bananas" Over Exercise

A 100-gram banana and all natural
butter is my fuel for exercise

I would be lost without bananas. I eat them on oatmeal for breakfast; I eat them when I'm hypoglycemic; and I eat them with peanut butter as a snack. Needless to say, they are a staple of my diabetes management plan. But, what I really love about bananas is that they are a power food for exercise, particularly for persons with diabetes.

What is so terrific about bananas? For starters, they are a good source of vitamin C, vitamin B6, potassium, and manganese. Most important, they are packed full of energy, and relatively low on the glycemic index. This means that they will raise your blood glucose levels at a moderate pace over a
long period of time. This makes them an EXCELLENT fuel source for exercise.

I typically do an hour of running/walking or cycling daily (if possible). I have found a single 100g banana (unpeeled) with a spoonful of all-natural peanut butter to be the best combination of carbs, fats, and protein to fuel a one hour cardiovascular workout. My routine is to 1) check my blood glucose levels, 2) eat the banana and peanut butter, and 3) begin working out after 20-25 minutes. The goal is to keep my levels between 140 and 185 while exercising. Therefore, if my glucose levels are high during my pre-exercise check (>135), I only eat half a banana in order to avoid spiking my levels too much. I have had very few problems with hypoglycemia while exercising by following this routine.

It is important to note that I only exercise 3 hours after my last bolus. This ensures that I don't have any active insulin placing downward pressure on my glucose levels. If you try this routine, please check your glucose levels again before working out, while working out, and afterwards. This will give you a better sense of what happens to your body before, during, and after exercise. Good luck!

Recap of the JDRF Walk in Gulfport

Team Live-abetes before the walk.

Mary and I participated in the JDRF Walk for a Cure in Gulfport, MS last Saturday. This was the first walk for both of us and we had a great time! Our team, Live-abetes, was able to raise about $700 for the JDRF, and we are very appreciative of our generous benefactors. Overall, the event raised a little over $15,000.

In addition to raising money, the Walk provided an opportunity to meet with other persons and families affected by type 1 diabetes. A total of 17 teams participated in the walk. One team was a corporate team, and 14 of the remaining 16 teams had a newly diagnosed person with diabetes. I always read about how children are being diagnosed at younger ages, but my experience at the Walk brought this fact to light. Many of the newly diagnosed persons I met were under the age of 10-years-old. Some were diagnosed as young as 18 months! It was heartbreaking to see young children who will never remember a "normal" life without the disease. I came away from the event very grateful to have been diagnosed at the age of 14/15 (two days before my 15th birthday), which provided me the opportunity to have a normal childhood eating birthday cake and playing sports without a care in the world; but, more resolved than ever to assist the JDRF in finding a cure.

A special thank you to the gals from the JDRF Mississippi chapter in Jackson who worked hard to organize the event.

JDRF Walk Today!

Mary and I are doing the JDRF walk this morning in Gulfport. If you would like to donate to our team, cleverly called "Live-abetes," please click this link and follow the instructions. I will have a blog post about the event next week!

Thank you for the support. God bless!

Mississippi Healthcare at a Crossroads

I'm not from Mississippi, but I love Mississippi. A lot. I was brought to the state after college via a service-through-teaching program that placed me on the Mississippi Gulf Coast. I met my wife, who was born and raised in Mississippi, and we plan to live, work, and eventually retire in this state. Next Fall, I will begin medical school at the University of Mississippi Medical Center in Jackson. It is here, in the capital city, where a debate over medicaid expansion and the future of healthcare and medicine in Mississippi is currently being waged.

Mississippi is hardly a picture of perfect health. To the chagrin of most citizens, Mississippi often finds itself in the worst position of most important state rankings. A 2011 analysis of obesity in the United States conducted by The Heart Forum determined the adult obesity rate in Mississippi to be 34.9%, which earned it the distinction of being the fattest state in the union. This rate is expected to grow to 66.7% by 2030. Keep in mind that these statistics only describe the portion of the population that is obese and do not account for people who are merely "overweight." This means that it is quite possible that less than 10% of the population could be persons at a normal weight by 2030, which is absolutely frightening. Along with obesity comes a myriad of expensive health issues - metabolic syndrome, type 2 diabetes, heart disease, and cancer.

According to the Kaiser Family Foundation, an estimated 442,900 of the state's 3 million citizens are uninsured. Many uninsured persons are members of the working poor class. They hold jobs that do not offer health insurance and earn too little money to pay for health insurance on the open market. Moreover, they often do not qualify for medicaid because they make too much money.

To top it off, the Mississippi health delivery system is facing a severe doctor shortage - both primary care and specialties - particularly in rural areas of the state.

The general state of Mississippi healthcare can be easily summed up as follows: we're fat and we lack access to health insurance and healthcare. Unless something changes soon, Mississippi will face an all out health crisis within the next couple decades. The state is truly at a healthcare crossroads.

Fixing the Doctor Shortage

Governor Phil Bryant

In October 2012, Mississippi Governor Phil Bryant announced a $10 million community block grant from the Mississippi Development Authority in order to expand the school of medicine and add 1,000 physicians to the workforce. These funds will go towards expanding the medical school size (currently 135 students) and the number of residency positions. According to a report commissioned by Bryant and conducted by the Mississippi Economic Council, each doctor in a rural area has a $2 million economic impact on the community. In other words, investing in more physicians pays back dividends.

Plans to increase the number of physicians should be commended. But, should the state also find ways increase access to healthcare?

Medicaid Expansion

On March 23, 2010, President Obama signed into law the Affordable Care Act. Dubbed Obamacare, the law sought the expansion of health insurance coverage for millions of Americans, reform of the health insurance industry, and changes to many aspects of the current fee-for-service reimbursement scheme. Under the law, states have an incentive to expand medicaid coverage because the federal government will pay for 100% of the expansion from 2014-2017, and then 90% of the program costs after that. For every $1 that Mississippi spends on expansion, the federal government will pay $14. On the surface, this appears to be "free" money, but in the words of the late economist Milton Friedman, there is no such thing as a free lunch. The expansion of state medicaid programs will be financed through large increases in federal taxes and fines on individuals who do not purchase health insurance as well as businesses who do not make health insurance available to employees.

Just what are the costs of expanding medicaid? A University Research Center study estimates that the state would spend $159.1 million more on medicaid in 2025 than it spends now. Moreover, the state can reasonably expect to generate $63.3 million in revenue; thus, leading to a loss of $95.8 million.

Some experts believe that the costs are overestimated. Retired state health officer Dr. Alton Cobb believes expanding medicaid will increase visits to primary care physicians and reduce the number of costly visits to ER. Mississippi currently ranks 7th in per-capita ER visits. From my own experience, I tend to agree with Dr. Cobb. Too many people go to the ER for ailments that could have easily been treated by primary care physicians at a considerably lower cost. Most trips to the ER result in a plethora of tests - urine tests, blood tests, CT scans, and x-rays - many unnecessary but performed out of fear of litigation. Expanding medicaid could curb such visits. In addition, retired state economist Phil Pepper believes expansion would create 9,000 new jobs in the health sector. Of course, this would mean that if medicaid expansion were to be undertaken, it would be nearly impossible to reverse for fear of job loss and devastating economic consequences.

CEO Evan Dillard

Who supports medicaid expansion? Hospital administrators. Currently, hospitals that treat uninsured patients receive money from the federal government to offset costs. Mississippi hospitals will lose millions of federal dollars if the state does not choose to expand medicaid. Moreover, hospital CEOs claim they will be forced to lay off employees and reduce the supply of healthcare due to funding cuts. According to Evan Dillard, CEO of Forrest General Hospital, "It's ludicrous for the poorest state in the country ... not to do expansion." Some Democrat and Republican lawmakers support expansion as well. If the state chooses not to expand, its citizens will be paying to expand medicaid in other states through federal taxes. They claim that they do not support the Affordable Care Act, but must act in accordance with the law of the land.


Who is against medicaid expansion? Primarily Republican politicians who fear the high cost of expansion and political repercussions for appearing to support Obamacare. Governor Phil Bryant has said that he will not support medicaid expansion. His position was bolstered last week when a poll showed that 76% of registered Republicans are against expansion even though only 13% claimed to be knowledgable on the issue. Bryant's two arguments against expansion are 1) the federal government will not actually end up paying as much as it says it will because it cannot afford it and 2) the medicaid system is currently replete with waste and fraud. Both arguments are sound, but does that mean the state should do nothing at all?

The Crossroads

The choice confronting Mississippi lawmakers will have a profound impact on the health, wellness, and economy of the state. If the state chooses not to expand, there will still be individuals who lack health insurance but need healthcare. They are not going away. Expansion could potentially curb overall healthcare costs by providing access to primary health care for thousands of people who need it. Moreover, expansion could be considered an economic investment as healthy people are more productive workers, more likely to work and pay taxes. If supplying a single physician in a rural area has a $2 million economic impact, what economic impact does making healthcare more accessible ultimately have? Even if lawmakers choose not to expand, they should find ways to make the system more efficient so that the dollars can be better spent. Choosing to keep the status quo would be the most devastating outcome. It will be interesting to see which road the state chooses to travel.

Exercising with T1D

Exercising is such an integral part of maintaining good blood glucose levels. I consider it to be the second best way (insulin being the first) to keep my sugars under control. In fact, I like to do fairly rigorous 15-minute workouts if my blood glucose levels are a little high in order to bring it down. Even though exercise is so important, it can be difficult for persons with T1D to figure out how to manage blood glucose levels during exercise. For this reason, I decided to make a video that provides some helpful exercise management tips.

A few notes about the video:

• I always get my blood glucose levels into the 140-180 mg/dL range with an upward trend prior to exercising. It's not shown in this video, but my blood glucose was 145 mg/dL when I started working out.
• I use a pump and do not adjust basal rates during the work out.
• Checking blood glucose levels is the key! You have to know what's going on during before, during, and after working out.
• I do bolus entirely for the recovery drink. You might not have to!
• It has taken me a while to figure out the best exercise routine that works. What I do may or may not work best for you. Diabetes is an individual disease after all.
• I am not a doctor. Please consult a licensed physician before beginning an exercise routine!

I hope you enjoy the video!

Adding Incentives to Your Management Plan

I have been very busy over the last month and half and have neglected my duties as a blogger! In addition to teaching nursing chemistry classes at Spring Hill College, I am currently working on a local mayoral campaign. It's been difficult to find time to write for the blog, but I promise to do better!

Around the holidays, my wife likes to torture me by leaving out fun-size holiday chocolates in a variety of locations in our home. As tasty as these treats can be, eating them can be a poor management decision because, let's be honest, you can't stop with just one! It's not just a momentary elevation in blood glucose levels that a person with diabetes should be worried about, however. Studies have demonstrated that the consumption of foods with sugar and/or high fructose corn syrup can increase LDL (bad) cholesterol. This is a topic that I have previously discussed on this blog.

The Nutcracker dolls closely

guard fun-size chocolate 

pieces in our home.

So, is it ever ok to just indulge and enjoy these delicious chocolates? I say yes, but only if you have earned it through exercise. In his book Not Dead Yet, Phil Southerland explains that he began biking when he was young because he realized that if he biked long enough, he could have a snickers bar and his blood glucose levels would still stay in range. Like Mr. Southerland, I too have found that I can have a piece of chocolate (or two) without much impact on my blood glucose levels if I have engaged in 40+ minutes of cardiovascular exercise. This includes things like walking, jogging, cycling, swimming, playing tennis, shooting hoops, or raking leaves. Hopefully, for your sake, it's not raking leaves because if you're like me, you loathe that activity. More important, you can eat that piece of chocolate or few bites of cheesecake (not a fat, huge piece) because exercise helps raise HDL (good) cholesterol; thus, adding a layer of cardiovascular protection. Incentives can also prevent the occasional (or frequent) sugar binge because you can still eat the sweets you love in moderation. At the end of the day, good management is all about living a life of moderation.

I like having incentives in my management plan because it keeps me accountable. I enjoy having a few pieces of chocolate, and since it's something I want, I'm willing to do the work to earn it. Adding incentives to your management plan is easy. First, come up with a plan. My plan goes as follows: if I exercise for 30 minutes, then I can eat 1 piece of chocolate; If I exercise for 1 hour, then I get 2 pieces, and so on. Second, put your plan in writing and sign it. This makes you psychologically more likely to follow it. As long as you stick to your plan, you can enjoy the sweets you love guilt-free and still maintain good control!

Bon Appétit: Broccoli and Cauliflower Creole Pasta

I have decided to showcase some of the delicious meals my wife and I make in a new segment called Bon Appétit. In addition to sharing recipes, I will list serving sizes, number of carbohydrates, and how I bolus for the meal.

The first dish that I want to share with you is broccoli and cauliflower creole pasta. The main spice used in the dish is Tony's creole seasoning, which is very popular along the Gulf Coast where we live. Tony's gives the dish a little kick and makes it very flavorful!

Below are the ingredients and a step-by-step list of how to prepare the dish.

Ingredients

Broccoli and Cauliflower 
Creole Paste

1. Whole grain thin spaghetti (1 serving size = 56g of dry pasta)
2. Broccoli
3. Cauliflower
4. Extra Virgin Olive Oil
5. Italian cheese
6. Tony Chachere's Original Creole Seasoning

Directions

1. Chop and wash broccoli and cauliflower. Steam it for approximately 12 minutes on medium heat. 
2. While steaming the vegetables, measure out the number of servings of pasta you want to cook. Bring water to a boil and cook the pasta for 6-7 minutes until al dente. 
3. Pour extra virgin olive oil on the cooked pasta and toss. Amount depends on how much pasta was cooked.
4. Place pasta and vegetables in serving dishes. Sprinkle Italian cheese and *Tony's on the pasta.
5. Serve!

*Tony's is relatively high in sodium, so be mindful if you have high blood pressure or are at high risk of kidney disease. You can buy sodium-reduced or sodium-free Tony's.

Nutritional and Bolus Information

Each serving of the dish has ~41 carbohydrates. I usually measure out 1.5 servings (84g of dry pasta) for myself when we make this dish. Whole grain pastas are higher in fiber and digest slower than white pastas. Therefore, I always use a 30 minute square wave bolus. I have found that I actually need to give a little less insulin for this dish than the number of carbs would suggest likely because of the fiber, but this might not be the case for everyone. My CGM always shows a very small spike over a 30 minute period for this meal and then a gradual decline to normal levels within 1.5-2 hours. Whole grain pasta is low on the glycemic index, which makes it a great choice for people with diabetes.

Bon appétit!

Exercise and BG Now - January 4 @ 6:15pm

Heart-rate monitor (L) and BG

meter (R)

Just finished cycling. I was on the saddle for about 1 hour, burned 697 calories, and my blood glucose levels are currently at 157. I checked my blood sugar at 4pm and was sitting at 98. I ate half of a cliff bar and half of a banana and waited about 1 hour before hopping on the bike. 157 is a little higher than usual after an hour of cycling and the CGM shows me sitting steady, so I gave a small bolus (0.7 units) and am getting ready to eat dinner. I love cycling because once it comes back down into range, it'll be solid the rest of the night!

My 2013 New Year's Resolutions

Well, we survived the Mayan apocalypse and, for the time being, a fiscal cliff has been averted, which can only mean one thing: 2013 is here, y’all! This year is going to be full of new things as Mary and I move to Jackson, MS and I begin medical school at the University of Mississippi Medical Center. In addition, we are taking high school students to Ireland and Scotland in June. Though it may be a bit cliché, I decided to write a post listing my top 5 New Year's resolutions for 2013. Some are obviously serious and some are, well, not. Regardless, here they are (drumroll please):

5. Be a good friend. I have a tendency to get busy with numerous side projects and forget to call, email, text, etc. good friends from high school and college. Our relationships with other people define us, and I know that I need to be a better friend.

4. Determine whether or not there is a cure for Bieber Fever. If there is, then surely they will teach us about it in medical school, right?

3. Continue to maintain a good HbA1c. This next year is going to be replete with challenges – moving, traveling, medical school. All of these events will pose their own unique management challenges for controlling my diabetes along the way. I intend to use my own knowledge as well as the support of the DOC to steady the ship and stay healthy.

2. Complete an ADA Ride for the Cure. I recently fell in love with cycling. I have completed a few organized rides, though none of them have been for a cause. My brother and I have talked about doing an ADA ride together, and I want to make this happen!

1.    Be the best diabetes advocate I can be. I’m excited to move to Jackson, MS because the only JDRF and ADA offices in the state are located there. This seems a little outrageous considering the high rate of diabetes (mostly type 2) in the state. Nevertheless, I hope to volunteer at a few events and connect with other people who are affected by diabetes.

Well, there you go, my 5 resolutions for 2013. What resolutions do you have for the new year?

Listen to Me, Because I Don't

A few weeks ago, a friend who recently acquired a continuous glucose monitor asked me for some tips on how to appropriately use the device. One of the first pieces of advice I gave him was to never make management decisions based the monitor, and to always check to confirm that the monitor was correct. Ah, such good advice based on months of experience. Now, if I only I had actually listened to my own advice a few nights ago...

Love the CGM, but it's
always best to check.

I went to sleep late - 12:30am. I was closely monitoring my glucose levels because they were a little high, and I was expecting an overnight dip because of an intense 1-hour bike ride in the late afternoon and because of the adult beverage I consumed a few hours earlier. I went to sleep and, like clockwork, the pump started singing like Mariah Carey at 2:30am, and it wasn't singing "Sweet, sweet fantasy baby!" Instead, it was indicating that I was low. The sensor was new and I had inserted it after the bike ride earlier in the evening. Prior to going to sleep, I had decided to cleverly change the sensor settings on my pump so that I would be alerted at 80 mg/dl instead of 70 mg/dl because I wanted to catch the low early. I rolled out of bed to treat the low. "Ha, I don't feel low" I thought. I have outsmarted the sensor and am catching the hypo before I have the symptoms! Chalk one up for me. I stumbled to the kitchen, ate 15 carbs of Oikos yogurt. While eating, I noticed that I wasn't shaking or sweating. My heart wasn't beating rapidly. I was slightly disoriented, but that's normal when you wake up suddenly in the middle of the night. Man, this is great! I walked back to my room to go to sleep. After nearly stepping on my cat, who likes to walk under my feet in the dark, I had a thought: what if I'm not low? I decided it would be best to check since I had already taken measures to treat the low. I checked, and my blood glucose was 138. Awesome! I didn't feel low because I wasn't low. I bolused for the carbs I had consumed, calibrated the sensor, and hit the sack. When I woke up, I was sitting at 81 and the sensor had come back into a state near accuracy.

What did I learn from this little episode? Listen to my own advice and actually CHECK before making management decisions. Also, train the cat to stop walking under my feet.

Reaching an Optimal HbA1c

We live in a results-oriented world, and for people with diabetes, the HbA1c test is the standard for determining how well we are managing the disease. For readers who are not familiar with the A1c test, you can think of it as a 4 month blood glucose average. People without diabetes normally have an A1c between 4.6% and 5.6%. The American Diabetes Association recommends that people with diabetes maintain A1c levels of less than 7.0% in order to stave off any long term complications. However, I strive to keep mine lower than 6.5% because I believe that the closer it is to normal, the better!

Santa delivered my latest A1c results on December 24 (a day early). My results? 5.8%. To say the least, I was overjoyed! This result was down half a percent from my previous A1c of 6.3%, which was also a very solid result. After twelve years with diabetes, I know that I am proficient at controlling the disease. This does not mean that every day is perfect (because it's not), but it does mean that I have more good days than bad. More important, I know that I am blessed to have access all of the resources that people with diabetes need to effectively manage disease. This includes an insulin pump, continuous glucose monitor, blood glucose meter and test strips, and an awesome endocrinologist!

We all have our own methods for managing our diabetes. After all, everyone's diabetes is a little bit different. I thought I would share a few that I use that have proven successful for me over the years.

Disclaimer: I am not yet a medical professional and this is not considered to be medical advice. These are merely methods that I employ that you may find useful. Always check with a doctor before making any changes.

1. Check Glucose Levels Early and Often. Many diabetes groups and organizations recommend that people with diabetes check their glucose levels 5 times / day. I do not believe that 5 times / day is nearly enough. In fact, I usually check mine 3 times before noon! The ability to instantly and accurately know our blood glucose levels is what separates us from people who had diabetes between 1920 and 1980. Information is power, and the more you know about what is happening in your body, the better able you will be to make proper management decisions. I check my levels a minimum of 8 times / day.
2. Don't Eat If Your Levels are High. Even if it is time for a meal or snack, I do not eat if my levels are higher than 140 mg/dl. I bolus, drink water, wait an hour, and check again. Like everyone, I have those mornings where my glucose levels are high when I wake up. Instead of eating and spiking them even further, I make my adjustments and wait. Depending on how much time I have, I may go for an early morning walk, which brings me to my next point...
3. Get Physical. I do a minimum of 35 minutes of exercise everyday. My new passion is cycling, but I do lots of things to stay active: walking/running, playing tennis, yard work, push-ups & sit-ups, etc. I use exercise as medicine. If my blood glucose levels are high (>150 mg/dl) two and half hours after a meal, I look at that as a great excuse to go for a 2 or 3-mile run/walk around the neighborhood. Why  give extra insulin when I could, instead, get the same result with a little exercise? Moreover, exercise is good for the cardiovascular system and reduces stress. Find something physical that you love and do it everyday!
4. Know What's Going into Your Body. I measure all of the food I prepare so that I know exactly how many carbs I'm consuming. I don't like surprises and try to leave as little room for error as possible. Yes, you can "eyeball" the carbs, but it's too easy to be off by 15 or 20 grams. Being off can leave you with high glucose levels for a longer period of time, which leads to a higher HbA1c. You can purchase a nice food scale for about $50 at Bed, Bath, and Beyond. I have used a scale for about two years, and it has been a game changer. I even take it with me when I travel places!

I hope that you find these methods helpful! What methods do you use?

On NOT Letting Diabetes Define You

By: Andrea Romie, guest contributor

Hi, my name is Andrea and I have Diabetes.

Wilford Brimley has become well-

known in recent years for his Liberty

Medical commercials

At the tender age of 12, I had a lot of growing to do, both mentally and physically, but I certainly already had a solid personality.  I was a loquacious, perhaps too mature (if you ask my parents), fiercely independent little girl.  However, when I was diagnosed with Type 1 Diabetes, I knew I had something that would change me and shape the rest of my life not for the worst, but in a much different way. Not long after I was diagnosed, I knew I never wanted my disease to define me.  I don’t refer to myself as a Diabetic, rather than someone with Diabetes.  I think there is a certain stigma or stereotype about “Diabetics” and I do not, nor do a lot of other people like me, fit the bill.  It doesn’t help my cause to have old men with white mustaches riding on horses talking about Diabetics and their “Diabeedez” equipment in lame commercials every night on prime time television.  If you don’t know what I’m talking about, take a gander at the YouTube link here.  I don’t feel like one of those Diabetics he’s referring to - ones who start their day off with a brisk walk at 5 a.m., eat dinner every day during the early bird special and reward themselves with a nice piece of sugar-free candy.  First, that stuff sucks and should not be allowed in the candy aisle, and second I never planned on having the same daily schedule for the rest of my life.

I knew very early on that I wanted to be healthy and responsible while living a life that allowed me to be a regular kid.  While I was still on “N” and “R” shots (we all remember those), I did NOT like having to wake up early during a sleepover to eat breakfast and take my insulin and I certainly did NOT like missing out on eating at the Rainforest Café during a class trip in Chicago because it wasn’t scheduled during my set dinner time.  That strictly regimented lifestyle was super annoying and not fun, especially for a pre-teen.  Within a year of my diagnosis, my doctor allowed me to go on Humalog and a long acting insulin which gave me freedom and a chance at being a regular kid again – just one who always had syringes, a blood sugar monitor and glucose tablets on hand.  After remedying that little snafu in Chicago, I figured, “this isn’t so bad, I can deal with this”.  Of course I have my bad days especially when I seem to be low ALL the time or high ALL the time for no reason. Sometimes I hate dealing with it but, in general, I have a “c’est la vie” attitude towards my disease.  I really hope that other kids dealing with their diagnosis can feel the same way – you can be just like everyone else, active, healthy, spontaneous but just a little, well, special.

Ever since my presentation to my 7^th grade class about these new shots I’d be taking, I’ve been extremely open and never ashamed of the fact that I have Diabetes; however, it’s not something that I lead with.  Like “Hi, my name is Andrea and I have Diabetes.”  There are so many other things that come up in conversation before the inability of my pancreas to create insulin.  We all will deal with it in our own way but for me, this is how I see it – Now, at 26, I am a loquacious, averagely mature, fiercely independent woman, wife, daughter, sister, friend, runner, amateur chef, marketing guru and oh, yeah, I have Diabetes.

KC Students Return From Fitness Academy

A terrific story was reported in the Sun Herald today about students from my hometown of Kansas City, Missouri returning from MindStream Academy, a fitness boarding school in South Carolina. The 14 students lost a combined 756 lbs. during their four months at the school! The goal of MindStream Academy is to help teenage students learn and develop skills to ensure long-term health and wellness. The school has a unique curriculum that teaches students how to make prudent decisions about eating and exercise.

The curriculum was practical and hands-on: Students took field trips to a grocery store and fast food restaurant to learn to make good purchasing decisions and studied things like knife skills in the school's kitchen. - The Sun Herald

The state of physical education in U.S. schools is perhaps as bad as it has ever been. As a former middle and high school teacher, I am well aware that students are not taught about nutrition, metabolism, and the importance of exercise. Interestingly, many medical school programs don't even teach doctors the basics of nutrition, so it should come as no surprise that U.S. citizens are poorly informed about how to eat healthy. Even though MindStream Academy is doing great work, I wish families did not have to pay more than $28,000 to teach students something they should already be learning in school and from their doctors! Nevertheless, these students and families should be commended for getting healthier and avoiding chronic conditions like type 2 diabetes, hypertension, metabolic syndrome, and even cancer.

Here is a link to the Sun Herald Article. If you want to see pictures of the students returning to KCI airport, you can click here. If you want to learn more about MindStream Academy, please click this link.

Read more here: http://www.sunherald.com/2012/12/21/4371883/mo-students-lose-756-pounds-at.html#storylink=cpy

Tips to Help You Avoid Cruel Practices by Health Insurance Companies

Let me begin by apologizing for not updating my blog in a while! I can promise that I will be better about updating it more frequently as we move forward.

If you were to ask me about the most frustrating part of living with diabetes, my answer might surprise you. It would not be frequent blood glucose checks, hypoglycemia at inconvenient times, unexpected and unexplainable highs, or even the expense of treating the disease. Instead, my answer would be dealing with some of the crueler practices of health insurance companies.

Earlier today, I received a phone call from Medtronic informing me that my health insurance company did not have a certificate of credible coverage on file and was, therefore, rejecting all claims related to diabetes treatment. My initial thought was “Here we go again,” because this is not the first time that a health insurance company has claimed to somehow lose, misplace, or never receive my certificate. Lucky for me, I was prepared this time. I switched insurance companies last June, and was sure to make phone calls to confirm that all of the necessary documents (application, certificate of credible coverage, etc.) had been received by the new company. After confirming with the new company that all was well, I wrote down the name of the agent and the date of our conversation. In addition, I had my old insurance company mail me a copy my certificate of credible coverage last June, which I filed away just in case something funny happened. You can imagine the surprise of the agent at my new insurance company when I reminded her of our conversation on June 21 confirming that they had received my certificate and that I was currently holding a copy of the certificate and would be more than willing to hand deliver it to her this afternoon if necessary. Somehow, she turned into Houdini and magically found the certificate in the system, so I didn’t have to make the 45-minute drive. 

These things happen to people with diabetes and other chronic conditions all of the time! Because health insurance companies are for-profit, their goal is to avoid paying as many claims as possible, and the easiest way to do this is to simply state that a person has a pre-existing condition with no certificate of credible coverage. Chances are pretty good that if you have a chronic condition, then you have experienced or will experience this at some point. I know how frustrating this can be, so I have provided a few tips for everyone below on how to avoid being swindled by your health insurance company:

1.  Always keep a personal copy of your certificate of credible coverage.
2. Never assume the insurance company has received any documents sent to them by you or another insurance company. Call them in order to confirm and write down the name of the person you talked to as well as the date.
3. Keep all health insurance documents and documentation in a file-folder and consider keeping the folder in a fire proof safe.
4. Make electronic copies of your application for insurance as well as your certificate of credible coverage so that you can easily email these documents if necessary.

I hope that you find these tips helpful. I feel blessed that my experience today had a happy ending, but I would still be fighting it for the next two weeks if I did not have a copy of my certificate!