Healthy sleep, healthy body, happy family, happy mom

Boy did we have a rough night last night. We're not sure if Aria is teething, had painful gas, or all of the above. My husband and I spent an hour and a half trying to calm her, then of course we had to calm her brother because she woke him up (and probably the whole neighborhood), and then each other so that we could get back to sleep.

She survived. And after a night of being awakened four or five more times (who knows how many really), I woke up exhausted. And in physical pain, once again.

This may sound like hell, and it kind of is. But the good news is that Aria really is typically a great sleeper. That's how we know that the crazy waking up must be something like teething. And it also gives me a chance to re-visit the importance of sleep for a healthy body - and for a happy me.

This is not new news from the mom of the infant twins world. I don't think I'm saying anything new when I tell you that sleep is important to your health; it's a chance for your body to restore physically, emotionally, and mentally.

All that saying, I have to write about this topic. Because I'm just so tired and that's what's on my mind. And because I feel a real difference in my health when I sleep and when I don't sleep.

Here's a brief example: I woke up two days ago with pain in my left hip. Mind you, that's the hip that has healed. I took a nap at around 4 pm. I woke up, and the pain went away!

I desperately wrote our pediatrician an e-mail asking for advice a few months back when the kids were waking up every two hours. I knew I wouldn't make it if we kept going like this.

What I didn't know it at the time, and now do, is that I was taking on a new family project: Get us all to sleep well. She recommended that I read "Healthy Sleep Habits, Happy Child" by Dr. Marc Weissbluth, which I call 'the sleepy book' for short.

The sleepy book tells us tired, exhausted parents all the reasons why lack of sleep is so detrimental to the health of infants AND adults. Sleep is important for mental alertness, and lack of sleep has been shown to cause fussiness, excited-ness, and an upset baby. It has been linked to attention deficit disorder in older children.

And an Australian sleep study done on adults shows that lack of sleep causes an increase in cortisol – the body’s stress hormone. Cortisol is a hormone that we diabetics are familiar with as it has also been linked to rising morning blood sugars (known as dawn phenomenon) and weight gain. Please check diabetes.org for more information or the links provided in this paragraph.

The sleepy book recommends creating an environment for healthy sleep, which includes: a regular sleep schedule, sleep consolidation - meaning lots of it undisturbed, naps (for children), and sleep duration night and day. His strategies work unless a baby is teething, sick, just received immunizations, or is hungry.

So first there's the schedule: We did this by logging when our kids' natural sleepy times and feedings are and then building a schedule around them. And then sticking to it. The schedule is key. We treat naps as sacred, and we don't keep them awake to play with visitors. Ever.

Undisturbed sleep is also important. Never wake a sleeping baby. Of course this is hard when you are also sticking to a schedule - with twins - but it somehow works itself out on most days. We do wake them up if we need to - mostly because of their feeding schedule, and the sleeping schedule falls into place around it naturally.

Longer night and day sleep results from putting kids to bed when they first appear drowsy. Not stretching them. So when we see Aria starting to slow down or Ethan staring into space, we know it's time for bed. If they're yawning, rubbing their eyes, or getting fussy, it means they're already overtired.

This works for us most of the time. The sleepy book does say that babies start to sleep through the night at around nine months after their due date. So we have some time to go. And I'll tell you, it's not an easy journey. And as everyone told me when this whole thing started, it does get better.

One thing I can say is that I have never been so aware of sleep before. I used to just do it. Now I pray for it and appreciate it when it does happen. I do believe that once the sleeping gets back on track that I'll feel better physically. Healthier and happier. We all need healthy sleep so that we can be healthy and happy. And I hope I will never take sleep for granted ever again...

P.S. I wrote this blog yesterday, Sunday morning, and last night both babies slept the whole night!!! And I slept for nine and a half undisturbed hours!!! I feel better already. My hands feel much better, and my hips do too.

P.P.S. I cannot possibly relay the wealth of information found in the sleepy book. Check out the sleepy book for all of the tips and tricks!

505 and the calmness of a deep blue lake

I have not forgotten about this blog! That I promise you. I truly enjoy writing, and I love the conversations that this blog generates with all of you. I am finding it challenging though to write every week and take care of Ethan and Aria, who are all but seven months old. So, I have decided to start blogging every other week rather than weekly, with posts still on Mondays. Enjoy! - Ophir

505 and the calmness of a deep blue lake

I didn’t write last Monday for one simple reason: My blood sugar went all the way up to 505. It was scary. Not only because I care about my health and my diabetes, but also because I have the babies to think about. And high sugars like that could land me in the emergency room if not treated immediately.

Numbers like those happen to me very rarely, but I have my "Back to Normal BGs" strategy down to a science. The kids were napping, and so I changed my pump site immediately. The culprit was clear: A faulty infusion set. The canula was bent. I injected a correction bolus with a syringe and even threw away the old vial of insulin just in case. I changed infusion sites, also just in case.

And then I freaked. Usually I lay on the couch and rest drinking diet ginger ale while I wait for my sugars to go back to normal. The last time this happened was 2008, and so I didn’t have ginger ale lying around the house. And I also had no chance of resting on the couch for more than 15 minutes.

And in the midst of all of my panic on what to do and how to find help, I also thought about this blog. And how another week would go by without a posting. Without me writing about, ironically enough, living with diabetes consciously, in a balanced, healthy way.

I had been debating that morning about a blog topic. I knew I wanted to write about a Buddhist meditation on the deep blue lake and was looking for my own real life example. The gist of the meditation: Wind, rain, storm, or sun, the depths of a lake are still, unwavering, and serene despite what is happening on the surface. According to Buddhism, that stillness - deep inside - is a metaphor for your spirit.

I was trying to think of my own story to tie into the meditation when I went to check my sugar. And boom, there it was 505. At the time, I didn’t see it as a writing opportunity. I was not calm and serene like a deep blue lake. I was crying. I was crying that I couldn’t think of who to call for help that lived close by. And I was ready to move next door to my parents like in Everybody Loves Raymond. Or, to Allentown, PA (which is really not my style and yes, it's very far away from us) to be near where my husband works.

But rather than pack my bags, I did have enough wits about me to call my husband and a friend of mine to brainstorm a solution. I wound up calling a friend who left work to help me. She brought me two cases of diet ginger ale. I don’t know why. But it helps me. And I called my neighbor who came over within seconds to help me with the kids. She and I sat for a few hours and had a lovely conversation, and she told me to always feel free to pick up the phone and call her. The kids had a great time with her. And she even brought over some music CDs for the kids to play along to. My sugar dropped back to normal within a few hours. And everything wound up being more than okay.

By the end of the day, I realized that I had my real life example for this blog. It was clearly not an example of how to implement the meditation effectively. But rather, an example of a time when it could have helped. I had allowed the stuff on the surface get the better of me when things were rough. Rather than tap into the stillness of the lake for a bit of calm despite the craziness.

You see, the stuff on the surface changes all the time. One minute, the weather might be rainy and the next sunny without a cloud in the sky. But the depths of the lake always remain the same. Just like our inner spirits. We should all tap into that stillness when things on the surface get rough. It helps the stuff on the outside go much smoother, much easier, because it comes from a place of peace and acceptance.

I’ll see you all again in two weeks.

Turning perfectionism into optimalism

I’ve always been a bit of an idealist and a dreamer, and now my daughter is teaching me that what I thought was dreamy and romantic has always been perfectionism in disguise.

My perfectionism permeates every part of my life. And when it comes to health and living with diabetes, I have grand expectations of myself. I will go to great lengths to cure my body, live in perfect health, and have amazing blood sugars. But then, I get completely frustrated after pricking my finger and seeing a high or low sugar. I think about how I exercised and ate just right, counted my carbs and yet my sugars don’t always hit the perfect mark. And then whatever joy I had in what I was doing or whomever I was with at the time disappears and turns to stress and anxiety. And well, unhappiness.

I didn’t really think that I was such a big-time perfectionist though until I was watching my baby daughter Aria play, and I saw some of my own traits in her. That’s when the light bulb went off.

I was trying to figure out her frustrations. Babies nowadays are given tummy time since they sleep on their backs all night. And they sleep for something like sixteen hours a day. That’s a lot of time on your back! Time on their tummies is precious as it helps them learn a bunch of things like crawling and rolling over. Sounds nice huh? Yeah, well, because they spend much of their time on the backs, they don’t really like being on their tummies. And boy do they complain about it.

Aria has slowly gotten used to being on her tummy as she’s gotten stronger. And she has been rolling from her back to her tummy for over a month now. But after a few minutes on her tummy, she gets very frustrated and starts to scream. I figured she just didn’t like it, and so I showed her how to roll back. But then she’d roll back to her tummy again five seconds later. An automatic reflex? Probably. Babies tend to try to do things until they’ve mastered it. But then my husband noticed that she would make motions with her hands on the floor, kick her legs, and that she was staring straight ahead as though on a quest to get somewhere else. My husband realized immediately that she was trying to crawl.

I was amazed that she was even trying to crawl because she’s only six and a half months old. Actually she’s five and a half months old if you calculate her corrected age (which you do when a baby is born premature). And crawling is a nine-month old baby milestone. And then I realized – she was trying really hard to do something unrealistic for her age. It could very well be normal baby behavior, although my son doesn’t act that way. Each baby does develop differently. But what gets me is how frustrated she gets that she can’t do it yet. Where did she learn that from? Of course I first assumed that she had learned it from my husband. But then I realized: Had she learned to be a perfectionist like me?

I wasn’t searching for an answer when I found it. I was randomly reading a selection entitled “Perfectionism and Optimalism” from Even Happier by Tal Ben-Shahar, positive psychologist and the teacher of the most popular course at Harvard.

“The key difference,” between the perfectionist and optimalist, Ben-Shahar writes, is that “the former essentially rejects reality while the latter accepts it.” He says that the perfectionist expects “her path toward any goal – and indeed, her entire journey through life-to be direct, smooth, and free of obstacles.” And when things don’t turn out as a perfectionist had planned, she is extremely frustrated and has difficulty coping. And that could describe my daughter’s bout with trying to crawl at five and a half months of age – and my, well, entire approach to life - to a tee.

An even happier way to approach life is as an optimalist – a person who accepts obstacles as a natural part of life’s journey. “She understands that failure to get the job she wanted or getting into a fight with her spouse is part and parcel of a full and fulfilling life; she learns what she can from these experiences and emerges stronger and more resilient.”

Ben-Shahar tells us that perfectionists pay a high emotional price. Their rejection of failure leads to anxiety. They tend to set unrealistic standards for success. And because they never meet these standards, they “are constantly plagued by feelings of frustration and inadequacy.”

Optimalists on the other hand derive great emotional benefit, according to Ben-Shahar, and are able to lead rich and very fulfilling lives by accepting that failure is natural. “They experience less performance anxiety and derive more enjoyment from their activities.” They set goals they can actually attain because they are aware of their limitations.

I would like to learn to be more like an optimalist. Not only for my daughter’s sake, but for mine as well. Ben-Shahar suggests a mindful approach to turning perfectionism into optimalism, such as journaling on areas where you are a perfectionist and areas where you tend to be more like an optimalist.

I can say that I’m a perfectionist when it comes to art and design, and I am an optimalist when I write. Which may be why I write, but don’t paint or draw even though I want to. I can’t help but wonder: What would I be doing if perfectionism – or fear of failure – wasn’t holding me back?

I heard myself saying to Aria the other day, “You can do it. Keep practicing. Rome wasn’t built in a day.” Perhaps I should take the words I use to encourage my daughter – for myself.

Type 1 diabetes at 25 weeks of pregnancy

I’ve reached that point in my pregnancy where my fabulous blood sugar readings have started climbing.

I’m 25 weeks pregnant with twins, and my sugars began to rise about a week or two ago. I’ve been told that this is totally normal and expected at this point in a diabetic pregnancy, according to my doctor and all the research articles on pregnancy and diabetes that I’ve come across. (Please note: I am not a trained medical professional. I am a Type 1 diabetic sharing my experiences. Be sure to speak with a doctor for medical consultation on all matters related to diabetes.)

My first and second trimesters have been marked by fabulous controls. According to all those same doctors and articles, low sugars are quite typical during the first trimester, and I had many of those. I could eat a cup of straight cane sugar, and my blood sugars would not rise past 80. Now, I eat a celery stick, and my sugar goes to 180.

Alright, maybe I’m exaggerating a tiny bit. But seriously, my last A1C was 5.8. I don’t remember ever seeing an A1C like that in over 36 years of living with diabetes!

And now I am struggling to bring down 180s, 160s, 190s, 210s….

Correcting sugars like mad. Faxing food and blood sugar logs to my doc on a weekly basis (more or less). Raising my basal rates, and giving myself more insulin at meal time. Changing my pump more often – going from every three days now to every 2.5 days (expecting, according to the doctors, that I’ll have to change it to every 2 days in another couple of weeks).

And, worrying about the health of the babies as a result of all this.

The only thing I can do is to continue what I’m doing – checking sugars, taking my insulin in a systematic, informed way, keeping track of it all, heeding the advice of my doctors. I eat healthy more often than not, and I exercise regularly. I do my best to keep stress levels low, and I try to rest with my feet up often (very necessary for me at this point in twin pregnancy).

The worrying part is the part that doesn’t help. I know this – logically. But sometimes, I can’t help but worry a little bit. Usually someone is there to make me feel better and lend an encouraging ear. And sometimes I am a total worrywart in my own little out of control tailspin world. Worrying is a totally normal emotion. I am becoming a mother, right?

I know it doesn’t help me though.

And that’s when I remind myself: The best thing I can do is accept that managing blood sugar fluctuations is a part of being pregnant with Type 1 diabetes. And act accordingly. The rest is out of my control.

I don’t know if the babies will be affected or not. I’ll actually probably never know.

By the way, the high risk doctor told me that high blood sugars typically affect the babies when you have sugars that continuously read 250 to 300, or higher. That does make me feel better since I don’t have those kinds of sugars.

So is all this worry for nothing? My experience in life has been that worrying usually is just that – for nothing. Especially worrying over things that are totally out of our control.

I’ve been told that motherhood is a lesson in letting go. How about motherhood with Type 1 diabetes and twins? I guess it’s time to learn the lesson. You can only do what you can do. Life does the rest.

Type 1 and pregnant…with twins

I’ve been keeping a secret from you. Waiting for the right time to tell. And oh, there’s been so much to talk about…so much!

Yes, I am 18 weeks and one day pregnant, with twins. But who’s counting? (A full pregnancy term is counted as forty weeks.) Hooray! Yes, we’re thrilled and deep in the throes of babies’ preparation. And all three of us are healthy and doing great. My husband Lior too.

It’s been tough keeping this a secret, for as you can imagine getting pregnant as a Type 1 diabetic is loaded with questions, fears, doctors’ appointments, more fears, lots of thinking, and in my case, lots of journaling, meditating, and yoga. It’s been a long road, and sometimes a torturous one, coming to a decision to put myself at risk to bring life into this world.

This is a high risk pregnancy – times three. Going into this pregnancy, I knew that I would be at high risk times two because of the Type 1 diabetes and being of “advanced maternal age” which happens after you reach the age of 35 (yup, it’s true!). But I didn’t expect twins – at all. It’s a great surprise. We’re thrilled. But yes, there are risks involved.

But here I am. Taking the plunge. And I must say that I’m doing quite well. I have everything I need – great medical care, a supportive husband, family, and friends, and a happy and healthy lifestyle.

I didn’t always see it this way though.

I was around 18 or 19 years old when I first realized that getting pregnant would be a risky thing for me. I went to see the movie Steel Magnolias starring Julia Roberts as Shelby, a Type 1 diabetic, and Sally Fields as her mother M’Lynn.

In the movie, Shelby decides to have children after her dream wedding. Her mother is concerned that Shelby’s body won’t be able to handle pregnancy, and yet she supports her daughter’s decision. The movie then jumps to a year and a half later when they celebrate Shelby’s child’s first birthday. The occasion isn't a 100% happy one. Shelby is suffering from kidney failure as a result of the pregnancy. She passes away after grueling treatment, including hospitalization, surgery, and a transplant.

Her mother M’Lynn is forced to bury Shelby at a young age and helps raise her child.

That movie shook me to my core. As a young girl, I had never realized that having children could be risky for diabetics. I kept it to myself though and just pondered. I wasn’t ready to think about having kids, and I didn’t really know how to digest the whole thing. But one thing is for sure, now I knew that having children wouldn’t be as easy, or as much a given, as I had thought.

Then, at the age of 19, I was diagnosed with diabetic retinopathy – which is damage to the eye's retina that occurs with long-term diabetes. I had a 50-50 chance of going blind. Then, when I was around 21, the doctors diagnosed me with kidney ‘challenges’ and placed me on a medication called Diovan. They also advised me to eat a strict vegetarian diet.

Getting pregnant became riskier and riskier. Pregnancy affects eyesight, as well as kidneys, and blood sugars, and more…

I didn’t want to risk my eyesight. I started contemplating adoption at age 24 or 25. (These were the days before surrogacy was a hot topic.) I dated different guys in my 20s, all the while wondering when I should spill the beans, letting them know that I wouldn’t be able to carry kids.

Life plodded along. I had discussed the topic with my friends more than once, but still hadn’t consulted a doctor. Then, when I was around 26 or 27 years old, I decided to discuss the topic of pregnancy with a former doctor of mine, Dr. P.

Dr. P was an old-school doctor who smoked cigarettes between patient visits, which didn’t faze me back in the mid 90’s by the way. She was the doctor who advised me not to use an insulin pump, which also at the time made complete sense to me. The pump was new on the market and people still didn’t know how effective it was. And she is also the doctor who told me that pregnancy would be a problem for me. Not related to fertility or anything like that, or the fact that I wasn’t dating anyone at the time, but because I am a Type 1 diabetic who had kidney ‘challenges’ and who had diabetic retinopathy.

Period. The doctor said it, and I accepted it. I was not to have children via pregnancy.

Well, then in 2001, life changed for me, big time. I decided to move to Israel. I left the comforts of the life and doctors I had known for 30 years, and moved to a country where having children has a whole different cultural vibe around it. Israelis receive 12 or 13 weeks of paid maternity leave. Dads can take time too. Many people have five kids (or more) per family rather than the 2.2 I had grown accustomed to here in the US. Everyone in Israel has healthcare. A whole new ballgame and a whole different attitude. Having kids, in any way, was encouraged – even by strangers you just meet on the street.

And I had a new doctor. He encouraged me to go on the pump. I resisted. He told me that my kidneys had healed, and that I could start eating meat again after 12 years of vegetarianism. Actually, they encouraged me to eat meat as it would help stabilize my blood sugars. I changed my diet and my insulin regimen, walked a lot, and my A1C’s started dropping. My retinopathy was stable for well over 10 years at this point. The turn-around had begun.

And then I met my husband. He proposed in 2004, and we married in 2005 and decided to settle down in the USA. I had brought up the topic of kids with my husband. He was completely okay with adopting. And yet I still thought of a million reasons why having kids at that time was a bad idea. My range of excuses: We were living in a one bedroom shoebox and needed to get our ‘house’ in order.

As time moved on, the subject of kids would come up from time to time. I would list my excuses and Lior would say, “When is it ever the right time to have kids?” “People all over the world in situations much more dire than ours have kids every day.” “Other people do it, why can’t we?” “Medicine has completely changed. Why don’t we talk to your doctors about pregnancy and then we can decide?”

Medicine has changed. I went on the pump in 2006, stepped up my work-outs, and ate even healthier, more calculated. My A1C’s continued dropping. I was diagnosed with Celiac, and gluten-free eating took my health to a whole new level of great. My kidneys were completely clear, and the doctors took me off of Diovan. My cholesterol levels were fantastic. My blood pressure was phenomenal.

We bought a home, were both working, and we were building up our lives to a point where I couldn’t avoid it anymore. I had been avoiding the kids’ topic. For years. The time was never right. But I was reaching my late 30s, and time kept on ticking.

I had to face it: What was holding me back? I knew very well what was holding me back. Pure, absolute fear of what might happen, the unknown. Losing my eyes. Losing my kidneys. Becoming like Shelby and dying young because I insisted on having kids myself rather than adopting. We looked into adoption, but the costs were beyond our scope. And Lior said, “Why don’t we look into getting pregnant, do some research, talk to doctors, and then we can decide?”

So we went to doctors. Lots of them – two (or three) endocrinologists, an ophthalmologist, and an OB/GYN. And they all gave me the green light! I was shocked. On top of that, I was sent to a high risk doctor for a consultation, and after she listed a whole slew of things that could go wrong, she said, “Don’t worry. You’ll be fine.”

Had I created this madness in my head for the last decade or so? Okay, it’s true, my health had improved. I became much more conscious, more on top of things. I checked my sugars constantly. Adjusted my insulin accordingly. But was it really that simple? “Don’t worry. You’ll be fine.”

If I just changed my way of thinking, I could have a healthy, easy pregnancy despite all of the risks involved. I realized that I had the choice to create the reality I want for my life – through the thoughts I choose to have. Of course, I still had to monitor my sugars, exercise, and eat right. But, keeping my perceptions in check, stress low, and a healthy attitude could really make the difference.

So we decided to get pregnant in 2010. Go for it. Take the plunge. We learned that we were pregnant in early October. And I can tell you that when I got pregnant, I was in a complete and absolute place of trust that everything would work out just fine.

What I’ve learned through this whole thing: It's one thing to talk the talk, but it's another to walk the walk. Don’t let fear hold you back from what you want in life. Ever. But just know if you have in the past, it’s never too late to just go for it.

I look forward to sharing more about Type 1 and pregnancy...Thanks for listening!

Balancing diabetes at work

The other morning, I was co-running a board meeting for the non-profit organization I work for, and while in the midst of introducing our guest speakers, I began to feel the pangs of a low blood sugar.

I pulled out my glucometer and held it under the table after I was finished speaking, pricked my finger, checked my sugar, and immediately reached for my handy glucose tablets when I saw the 48 reading on my monitor – all this while attempting to stay focused and sound remotely intelligent. Which is quite a tricky thing to do when going low.

As my sugar slowly climbed back up, I realized that I had a blog topic on my hands.

I typically don’t write about balancing work and diabetes here on this blog, mainly because I am afraid that whatever I write here will somehow affect my professional life. I wouldn’t want people to think I’m more or less capable of doing my job because I have diabetes. I focus on what others’ may think or say, rather than my main objective for writing this blog: Learning and sharing on how to thrive with diabetes and life’s challenges.

My strong feeling that I have a topic on my hands won this time – over the hypothetical voices of others. Living with diabetes is my reality, and I hope that whatever strengths, experience, and knowledge I bring to the workplace far outweigh the fact that I check my blood sugars and need to eat certain foods regularly. I believe I’ve been fortunate in that respect throughout my life, and rarely have I encountered people who have forced me to prioritize work over health.

Side note: I know that not every workplace is like that. The American Diabetes Association is a wonderful organization to turn to if you have encountered problems with diabetes and the workplace, such as discrimination, and need assistance.

And then those moments come along, like the one the other morning, where I’m in the middle of working, and I find myself trying to balance feeling the low blood sugar, taking care of it, and all while in the midst of something at work that demanded my full attention.

How do we diabetics do it? How do we diabetics balance work with our health needs?

I’ve come to the conclusion over the years that balancing diabetes at work is about setting healthy priorities and boundaries while demonstrating self-confident assertiveness. Not defensive assertiveness. Or “I’m the victim” assertiveness. Or passive aggressiveness. I’m talking about the type of assertiveness that comes from accepting that you have diabetes and not caring what others may think or say.

Because you care about you.

After years of not accepting my diabetes or thinking I did, but really not, I prioritized health over what others may think or say at that board meeting. I wasn’t embarrassed to pull out my glucometer and check my sugar while sitting with ten or fifteen other people around the table. I didn’t care if anyone noticed. I went ahead and checked. And thank God I did! Or else, my blood sugar may have gone even lower and could have resulted in a trip to the hospital.

And that’s not healthy. Physically or emotionally.

I spoke with one of the meeting participants afterwards and told her about my low. She looked incredibly concerned and told me she hadn’t even noticed. And that’s when I remembered that most people aren’t examining others in the way we may think they do. People tend to be focused on themselves or whatever they’re going through.

So why shouldn’t I be as well?

I’m so happy that I checked my sugar when I did. And I’m proud that I’ve prioritized me.

In honor of Halloween: Diabetes, the story of a serial killer

I had a crazy dream last night, which by some might be construed as a nightmare, but by others, quite comical.

I was at home, in the kitchen actually, and I saw a grungy looking man sitting in a chair across from me. The man stared at me, looked at me funny, and then pulled out a knife from his pocket.

And then he threw the knife at me.

I suddenly realized that I was sitting across from a knife-wielding killer, who was pretty slow on the take and not very good at throwing because he missed. And he wasn’t so far away from me.

So I looked for a knife as well and threw one back at him. But I missed. So we simply sat there, quite lazy for two people trying to kill each other, and just threw knives at one another.

The killer eventually got up off of his chair and headed toward me. I realized that I could take out my trusty insulin pen (which by the way, I haven’t used a pen in over five years) and I started dialing up and injecting insulin into the killer’s arm.

But I could only dial up 10 units at a time. So I kept dialing up and injecting, dialing up and injecting, dialing up and injecting.

Until the killer fell into an insulin coma lying still on a reclining chair near the kitchen. He didn’t die though.

I woke up. It was 5 am. And like a well-educated diabetic with over 35 years of experience, knowing that a dream like this meant there may be blood sugar trouble lurking, the first thing I did was check my sugar. 175. I bolused a correction and fell back to sleep.

Alright, so yeah, some of you may be laughing. Some may think I’m weird. Some may be wondering why I would share this with all of you.

This comical nightmare, I believe, is actually a metaphor for the life of a diabetic. My subconscious knows that insulin protects me from harm. That insulin saves me. It keeps me alive. It protects me from the slow, silent knife-wielding killer that is high blood sugars.

The silent killer is slow but persistent just as the streams of high blood sugar are that flow through a diabetic’s body. Pounding away at our bodies, causing immediate and long-term consequences like blindness, kidney failure, heart problems, and so on.

And the only way to protect ourselves – is through insulin.

Perhaps related to my having the insulin dream last night, I read in the October 2010 edition of Diabetes Forecast yesterday that The New York Historical Society is capturing the story of the discovery of insulin in an exhibition that began on October 5, 2010 and will continue through to January 31, 2011.

A diabetic’s fight for life, the struggle with the silent killer, has changed dramatically with the discovery of insulin in 1921. I’m simplifying, but before the discovery of insulin, doctors did not know how to treat diabetes. Patients were often placed on starvation diets with the hope that they would live a few years longer.

I urge us all to be thankful for the discovery of insulin, to put those injections and finger pricks into perspective. Diabetics today, with the proper care, can live long, fulfilling, and beautiful lives.

I believe that my dream is telling me to wake up, check my sugar, and be thankful that I can bolus a correction for a 175 sugar. And to take the time to learn about the past, and put into perspective how far we’ve come. Thank you, insulin.

Two topics: My newest story – a 6.4 A1C and Step out to stop diabetes!

Step Out to Stop Diabetes!

Hello everyone! As written in last week’s blog, I am participating in the American Diabetes Association’s Step Out to Stop Diabetes walk-a-thon on October 24 in Princeton, New Jersey.

Thank you so much for all of the donations that we have already received! Only a week into fundraising, and I am thrilled to report that I am 32% of the way toward reaching my goal of raising $500 for the education, research, and advocacy programs that the ADA provides to help fight diabetes.

There is still time to help me reach my goal! Please click here to visit my personal step-out page, read all about why I’m participating, and become a sponsor.


Topic #2: My newest story – a 6.4 A1C

I was convinced that I had a 6.7 A1C, which in Type 1 diabetes world is pretty darn good. But I wanted the 6.5 that I had achieved back in April.

All diabetics get A1C tests, as well as oodles of other blood work, to see how well we are managing our diabetes. I get mine done once every three months.

I have not been the perfect diabetic lately. I’ve been so busy! So stressed! Running from appointment to appointment. I had minor surgery on two of my fingers almost eight weeks ago. I haven’t been exercising as I normally do. Okay, I admit it. I’ve gained a few pounds over the last two months. And yes, I’ve been sneaking snacks of low-fat ice cream and full-fat potato chips loaded with yummy salt and oozing comfort. I was thinking about those 200 BG’s I’d corrected for, and those morning highs. Most of all, I was dreading the strict lecture I convinced myself I would receive from Dr. W about tighter control over my blood sugars.

I would be lucky if it was a 6.7. And I was beating myself up for it. I had achieved so much by reaching that 6.5. And I let it slip away.

I went to Dr. W this morning for my quarterly appointment. I asked the receptionist for copies of the lab results as soon as I stepped through the door. I thought about the records I had compiled of my eating, exercising, and bolusing for the appointment. And I regretted doing it already. They would show Dr. W. exactly what a bad girl I’ve been. He’d have the proof right in front of him.

Judge and jury pronounce me as guilty. Lock me up and throw away the key.

The receptionist handed me the white pages filled with courier style blank ink. I’ve skimmed these a million times. In range. Out of range. Kidney function and cholesterol – which are all perfectly fantastic by the way. Something to still be proud of – since they weren't always that way. A bit anemic. Yes, I knew that.

And there it was, what I least expected. A1C – 6.4!

I was so surprised! How did that happen? And then I had a BIG realization sitting there in the waiting room smiling from ear to ear.

I realized that I had created a story, a very self-damaging one actually. Leading up to today, I was beating myself up for being the “worst” diabetic ever. I thought I hadn’t been managing my diabetes as I know I can or should. In my mind, I wasn’t living up to some pretty high expectations I have of myself. I had been telling myself that I let my health go.

And I really hadn’t. It was all in my head. The proof was right in front of me. Facts don’t lie.

And so I realized that I had to change my story. We all create the stories of our lives. Our realities. And I had the opportunity – right now, in this instant – to change one that wasn’t serving me.

I re-assessed. I do check my blood sugars regularly and adjust my insulin accordingly. I keep track of my eating, exercise, and sugars as much as possible. I exercise most of the time, eat healthy more often than not, and still meditate and journal to keep my stress levels as low as possible. Okay, so fine, I cheated here and there, but clearly, that’s okay if it’s within reason. All of the things I mentioned in April’s blog about reaching a 6.5 A1C. None of that had changed. Just the story I had created in my head.

And then I started thinking about all of the other stories I’ve created. The stories with the same moral: “Whatever I’m doing isn’t good enough.” You know the ones. Whether related to weight, hair, skin, or other non-body topics like stuff to do around the house, finances, and so on. There are lots of self-damaging stories that people create, like, “If I had more, then I will finally feel accepted.” “Would people accept me if I had less?”

I do love a good story. I suppose that’s what keeps me blogging. But some stories are just downright awful. And it’s up to me – up to us – to gauge when a story is true – and when it’s just a piece of fiction that’s better off in the trash.

I chose today to throw my tragic-fiction away. And I’ve created a new story for myself. I call it the “I take great care of my health” epic novel. Because with this positive attitude toward health, I expect it to last a while!

Thriving with diabetes

Hello everyone,

I wrote the following post as a guest blogger for Kelly Kunik from Diabetesaliciousness™ which she will post later this week. In addition to blogging, Kelly advocates for diabetics at conferences throughout the year and speaks with children with diabetes about living with the disease. Please visit Kelly's blog this week to show your support.

Thank you, Ophir


I woke up with a 234 blood sugar reading today. I know why. My husband and I went out to dinner last night, a spontaneous date inspired more by laziness than romance. We sat and ordered our meal: For me, gluten-free Singapore rice noodles with chicken and veggies at P.F. Chang’s. I bolused insulin to compensate for the meal. But not a long-acting dual wave bolus, as the little voice inside of me told me to do.

A nice long dual wave filled with lustrous Humalog probably would have done the trick of offsetting the sugars released in a fatty meal. But I didn’t do that. I thought about it. But when the time came, when the opportunity arose, I didn’t hit those extra buttons on my insulin pump.

I have been a Type 1 diabetic for over 35 years, have been to tons of doctors, nurses, and diabetes educators, and I keep up with all of the latest and greatest technologies and studies. And so, a high that results from a “I knew better” can be a bit exacerbating. I do know better. And typically after a “I know better” high blood sugar, I feel guilty.

Not today though, and I’ll tell you why: I’ve chosen to focus on self-growth instead of on what I did or didn’t do. I’m going to figure out why I didn’t set a dual wave when I know I should. What happened in that subconscious instant when I made that choice not to do what’s best for me and my health?

I remember at the time, I was feeling hot, tired, anxious from a long week of work, and I just wanted to let go of all the stress. Drink a glass of wine, eat some yummy noodles, and enjoy being out and about. I wanted to enjoy the moment and be happy.

But is that real happiness? Does having a great time mean not taking care of blood sugars? All I’m really doing is hurting myself. A moment of pleasure followed by hours of blood sugar highs and lows – and emotional ones as well.

I found some enlightenment. While reading Women, Food, and God in which author Geneen Roth talks about the perils of weight loss, going on diets, and never really reaching that state of pure bliss with one’s body. She explains that many of us go through life setting a goal, such as losing 10 or 20 pounds, but not allowing ourselves to ever reach it. Let me say that again: Not allowing ourselves to ever reach it.

Boy, did I ever relate to that. I’ve wanted to lose those 10 or 20 pounds since freshman year in college, and not to give too much away, but that’s been a while. And then she says it, the line that got me: Because without that goal, we’d be lost. Reaching that goal has becomes our identity.

I realized that her statement not only applies to weight loss, but it applies to all goals in life. It can apply to reaching that perfect weight and also that perfect 6.5 A1C or blood sugar reading – or how about projects around the house, creative pursuits, education and career, love, and so on.

And as Roth says, we tell ourselves that once we reach that goal, our lives will be better. We’ll be happy. I’ll be happy.

This seems counterintuitive, doesn’t it? Because then, when it comes time to really making it happen, that moment of truth, I didn’t set that dual wave bolus so that my sugars will turn out great. I didn’t order the steamed veggie platter. Nor did I exercise for an hour afterward. Because perhaps a part of me thinks that if I reach my goals, well then what will I do with my life? Who will I be? I’ll feel lost, alone, without a purpose. And all I really want is to be happy.

Geneen Roth explains: That person aiming for those goals, the person who will only be happy once reaching them, was never who I really am, who any of us are. The real goal, the way to live life to the fullest and thrive with diabetes, is to live life as our authentic selves through being – where you live each moment as it is - whether you are happy or sad, angry or hurt, or inspired.

According to Roth, many of us try to push away what we are really feeling and sensing because we are so focused on being “happy”. Fixing the problems. Many of us, including myself, suppress our feelings through food. But by being with whatever we are feeling, whether it be good or bad, we can live more fully and more authentically – and in essence, it makes us even happier. Because we are being our true selves.

You can bring those moments of being into as many moments of the day as possible. Feeling, sensing, tasting, smelling, touching, and listening to wherever you are physically and emotionally at every moment of every day.

Last night, I heard that soft, little voice telling me to set a dual wave bolus, but I didn’t act because that voice was drowned by the noise of my ranting thoughts. Trying to think of how I could be happier, instead of just being.

Trial and error: Me and my new Medtronic Revel insulin pump

It all started with a phone call one evening after a long day at work, a sales call actually, from a Medtronic representative. “You are eligible for an upgrade,” she said, “You’ve had your pump for over four years. Medtronic has come out with the new Revel, an upgrade from the Minimed.”

The second generation hath cometh.

Sigh. I was totally zoning out in front of the TV, and I kicked myself to pay attention. I was so not in the mood to speak with sales associates at that moment. I asked the necessary questions, and then told her that I wanted to look into it. I’d get back to her.

I remember the confusion when I first went on the pump in 2006. Which pump do I choose? Back then, I was debating between the Minimed Paradigm and the Animas, a waterproof model where you can store hundreds of carbohydrate food amounts and not have to research or remember how many carbs are in a carrot or a piece of chocolate cake.

And yet, I chose the Minimed Paradigm 522. They were on the cutting edge of technological advancements, had just come out with a Continuous Glucose Monitor (CGM), which monitors your blood sugar levels every five minutes and then communicates them with your pump.

The only integrated system on the diabetes market.

So I chose technology over what I deemed as convenience. And I always wondered...did I make the right choice? I went through the CGM training. But I never really got into it.

My confession: I don’t use the CGM. The needle is too big and painful for my taste. The CGM also sounds alarms every time sugars drop or rise above a certain range. That’s fine, actually that’s good, but I would often find that the numbers weren’t accurate after doing a manual glucose check. So I would be awakened at 3 am with a supposed 240 BG, when actually my BG was more like 86.

This drove me mad, bonkers, frustrated! I packed the CGM in a box, still sitting in my closet, always wondering if I should just suck it up and put the darned thing on.

Opportunity had arisen once again. I can make the switch. Freedom from CGM pressure! Maybe I can go in a pool with a pump! Now, there’s the OmniPod, the Animas Ping, and who knows what else? I know nothing about them!

And I still don’t!

Instead, I began by researching the Revel. I called Dr. W and asked for his opinion. He gave it a thumbs up. I read on-line reviews. Thank you, Amy of Diabetes Mine, who posted a review by Techie Type 1 blogger Scott Hanselman. I learned about new features such as better charting and alarms, showing active insulin more often to help eliminate insulin stacking, and the ability to bolus in .025 increments, an improvement over the Minimed’s .05 increments.

And I asked for a brochure, which the sales representative sent right over via e-mail. And there it was, on a PDF, that darned integrated system again: “The 3 Key Elements of Effective Diabetes Management”.

1) Insulin Delivery
2) Continuous Glucose Monitoring
3) Therapy Adjustment

Sigh. It sells me every time. The responsible thing to do. Be as effective as I can be to monitor and adjust, trial and error, living and learning. That’s what the Revel is all about. And quite frankly, that’s how I live my life.

Living and learning. Trial and error. Monitor and adjust. It’s called living a self-aware life – and then doing something about it – to make your life better.

I started my new Revel pump on Saturday after an hour and a half Medtronic webinar and audio teleconference training for experienced pump users. The words trial and error came up at least five times. Now I can capture events like exercise or eating pizza, download it to my computer, and then see how it affects my blood sugars and make adjustments accordingly.

Wouldn’t it be great if we could do that with life too? Capture the events in our lives, download them to our computer into graphs and charts, and see how we would do it differently next time, or keep it all the same because whatever we did actually worked? An integrated system for living a self-aware life? Catching our patterns on screen and then being able to adjust with a few clicks of a button?

Perhaps the Revel can teach all of us how to revel in life - by being aware of our patterns and using that information to take action? Because it's all a matter of trial and error.

Back from vacation, back to the grindstone

I’m back from an absolutely fantastic vacation. Lior and I went to New Orleans for five days. New Orleans is a great city. The people are friendly and easy going. And the city is filled with an incredible amount of creative energy – writers, artists, musicians – and chefs. Oh yes, lots of great food. Really fattening food. Alcohol. Temptations.

New Orleans is not the healthiest city to be a tourist with diabetes and celiac – an allergy to wheat, rye, and barley. I also don’t eat pork products and only eat certain kinds of shellfish. So needless to say, finding the right kind of foods was challenging for me.

Lior and I combed the French Quarter both on-line before the trip and while there via guidebook and on foot in search of meals that fit at least most of my requirements. And when we did, the food was positively delicious. But it wasn’t easy.

And my blood sugars suffered. I went as high as 300 on one occasion and had a terrible low of 44 in the airport on the way home. I cursed every fattening, starchy meal I ate while sitting on a bench at the Philadelphia airport in a groggy haze recovering from that hazardous low sugar. Thankfully, Lior was there to pick up the suitcase. I was a mess.

The blood sugar roller coaster ride is exhausting. Physically draining. Frustrating. And I felt guilty. I’ll be honest. Despite all of the fun we definitely had, food, diabetes, and celiac was a sore point of the vacation for me.

But of course, I try to live life finding the lesson in my diabetic experiences and then use that lesson so that I can thrive with diabetes. I use this blog as a forum for doing that.

To do that, I need to be honest. I need to back track a bit. I knew ahead of time that I would be steering off of my healthy eating course on this vacation. When we first decided to go to New Orleans, Lior and I researched restaurants trying to find a place with just the right balance of vegetables, healthy grains, and nutritious options. But what I found was an array of exciting restaurants to explore - with lots of unhealthy choices.

So I rationalized: I’m not in New Orleans every day. My whole life’s motto is to live life to the fullest and take advantage of every moment.

And so I decided that food would be part of the experience:

Wednesday night at GW Fins, I ate a very succulent tilefish with shrimp etouffee, mashed potatoes, and lobster butter sauce, and I had blackberry and mango sorbet for dessert. Lior and I both agreed that GW Fins was our second favorite meal of the whole trip. I drank a beautiful glass of Riesling later at Irvin Mayfield’s Jazz Playhouse while Lior drank who knows what. But lots of it.

Thursday night at Desire Oyster Bar, I ate blackened snapper with crabmeat on top of sautéed green beans, peppers, and capers, and a baked potato. The meal was good. I also tried a bite of oyster for the first time in my life. Delicious but a bit chewy for my taste. I did love the atmosphere though. The restaurant‘s windows opened out onto Bourbon Street, and the ceiling fans, lights, and tile floor reminded me of the oyster bar in Grand Central Station in New York (which is most likely a copy of the ones in New Orleans).

On Friday night we ate at Arnaud’s Jazz Bistro. The band played classic jazz while I dined on mushrooms Veronique, salad, chicken in béarnaise sauce, Brabant potatoes covered in hollandaise sauce, and I had caramel custard for dessert. The food was okay, not great. But the experience was worth it. We then returned to Irvin Mayfield’s Jazz Playhouse and listened to Leon “Kid Chocolate” Brown on his trumpet (or perhaps it was a trombone, can’t remember) while Lior drank five martinis. I drank juice. The guilt trip started that night.

And on Saturday night, we rode the St. Charles Avenue Streetcar to Brigtsen’s, a James Beard Award winning restaurant. As you can imagine, I ate the most delectable, unforgettable meal ever: Blackened tuna with smoked corn sauce, red bean salsa, & roasted red pepper sour cream, mashed potatoes, sautéed green beans, and the most incredible café au lait crème brulee for dessert.

I gained two or three pounds while I was away, had crazy blood sugars, and I think there may have been some gluten in one or two of those meals. I felt sick to my stomach from all of that crazy food that Sunday at the airport, and actually that entire day, and you know what?

It was worth it.

I know I’m supposed to write about eating healthy all the time, exercising, and taking good care of your health. But you know what? It’s true. It’s not a rationalization. I’m not in New Orleans every day. And I love delicious food. I tried my best to maintain a gluten-free diet. I tried to eat vegetables whenever I could. I walked every day, and even went to the hotel fitness center one day and did some yoga every other day while I was there. And I had a great time.

I did feel guilty when I got back home though. But you know what? That’s okay too! It means I care about my health, and was fully aware that I was breaking the rules.

The guilt has also pushed me to focus on healthy living again now that I’ve returned. I decided to start counting calories and intensify my work-outs some more. (I had gotten a bit lazy before going away on vacation.) I have already lost the two or three pounds I gained while in New Orleans. And am on my way to losing some more.

I have actually found that being a little bit sinful and letting loose once in a while has been a great motivator to push forward now that I’ve returned to the grindstone.

What’s the diabetic lesson I’ve learned? We all need a break sometimes. I know I did. And I am willing to turn those guilt trips into acceptance, have some fun, and then transform all of that energy I used on feeling guilty into pushing forward and making even better and healthier choices once the vacation is over.

Will I feel guilty on my next vacation? Probably, but maybe that’s a good thing after all?

My top five reasons why I love exercise and you should too

Dear Conscious Diabetic readers,

I have joined fellow d-bloggers and am participating in Diabetes Blog Week. I will be posting new topics every day this week on living with diabetes. Click here to read my Conscious Diabetic Monday post entitled: Diabetes and loving kindness practice.

Have a great day,
Ophir

Diabetes Blog Week topic #5 is exercise: Love it or hate it?

A wise person told me a few years ago that the only way to get diabetes under control – the only way to really make a difference and achieve healthy blood sugars and A1Cs – is to exercise consistently five days a week.

I was always an exerciser as a kid – riding my bicycle for hours, going for walks, roller skating, and playing tennis mainly - but I was kind of on-again, off-again about the whole thing. Then as an adult, the off-again phases became more frequent until I received that priceless piece of advice. And I decided to commit to consistent exercise.

I have listed for you my top five reasons why I have learned to love exercising five days a week, and have stayed committed to it for at least three years now, and why I think that everyone should get up off the couch and start loving exercise too!

5. Attention all Type 1, Type 2, pre-diabetics, and non-diabetics, exercise helps control blood sugars and can prevent diabetes altogether in some cases! Studies conducted at the U.S. Department of Health and Human Services found that “Physical activity 30 minutes a day on most days – or certainly five days a week – is a good place to start because that tends to maintain the blood sugar in a more normal range….And losing a few pounds, with proper eating and physical activity, can reduce chances of getting diabetes.”

Overall health improves as well through consistent exercise. I personally reversed some kidney problems I had developed when I was younger once I began exercising regularly and getting my blood sugars under control. I have also been taken off two medications, my cholesterol is superb, and I simply feel healthier, lighter, and more energetic.

Of course, this is mixed in with a healthy lifestyle as well: eating the right kinds of foods, sleeping properly, drinking lots of water, not smoking or drinking excessive alcohol, taking insulin and checking blood sugars, making my well-being a priority, and so on. Exercise is part of the overall health package.

4. Exercise is a great way to release stress, blow off steam, sweat it off, and burn off anger and frustration. Kick-boxing, martial arts, yoga, running, walking...all of the above and more…are great ways to let go of whatever is holding you back!

3. I’ve learned more about who I am. As you release the things that hold you back, you make room for who you really are to enter into your life.

I love yoga, walking, and aerobics that mixes in toning exercises. I love a good Jillian Michaels DVD because she pushes me to realize my potential, and I also love taking a nice walk outside and smelling the roses, being meditative, while also moving. Yoga is my all-time favorite exercise because of its mind-body-spirit approach – looking at the body as a whole.

I’ve come to learn that who I am as an exerciser reflects who I am in other parts of my life as well: Ambitious and driven while also staying attuned to mind-body-spirit.

2. You look better on the outside when you take care of what’s going on inside. I look better: Skin, eyes, hair, muscles, and all. I fit in my clothes, and they’re even loose at the moment! What a great feeling it is to walk into a store, pick out a pair of jeans or slacks off the rack, and fit in them! And look good!

1. I am happy, balanced, more confident, and at peace more oftentimes than not. We all deserve goodness in our lives, and you start to receive that goodness when you take care of what’s within you. Happiness comes from loving yourself, and what better way to do that than through exercise.

So, let’s get moving!

To carb or not to carb?

Dear Conscious Diabetic readers,

I have joined fellow d-bloggers and am participating in Diabetes Blog Week. I will be posting new topics every day this week on living with diabetes. Click here to read my Conscious Diabetic Monday post entitled: Diabetes and loving kindness practice.

Have a great day,
Ophir

Diabetes Blog Week continues and Karen of Bitter-sweet has asked us to answer the question: To carb or not to carb? What side of the fence do you fall in?

Let’s just get this out of the way: I carb.

I’ve spent quite a bit of time on this blog, thinking it through, writing several versions, and not really knowing how to approach this topic. In my original entry to you, I actually started dissecting the different kinds of carbohydrates – complex and simple, and talking about the Glycemic Index. But you can just click on the links to learn more about that.

Then I realized the reasons why this blog was so difficult for me to write: I didn’t want to give a nutrition lesson. And although I’m not a nutritionist or a diabetes educator, I feel very self-assured in my reasons for eating carbs at every meal. These reasons are based on practice, education, and the experience of living with this disease for over 35 years.

And I know that others do not necessarily feel the same way.

I’ve often felt like a pain in the neck when I insist upon healthy carbs at dinner time or a catered event or when invited to someone else’s home. Then add to that, I also have Celiac, an allergy to wheat, rye, and barley. I don’t want to be a pain for others, but I need to think of me and my health first. And balanced blood sugars matter to me. They are a part of the equation. And that means eating balanced meals.

So why not just eat a healthy plate of grilled chicken and veggies? Why must I insist upon adding a sweet potato or buckwheat to such a meal? I have found that diabetes is a practice in trial and error – testing how different foods release into the bloodstream and react within your body. And for me, a mix of vegetables, fruits, protein, healthy fats - and carbohydrates - are a must-have at each of my meals. I stay steady and balanced when I do that.

So yes, I carb. Because that’s what works for me.

Making the low go...

Dear Conscious Diabetic readers,

I have joined fellow d-bloggers and am participating in Diabetes Blog Week. I will be posting new topics every day this week on living with diabetes. Click here to read my Conscious Diabetic Monday post entitled: Diabetes and loving kindness practice.

Have a great day,
Ophir


I woke up to the clanking sound of metal hitting a glass as I slowly opened my eyes. My mom was hunched over my bed holding a glass of orange juice, and she was yelling to my father to bring more sugar. She bent down to give me more to drink. She forced the glass to my mouth, but only a few drips made it to my throat. The rest – all over my face. My skin felt sticky, and I was in pain and feeling a bit nauseous. I’d had enough already.

And then I noticed that puddles of orange juice had dried on my face and on the bed. I realized in that moment that my parents had been at this for a while. My mom and dad had brought me back to life, and I was 12 years old.

We have been asked to write about our favorite low sugar treats for today’s Diabetes Blog Week entry.

I used to think of lows as fun since I would be able to eat all sorts of foods that I normally wasn’t allowed to eat as a diabetic. A chance to taste the forbidden! Cookies, cake, and pastries. Candies, chocolate, and sugary drinks. All of the stuff that everyone else was eating, but not me and my diabetes.

But the fun was a temporary fix. A badly treated low could turn into a roller coaster ride of lows and highs, never giving my body the opportunity to heal and feel right. Lows are meant to be treated, not accosted. For just as in life, every low must go up. And eating the right kinds of foods can bring the sugars back to a place of balance. Eating the forbidden fruit though can cause long-term anguish.

Somewhere in my mid-20s, I became a tad more enlightened, and I would eat dates, figs, and dried apricots during low sugar episodes. Or I would go for 4 oz of orange juice. The idea was to be somewhat healthy about the low, still eat something yummy, but not wreak havoc on my entire system.

Around five years ago, the same time that I went on the insulin pump, I met with a nutritionist who taught me the ideal way to treat a low, so that the lows go away, rather than transform into a painful and physically challenging roller coaster ride. She told me to chew on four glucose tablets, wait 15 minutes, and then check my sugar again. If it’s still low, eat 4 more tablets, and repeat. If the sugar is above 70, and if I’m not planning on eating a meal within the hour, then I was told to eat 12 grams of carbohydrates and 8 grams of protein. The idea: Just enough quick sugars to raise blood sugar levels quickly and then stabilize with a balanced meal.

Glucose tablets are not great tasting. They’re not fun or intriguing. I do have a favorite flavor though – tropical fruit from Stop and Shop – but it’s nothing to write home about. They are portable, don’t require refrigeration, and most importantly, it works.

I’m taking care of myself in a healthier way by seeking balance rather than the highs and lows. Balance. One of the lessons of diabetes.

Diabetes and loving kindness practice

Diabetes hands us an array of lessons on living our best lives. One of the most important is that of self-love.

I often bring up self-love in this blog because I truly believe that you need a lot of it to live a conscious, healthy life with diabetes – and actually with any other disease. Let’s face it. You need to care a lot about yourself to put in the effort and the work to get and keep blood sugars balanced and live the life you want to live. This is true for anything in life. And in the case of diabetes, I know from my experience that self-love practice is a complement to the rest of diabetic health management.

I first discovered where I fall on the self-love spectrum in my 20s, but the real change to true self-love began when I was working at a non-profit that developed websites, workshops, books, and other materials on finding peace within oneself. Their motto: “Peace begins within me”. I love their philosophy: Once you are at true peace with yourself, the circles of peace grow and spread creating a more peaceful and harmonious world.

I worked in the kids and youth department, and my job was to manage content for two websites, a few video games, books, and other activities mainly focused on building self-esteem in children. The non-profit itself also ran workshops and websites for adults. Potential adult workshop leaders would lead sessions for the staff to test which included meditation, alternative therapies, and guided imagery sessions. We would typically attend one or two of these test workshops a month.

When I began working at the non-profit, I was far from the type of person who would meditate. In the beginning, I often snickered thinking they were ridiculous. But then I began to see their value as I listened to the lessons they taught. Many of these workshops were planting seeds for my own transformation. And in terms of self-love, one in particular stood out for me - a group loving kindness practice.

We were divided into pairs and asked to face one another. My partner, a very close friend of mine, we’ll call her R, was asked to go first. She was told to repeat the workshop leader’s statements. We both looked at each other and rolled our eyes giggling in unison.

“May I be happy,” The workshop leader said.

R repeated, “May I be happy.”

And then the leader continued one by one stating, “May I be healthy. May I be safe from harm. May I be at peace. May I be free from suffering.” And R repeated each one thoughtfully.

“I love me,” the workshop leader stated, “Now hug yourself.”

R did just that. She hugged herself, smiled the biggest smile you can imagine, and sang, “I LOVE ME!”

My face froze as I stared into R’s eyes. Could I do that? Could I stand in front of a group of people and hug myself and sing “I LOVE ME!”

This is how I discovered where I fell – at that time – on the self-love spectrum. I felt my body become tense, and wasn’t sure that I could do what R had just done. I realized that I may not be at the 100% mark on the self-love spectrum.

It was my turn, and the workshop leader told me to state these wonderful wishes for people we know, people who have helped us, people we love. I was a bit disappointed that I didn’t get the chance to try it and proclaim self-love in public.

I repeated the workshop leader’s words: “May you be happy. May you be healthy. May you be safe from harm. May you be at peace. May you be free from suffering.”

R smiled. But I felt as though I was putting others before myself. As I left the workshop, I decided to make self-love a mission.

Loving kindness can also be practiced solo. I was reminded of this wonderful self-love building Buddhist meditation practice this weekend while reading "Love in Full Bloom" an article found in Yoga Journal’s April edition. Writer Frank Jude Boccio tells us that self-love comes from practicing “The Four Limitless Ones”: loving kindness, compassion, joy and equanimity.

Loving kindness and compassion can be combined into one practice, and it’s a good place to begin on the self-love journey. Boccio states, “when we practice [them], we start by cultivating a friendly, unconditional regard for ourselves, before attempting to cultivate the same for others.”

Begin by reflecting on your own goodness, a time when you did something good for someone else that was kind, generous, caring, or loving. It can be as simple as opening the door for someone, letting a car go ahead of you at an intersection, smiling at someone on the street, or saying thank you. In addition to Boccio’s suggestions, I also suggest that people with diabetes – or with any other disease – take the time to be grateful for your body, mind, and spirit. Be grateful for your breath, your beating heart, your sense of touch, sight, smell, hearing, and taste, your creativity and intellect, and anything else that arises – where you are grateful for you and who you are.

Then, you can continue with the loving kindness practice much as we did at that workshop that day. Begin by finding a quiet and comfortable place. Follow your breath. And then state: “May I be happy. May I be peaceful. May I be safe from harm. May I be free from suffering. May I be healthy. May I experience ease.” And feel free to add, “I love me.”

You will know where you fall on the self-love spectrum – and perhaps where you have work to do - if you feel any tension or unease with any of the statements. Once you are ready, begin to extend the same loving kindness to others in sequence: a person who has helped you, a person you love, family, friends, and then to people who are neutral to you – that you neither like or dislike – and then once you are ready, begin to extend the same to people you don’t like or who anger you, and then finally extend the same loving kindness to all humans and creatures around the world.

Through self-love, we live a better life. I know that I have come to a place on the spectrum where I feel blessed for the wonderful life I live, and I can proudly declare in public: I love me. Getting there, like managing diabetes, is a process filled with ups and downs. But it’s worth it.

Click here to read Yoga Journal’s “Love in Full Bloom”
Click here for Sharon Salzberg’s loving kindness audio meditation and transcript.

Diabetes and a good night’s rest: Another tool for living your dreams

I usually sleep 8 hours every night. I hit the pillow, and I’m out like a light. I wake up the next morning rejuvenated and ready to go. But not this past Saturday.

Lior and I had a whirlwind of a day on Saturday. We had a neighborhood yard sale in the morning outside in 90-degree heat, took much-needed naps in the afternoon, and then went out for dinner that evening. Indian food – yum!

My meal was definitely super-high in fat. And I knew I was risking high sugars when I placed my order. But I decided to go ahead and do it anyway. I did what I could to prepare my blood sugars for my unhealthy decision – dual wave bolus and all – but what I ordered was the complete antithesis of healthy and well-balanced.

I checked my sugar two hours after the meal to see how my body was responding to the food and dual wave. It was high – 230. I bolused to correct the high sugar – which means to inject insulin in pump talk – and I waited an hour to check my sugar again. It was still high – 220. I debated with myself for a minute. You have to be careful when bolusing insulin too many times. Sometimes it just takes the insulin a while to do its job and if you bolus too much, you can wind up with low sugar later. But I just knew to keep bolusing. I wouldn’t be going low this time. So I did.

We watched a movie – ironically enough Cloudy with a Chance of Meatballs where characters overindulge in food – and I decided to go to sleep a few hours later, around 11:00 pm. I checked my sugars again before falling asleep. Still high, again in the 200s. I decided not to bolus. And over the next couple of hours, I lay in bed obsessing about who knows what, tossing and turning for two hours. I couldn’t sleep. I checked my sugar again at around 1:00 am – 213. No change, still high. I bolused again. Finally I was so exhausted that I fell asleep at 1:30, high sugars and all.

I woke up the next morning exhausted and in pain. I checked my sugar. It was still high – around 205. I bolused to correct the high sugar once again and started my day.

There is a link between high blood sugar and lack of sleep. Actually, some studies show that inadequate sleep can be a contributor to Type 2 diabetes. But was my lack of restful sleep due to the high sugars, unhealthy foods, or anxious thoughts? Could it have simply been the heat and mid-day nap? I didn’t exercise that day, could that be it?

Answer: All of the above. I think my Saturday night madness is an example of how truly connected our body-mind-spirit really are in living peaceful lives. Unhealthy eating, lack of exercise, high blood sugars, stress, and stepping out of my typical sleep routine. And in the end, it all showed up on my glucometer – loud and clear – 230, 220, 213, 205.

Okay, so that’s mind and body. But why did I bring up spirit?

Spiritually speaking, the time before we go to bed and when we first wake up is considered very sacred. Sleep is a time for us to rejuvenate and get the needed rest we need to take us into the next day. And it is also the time when we transition from the waking outer world to connect with our inner world. It’s a time when dreams happen, clueing us into what resonated with us during our day, and when we’re tuned in, our dreams may speak to us about our life’s passions or things that are holding us back. And for some, bedtime is a time for prayer, setting intentions for the next day. Some even believe that our soul goes up to heaven or to God during sleep to receive messages and rejuvenation that will set us on our spiritual paths.

In “A New Earth”, a book on living one’s purpose, Eckhart Tolle advises readers to meditate, scanning the body and paying attention to breath, before going to sleep and first thing when waking up in the morning. In “The Secret”, a corny but worthwhile read about the Law of Attraction, Rhonda Byrne suggests thinking positive thoughts before bedtime, placing an order with the Universe to deliver good things. And in “Have a Little Faith”, the Reb Albert Lewis tells author Mitch Albom that he thanks the Lord for returning his soul to him each morning when he wakes up.

Usually, I use sleep in this way. I pay special attention to thinking good thoughts/meditating/praying before I go to bed and when I wake up in the morning. And as I wrote in the beginning of this entry, I fall asleep in an instant and I wake up completely refreshed. I go downstairs to exercise. I eat a healthy breakfast and get ready for the day. And the results of these mind-body-spirit practices are evident in my life. I recently reached my dream of a 6.5 A1C and I’ve reached other dreams as well such as becoming a writer, falling in love, and owning a home.

I use sleep as another tool for living the life I want to live.

Sleep is an important part of taking care of ourselves. No question about it. And it is completely related to everything else we do during the day. And if you are attuned to mind-body-spirit practices, you can utilize sleep as well. Eat healthy, exercise, stay hydrated, reduce caffeine, and set your intentions for the life you want to live before you go to bed and when you wake up every morning – and watch how the world conspires to give you the life you want.

The 6.5 A1C

I was sitting on an examining table at Dr. W’s office, my endocrinologist, a couple of weeks ago waiting for him to get off the phone when I asked the nurse if she could make a copy for me of my quarterly lab test results, the results that would tell me my latest A1C - the test that gauges how well diabetics manage the disease. How well I’m managing my diabetes.

I was amazed at myself because I have been asking for those lab test copies the minute I walk in the office door for decades, and that day, it completely slipped my mind until I was sitting on the table waiting for Dr. W to tell me what latest thing I needed to change or do. That’s usually what happens at these doctor’s appointments.

I have been somewhat obsessed with the A1C number for the past decade or so. Why? I hate failing in general, but that one in particular is one that I loathe failing. The goal is a 6.5, and I had never gotten there before. I had been holding steady at 6.7 for five or six years, not quite making the 6.5, and before that I was holding at a 7 for about two or three years, and before that an 8.4 for I don’t know how long, and before that, I have no idea. For the past decade or so that I’ve been conscious of my A1C and actually trying to make it better, I have felt frustrated and less than adequate at the one job I work at the hardest - 24 hours a day, 7 days a week.

And then as I sat there in the doctor’s office, I realized that I hadn’t thought about the dream A1C in a long time, the 6.5. For the past three months, I had still been exercising, meditating, eating healthy, and monitoring my sugars in relation to all of these things, but I hadn’t really thought about the goal itself. I realized that I had let it go and began simply plodding along living my life in a balanced and healthy way.

The nurse returned, Dr. W still on the phone solving a crisis with another patient, and she handed me the pages. I thanked her and began scanning. Cholesterol – fantastic! Protein in urine – None to be found (protein spillage determines possible kidney disease which I had when I was 21 years old)!

But I was really searching for the A1C. I had to see the numbers, the results of all my hard work – the monitoring, pricking, bleeding, squeezing, tracking, evaluating, assessing, meal planning, weighing, exercising, and sugar inducing during the lows, and so on.

And as I continued scanning, I found it. There it was: A1C – 6.5. I reached my goal! Or at least the goal that endocrinologists have set for me since I started this diabetic journey in 1974. And it only took over 35 years to get here! But I’m here now!

The 6.5 A1C journey has been a long one. The first A1C I remember was an 8.4 which I learned about somewhere in the mid ‘90s. I guess that was the first A1C that I was half conscious for, which I assume was the case since I kept the document on file and still have it today. The next lab test document that I have in my file was taken a few months later, and the A1C read 8.2.

So what changed? How did my A1C path shift and start trending toward healthy levels?

That’s a big question. It’s a lot of things: patience, persistence, doctor-patient relationships, science, tracking, willingness to change routine, education, eating healthy, exercise.

It started with Dr. P back in the 8.4 days. Dr. P was considered an aggressive doctor, but quite frankly, she was exactly what I needed. Dr. P was incredibly persistent with me on monitoring and tracking my blood sugars. She also sent me to a nutritionist. I learned how to better plan my meals and eat healthy, well-balanced food. I started a regular exercise program and found myself becoming addicted to it! I read Diabetes Forecast monthly to learn about the latest information and stay informed. I had also started seeking support and talking about my diabetes for the first time in my life.

Types of insulins were advancing back then too, and Dr. P kept up to date. She switched me from pigs’ insulin to synthetic Humalog and Lantus, all injected through needles and back then considered the latest and greatest in insulin because they resemble human insulin more closely. I had made my way down to a 7.2.

I switched to the pump four years ago, after the Dr. P years but before Dr. W, and after reaching a 6.8. The pump has been the greatest blessing for diabetics as it attempts to mimic a fully-functioning, insulin producing pancreas. I had to basal test for a long time – which involves fasting and testing sugars every hour on the hour – until the docs found the right patterns for me. But I stayed persistent and tried to be patient (not always succeeding at that part), and eventually I found Dr. W who really understood how to set a basal pattern correctly. At that point, I had made my way down to a 6.7.

The big “ah ha” was when he told me that my basal patterns are fine, I need to focus on how much insulin to administer for different kinds of food. I had already learned carb counting, which is the typical lesson we diabetics learn when we go on the pump. We calculate how to bolus – or inject – insulin based on how many carbohydrates we are eating. But Dr. W claims that there’s more to it than that. Dr. W’s theory is that each food reacts differently in every person’s body, and so it’s up to us to look at each food and test how our bodies react to it. Then figure out the right bolus.

The more you are aware of your sugars in relation to the meals you eat, the dosages of insulin you administer, and the amount of physical activity you perform, the better your sugars will be. I find this all to be a royal pain in the neck. I hate tracking and testing it. I mean, I really hate it.

Dr. W would love to set up a study on this topic. I think that people first have to want to do it, to care that much about their health and bodies, to do all of the work involved in diabetes management.

And where does that desire come from? It comes from within.

Besides all of the stuff that diabetes doctors and educators have been talking about for years, all of those details I only glossed over above, there’s also the human side. Being a healthy diabetic requires living with the disease in an emotionally healthy way: Knowing who you are and accepting yourself fully. Listening and having compassion for yourself and others. And living your life’s passions to the fullest. It’s all connected.

Your state of mind - and dare I say connection to spirit - affects your state of body.

Dr. W got off the phone and started telling me the story behind the emergency call, apologizing for taking so long, “This guy just had his leg amputated. He’s on dialysis. I wish I had the ability to teach people how to live with the disease beyond what I can do in this office,” is more or less what he said.

He picked up my lab tests. “Look at these numbers,” Dr. W was scanning too, “We’ve been seeing each other for the past year, and I’ve seen you come a long way. 6.5 A1C. You’ve lost 5 pounds which is very good for a person at your weight. Perfect cholesterol. Not an ounce of protein. You’ve basically cured yourself of kidney disease.”

I left Dr. W's that day realizing that I’m in the best health I’ve ever been in my life, and I felt very proud. And I realized that the journey changed for the better the moment I became conscious. The moment I became conscious of self-love.

Changing habits with a detox: Part 2

I have always known that mind, body, and spirit are linked, but I never realized just how connected they really are until I did a detox this past week. Last week I wrote about my goals for doing the detox that I found in the March edition of Natural Health magazine. I wanted to change some habits: Stop snacking on unhealthy foods in the late afternoon and in front of the television after dinner.

Within the first few days of the detox, as my body began to clear itself of the toxins found in damaging foods, such as high fructose corn syrup, trans-fats, and all the other buzz words that nutritionists and fitness professionals talk about, I also found that I didn’t want to eat those foods either.

My mind became clearer as well. After a day or two, I suddenly realized that I wasn’t turning on the television first thing in the morning or checking e-mails every few hours. Actually, I didn’t check my e-mail even once all day yesterday! That’s miraculous for me! Without all of that television and e-mail, I had more time. I read more and had some personal revelations about who I am, my purpose became clearer, my blood sugars were simply fantastic, and I also found myself more present during the day. By Friday, after six days of detox, I suddenly realized that I hadn’t written one personal to-do list all week long! To-do lists have been one of the most consuming habits I have ever had. They have run my life, and I am thrilled that I didn’t write one all week. And I hadn’t even sought to change that habit!!!

I have finished the detox, and I can say that I rid myself of a lot of unhealthy habits. And although I have watched television, checked e-mail, and written a to-do list since, I have not eaten junk food, and I also believe I’m off lethal food additives like: high-fructose corn syrup and trans-fats. I also feel that I am still attuned to my purpose, and I plan to keep it that way!

The question is: Did I detoxify my life from unhealthy foods and habits because of what I ate? Or is it because I set an intention at the beginning of the week to change habits?

I believe it’s a combination of both.

Deepak Chopra wrote about the Law of Intention and Desire in the Seven Spiritual Laws of Success: “Inherent in every intention and desire is the mechanics for its fulfillment. And when we introduce an intention in our pure potentiality, we put this infinite organizing power to work for us”.

What this law is saying is that you can change your life for the better if you have the intention to do so, and the whole Universe will conspire to help you out. BUT, you have to also pay attention to the six other spiritual laws of success. Click here for a summary of all seven, and I strongly suggest reading the whole book.

But how is this possible? Okay, now we’re getting into quantum physics a bit, but let me try to explain. The law is based on the fact that energy and information exists everywhere in nature; a flower, a rainbow, a tree, and the human body – when broken down into its components – are all energy and information. The whole Universe is filled with interrelated energy and information. The only difference in the energy and information between humans and a tree or a flower is the content within our respective bodies. We can change the content of the energy and information of our bodies at the atomic level, and then it influences our external bodies, our environment and our world. The quality of the intention will cause things to manifest because it is linked to the energy and information in the entire Universe.

This is worth repeating: You can change your life for the better if you have the intention to do so, and the whole Universe will conspire to help you out as long as it is for the benefit of the entire world.

I chose to change bad habits with my detox, and it worked because I set a quality intention to change it. It cleared my mind, body, and spirit for greater things to enter my life. And, if you intend to detoxify your life from poisonous things, you can do so too. First choose: Do you find anything in your life to be toxic? What is it? Now set an intention to change it. You may want to detoxify from food too and/or make healthier food choices. You can also decide to clean out a cluttered closet, get rid of unhealthy relationships, or clean up your finances. (I am not a doctor or a therapist, simply a blogger who enjoys making my life better, and so I only ask that if you decide to do any detoxifying or decluttering, check with a professional in the chosen field first.)

You can change your life for the better by getting rid of whatever is holding you back. You just have to set the intention to do so, and the Universe will conspire to help you out. It works.

Here’s a list of resources that can help:
*Pema Chodron, Getting Unstuck CD
*Deepak Chopra, Seven Spiritual Laws of Success
*Natural Health, Detox you life (not the detox I did)
*Detox tips on Oprah.com:
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Changing habits with a detox: Part 1

I started a detox yesterday that I found in the March 2010 edition of Natural Health magazine. The typical and most obvious reason for doing a detox is to, as the name implies, detoxify the body from pollutants found in food and the atmosphere. You are advised to change the type of foods you eat, and in the detox that I’m doing, the reader is told to meditate, journal, practice light yoga and walking, and go to the sauna during the process.

I had always thought that a detox was not doable for me since I’m diabetic. To me, a detox meant drinking blended spinach drinks and eating grapes. I figured that I would be on the ground in a diabetic coma within one hour with a diet like that. The magazine’s program seems very doable though. As for the food, it advises to: “think fresh, whole, organic foods. Eat plenty of vegetables (choose sweet potatoes instead of white potatoes), fresh fruits, non-gluten grains, beans, legumes, small amounts of nuts, seeds, nut butters, lean, organic poultry and wild fish.” Alas, this detox does not mean starvation. (Disclaimer: I am in no way advising that you do a detox. If you do decide to do so, be sure to read the entire magazine article and check with a doctor first.)

I did not have any goals in mind when I decided to start the detox. It just seemed like a nice idea, a project. But then I slowly formed a goal: Use the detox as a needed push for changing some habits.

I eat healthy most of the time, but I have two weak points during the day: grazing around 4 or 5 pm and late night snacking, after dinner in front of the television. I eat healthy junk, and I weigh and measure it. I don’t feel the guilt inherent in late night snacking because of this. So why stop? Health: Weight loss and better blood sugars. I figured that this detox could train me to stop eating when I’m really not hungry.

Around the same time, I was also listening to a Pema Chodron CD workshop on getting unstuck. Pema Chodron is the first ever female, Western Tibetan Buddhist monk. Pema talks about a Tibetan Buddhist principle called shenpa during the workshop. Shenpa is a feeling which is very hard to define but is translated as attachment. It is like a hook, which you can sometimes feel in your body as tension, and usually occurs as a reaction to something or someone else. And you react to that hook, or attachment, either by going numb, getting aggressive, or having cravings.

Let me give you an example: Someone says something to you that touches a nerve. How do you react? For some, their body gets tense, and they keep their hurt feelings inside and then will talk about the person later, go out for happy hour, or watch television and eat lots of comfort food. Some people will answer with a quick comeback or yell or plead with a statement seeking approval. Some people will drink alcohol or do drugs or completely numb out. That feeling that hooks you is shenpa. Most people seek comfort from shenpa, as I wrote through numbness, aggressiveness, or cravings, but this only brings comfort in that moment. According to Pema, shenpa is the cause of addiction.

I’ve never really thought of myself as having an addictive personality. I hardly drink a whole glass of wine when I do drink. I don’t do drugs or smoke. But I do love watching television. And I love my morning coffee. And I love to snack! Do they bring me comfort? In that moment, they do. But then I’m sorry later. I wind up not losing those pounds that I’m working so hard most of the time to lose, and even worse, my blood sugars wind up being less than ideal.

Pema suggests that the way to get unstuck from shenpa is through the four R’s: recognize, refrain, relax, and resolve. First, become aware – recognize – when shenpa arises. Then, refrain from reacting and as I’m learning, reacting is really quick, momentary comfort seeking. Reacting can mean going numb or craving what you don't have, too, not only yelling or answering back aggressively. So in my case, that would mean refraining from snacking on comfort foods. Relax means to be with the shenpa, with the hook, rather than suppressing it through go-to comforts. Pema suggests breathing with the feeling. It doesn’t go away, but instead of suppressing the hook and possibly causing disease, pain, and anxiety, you are giving it space. Finally, resolve means to accept that shenpa is a part of life, and will continue to arise over and over again. Once you accept it, not pushing it away, you can live life more fully.

After hearing these teachings, I realized that I could use this detox to change some habits and hopefully live a healthier and thus happier life.

Here’s an update from the first day: I noticed that I didn’t feel the need to watch as much television, nor did I check e-mail or visit websites, nearly as much as I typically do. I am finding that I have more time, and so I went for a walk by the river yesterday and have been reading a book for the fun of it. I did watch some TV last night, and found that I began to crave chocolate after viewing a Hershey’s commercial. Otherwise, I hadn’t even thought of eating. I only miss coffee when I think about it.

I hope that by the end of this process I’ll figure out which habits I want to keep and which I will release from my repertoire for the long haul. Stay tuned for "Changing habits with a detox: Part 2" next Monday!

Have you ever done a detox? Tell me all about it! I'd love to hear about the program you did and how it affected you.