Chapter 1 For ‘Betes Sake!

I should tell you, before you even begin reading this book, that it doesn’ t bother me whether someone calls me a “ person with diabetes” or a “ diabetic.” It’ s all the same in my opinion. I’m Ginger. I have blue eyes, freckles, and curly hair. I have never, in my entire life, enjoyed anything about mathematics. I have an inappropriately loud cackle. I drive too fast. And I have diabetes. Diabetes is a huge part of my life and your life, and we could probably fill a 500-page book with how much this disease impacts the thoughts and emotions in our heads. That is not this book. (But yes, I want to write that one next.)

This is a book for people with Type 1 and Type 2 diabetes who want to find more control over their disease, and perhaps even feel empowered by it. Yes, I mean empowered by diabetes, because while we can’ t control every single blood sugar fluctuation, we can learn more about why those blood sugar fluctuations happen, and why our insulin needs change over time. I have found that the more I understand the actual science behind what’ s going on in my body, the less frustrated I am, because I have clear understanding of what is in my control, and what is not.

Through developing a greater understanding of how your body works and what it needs, you will gain more control over this disease instead of feeling like this disease controls you. You won’ t feel like you’ re trapped on that blood sugar rollercoaster. And most importantly, even when your blood sugars aren’ t perfect, you will step back and think about the situation intellectually, instead of responding emotionally.

If you’ re reading this book, you want to learn about your body and your disease. Instead of feeling guilty or frustrated when you see a high blood sugar reading on your meter, you are ready to look at the number and ask, “ Why did this happen? How can I prevent this from happening again?” You want to understand why it’ s high, or low, or “ perfect,” and what you can do next time to prevent unwanted fluctuations in your blood sugar.

The hardest part about living with diabetes is often balancing life around that rollercoaster of blood sugar readings. The rollercoaster, though, implies that sometimes you’ re getting too much insulin and sometimes you’ re not getting enough insulin. But there is a reason behind every number and you are capable of understanding those reasons.

This book is for people with diabetes who refuse to let this disease loom over their life like a dark cloud. This book is for people who don’ t want to waste any more time feeling pissed off and angry. This book is for people who want to take full responsibility of their diabetes and live the healthiest and happiest life they can live.

You’re already moving in the right direction!

This disease is hard work. Every day. In order to find more balance in your life as a diabetic, your goal does not have to be “ diabetic perfection,” but instead to be constantly making progress. You and your relationship with diabetes is a work in progress.

It’ s one thing to want to learn more about your diabetes, but it’ s an entirely different level of proactive courage to actually make the time and take the action to learn more. If you want to be more in control of your diabetes and you’ re actually sitting down with this book, you’ re

accomplishing one of the hardest steps. From here, it’ s all about having patience while you continue to learn.

Balancing life around this disease, both Type 1 and Type 2, is about much more than just “ avoiding sugar,” taking shots and swallowing pills.

Diabetes has to be balanced around everything!

Every time you eat. Every time you go to sleep. Every time you run or play basketball or take a long walk. Every time you take a long exam or spend all night preparing a presentation for work. While you’ re at work. While you’ re at school. While you’ re out to dinner with your friends and your family. Chinese food. Birthday cakes. Frat parties. Holiday parties. Everything and everywhere—diabetes is along for the ride.

Diabetes can interfere with such seemingly ordinary things that we deal with every day: When your blood sugar is low in the middle of the night, you can’ t sleep, then you treat it, then you’ re exhausted, but you’ ve got to be up and ready for work at 6 a.m. You wake up with a splitting headache, and no energy...but life must go on.

When you’ re in the middle of an algebra exam and your blood sugar drops, you can’ t focus, you have to stop and get some juice, and it won’ t be for another thirty minutes before you even start to feel better. Let’ s hope you were almost done with that algebra exam.

When you’ re in the middle of your workday, your blood sugar is over 250 mg/dL and you feel so sluggish and you can’ t think straight. You just want to lie down, but you’ re scheduled in meetings all afternoon, and you’ re just hoping you can hide how lousy you feel until your blood sugar drops back down to normal.

When you’ re trying to exercise every day, but your blood sugar is high while you’ re working out, then low three hours after you’ re done, and the mere idea of enduring that blood sugar rollercoaster again when you try to exercise tomorrow is exhausting!

But here you are, reading a book that is designed to give you more tools and knowledge to work your way around those parts of the day and those unexpected fluctuations in your blood sugar. A book designed to help you understand and prevent those fluctuations.

Now, if you’ re ready to give it your best effort, let’ s take a minute to make sure we’ re all clear on what it really means when your body has been diagnosed with diabetes.

Let’s clear this up: What is Diabetes?

For a moment, imagine that your body is actually a pizza delivery restaurant. I know this sounds ridiculous, but please bear with me.

You are the owner and you decide how many pizzas will be made each day. The pizzas you bake make money and keep your restaurant running smoothly. When the pizzas are done baking, you put those pizzas in boxes, and they are ready to be picked up by a delivery boy and driven to other areas of town. The people receiving those pizzas are now able to eat and use the energy from their meal to get all of their own work done so their lives can run smoothly, too.

The restaurant is your body. The pizza your restaurant bakes is the food you eat. The pizza being put into boxes represents the food you’ ve eaten entering your bloodstream in the form of glucose or sugar. Your delivery boys are the insulin that your body still makes if you are not diabetic or used to make if you are presently diabetic. They deliver the pizzas just as your body relies on

insulin to carry the glucose in your blood throughout your entire body, wherever it needs to go, just as delivery boys drive pizzas to the hungry people in town. When people eat the pizza for energy, this is just like the many parts of your body getting energy from the insulin carrying the glucose.

As a pizza delivery restaurant owner, you know that you need ten delivery boys every night in order to keep the pizzas delivered quickly enough to the different areas of town. Ten is the perfect amount of delivery boys to keep your restaurant in business.

What happens when the pizza restaurant isn’t running properly?

Now, imagine that none of your delivery boys showed up for work one day! But you kept making pizzas because that is how your restaurant makes money, and you need money in order to keep everything in the restaurant working. If you stop making money, your restaurant will shut down. Without the delivery boys, the pizzas in the boxes are just piling up in the restaurant. They have no way to get to any other area of town to feed the people who need them. They just sit and wait on the kitchen counter. Eventually, the pizzas get cold, the cheese starts to smell, grows mold and gets crusty. The pizza crust hardens and the tomato sauce grows a little sour. The whole restaurant starts to smell.

There are pizzas baking and baking and baking, but there are still no delivery boys to deliver the pizzas, and there is no money coming back into the restaurant. The people in the town are angry! They need their pizza! They need pizza so they have enough energy to go to work and take care of their own responsibilities and jobs so their lives continue to run smoothly.

No delivery boys? No pizzas for the people. No money for your restaurant. Eventually, your restaurant will be forced to shut down.

This is Type 1 diabetes. Your body needs food to survive. The food needs to be converted

to glucose in your blood to be used for energy, but your body also needs something to carry it throughout your body so you have energy and everything functions the way it’ s supposed to. That “ something” is insulin and it is produced by an organ called the pancreas.

Without insulin, the glucose from the food you eat cannot be properly used. Instead, the glucose just sits in your body’ s bloodstream. It builds and builds and builds, and starts to irritate your kidneys, your heart, your liver, your eyes, your fingers, your toes—everything. The rest of your body is waiting for that glucose because it uses that glucose as energy. Without the insulin to carry the glucose, your body will eventually begin to breakdown and then completely shut down.

What is the solution?

Well, as the restaurant owner, you need to hire new delivery boys. You need a whole new crew, and you’ ll need to train all of them. It may take some time. Because they’ re a new group of people, you’ re not quite sure yet if ten is the right number. You may need 11 or 18 or 25! If your business starts making more and more pizzas, you may need 15 delivery boys. If your business begins to make less and less pizzas, you may only need 8. Throughout your entire career owning the restaurant, your goal will be to find the right balance of delivery boys for the amount of pizza you are baking.

Throughout your entire life with Type 1 diabetes, your goal is to determine how much insulin you need to keep your body running smoothly.

What about “insulin resistance” and your pizza delivery restaurant?

While we will discuss insulin resistance and insulin sensitivity further throughout the book,

it should be clear that there are many things that lead to insulin resistance. When that insulin resistance becomes severe enough, it can lead to Type 2 diabetes. While many of the things that lead to insulin resistance are beyond your control, and can be attributed to other chronic conditions, genetics and even your ethnicity, there are many things any person can do to help improve their own body’ s sensitivity to insulin.

Now, let’ s imagine your restaurant is still making pizzas and putting them in boxes, and all ten of your delivery boys have showed up for work on time. But you, as the owner, have decided to make three times as many pizzas as usual even though your restaurant really didn’ t need that many pizzas.

The delivery boys are extremely overwhelmed. They can’ t keep up. They’ re trying as fast as they can to deliver all of these pizzas around town but the pizzas are still piling up in the restaurant! And the people in the town really don’ t even need all of those extra pizzas. They have plenty. Also, you’ ve decided to expand your delivery business to serve even more people. Now your delivery boys have to bring pizzas to other towns, even though they’ re already struggling to get their work done in your hometown.

The delivery boys are really tired. Exhausted. Instead of working faster and harder to keep up with pizzas, they are slowing down. The pizzas are piling up, the restaurant is starting to smell, but fortunately, the delivery boys are able to barely work hard enough to keep the restaurant in business.

It smells, it’ s not doing well, and the pizzas really don’ t taste good anymore, but the business is still running. Eventually, you’ ll have to hire at least 20 more delivery boys just to keep up, and you really can’ t afford to manage that many delivery boys at one time. You are going to get pretty tired, too. Either way, if you don’ t do something to make the restaurant more balanced, everyone is going to get frustrated, and the restaurant will slowly shutdown.

This is one of the most common examples of “ insulin resistance.” Your body needs food to survive, but you’ re giving your body more food than it can handle, and not enough exercise to help you burn all of those extra calories. Many of those calories are being stored as body fat, which means you need even more insulin as you continue to gain weight. Your body isn’ t used to having to make that much insulin to take care of all that extra glucose or extra body fat.

Some of it is being carried by insulin to provide energy throughout your body, but a lot of that glucose is still sitting in your bloodstream and irritating your eyes, your kidneys, your toes, your fingers, etc. The glucose from those extra pizzas will pile up in your bloodstream and sit, and wait, and try to destroy every part of your body. Eventually, other areas of your body won’ t be able to keep up, and they’ ll start to breakdown. Over time, they will shut down completely.

As I mentioned earlier, there are many things in life and the human body that lead to insulin resistance, but your eating habits, your activity level, and your bodyweight are three things you can do to help improve your body’ s sensitivity to insulin, putting you at a lower risk for developing Type 2 diabetes.

What is the solution?

Well, you as the restaurant owner need to understand how many pizzas your restaurant can actually handle, how quickly your delivery boys are able to get their job done, and what you can do to help them keep up with their deliveries. It’ s up to you. Either you can stop making so many pizzas, and only make the amount that you know the delivery boys can handle, or you can hire more delivery boys, crowd up your restaurant, but still make an effort to handle such a

large amount of pizzas at any given time. The quality of your restaurant will still suffer, though, because you will struggle to continue making pizzas while managing so many delivery boys.

The demands you’ re putting on your body by consuming too much food and not exercising enough is leading you to become insulin resistant, which will be explained further in Chapter 5. When this resistance becomes severe enough, you develop Type 2 diabetes. The main solution for most Type 2 diabetics is to increase activity and decrease the amount of food you’ re eating.

How can Diabetes Science Experiments help YOU?

In the next chapter, I will clearly explain what a Diabetes Science Experiment entails, but why do you want to learn about this? How will it change your life? Well, because you want your restaurant to stay in business! But I’ m going to leave the pizza restaurant analogy behind for a bit.

You do need your doctor. Hopefully, your doctor has supported you during those first days after being diagnosed with diabetes. They help you understand your basic insulin needs, how well your overall control is, and where you can focus on making improvements. But life is not consistent, and neither are your insulin needs. A doctor learns everything in the medical textbooks and studies their patients’ blood glucose monitors and A1C levels, but it’ s the day-to-day details of living that make diabetes truly complicated, and those details are your responsibility.

The reason I felt compelled to write this book is that I’ ve come to a place in my own understanding of my body and my diabetes where I no longer believe in “ mysterious high blood sugars” and “ unexpected low blood sugars.”

There is a reason behind every number!

By realizing that there is a reason behind every single number I see on my meter, any high or low blood sugars no longer leads me to feeling angry, frustrated or discouraged. When I can explain those numbers clearly using true facts of how my body functions, and then actually adjust my insulin and nutrition to prevent those unwanted numbers from happening again, I have much greater control over how diabetes impacts my day and my life.

The rollercoaster ride of “Mystery Highs” & “Unexpected Lows”

It wasn’ t until I’ d lived with diabetes for over ten years when I began to understand that there is a very good scientific reason, for example, why at the age of 15, I began needing almost twice as much insulin for the carbohydrates in my breakfast meal compared to any other meal during the day. This is called the “ dawn phenomenon,” but what does that really mean? The “ dawn phenomenon” sounds more like the title of a zombie movie rather than a helpful explanation for annoyingly high blood sugars. We will talk about “ the dawn phenomenon” and how to manage your blood sugars around it in Chapter 7.

And there are also very good reasons as to why the typical “ 500 Rule” method of determining how much insulin I need for every gram of carbohydrate I eat (your “ insulin to carbohydrate ratio” ) really doesn’ t always work. We’ re going to dig deeper into that later in the book, too.

There is a very good scientific reason why I don’ t need to eat any extra carbohydrates before powerlifting training to keep my blood sugar from dropping, but I will need extra carbohydrates for 45 minutes of cardiovascular exercise on a stair master or elliptical machine. And now I can also explain why going on a 45-minute walk in the morning on an empty stomach won’ t lower my blood sugar at all, but if I went for that walk in the afternoon, then I will need at least 25 extra grams of carbohydrates to keep my blood sugar from dropping low.

There is a very good scientific reason to explain why four hours after I finish weightlifting, my blood sugar starts to plummet if I don’ t eat a meal, and I need to cut back on the insulin for that meal, sometimes by 50 percent. And there is another reason to explain why I need an additional three units of long-acting insulin the night before a powerlifting competition in order to compete with the high blood sugars produced by the adrenaline and other stress-induced hormones during a competition.

And I’ m sure any doctor could have probably said to me, “ Oh, well, of course, that’ s because adrenaline blunts our sensitivity to insulin.” But what that doctor cannot do for me is tell me exactly what’ s going to happen, and exactly how to change my insulin dose, and how to keep my blood sugar balanced throughout a long day of competing. These are things I discovered slowly, through trial and error, a lot of patience, studying exercise physiology, and through conducting many of my own “ Diabetes Science Experiments.”

But this doesn’ t just apply to powerlifting. It applies to every aspect of my life and your life with diabetes.

Are you tired of playing the guessing games?

Many of us are continually playing a guessing game throughout the day. Guessing how this meal will raise your blood sugar, guessing how this exercise will drop your blood sugar, and guessing why sometimes exercise even makes your blood sugar high. Guessing why breakfast needs more insulin than lunch. Why a walk in the morning before breakfast needs fewer carbohydrates than a walk at night. You’ ve been guessing and guessing, over and over, only to find your blood sugar swinging this way and that way.

Swinging through all of those “ mysterious highs” and “ unexpected lows.”

Oh, how I love that phrase: Mysterious highs. The “ Well, my blood sugar went up to 300 mg/ dL after I went to the gym...oh, well, I don’ t know why.” That’ s not good enough. Doctors teach us how to take our insulin based on carbohydrates at mealtime, boluses for high blood sugars, and to eat an extra 15 grams of carbohydrates before we exercise. But there is so much more to it than that. Even a non-diabetic person produces more insulin on highly stressful days, on the days before their menstrual periods, while they’ re working out with weights, in the morning around breakfast and even during a day of rollercoaster rides at Disney Land because of hormones like cortisol and adrenaline that can blunt the efficacy of insulin.

Even a non-diabetic produces more insulin with meals that contain more than 25 grams of protein, or more than 20 grams of fat. They produce less insulin during the hours after they exercise, during a day when they are in surgery, not consuming any food and lying in bed all day, and during a low-carbohydrate diet. They also definitely produce less insulin if they lose five pounds, and they produce more insulin if they gain five pounds.

Everything and anything can impact your blood sugar levels and your insulin needs. It is about so much more than just carbohydrates and the number on your meter. Your goal as a person with diabetes is to help your body balance your blood sugars the same way a non- diabetic’ s body would, so you’ ll want to get all of the facts straight first.

What motivated ME to create Diabetes Science Experiments

During my senior year of college, when I first began lifting weights with serious intentions of getting somewhere as an athlete for the first time in my life, I started to think of my diabetes like a “ Science Experiment.” Really, I just wanted to get in shape, and had absolutely no plans to become some kind of competitive powerlifter. I’ d made a lot of progress on my own, but I

decided it was time to get a personal trainer and take my progress to the next step.

I was really lucky to have been matched with a trainer, Andrew Berry, who already had a foundation understanding of diabetes, nutrition, and exercise physiology. He made it quite clear from the beginning that balanced blood sugars were going to be crucial to my advances in building strength and muscle. And it wasn’ t long before my goals went from “ getting into shape” to “ I want to win.”

But I had also learned that if my diabetes is not under true control, I won’ t benefit from all of the challenging, strenuous, intense work I am doing in the gym. I won’ t build muscle correctly. I won’ t burn fat correctly. I won’ t recover quickly enough in time for my next training session. I won’ t be able to train as hard or train as long. My muscles won’ t grow as strongly or strengthen as quickly as they could if my blood sugars aren’ t under control. Everything will be impaired because of diabetes. And that is something I just can’ t allow.

I don’ t think Andrew will ever realize how significant he was in the foundation of my progress, but I was very drawn to him as a trainer right from the start, because I could tell he was a no- nonsense kind of guy. You see, Andrew never felt sorry for me because I had diabetes. And he didn’ t look at me and say, “ Well, this is going to be really, really hard because of your diabetes.” Instead, he spoke and trained me in a way that always translated to me as: “ Ginger, if you really want to get stronger, then you have got to really understand your diabetes management. Period.” He never questioned whether or not I was capable of doing it, but it was up to me to make it happen.

During those first few months of serious training, I learned more about my blood sugar than I had ever learned in the hospital. I had to pay close attention to prevent any dangerous blood sugar situations. I had to pay close attention to succeed athletically. And more importantly, I wanted to. That was the beginning of my life-long Science Experiment.

It was the beginning of a life with diabetes in which I didn’ t feel overwhelmed or burdened by the disease, because I thoroughly understood what was going on in my body. And I simply came to know more about my disease than any doctor ever could to teach me, because I live with this disease every day and this is my body.

After I graduated from college, when I no longer had health insurance and the bills started coming to my apartment, with my name on them instead of my mother’ s, the significance of my Diabetes Science Experiment became very obvious. I remember seeing the bill after what was one of the most unprofessional doctor-patient conversations I’ d ever experienced.

This man with a medical degree in Endocrinology, who charges $400 for a 15-minute conversation, accused me of lying about whether or not I ever forget to take my insulin. He smirked and rolled his eyes when I said I had been training intensely with weights and was considering powerlifting training. He interrupted me every time I tried to speak to explain my life and my diabetes, and he never smiled. I gained nothing from my visit with one of the area’ s most well-known, prestigious doctors from this hospital’ s Diabetes Research Center.

I didn’ t bother seeing another endocrinologist for almost a year, and so I was motivated by yet another reason to truly understand my diabetes: I couldn’ t bear to spend the money on another doctor just for a chance to find out my A1C percentage. I needed to be as in control of my own health as possible. I needed to figure out on my own if my insulin needs were changing or if my insulin-to- carbohydrate ratio needed an adjustment. I needed to see a pattern of highs or lows and be able to pinpoint the cause. I needed to take the guessing out of my diabetes and have enough understanding to apply real thought and planning. I needed to be in control.

Because I started researching my own disease like a science experiment, “ mystery highs” are rare for me. I’ m not saying I don’ t have high blood sugars, but when they happen, I can look back on my nutrition, stress, activity and insulin around that time and determine exactly what happened.

I have diabetes: fluctuations are going to happen. You can still have very well-managed, healthy diabetes with blood sugars that fluctuate from time to time. There is no way you can control every single variable that impacts your blood sugar, unless you are checking your blood sugar every half hour—which is not an option I’ m willing to consider.

What you can do, however, is learn how to anticipate your blood sugar instead of running right behind it guessing, getting frustrated, feeling tired and sick, and getting angry. You can learn how to interpret those highs and lows more accurately, take that information and apply it to the next time you find yourself in a similar situation.

Since I began truly studying my diabetes, keeping notes and performing “ research and experiments” during any situation that might throw my blood sugar off in one direction or the other, I’ ve not only limited my low blood sugars to once or twice a week, but I also simply feel in control and prepared. I don’ t have to waste any more time or energy getting upset about inexplicable highs and lows, because I know why they happened, and I know what I can do to prevent them if I choose to make the effort.

Diabetes doesn’ t keep me from reaching my goals in powerlifting. It doesn’ t interfere in my work as a personal trainer or as a one-on-one yoga instructor during which I’ m constantly moving and exercising. It certainly doesn’ t interfere with hanging out with my friends or going out to dinner and eating new foods.

And most importantly, it doesn’ t keep from me feeling healthy, from being healthy, being full of energy, and being very happy. Diabetes does not stop me from my ongoing plan to live my life well and live my life happily.

While nothing in life is really untouched by diabetes, in this book, we’ re going to look at all of the major parts of creating your Diabetes Science Experiment. I’ m going to talk you about some of the most commonly impacted parts of your life, and how to study your blood glucose readings in a way that brings true understanding and knowledge. Overall, you will gain a better understanding of how your body works.

As you progress through each chapter, my hope for you is that your knowledge and understanding of your body leaves you feeling prepared to see any “ mystery high” or “ unexpected low” and make a plan to understand why it happened and how to prevent it from happening again. No doctors or medical textbooks required. No fancy technology, either. Just a blood glucose monitor, insulin, and enough patience to work your way through any overwhelming frustration you encounter along the way.