Yes, I Can Eat That

This blog post was originally published on Hugging the Cactus on March 7, 2022. I’m sharing it again today because I (and other people with diabetes) constantly battle the misconception that I can’t eat foods that contain sugar/carbohydrates. Why, just the other day, someone who has known me since I was 12 years old made a comment about how I couldn’t eat cookies! In that situation, I smiled politely and gently corrected the individual, but the bottom line remains: This is some diabetes stigma that I’d like to defeat. Read on for more…

Yes, I have diabetes.

Yes, I can eat cheesecake and pizza.

Yes, I can actually eat whatever I want – I just have to know the carbohydrate content of whatever I’m consuming (and being mindful of portion size doesn’t hurt either).

Yes, I’m telling you this because at the time of this writing, that’s actually what I had for lunch this afternoon: homemade pizza and cheesecake. The pizza crust was store-bought, but everything else – from the sauce to the cheesecake crust to the strawberry topping – was made by me and it was damn good.

I guess I’m just taking a moment to 1) congratulate myself on semi-mastering the home-cooked versions of these two foods, but also to 2) reflect on how there’s so much stigma, STILL, on what people with diabetes can/can’t or should/shouldn’t eat. It’s wild to me that there are countless people in our world who misunderstand that a diabetes diagnosis automatically eliminates certain food groups from an individual’s diet.

Let me say it louder for those in the back who can’t hear: People with diabetes can eat whatever they want. Diabetes varies from person to person, and so do dietary preferences – so just because one person with diabetes might follow a strict keto diet, it doesn’t mean that ALL people with diabetes do. It doesn’t make it right or wrong for a person with diabetes to choose or not choose to eat certain things – period, bottom line, end of the story.

And by the way – I took a big old bolus of insulin for aforementioned pizza and insulin and my blood sugar didn’t spike past 188 mg/dL several hours later – score! So I’m also using this blog post to remind myself that it’s okay to eat “treat” foods like this from time to time, and that does not make me a bad diabetic.


AITA: Diabetes Edition

If you aren’t familiar with the acronym AITA, then let me break it down for you: It stands for “am I the asshole”?

It stems from Reddit, which is basically a ginormous discussion thread website. It provides a forum for people to post stories in which they’re unsure whether they’ve acted like, well, an asshole. Then other folks who see the initial post can chime in with their opinion on whether they think yes, the OP (original poster) did act selfishly/foolishly/asshole-ly or no, the OP acted in accordance with what they would have done, had they been in that person’s shoes. It can be a wildly entertaining guilty pleasure to fall down the rabbit hole of these discussion threads and deduce for oneself if a perfect stranger on the Internet did indeed act like an asshole in a given situation or not.

I found myself immersed in one of these AITA threads that my cousin sent me because, of course, it had to do with diabetes. Long story short, the OP wondered AITA for moving their roommate’s insulin out of the way, causing said roommate to panic and be forced to resort to an emergency insulin supply because they were unable to locate what had been stored in the refrigerator. Now, in just that context alone, I would’ve said that the OP wasn’t an a-hole because they probably just didn’t know any better, but as I scrolled further along in the thread I discovered that they thought it was fine to do and that diabetics were fine in historical times when there was no refrigeration. And he took his ignorance a step further by posting a comment about how he didn’t know what the big deal was about taking a vial of “sugar water” – yes, that’s what he called insulin – out of the fridge.

That’s when I immediately realized, yep, the OP can wear the AITA crown with certainty. This whole anecdote might come across as a teensy weensy blip in the universe of Internet discussion threads, but to me, it stands out as a perfect example that even people who are closest to those living with T1D can get such a significant detail about it so, incredibly wrong. And it’s proof that we’ve got a long way to go in terms of educating the world on the importance and purpose of insulin, apparently, even though stories about it have hit so many headlines in recent years.

TL;DR (another Reddit acronym meaning too long; didn’t read): Let’s get it straight, now, that insulin is a life-saving medication that needs to be stored properly in order for it to be used – and IMHO (in my humble opinion), never take it away from a person living with diabetes without asking them about it first.

Flatbread Failure

Any type of pizza, plus diabetes, usually equals one giant headache in terms of nailing a correct insulin dosage.

Nine times out of ten, my blood sugar ends up high in the hours following a pizza meal. This is a fairly common phenomenon for people with diabetes, because even though pizza contains high amounts of carbohydrates, it also contains a large amount of fat that ends up delaying the digestion of pizza – resulting in a belated blood sugar spike. My go-to workaround for this is to do an extended insulin bolus, meaning that I take part of my insulin dose at mealtime and my pump will deliver the remaining dose later on, but it can be tricky to nail the timing of it.

So imagine my surprise when, after enjoying an evening out with my boyfriend in which we split a very tasty flatbread pizza (half buffalo chicken, half brussels sprouts and bacon), my blood sugar didn’t spike even a little bit post-meal. In fact, it actually ended up tanking – so much so that over the course of 2 hours, I had to eat 3 packs of fruit snacks and a handful of leftover Easter candies in order to keep it from dropping too much.

My mind was blown. I had actually eaten more flatbread slices than I normally do during this meal – the two of us nearly demolished a large-size flatbread, which is quite a feat – and so I bolused for 60 grams of carbs, using the manual mode on my Omnipod 5 PDM to enable an extended bolus in which I gave myself half my insulin dose upfront with the remaining half to follow 1 hour later. I actually thought I was underestimating the total carbs I’d consumed, especially considering I had two cocktails with my meal. But nope, I had completely missed the mark on this one and paid the price as I did whatever I could to keep my blood sugar up in the hours before I planned to go to bed. You can see from my CGM graph below that this was a bit of a prolonged struggle, one that kept me up much later than I would’ve liked.

But, oh well. That’s just how it is with diabetes sometimes, and I remain optimistic that I can nail the pizza bolus next time. After all, I’ve done it before, so I can do it again. And this is the kind of bolus experiment that’s kind of enjoyable – any excuse to have some delicious pizza.

What (Not) to Wear: Medical Device Edition

I’m going to two weddings this spring and summer and rather than stressing about which dress I’ll wear to each, I’m finding myself more focused on where I’ll wear my insulin pump and my CGM.

It might sound like I’m making a mountain out of a molehill, but truly, I’m having a hard time deciding whether or not I want to make an effort to hide my devices or don them proudly along with my formalwear. Now when I say “hide”, I don’t mean that I want them out of sight because I’m ashamed of them or anything negative like that. It couldn’t be further from the truth. I’m proud of and grateful for my pump and CGM, but that doesn’t mean that I want them to be front and center on a special occasion. I’d rather let my style – my dress, my make-up, and my jewelry – shine because they’re more reflective of who I am as a person. My diabetes is also a part of my identity, but I don’t want to showcase it if it can be avoided. I also don’t want to attract stares, because whether I like it or not, people will always look and wonder what my pod and CGM are and why I have to wear them.

At a family wedding a few years ago, I was proud to showcase my cute pod sticker…but these days, I’m not so sure that I want to go about advertising my diabetes so boldly at a couple of upcoming weddings!

So based on that logic alone, I’m leaning towards wearing my pod and CGM on sites around my abdomen or legs, keeping them neatly tucked away underneath my wedding attire. But I also need to take into account my site change days. My pod is changed every 3 days, and my CGM sensor is replaced every 10 days. I could plan backwards from the wedding dates and figure out where I need to place my pod and sensor according to that, but let’s be real here: I don’t always have the mental bandwidth to plan that far in advance. Pod and sensor site changes are so routine to me at this point that I just kind of go through the motions every time that I change them, and don’t give much thought to their particular placement beyond making sure that I’m properly rotating my sites. Maybe I’m just being lazy by claiming it’s too much extra work, but honestly, there’s so much work that already goes into diabetes on a daily basis that I just don’t want to give in and plan out a site change timeline that guarantees covered-up diabetes devices.

We’ll see what happens, but one thing is for sure: Whether I showcase my sensor and pod in visible spots or if I choose to keep them covered up, I won’t let my diabetes spoil any aspect of having a great time celebrating at both weddings.

How I Decide What’s “Bolus-worthy”

“Bolus-worthy” is a term that, I believe, is semi-universally used by the diabetes community to describe food/drink that’s worth taking insulin for. Not just any typical amount of insulin, though – usually something that meets bolus-worthy criteria is something that requires extra insulin, and probably a little bit of guesswork, too.

What makes something “bolus-worthy”? And is it always truly worth it, even if it produces less-than-desirable blood sugar outcomes? I’ll attempt to answer both of these questions from my own unique point-of-view.

I think that a food or beverage is bolus-worthy when it’s something that I can’t and won’t indulge in often. It’s important to consider the “and” between those statements because it must meet both of those conditions; otherwise, it’s simply not special enough to be considered bolus-worthy. So something like the slice of carrot cake that my mom and I shared on our annual outing to a local teashop was totally worth taking extra insulin for, whereas pretty much anything I could order from a McDonald’s menu isn’t (I only ever go to fast food restaurants as last resort, and it doesn’t make me feel particularly good to eat food like that often). I believe in allowing myself carb-laden foods – ice cream, pizza, desserts from a bakery, you name it – whenever the desire strikes, but I do try to be careful about making sure I don’t do that often so that way I can have a better handle on my blood sugar levels as well as make myself more likely to really enjoy the indulgence.

But just because something fits into my “bolus-worthy” definition, is it always worth potentially paying the price of having a blood sugar I’m unhappy with later on? It depends. On an occasion like my birthday, I like to pretend that any out-of-control blood sugar levels don’t count as I eat whatever celebratory goodies I like – even though I’m subconsciously aware that of course they do, and TBH I actually prefer to stay in-range on my birthday so that my diabetes can’t steal the day from me. I guess this is kind of the beauty of the “bolus-worthy” label, though. To me, it implies that whatever it is that I’m having is reserved for special moments. That in itself makes anything worth it, if it’s contributing to the meaning behind an occasion.

And I look forward to putting this theory of mine in action on my birthday in a few short weeks, a time that I guarantee will be filled with food and drink that I deem 100% certifiably bolus-worthy!

The Luckiest

I feel like the luckiest person with diabetes in the world – not because I have diabetes, but because diabetes has made me grateful for many things in life; mainly, my support network.

I’ve had two very minor health scares this month (one being my bout with the stomach bug and the other being a scary middle-of-the-night low blood sugar), and in hindsight, it’s embarrassing to think about how worked up I got over both of these incidents. But I’d be remiss if I didn’t recognize the people who helped me get through these events and didn’t judge me whatsoever for the anxiety that, at those moments in time, I struggled to reign in.

My parents and my partner listened patiently and offered advice each time. They didn’t hesitate to offer to run to the store to get me anything that I needed, nor did they complain when I called late at night to let them know what I was experiencing. Fortunately, I don’t always need this level of support (especially when it comes to dealing with a low), but that doesn’t make me any less appreciative of the fact that they showed up for me when I was feeling particularly panicky, heightened by being alone.

And that’s what makes me the luckiest – the knowledge that I’ve got the best allies in my corner who are there for me when I’m strong as well as vulnerable.

4 Tips on How to Handle T1D, Treats, and Temptation

This blog post was originally published on Hugging the Cactus on April 12, 2021. I’m sharing it again, ahead of the Easter holiday, as a reminder to myself and others that it’s perfectly okay for people with diabetes to indulge in sweets – just like everyone else, though, it’s important to do so mindfully. Read on for my tips…

If you regularly read this blog, then you know that I’m not a strict person with diabetes, in the sense that I don’t really restrict the foods that I include in my diet.

I’ve always been of the mindset that my diabetes can’t dictate what I choose to consume, though it might limit the actual quantity of a given food type that I eat.

So while my fridge and freezer is almost always stocked with fresh and frozen fruits/veggies/proteins, my pantry often stores more shelf-stable (and usually less healthy) things like crackers, cookies, and even candy. In fact, a full week post-Easter, my cabinets contain 3 bags of jellybeans, a chocolate bunny, and several Reese’s eggs. And it’s very tempting to reach into the cupboards and help myself to as much sugary sweetness as I can stomach in one sitting – screw my diabetes/blood sugar, I’ve got delectable confections to consume!

But of course, I know that indulging my cravings will only wreak havoc on my blood sugar levels, so I’ve found a few ways to curb temptation but still keep tasty treats in my home. Here’s 4 things that have worked for me:

  1. Only eat these treats when my blood sugar is low. I call this “medically necessary” candy consumption, and let me tell you, it makes low blood sugars a whole lot more tolerable when they’re treated with something that’s more fun and yummier than chalky glucose tablets or juice boxes.
  2. Keep them out of sight. I do my best to shove bags of treats in the very back of my top cabinets. That way, if I’m tempted to dig into them, I remember that I won’t be able to reach them unless I get a chair and rummage through the contents of the top shelves…and usually, that’s enough to take away my desire to snack on something sugary. I’m not saying it always happens, but laziness will typically beat my sweet tooth.
  3. Pre-portion single servings of treats. I have a real problem with snacks that come in bottomless bags – it’s hard to know when to stop and my blood sugar always suffers the consequences. So I like to study the serving size on bags and use it as a guide to portion out single servings of treats. It’s much easier to bolus for whatever it may be (or treat a low blood sugar as described in tip #1) when I know the exact carbohydrate count; after all, a few handfuls of an unknown number of Skittles have far more carbs than a single serving of 15 Skittles.
  4. Be picky about the types of treats kept in the house. My kryptonite is most definitely Reese’s cups…I love the salty/sweet combination of peanut butter and chocolate almost as much as I love my dog. So I recognized that a bad habit was forming when I kept a little bowl out in my living room filled to the brim with mini cups. I was breaking every single one of the above rules with this practice! After I realized this, I put the bowl away and stopped buying Reese’s every time I went to the grocery store. I still have other things around the house that will satisfy my sweet tooth (before Easter, I bought a package of dark chocolate Oreos that I’ve easily kept around for the last 6 weeks because they don’t tempt me in the same way that Reese’s cups do), so I’m really not depriving myself at all.

Temptation can be tricky to navigate when you have T1Ds and love sugary treats as much as I do…but as long as you can come up with ways to cope with temptation like I did, then you don’t have to feel guilty for giving in to your cravings every now and then. I sure don’t!

A Diabetes First

Forget “a diabetes first” as the title for this blog post – “a first” would suffice. That’s because I experienced *drumroll please* my very first stomach bug this past weekend! (At least, the first one that I can remember; most certainly, the first of my adulthood.)

I don’t know how I caught it and honestly, as I sit here and write this, it’s taking the very little energy I have to summarize what I dealt with over the weekend. But here’s the short version: I was out shopping with my partner on Friday evening. On our drive home, I grew increasingly nauseous and essentially bolted it to the bathroom when we made it home. I won’t cover all the gory details here, but basically, I was pretty ill for many hours. Food and drink quickly became out of the question for me, and even though my stomach was churning relentlessly, I still had enough mental bandwidth to check my blood sugar every so often to make sure it wasn’t climbing or falling.

Much to my relief, my blood sugar was the only thing that remained stable all weekend long. As I fought through waves of nausea, I was grateful that I didn’t have any insulin on board as an additional factor to contend with. It seemed like my diabetes knew I was going through enough, so the least it could do was play nice while my body dealt with the bug as best as it could.

I’ve slowly reintroduced foods into my diet today – I never would’ve thought I’d be so simultaneously excited and nervous to eat saltine crackers, rice, or plain chicken – and I’m still amazed at how my diabetes seems to be cooperating as I continue to recover. Granted, this could be because I’m eating very simple carbohydrates and not many at one time, but still. I’m appreciative of the fact that I can rest up without worrying as much about my blood sugar levels.

Don’t get me wrong, though…as nice as it was to have approximately 48 hours of in-range blood sugars (above 80 and below 150 on my own Dexcom graph), I definitely wouldn’t trade them in favor for a stomach bug. I’d much rather put in a little more effort on my own to obtain in-range readings than have to go through that whole ordeal again.

Do We Take Medical Technology for Granted?

This was originally published on Hugging the Cactus on December 4, 2019. I’m sharing it again today because there have been many diabetes tech outages since then – and I’m certain there will be more in the future – but my question still remains: Do we take medical technology for granted? I ponder the answer to that below…

Alright, now that I’ve got THAT out of the way…

For the last several days, the DOC has been in a bit of a panic. And when I say “bit” I mean “a helluva lot”. That’s because the day after Thanksgiving, Dexcom Follow stopped working. This means that parents/caretakers who rely on the technology to monitor their child’s/loved one’s blood sugar levels were left in the dark. It sparked confusion, outrage, and downright fear, all of which only seemed to intensify over the weekend and into this week when the problem was only partially solved for most users.

Rather than coming together to support one another, the DOC swiftly divided into two camps: The first consisted of individuals who sought to gently remind others that this technology is still pretty new. It hasn’t even been around for two decades. That meant that for many years before then, people with diabetes were doing things the “old school” way, and getting by just fine. Doesn’t this mean that we should all be able to make it through unexpected technology blackouts, knowing that we have our blood sugar meters to fall back on?

The second camp was in a greater fury over the issue. This camp relied on the Dexcom G6 system because those within it simply didn’t know a life without the continuous glucose monitoring technology. For them, the outage was a bit like asking them to Google something without access to the Internet – it’s pretty much impossible, unless you’ve got an Encyclopedia handy. Oh, and it’s MUCH higher stakes, because people who don’t recognize symptoms of low or high blood sugar need this technology to work in order to stay on top of fluctuating blood sugar levels. Let’s not even get into how much is PAID for this expensive piece of medical equipment…one would argue that the high cost of supplies means that the technology should work at all times, no matter what.

If you’re like me, you can see that both of these groups have perfectly valid points. I’ve had diabetes long enough that I didn’t even use – and didn’t see the point in using – continuous glucose monitoring or insulin pumps until a few years ago. I took care of my diabetes the old fashioned way growing up: doing fingerstick checks multiple times per day, treating low blood sugars with 15 carbs then waiting 15 minutes, checking blood sugar levels about an hour after injecting insulin to make sure highs were coming down the way they should. This way of handling diabetes worked for me for a long, long time…throughout elementary, middle, and high school, right up to college.

Then I got a continuous glucose monitor (I believe it was the Dexcom G4) just before starting my freshman year of college. And I haven’t really been without a CGM device since then. It’s changed my life and helped me navigate adulthood with diabetes. Whenever I do experience periods of the technology not working the way it should, it’s infuriating because I feel like it’s not worth throwing away buckets of cash on it in those periods of inconsistency and inaccuracy.

But here’s what I’m wondering, as a result of this Great Dexcom G6 Outage of 2019…do we take this technology for granted?

Do we truly appreciate the times that it works the way it should?

Do we expect too much from something that, technologically speaking, still has a long way to go in terms of working perfectly?

Do we rely too heavily on continuous glucose monitors to provide us peace of mind when, in reality, they simply provide us with real-time updates of our blood sugar levels (i.e., it’s a stream of data)?

I don’t have answers to these questions. I can reflect on my own answers to them; furthermore, I can ponder how and why the DOC gets so divisive in these times where we should try to come together, listen to (and learn from) differing perspectives, and figure out what we can do to best support one another during trying times.

Another Day, Another Annoying Diabetes Reference

I have controversial taste in entertainment.

While I’m a huge fan of trending shows like The Last of Us and Wednesday (I recently finished both first seasons and fell in love with the characters on both shows/mourn the fact that they likely won’t produce second seasons until 2025), I’m also really into what my mother calls “trash TV”.

This is synonymous with reality television – think along the lines of anything that the Bravo network plays. Most of those shows symbolize pure escapism and innocently mindless entertainment for me, and I’m addicted, so much so that my trash taste in TV translates to my podcast listening.

I listen to a handful of podcasts hosted by personalities that either appear on the Bravo network or talk often about Bravo-lebrity drama, and while I usually find them wildly entertaining, I’ve noticed an emerging trend on these podcasts in recent months that makes me incredibly irritated. And that’s how often diabetes comes up as a topic on these podcasts.

Nine times out of ten, it’s about Ozempic (the type 2 diabetes drug that famous and non-famous folks alike have started using in order to lose weight). Usually, the podcast hosts are poking fun at it or spending way too much time speculating who is and isn’t using it, and it drives me up the wall. NOBODY is talking about the morality of taking a type 2 diabetes drug when they do not have that condition themselves, or the fact that since it’s become so popular it’s made it scarce and potentially unavailable to the people that really need it. Now, I’ll take a step off the soapbox for a second because obviously I 1) don’t have type 2 diabetes and 2) don’t use or need to use Ozempic; therefore, I don’t have a true stake in the game other than that I could imagine myself being even more worked up if it were a matter of people taking Humalog for similar reasons (goodness knows the rage that I would feel if Humalog was becoming virtually fetishized because taking it resulted in some desirable outcome).

I also shouldn’t sit here and judge people who go on Ozempic who have maybe tried multiple other weight loss methods that have failed them, and they’re genuinely using the drug to try and get healthier – I can empathize with that more. No, what really bothers me is the resulting dialogue that seems to happen every time Ozempic is brought up, and that is pure ignorant bliss regarding what diabetes actually is and how significant of a role it plays in the daily lives of people living with it. Multiple podcasts that I listen to have covered the Ozempic “fad”, explaining to their seemingly naive audiences that it’s a drug for diabetes, followed by a punch line about how they don’t even know the difference between type 1 and type 2, and saying things along the lines of how they hope they get diabetes just so they have an excuse to take Ozempic.

It’s gross. And quite frankly, embarrassing for these podcast hosts to admit that they know so little about a condition (and I’m speaking broadly here about both T1D and T2D) but then claim they want to be diagnosed with it so they can maybe indulge in their vanity and lose weight. There’s much better ways to make clever little jokes about diabetes and I’m getting tired of people being lazy in their comedy by continuing to be misinformed.

Maybe all of this is a signal to me that it’s time to take the trashy podcasts out of my rotation…