Drinking With Diabetes: Answers to the Questions No One Wants to Ask

Ah, alcohol.  One of the most hotly debated illicit substances in American history.  Growing up in a society where the drinking age is regulated legally but not enforced socially puts individuals, namely adolescents/teens, in a tough spot.  Many young people feel uncomfortable or guilty discussing underage drinking openly with their parents.  This is dependent of course on the parent-child relationship, and how the person was raised.  Maybe your parent/parents are accepting of drinking as long as you do it responsibly.  Maybe they hammered it into your head that it was not to be touched until age 21. Whether you fall into either of these two categories, or even if you are overseas where underage drinking (and drinking in general) is less taboo, one thing is for certain: if you are living with type 1 diabetes, you must tread carefully when it comes to alcohol.

While it's not impossible, drinking with diabetes is infinitely complicated.  It requires careful experimentation and constant monitoring.  Every body is different, therefore there is no cookie-cutter method for safe drinking.  However, some truths are applicable to most drinks and all PWD.

Bottoming out is very common.

Whether it's the next morning or an hour after your first drink, bottoming out typically happens after a night of drinking.  For me, a night of wine leads to all-night high blood sugars, then a drop after breakfast the next morning.  A night of vodka-cranberry leads to an evening of very high blood sugars, then a drop just before bed or in the middle of the night.  This can obviously be a risky situation, especially if you do not feel your lows at night.  Generally I try to air on the side of caution; keeping my levels higher and giving half-corrections.  Cautious experimentation should be had to figure out how certain drinks affect you.  In moderation, I've found beer to be the most steady course.  Typically if I give little bits of insulin for each beer, my blood sugars stay in the 200s and don't bottom out--unless I over-bolus, whether for the beer itself or for food consumed during drinking.

Snack often.

No one should drink on an empty stomach, but the risk of bottoming out runs extra high with type 1 diabetes.  When I was an infant, the diabetes educator who came to my house told my parents (because yes, they did ask about drinking even back then, as I've found many parents do) that he would snack on peanuts while drinking.  Of course, you don't want to make yourself sick by overeating.  Shy away from extra sweet sweets--not only will they make your hangover worse, they'll spike your blood sugar and make the regulatory process even more complicated.  But snacking on a bag of chips or even grabbing a late night slice of pizza can be good for soaking up some of that alcohol and keeping your sugar steady overnight.

Test often.

There's no piece of advice that I could give that is more simple or more important.  Test often.  Test every hour. At the very, very least, test before you go to bed.  The bottom line is, your judgement is impaired.  You cannot feel your highs or lows as well.  So test.  It's better to know where you're at than to be floating in BG-alcohol outer space; a complete mystery to yourself and others.  Especially test if you're vomiting.  Medical professionals typically suggest that if you're vomiting from drinking and have type 1 diabetes, you should immediately go to the ER.  This is a loaded judgement call.  But it's always better to be safe than sorry.  So again, at the very least, TEST.

Keep your eyes open.

This is another piece of advice I would give to all who are drinking, especially when you are in a new place or with unfamiliar people.  It's a good idea to have at least one buddy with you who knows that you are diabetic, and what diabetic means, if you plan on getting hammered.  However, no matter what excellent support system you surround yourself with, no one knows your body as well as you.  Therefore it's in your (and your diabetes') best in interest to keep your eyes open.  We all know how scary it is to not be in control of our bodies.  Blacking out or passing out from drinking wipes out your ability to consciously respond to your blood sugar.  Being outside of the locus of control both physically and cognitively is a dangerous place to be.

Above all, the general rules for drinking with diabetes are very similar to the rules for drinking without it:  be smart, be safe, and experiment cautiously.  If you're a parent, foster communication between yourself and your child.  Let them know it is okay to ask questions about drinking.  Zero communication means they may be more defiant, or go in completely blind.

Why CrossFit Needs to Stop What They're Doing and Educate Themselves

By now I'm sure many of you have read about CrossFit's recent tweet regarding Coca-Cola and diabetes, whether you saw it on Twitter or read about Nick Jonas' response in the Hollywood blogs. If you haven't been so blessed as to see this perfect example of illness-shaming and ignorance, fear not, I have attached a picture.

The tweet reads, "Make sure you pour some out for your dead homies," and is attached to a picture of Coke with the slogan "open diabetes." Now, there are many things wrong with this tweet, as I'm sure most of you with common sense know. However, CrossFit seems to need it spelled out for them, judging by their further ignorant replies to the T1D community's outrage (see below). So I have taken the time out of my busy day to help these folks out.

1. "Pour some out for your dead homies." Over here in America, we are making great strides. Marriage equality has finally been legalized. Feminism is speaking out against slut-shaming. We attempt to continue the fight for human rights as the years go by. So why are we still thinking it's acceptable to illness-shame people? CrossFit, I'm sorry you think that we are "sensitive," but I would call seeing this tweet after losing a mom, dad, friend, or whomever and being devastated & insulted "being human." We do not insult the dead who succumbed to lung cancer after smoking. We do not insult those who were victims of sexual assault and say "they had it coming--" so WHY are we still making these comments regarding diabetes?

2. "Anyone can get T2 diabetes, even those with T1." Let me get this straight. Are you saying that those who have type 1, a disease in which your pancreas irreversibly stops producing insulin altogether, can develop type 2, a disease in which your pancreas slows down insulin production and can in most cases be reversed with diet and exercise? Maybe I didn't pay attention in science class or at my 934 doctors appointments since I was 13 months old, but that doesn't make much sense to me.

CrossFit, it's time to recognize that you have made a grave mistake in your marketing strategy. It's time to stop making illegitimate excuses and apologize. Or, if nothing else, it's time to EDUCATE YOURSELVES.

When Diabetics Unite

I recently had the pleasure of working with Joe Griffiths, content writer for Voucher Codes Pro who put together a spectacular compendium for diabetics and diabetic support. You can find my snippet along with others & links for great resources, blogs, and help sites here! If you click around you'll also find other useful info that Joe's put together such as hypo/hyper info, diabetes misconceptions, and the works.

What's so great about projects like these is that they tie together people with diabetes from all around the globe. The diabetic online community (DOC) has brought together so many people that if you ever feel alone, someone half a world away can be there in an instant for support. Just knowing that so many people with diabetes are out there besides you is reassuring enough. But the DOC goes beyond that. It provides tips, how-to's and life hacks--and an endless amount of them.

So start clicking, start sharing, and start supporting---spread the D-Love! :)

Autoimmune Diseases: Definition of RUDE

"Love yourself." It's what we're taught in school, what we're taught at home, what we're told (hopefully) by our parents. But how are you supposed to love yourself when your own body is attacking you? It turns the millions of people suffering from autoimmune disorders into moving, breathing paradoxes. We try every day to love ourselves the way we are; meanwhile on the inside our bodies have wreaked havoc on our healthy, helpful cells that were just trying to do their job. How rude.

Let's start with diabetes. There I was, a little chunky happy baby with parents who cared for me and a big brother to look after me. And then my insulin-producing beta cells started to get picked on by my other cells. My other cells, who are supposed to be keeping me happy and healthy, were killing my happy healthy beta cells until none were left to make any insulin. If you ask me, these cells sound like big fat bullies.

As if these cells hadn't had enough, more of them kept bullying my healthy cells--this time in my thyroid. Until, you guessed it, my poor thyroid cells couldn't produce enough hormones either. I am not even two years old yet and my body has already decided that for some reason it does not like itself.

But, what can we do? As much as our cells might be hating on us and our bodily systems inflecting little insults here and there (an overactive HPA axis, an underactive production of growth hormone) we can still dwell on who we are as people. We can try to "love ourselves." Even though our innards are rude and self-deprecating.

**Disclaimer: If you could not tell from this post, I am not a medical doctor and my allusions and references should not be taken as scientific evidence**

The Complication That Nobody's Talking About

Part of the job of being diabetic is being bombarded with unpleasant information.  Commercials, pamphlets, homework, ignorant strangers--they all love to chime in and pester us with the statistics of diabetes complications. Since about 4th grade I've learned to keep only one ear open. You can only hear such facts so many times before you start to really panic. But each time a new one arose, I was educated on it, talked about it, then tucked it away in a neat little box in the back of my mind.

However, there is a certain complication that I never heard about on TV.  I never was informed about it in the doctor's office. I never had an ignorant stranger tell me an incorrect fact about it (sadly). In fact, I didn't even know that it was a statistically significant, existent, real complication until my college years. Although my common sense had brought me to the conclusion quite awhile before.

People with diabetes are approximately twice as likely to develop depression or anxiety than people without. This can be said of many other chronic illnesses and disabilities. While this complication was not out in the open to me until young adulthood, the more time I spend with the knowledge, the more sense it makes. Diabetes is a constant weight on the back of your mind. No matter how well-adjusted you are, no matter how brave, you constantly have the pull of it slowing you down.  You have to think ten steps ahead: will I go to the gym today? Should I not give insulin for this snack? Do I take my pump off now? What if the gym is then closed? What if?

There is such a great deal of subconscious what-iffing in diabetes that it now seems strange to me that someone wouldn't develop depression or anxiety. "What-ifs" are such a major component of anxiety disorders in particular--so what can be expected to happen when they are so deeply ingrained in your daily life? As people with diabetes we constantly have a weight attached to us. And if we don't, we run the risk of damaging our bodies. The constant nagging thought at the back of our mind is bigger than homework, bigger than relationships, bigger than work. It is our survival.

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Of course this isn't to say that people with diabetes are doomed to live a life plagued by melancholy and worry. It merely means that we are more susceptible to another complication--one that we need to start talking about. We need to start talking about it because once it is out in the open, once we deal with it, we can not only live with it but thrive. I read a snippet the other day from someone stating that depending on the way you look at it, mental illness can be seen not as a demon, but as a superpower. We can use it to our advantage. It makes us more resilient. More empathic.

But that's only if we don't ignore it.

On the Sunny Side

I think it's important every so often to mix in blogs that don't totally revolve around diabetes, medicine, or anything dreary or sad. This is especially important now that I am a full-time MSW student and am learning many distressing (albeit, fascinating) new things. My mom always asks me why I don't have any happy stories to tell.

But this is a happy story! It's also what will be occupying my teeny tiny spring break. No, it's not Cancun or Cabo or even Miami. But it IS my 2015 BOOK CHALLENGE. I know, exciting.

Let me tell you what I love about books.  Besides teleporting you away to another world where you don't have to worry about anything or anyone, they also make you smarter.  They say the best way to improve your writing is to read.  And it's true.  Whenever I read a particularly good book, I have a burning desire to write for weeks after.  Books are a distraction.  They give us a break from school, from diabetes, from stress, from everything.  They are a way to keep fantasy and imagination an active part of our lives.

You learn new things when you read books. Tiny little tidbits of information that may or may not be useful to you, but it doesn't matter because you can feel your brain growing.  What I like about finding a good book challenge is that there are books from all different categories on it. For example, my first book (one with nonhuman characters) was Call of the Wild, a fiction novel written from the point of view of a dog; and my second (one you were supposed to read in school but didn't) is Is There No Place on Earth for Me?, a nonfiction work written by a journalist accounting for the life of a woman with severe, treatment-resistant schizophrenia. You never know what you are going to learn next, or what wonderful quotes you're going to stumble upon.

So if you're looking for a new hobby or something to do in your spare time, try a book.  Even if it's ten minutes before you fall asleep each night. You never know what you might find.

Some of Kristi's Favorite Writers

• John Green
• JK Rowling
• Paulo Coelho
• Dr. Seuss
• F. Scott Fitzgerald

         

The Monster Under the Bed

It is a thief in the night.  The monster under the bed. The lingering thought in the back of your mind that sticks from when you are brushing your teeth, through your dreams and nightmares, and into the early morning. Will I go low tonight? Will I wake up in a cold sweat dying for cupcakes and ice cream? Is my meter near my bed? Is there juice near my bed?

Nighttime low blood sugar isn't the most pleasant of things to talk about, but it's something that has really be gnawing at my restful sleep the past couple of nights. I am fortunate enough (knock on wood) to wake up when my blood sugar goes low. However, this typically is never a pleasant experience.  When I was young, I would sit straight up in my bed and call for my mom until she came and fed me juice and wiped away the cold sweat that had accumulated all over my face.  Now, I half-wake, toss and turn, mumble to myself, and have a strange internal conversation until I finally roll over and grab my meter:

"Get up. Open your eyes. You are low."

"No."

"Just roll over. Just test and you can go back to sleep."

"No. Too tired. Too asleep."

"I SAID GET UP."

I'm not quite sure why this conversation happens and why I don't just sit up and test. Is it sleep deprivation? Is it my subconscious trying to be in denial of my diabetes need? Either way, it scares me when I wake up and find that I am in fact low. Why was I trying to stay asleep? Which leads me to further worry about those who do not wake up when they feel low. Thankfully, modern medicine has come a long way and many sensors can now stop incoming insulin when they read a low blood sugar.

However, this doesn't make nighttime hypoglycemia any less stressful, both for parents and for those with type 1. It is a haunting that we have to learn to cope with. And it doesn't exactly do wonders for one's psychological well-being. Things such as nighttime lows remind me why those with type 1 diabetes are much more susceptible to depression and anxiety. And that's okay. It is something we have to talk about, and something we have to deal with. Much like our blood sugar levels. It's all part of the job.

When Homework Hurts (More Than Usual)

Do any of us like homework? The answers will vary. Some of us do. Some don't. But no one likes doing homework when the material is thirty pages of reading about how diabetes is one of the primary causes of kidney failure.  Or an hour long documentary on retinopathy in which the narrator never specifies between type 1 and type 2.  Or that blindness and retina damage more than likely occur only when diabetes has been poorly managed/uncontrolled for an extended period of time. What a Debby Downer.

All diabetics encounter this problem at some point in their lives.  The commercials that ask, "Are you diabetic? If so enjoy your future with heart disease!"  The ignorant strangers who immediately counter you with "Oh! My grandpa died from that."  Do we get used to it? I guess. Do we like it? No. Would we like it to change? Yes. We're WAITING, everyone.

Now I'm not saying that we should be forever sheltered from the frightening statistics in our homework, especially those brave souls who decided to attend school and take classes specifically in the medical field.  What I am hoping for is more detail. More specification between type 1 and type 2.  More specification between the end result of adhering to your diabetes care and not adhering. And more consideration for those who don't have the means for this care. No disease or disorder should be thrown into the blame game.

I recently was doing some volunteer work, during which my old endocrinologist stated that there is no reason why a newly diagnosed baby girl couldn't live a healthy life until she was an old gray-haired lady, much like the doctors who diagnosed me told my parents.  She also said that complications more commonly result from type 2 diabetes, and that many of the complications we are seeing today are the result of the lack of advanced care there was when the elderly today were diagnosed.  And I thought, can someone tell my professors this?  Can someone inform the media???

I understand that I have to do my homework. I understand that when the topic of the week is end stage renal failure, diabetes will be mentioned.  But that doesn't change the way it makes me feel when I read it.

A Backpack Full of Boulders

Grad school is hard.

I knew this going in.  Especially entering a field as intensive as social work.  You've got your homework. You've got your field work. You've got your homework for your field work. Classes. Commuting.  Commuting with a broken CD player while the same 5 songs play on the radio. Your part-time job.  But all of this is in addition to the heaviest work of all--your diabetes.

Having diabetes for so long, I hardly think twice before starting on an endeavor about how it will affect me.  I just assume that it will fall into stride and I will figure it out as I go along. However, this isn't always as easy as it sounds.  Driving home from central to north Jersey at 9pm is annoying at best, but when your blood sugar has been running low all day and you don't know why, it becomes downright aggravating and even dangerous.  Without a sensor I am constantly wondering if my blood sugar is going to drop while I am driving, so I test like I nut before and during.  And the last thing I want to do is wait 15-20 minutes to make my hour drive home, when I have to wake up at 6am the next day for field work.

On one of these late drives home, I was thinking about how tough grad school felt. I'm typically a good student, and I love social work and love what I'm doing. So why did I feel like I was crawling through the mud by the end of the week?

It slowly dawned on me that going into grad school, I already had a heavy load.  I pictured a backpack stuffed with rocks, with straps that were sutured into my shoulders. Sometimes we forget about how heavy diabetes and other things can be, and how when we start a journey, we can't take the backpack off to lighten our load.  We just have to adjust to the extra weight. Maybe do some squats. Or whatever the mental equivalent of squats is, to strengthen ourselves. 

Spare A Rose

Ah, Valentine's Day. Is there any other day quite as simultaneously loved and hated by so many? I think not. But instead of whining about being single or getting gross and googly-eyed over your significant other, here's a better idea: Spare a Rose, Save a Child.

The big picture behind this program is much more than just sacrificing roses--and it will last much longer than the end of February.  By taking the money you would spend on a rose for your significant other and donating it to Spare a Rose, you provide an entire month of life for a child with diabetes.  One rose = $5 = one month of medical supplies.  One dozen roses = $60 = a year of medical supplies.  These supplies will save the lives of children who cannot otherwise afford medical care for their diabetes.  It also spreads awareness about the gross inequality experienced around the globe when it comes to living with type 1.

Many organizations have been sprouting up for causes like these, which I think is great.  Until very recently I was not even aware of how little care those in third world countries receive for diabetes.  The diagnosis is essentially a death sentence.  But programs like Save a Rose are working to change this.  I even discovered a foundation through which you can donate medical supplies directly to those in need.

One of the things I have discovered both through my personal journey and through my education in social work is that giving back to others has significant emotional and psychosocial benefits for those who are giving, not just for those who are receiving.  So this Valentine's Day, consider giving up that bouquet of roses for your boo (let's face it, they're gonna wilt anyway). Consider giving up that 20 oz bag of chocolates you were gonna buy for yourself.  And consider giving life instead.

What the heck is coffee doing to my diabetes ??

There are few things I enjoy more in this world than a good cup of coffee. In fact, without my two morning cups I cannot leave the house. Or socialize. Or smile really. But my question is, why does coffee seem to wreak havoc on my blood sugars? Am I alone here?

To shed a little light on the troubles I've been having with my beloved, let me break it down for you:

Morning Lows

The morning lows came first. While I was on winter break, I did a lot of BG monitoring and rate testing. In the mornings, I started measuring out my cereal and Trop 50 to a T and testing my BG two hours after breakfast. I ended up having to up my ratio and lower my basal rate--but it still wasn't enough. I still was going low two hours after lunch. At this point I was covering for about 15 carbs for my morning coffee because of the creamer that I use.  Several mornings of dizziness and agitation later, I decided to try not covering for my coffee.  And poof! the lows went away.

Morning Highs

After I stopped covering for my morning coffee, I thought my morning levels were taken care of. However, once I started up school again, things changed. I started out my morning as usual--measured out my breakfast, gave my insulin according to my new ratio, and gave no insulin for my morning coffee. But alas, two hours later, I found myself in the mid-300s--very confused and very annoyed.  This continued to happen to the point that now I cover for 15 carbs again for coffee. I have been doing okay but why the sudden switch? And why on occasional mornings do I find myself going low two hours after breakfast?

Runnin' on Dunkin'

Further complicating the coffee issue, I began to do some investigative research on my beloved Dunkin' Donuts. I then discovered that the pumpkin flavored coffee I have fallen in love with has much more sugar than hazelnut or french vanilla. So I made the switch to hazelnut and have gotten mixed results--sometimes I go low after giving 1 unit of insulin for a medium, and sometimes I am perfectly fine with no insulin at all for one.  I have found that a unit and a half (my ratio is 11 in the morning and 9 during the day) is usually consistently good for a medium pumpkin on the days that I treat myself.

I have considered the possibility that some mornings I am more tired than others, and some I am more anxious than others--something that may affect the way my body reacts to coffee.  I also know that coffee can sometimes affect your adrenaline levels, which can in turn affect your blood sugar. But it is proving to be a slippery slope to navigate!