In a break from my usual postings, this one is a stream of consciousness diatribe on my person experiences. Please indulge my musings since I’m nearing the half-century mark of living (well) with type 1 diabetes.
I got diabetes back in the Dark Ages (1968) of its treatment. The only feedback I had on my blood glucose levels was testing my urine, which was several hours behind my actual levels and no reflection on my immediate levels. I never had a number to go with a bright orange (4+) reading of my urine–meaning that I was at the high end of the scale for glucose in my urine–but it did give me a lot of negative reinforcement. It told me that I was “bad” or “not in control” or an unlovable kid–or something along those lines. In other words, it was worthless and only made me feel bad about myself and my diabetes as I grew older. I was convinced that I was going to die from diabetes complications before graduating from high school.
Getting a blood glucose meter when I was in my early 20’s–after 18 years of diabetes without there being any to measure it–was both eye-opening and terrifying. I actually had to go through the emotional stages of dealing with a chronic disease. I realized that I had likely been running in the 200s most of the time (despite taking my insulin as prescribed and following a “diabetes diet”). No more head in the sand! I had diabetes for good and had to deal emotionally with having it. Getting it as young as I did (age of four) and then not having the tools to manage it had effectively allowed me to avoid all of that before.
Once I got a meter, I religiously kept a log of everything affecting me and my blood glucose–food, insulin dosing, exercise, stress, lack of sleep–until I had a handle on how my body reacted to almost everything. In fact, I wrote down everything for over 25 years! Doing that, along with getting a PhD in exercise physiology and teaching nutrition for 19 years at the college level, gave me a greater understanding of how complex our bodily systems are when it comes to keeping blood glucose levels at optimal levels using suboptimal methods (insulin delivery through the skin instead of from the pancreas being the worst barrier of them all). Many of these methodological shortcomings of managing type 1 diabetes are still in play today.
I look forward to meeting the milestone of living for half a century with type 1 diabetes soon and getting my 50-year medals from Joslin and Lilly for doing so. It’s an accomplishment that is worth bragging about–even though I’m fine with living with diabetes at this point in my life. It would be nice to have a cure, but I’m okay with it either way. I live life to the fullest and focus on the important things in life. Because diabetes is largely responsible for teaching me to do that, having it has really been more of a blessing than anything else.
You finally decide to get active to help manage your type 1 or type 2 diabetes better or to prevent type 2 altogether, and once you’ve hit your stride, you get an injury that puts you back on the couch! Getting injured from being active happens often enough that you need to know how to prevent and treat injuries so you can stay on track. The best medicine is prevention, so trying to prevent injuries before they happen is the best way to avoid having to take time off from exercising and sidetracking your fitness program. Here are some things you need to know:
The incidence of activity-related injuries, such as inflamed tendons (tendinitis) and stress fractures in bones, rises dramatically when people do more than 60 to 90 minutes of moderate or hard exercise daily. These types of overuse injury are nagging and persistently uncomfortable. Overuse injuries occur following excessive use the same joints and muscle in a similar way over an extended period of weeks or months. If you develop an overuse injury, it’s likely to be the result of excessive training, or doing too much too soon. In my own experience (since I’ve been regularly active for decades), they can also arise from doing something unusual, such as putting down a paver driveway, beating the yard into submission, or cleaning excessively prior to putting the house on the market.
Overuse injuries are more common in anyone with diabetes because elevated blood glucose can affect the health of your joints. Although everyone gets stiffer with age, diabetes accelerates the usual loss of flexibility especially when blood glucose is higher. Glucose “sticking” to joint surfaces makes people with diabetes more prone to overuse injuries like tendinitis and frozen shoulder (1; 2). It may also take longer for joint injuries to heal properly. The bones themselves can be thinned by exposure to elevated blood glucose levels, making fractures more common in people with any type of diabetes (3). The best prevention of any of these issues is optimal blood glucose control and regular stretching to maintain motion around joints.
You’ll likely benefit from doing a variety of activities on a weekly basis, an approach known as cross-training. Changing up your workouts is really they key to avoiding overuse injuries, keeping exercise fresh and fun, and getting more fit. Each activity a person does stresses muscles and joints differently, which lowers the risk of injury. It adds variety to an exercise program when you include activities like walking, cycling, rowing, swimming, arm biking, weight training, aerobic classes, and yoga, and it gives you the flexibility to choose different options based on your time constraints, the weather, and other factors. It also allows you to rest some muscles and joints without stopping exercising entirely. Alternating hard and easy days to lower the constant stress on muscles and joints is also a great idea.
To prevent overuse injuries, progress your exercise slowly (particularly the intensity), choose safe activities for you personally, always warm up and cool down, and make sure that you stretch your muscles regularly to stay more limber. For ongoing problems, treat affected areas with R.I.C.E. (rest, ice, compression, and elevation), combined with anti-inflammatory medications like ibuprofen (Advil or Nuprin) or naproxen sodium (found in Aleve), and avoid going back to normal activities or aggravating joints further until your symptoms resolve.
Finally, taking at least one day a week off from planned activities to rest allows your body time to recuperate and may prevent overuse injuries like tendinitis and stress fractures. It doesn’t mean that you have to stop moving, though, so keep your bodies in motion even on your days off for optimal blood glucose control.
1. Abate M, Schiavone C, Pelotti P, Salini V: Limited joint mobility in diabetes and ageing: recent advances in pathogenesis and therapy. Int J Immunopathol Pharmacol 2011;23:997-1003
2. Ranger TA, Wong AM, Cook JL, Gaida JE: Is there an association between tendinopathy and diabetes mellitus? A systematic review with meta-analysis. Br J Sports Med 2015;
3. McCabe L, Zhang J, Raehtz S: Understanding the skeletal pathology of type 1 and 2 diabetes mellitus. Crit Rev Eukaryot Gene Expr 2011;21:187-206
Ever go to a fitness facility in January and then back in April? The difference in the number of people working out is tremendously fewer, even just a few months after most of them were all gung-ho about getting into shape in the new year. Why does this happen?
The most common reasons why people start and stop an exercise program are well documented: 1) a perceived lack of time, 2) exercise-related injuries, and 3) exercise is not fun (which often is due to starting at an exercise intensity that is too high for their fitness level). Lack of time (perceived or real) is likely the biggest stumbling block for people trying to adopt a new exercise regimen. You can overcome this barrier by deciding to stop thinking of exercise as a planned activity and instead try to move more throughout the day. You’ll be amazed at how much more active you will become and how little time you have to sacrifice to do it. Any movement you do increases the amount of energy that you expend in a day.
In fact, for most people, the majority of their calorie use during the day comes from unstructured activities rather than from a formal exercise plan. Just standing up for two hours a day more can expend upwards of 350 calories daily and may be the difference between remaining lean and gaining excess body weight.
To avoid becoming demotivated to exercise, try these strategies:
- Fit exercise in whenever you can, even if it’s just for 10 minutes at a time
- Schedule exercise time into your daily lives (and keep to that schedule)
- Avoid getting injured by starting out at an appropriate exercise level (not too long or hard) and progressing slowly
- Include stretching to help prevent injuries and balance exercises to prevent falls
- Pick activities that you actually enjoy doing (like dancing) and do those to stay more engaged and motivated to be active
- Keep your body in motion all day long in any way possible
Did you know that one of the top secrets of people living long and well with any type of diabetes is that they “erase” their blood sugar mistakes with exercise? Why does this work? It’s simple, really. Although your muscles account for only about 40 percent of your body weight, they can take up 80 percent of any glucose load that you get through your carbohydrate intake. Thus, by enhancing your muscles’ capacity to take up glucose with or without insulin, exercise comes closer than anything else to “erasing” your mistakes with your food, insulin, or other medications that lead to hyperglycemia. For example, people can eat more carbohydrate and process it more effectively following hard or prolonged workouts, but usually not at other times.
Much of this effect also is due to the action of insulin in your body following physical activity. When your insulin works better, you need less of it to have the same or even a greater glucose-lowering effect. The greatest enhancement in insulin action occurs in the few hours following exercise when your muscle glycogen is most depleted and requires replenishment. During this time, you will likely need considerably less insulin to process any carbohydrates that you eat, and you can get away with eating more carbs after exercise, particularly if it was strenuous and prolonged.
What are some of their other secrets to success with diabetes? They run the gamut of emotional, knowledge, control, dietary, other exercise, medication and technology, carry a toothbrush? For what purpose, you ask? To brush your teeth after eating to keep yourself from being tempted to eat more, of course. Actually, it’s actually a very good suggestion. It works well in the evenings, too, after you’ve finished your dinner. If you go ahead and brush your teeth soon after your meal is done, you should feel somewhat inhibited from eating dessert or snacking more afterwards.
There is likely an even more important reason to follow this advice: people with diabetes are more likely to develop periodontal (gum) disease, and good oral hygiene can help prevent problems. While poor oral hygiene is a factor in gum disease for everyone, having diabetes accelerates the process and can lead to tooth loss. Poor circulation and high glucose levels in saliva also promote the growth of bacteria residing on teeth and gums and plaque formation, which has actually been linked to a higher incidence of heart disease and strokes. The likely link is that oral bacteria can aggregate in the mouth, enter the bloodstream, and then attach to plaque developing in your coronary arteries, thus contributing to arterial plaque formation (not just plaque on your teeth). Periodontal disease also increases a potent clotting agent in the bloodstream called fibrinogen, which increases your chances of getting a blood clot that may cause a heart attack or stroke.
To cut down on plaque formation and excessive bacteria on your teeth (and gums), it is recommended that you brush your teeth at least twice daily and floss between them once a day. However, toothbrush trauma can cause gum recession, so learn how to brush correctly and always use a soft toothbrush. Also, don’t smoke as any type of smoking accelerates the progression of gum disease, as well as heart disease.
You can learn a lot from the inspirational individuals living with diabetes profiled in my book, 50 Secrets of the Longest Living People with Diabetes. In particular, the secrets given by the two Cleveland brothers from Syracuse, New York (Bob, living with diabetes since 1924, and Gerald, since 1932), sum up everything that you really need to focus on to live long and well with diabetes. First of all, both of them placed physical activity as number one on their list of their top secrets to longevity (as did many other old-timers).
The Clevelands’ second suggestion relates to monitoring of blood sugars, with their individual advice being to “be aware of what you’re doing” (Gerald) and to “keep a constant check on your blood glucose situation” (Bob). Doing so requires frequent blood glucose checks, along with vigilance about intake of carbs, fat, salt, and more that can affect your blood sugar.
Their third secret involves your emotional state and outlook on life. Bob advises everyone to “live a good, clean life,” replete with plenty of outdoor activities, a healthy diet, and a stable lifelong relationship. Gerald’s comments are that he’s “had a terrific life,” and he makes this comment in spite of having had to deal with diabetes for 76 years, longer than most people live. Both looking for the silver lining in any situation and appreciating what you do have appear to be keys to maintaining a positive outlook on life.
Finally, they both credit their longevity equally to their mother’s diligent care when they were younger and to advances in diabetes management over the past three-quarters of a century. “I marvel at being able to find out what my blood sugar is in only five seconds. There certainly have been great advances in diabetes care over the past 80 years!” says younger brother Bob. As Gerald says, “Have faith that the best things in life are ahead of you.”
As for the rest of the old-timers living with diabetes for 40 or more years, their secrets most frequently emphasized the following items as being what they consider to be most important to their longevity with diabetes:
- Maintaining a positive attitude about diabetes and life in general
- Setting goals, particularly ones that are focused on having good health habits
- Learning all you can about diabetes and how to control it and its potential complications
- Having a supportive spouse, family, or friends and involving other people in your diabetes care
- Sharing your diabetes with others or counseling them on how to live well with it
- Regularly monitoring your blood glucose levels
- Finding a good doctor, preferably an endocrinologist
- Always taking your insulin or other medications to control your blood sugars
- Watching your diet (whatever it may be)
- Exercising and staying as physically active as possible
Although none of these secrets is actually earth-shattering, taken as a whole, they do strongly suggest that certain behaviors are more important than others. Moreover, they emphasize the point that what people have to do to live long and well with diabetes is possible for anyone. Yes, you too can live a long and healthy life with diabetes. If your diabetes has not been that well controlled up to this point, it’s still not too late to start reaping some of the health benefits of improving your control now. You may even be able to slow the progression of or reverse some of your complications with a little more diligence to your blood sugars.
Diabetes care is rapidly changing nowadays, and there are new monitoring tools and medications to better control glycemic peaks and valleys. Most of the people who gave their secrets for my book have gone through a significant portion of their lives with diabetes without all of these tools, or even adequate education, available, so think how much better you should be able to manage by having all of them at your disposal.
I had to wait more than half my life to overcome the only thing I had never been allowed to do with type 1 diabetes…but I finally prevailed.
You can do almost everything you want to with diabetes. One blaring exception is scuba diving through any NAUI (National Association of Underwater Instructors) organization.
My story is that when I was a graduate student back in 1987, I signed up at the University of California, Davis for a scuba diving certification course. I didn’t know about NAUI or much of anything scuba-related, but got a rude awakening when I was booted out of the class after having a required physical exam and admitting that I had type 1 diabetes. I was devastated. Despite having had diabetes since the age of four, I had never let it stand in my way of reaching my goals (even though I didn’t have a blood glucose meter back then).
So, I went with the UC Davis scuba class to Lake Tahoe and waited lakeside while everyone else in the class got to dive. I guess I was just a glutton for punishment!
What I didn’t know at the time was that the other primary scuba diving organization (PADI, the Professional Association of Diving Instructors) lets people with type 1 diabetes dive, and thousands of individuals with diabetes have dived safely over the years. The Divers Alert Network (DAN) has also advised people with diabetes about staying safe while diving, and many of their recommendations are based on the extensive experience with diving with adults with type 1 diabetes amassed by Steve Prosterman, a diving instructor at the University of the Virgin Islands (who also happens to have type 1 diabetes).
I met Steve at a diabetic athletes’ meeting I attended back in 1990, and after hearing my story, he graciously invited me to come to UVI anytime to learn how to dive with him. I waited 27 years to take him up on his offer, but I finally fulfilled my almost lifelong dream of going scuba diving–on my 50th birthday! It was the best way I could have ever celebrated a half-century of life and almost 46 years living with type 1 diabetes. Thank you, Steve, for helping me make my dream come true!
Sheri, 1; type 1 diabetes and NAUI, 0. Finally!!
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