T Minus Two Type Two Diabetes and Other Passions

28Feb/125

Steamed.

This afternoon, I quickly ducked into Twitter to find that my Twitter friend Scott had posted a link to an article about the FDA expanding guidance on statins. (That article can be found here.)  The article (or the portion of the article available to non-subscribers) indicated that the FDA now believes that people taking statins face a "small increased risk" of elevated blood sugars and diabetes.

My tweeted response was "Well, just put me in the ground and call me a turnip. :( "

It was all I could say.

Later, I saw an article indicating that the new guidance included a warning about the possibility of memory loss, loss that goes away when the statin use is stopped.

Friends, I'm angry.

I'm not mad at the FDA, or the drug manufacturers, or my doctors. Heaven knows I'm not mad at Scott: I very much appreciate his work to make us aware of science news and doings in the pharmaceutical industry.

I'm just mad.

  1. I have diabetes.
  2. I've been on a statin since before I had diabetes.

I'm not mad that statins may have caused my diabetes, because I think that's pretty unlikely.

See, Type 2 is thought to be caused by genetic factors, combined in many (but not all) patients with "lifestyle factors" such as obesity. Beyond that, it seems that every other week brings news about something else that may have contributed, such as my depression or a lifetime of disrupted sleep patterns. Frankly, I've come to avoid news about what may cause T2: I already have it.

But THIS?

This, friends, is a possible causative factor that occurred because I was doing the best I knew for my health.  I wasn't eating a double-cheeseburger, which I've never believed to be an especially bright idea. I was doing what my doctor asked.

Again, I don't think statin use caused my diabetes. But it apparently has for some people, people who were also doing the best they knew for their health.

I'm not blaming anyone. I'm just really, really mad.

28Feb/122

Ramped-up Milk Toast

A disinclination to leave well enough alone may be my greatest strength as a cook. It is also probably my greatest weakness. Compulsive adding sometimes improves, sometimes it detracts.

My dad was one of four children to have grown up in Liverpool, United Kingdom. Saturday morning breakfast consisted of the end crusts from the week's bread cooked in milk with a little sugar. My brain refuses to cough up what the family called this concoction, so I'll just call it "milk toast". (I don't know if my grandmother toasted the bread or not.) I had this once or twice on visits to my grandparents. As far as I can remember, we never had it at home.

But, the once or twice I had it as a kid left a powerful impression of warmth, sweetness, and carb-y happiness. Perhaps a dozen times as an adult, I have made this milk toast as best as I can remember it.

Tonight found me in A Mood. I was feeling deeply frustrated with my inability to move forward on some projects, or even find time to try.  As I surveyed my kitchen, I spotted the leftover bagels on the counter and thought of milk toast.

I cut two bagels (about 4 or 5 inches in diameter) into bite size chunks and threw them into a small pan. I was going to grab the milk when my inability to leave well enough alone kicked in. Before I added the milk, I threw in a couple of dollops of part-skim ricotta cheese I had from something I never made. I then added enough milk to cover the bread. For sweetener, I used a tablespoon or two of real maple syrup I'd purchased with a Christmas gift certificate from my boss. I heated the concoction until it had been barely bubbly around the edges for just a few minutes.

My friends, on this particular evening, my ramped-up milk toast fit the definition of "comfort food" for me like a key fits a lock. The bagels maintained some structure as sandwich bread would not. The cheesed added just a bit of creaminess to the skim milk. The sweetness from the maple syrup was absolutely perfect.

This was one of those times when not leaving well enough alone paid wonderfully warm dividends.

Filed under: Cooking 2 Comments
26Feb/122

Bagels, and Much More

I'm struggling a little bit with how to organize this write-up of my weekend in the kitchen. The chronological approach, which serves my purposes otherwise, has the downside of "burying the lead". Well, consider it buried. (I think it liked daisies.) If you're just here for the bagels, skip ahead to Sunday.

Friday

My workplace is open President's Day, and I chose to take my floating holiday on Friday to make this a three-day weekend. I spent most of my day off twitching, but did manage to cook a couple of things. I made a stove top macaroni and cheese which was really good and will be my go-to for that dish in the future. It was the FOURTH mac 'n' cheese I shared with my neighbor lady and the first she liked.

I also roasted a chicken. When it was done, I remove the hindquarters and carved off the breast meat. I threw the carcass into a pot with some carrots and onions and water to cover. I also threw in the neck and gizzards from inside the chicken, and I seasoned with salt, pepper, star anise, and ginger. When strained, the resulting stock was pretty good.

(The chicken breasts and stock will be coming up again in this post. And again. And again.)

Saturday

My biggest objective for Saturday was to make whole wheat bread. I've made this recipe twice previously and been pleased with everything except the limited rise I've gotten. (The rise is really only an issue because I want the slices to be big enough for sandwiches.) As an experiment, since I understand whole wheat flours tend to be low gluten, I added about 1 tbsp of vital wheat gluten for each cup of flour. It turned out really well.

I used one and a half of the chicken breasts in a chicken salad with fennel and basil, the recipe being from the "Healthy Family Cookbook" from America's Test Kitchen. It was...okay. I'm not sure I'll make it again.

I used some of the chicken stock I'd made for "Carrot Ginger Soup", also from the "Healthy Family Cookbook". It's pretty tasty. The chicken stock also served as the cooking liquid for some bulgur I did in my rice cooker.

The highlight of the day, though, was the pizza I made. It was a cheese pizza on a whole wheat crust, both recipes coming from the "Healthy Family Cookbook". I was REALLY tired by the time I got to it, but wanted to get it done, because I want the method under my belt. Here's what it looked like out of the oven:

(Please note: the shape is not "odd", it's "rustic". So there!)

The pizza really was good. And, I have another pizza's worth of dough in my freezer for next time I have a pizza urge!

Sunday (and finally with the bagels)

If you've been kind enough to read my other entries, you may have gathered that I don't always have good reasons for what I want to cook. But, I really love bagels, and when I found what looked like a manageable recipe in the iOs app version of Mark Bittman's "How to Cook Everything". (I assume it's in the print version as well.)

Here's the basic procedure: 1) Make the dough; 2) Let rise until doubled; 3) Form bagels, 4) Let rise again; 5) Boil (1 minute a side); 6) Bake.

Some illustrations:

Formed, before 2nd rise
Being boiled

Before baking. The bench knife is about 6"wide.

The final product.

I was quite pleased - tasty and with a very nice chew. Would a New York deli maker have been proud of them? No. Are they better then most of the bagels I've had in the Midwest? Yes.

The last two dishes I made were sort of designed as ingredient use-ups. I made a frittata (sort of - forgot the cheese) with the yolks left over from my angel food cake. It was flavored with a shallot I've had lying around and half a chopped andouille sausage link.

I finished up with a version of Mark Bittmn's "Simplest Paella" (also from "How to Cook Everything"), which I'd made before. It's easy because it just uses a normal skillet, and once all the ingredients are in it finishes in the oven. About half the stock was the tag end of the batch I'd made on Friday. I also threw in the last of the chicken breast, the rest of the andouille sausage, and some baby shrimp. It's really good.

Is it any surprise that I ran my (smallish) dishwasher four times this weekend?

Filed under: Cooking 2 Comments
25Feb/125

Tiny Bubbles

"Bubble, bubble, toil and trouble..." Shakespeare, 'Macbeth'

Many years ago - I was still living at home, in fact - I attempted to make an angel food cake. I remember how tired my arm got from holding the electric egg beater, and I also remember how the end result was more of an angel food discus.

When I began to seriously considered getting a stand mixer, one of the first uses that occurred to me was to have another showdown with my old enemy angel food. I've looked at a few recipes, and when I recently acquired the "America's Test Kitchen Healthy Family Baking Book" I found a recipe I decided I could probably trust. I also acquired a tube pan.

This last Tuesday found me In A Mood. The frustrations of the day suddenly coalesced in a weird recklessness, so I bought a dozen eggs on the way home from work and headed immediately into the kitchen.

The thing with angel food, see, is bubbles. You start by creating your bubbles by whipping air into egg whites that have been fortified with sugar (powdered in a food processor) and cream of tarter. You then provide structure for your bubbles by adding your dry ingredients, carefully folding so as to disturb as few as your bubbles as possible. After baking, you let your cake cool upside down so that your bubbles are not crushed by the weight of the structure you provided for them.

Here is what my bubbles looked like after I removed them from the pan:

And here is a slice of my bubbles:

Thanks to a good recipe, a reasonable level of care and obedience on my part, and perhaps a little luck, my bubbles were fabulous. They were moist, tender yet with a satisfying bit of chew, and were bundled together in a very nice consistency. My very favorite thing, which was true only of that first very fresh piece, was that the browned surfaces were covered with what seemed to be an extremely thin layer of candy, so there was a tiny bit of crunch. That layer was gone by morning, I'm assuming due to having 'melted' in moisture absorbed from the air. It was still wonderful, though, and the people I shared it with loved it.

A few days after making my cake, I happened to see an episode of the America's Test Kitchen program "Cook's Country" in which they demonstrated precisely the recipe I had followed. It was weird but gratifying to watch them step through the procedure I had followed, and it seemed to me that I really had done it pretty much right. They seemed to get more bubbles whipped into their eggs than I did, and thus their finished cake had maybe an inch more rise, but I don't feel even a scintilla of regret - they're the experts, after all, and who knows if they were able to get their fabulous result on the first take?

I have to say that while there was some toil and even a bit of trouble in making my bubbles, I don't have any trouble contemplating making this again. It really was a success.

Filed under: Cooking 5 Comments
24Feb/124

Cooking Versus Baking

So, as I've mentioned, I'm taking tentative steps into the world of baking. And I have some thoughts about baking as a craft, from the standpoint of a nearly-total beginner.

It's often said that people are either cooks or bakers. I don't know how close that really is to true, but I do find that there are some things about baking the run a bit counter to my personality.

Baking is exacting, and I'm a bit slapdash. Baking calls for attention to detail, which leaves me a bit impatient. And, in baking, a recipe can fail for any of a forest or reasons, leaving an infant such as myself scratching my head in puzzlement. Teaching myself to cook is hard enough -- I really suspect that baking is best learned in apprenticeship.

Of course, there is tremendous creativity in baking. But, I fear that until such time as I master many more of the skills, my creativity will be pretty much confined  to recipe selection. Baking is like the Elizabethan sonnet: part of the beauty comes from the rigid structure. In baking, the structure is not from rhyming schemes and meters but from chemistry and physics, and if the structure is not adhered to the recipe will fail. Most of the things I cook allow me to improvise is I go along, but in baking success can only come from slavish devotion to the recipe.

From my tiny chair here in baking kindergarten, it seems like there are hundreds of little techniques that will have to be somehow learned if I'm going to do much baking. Maybe I'd feel the same about cooking if I was in cooking kindergarten (instead of my lofty advancement to to the third grade). But, it seems more than a little intimidating.

Still, it's also fun. I've made some tasty things, and I look forward to learning some of the lore. My core goals are pretty limited - I want a few different breads in my repertoire, and I'd like to find a dessert or two that I can really have confidence in.

This weekend, I want to make bagels!

Filed under: Cooking 4 Comments
21Feb/126

A Different Kind of Advocacy


Those of us who blog about living with diabetes have - as a group, anyway - a number of goals. We hope to make connections with people in similar situations who may be feeling alone or incapable. We hope to raise awareness outside of our community. We hope to use group action to influence media and government.
Sometimes, though, we're writing to our community - to each other. Much of my writing has been aimed at explaining Type 2 diabetes, particularly its progressive nature and the resulting vast diversity in individual situations, to the larger Diabetes Online Community. Others work to help the community understand life with particular complications or with the combination of diabetes and other health conditions.
Like diabetes, clinical depression can be difficult to understand for those who don't experience it. It's hard for those who've not been there to understand the full impact of the combination of emotional and physiological symptoms that go so far beyond sadness. Those of us who do experience it need the company of those who "get it", and we also need those closest to us to know that we're not making it up or that we just need to 'snap out of it'.
Why is this a community issue at all? Isn't emotional health a personal issue? The fact is this: depression is deeply corrosive to individual diabetes care. When we're depressed,we may not feel that self-care is worth the effort, we may lack the energy for our daily routines, and the planning and calculations involved may be too much for temporarily-diminished mental capacity. Like community awareness, like health care policy, like economic access to medicine and supplies, depression is an issue we as a community must be aware of and concerned about.
Depression has an enormous impact on our community. While I've seen no surveys, it seems to me that the percentage of diabetes bloggers and tweeters who struggle with it must be very large. Yet, though open discussion of it is growing, there is still a need for a different kind of advocacy:
  • We need community members who experience depression to know that they're not alone
  • We need community members who have these symptoms but have never been diagnosed to recognize that what they're experiencing may be something that's happening TO them rather than something they're causing.
  • Though decisions about what, if any help to seek are very personal, people with depressive symptoms need to know that there are options.
  • We need our "Type Awesomes" (family members of people with diabetes) to have enough awareness to perhaps recognize depression in those they love.

Depression and other mental and emotional conditions still carry stigma, and not everyone who have them are going to feel it's appropriate to be open about them. No one should blog on this subject if they're not comfortable. But those who DO feel comfortable in discussing their experiences can benefit others by doing so. When I finally - after more than 20 years of episodes - saw a psychiatrist, the best thing - the freeing and exalting thing - about that first meeting was that the strangeness my life had become made sense to him.  To a lesser degree, I've found the same comfort in reading posts by others who experience depression.

There's also work to be done by those who advocate outside of our community. We are just beginning to see health providers and organizations show awareness of the potential emotional impact of our disease.   But much more needs to be done in this area.

Depression matters. Be aware.

This post is my February entry in the DSMA Blog Carnival.  If you’d like to participate too, you can get all of the information at http://diabetessocmed.com/2012/february-dsma-blog-carnival/.

Filed under: Mental Health 6 Comments
16Feb/124

Eduficated

Once or month or so,  my doctor's office has a CDE come in and teach a two-hour diabetes education session. I've been taking a pass, being skeptical about how much I'd learn. This time, though, I decided to quit being difficult and take advantage of the resources being offered me.

It turns out that our instructor is a CDE and has been Type 1 since age 12. (Werther's Candies are her favorite hypo treatment.) As near as I can tell, she's a Sanofi employee and gives these education sessions for a living. I really liked her.

My two classmates were an elderly couple who seemed to have somewhat limited comprehension but were nonetheless a hoot.

I did pick up a few things. The instructor said that part of the reason for exercise is that improving the ratio of muscle to fat lowers insulin demand - that's something I can remember. I also learned that I should check for ketones on sick days and call my doctor if I even have the "small" level.

I was very pleased that the session touched on depression. The instructor said that it's believed that people with diabetes may have reduced serotonin receptors in the gut, and gave advice on what conditions should trigger a conversation with a doctor.

I gotta say, though, that the highlight for me was the opportunity to play with an insulin pen. Part of the point of the session, I think, was to increase the comfort Type 2's would have about going on insulin when the time came. The instructor passed around these pens filled with water and taught us how to prepare a shot. We weren't allowed to inject, though. This disappointed me a touch, because I would have gladly injected saline to see what it was like and out of solidarity with my brothers and sisters in the DOC. But still, I'd heard them talked about so much, it was fun to see what they're actually like. (Doubtless, if and when I need to use them for real, the thrill will wear off in a hurry.)

So, anyway, I'm now eduficated in the mysteries of the beetus. When does BG paradise start? (I kid, I kid....)

14Feb/124

A Master of Disguises

I listen to a lot of sports talk radio. (It's company, of a sort, and political talk of whatever stripe is bad for my blood pressure.)  It seems like every station has at least one crank caller, usually obsessed with one topic, who've been told not to call in any more. For some, though, the desire to get on the air and speak their peace leads them to call in with fake names or (badly) disguised voices. Once they get going on their hobby horses, however, they're easily recognized.

For me, depression has at least a couple of sets of symptoms. First, there are the mood symptoms, such as sadness and feelings of worthlessness, that most people associate with depression. However, there are also other symptoms, one or more of which may accompany any given episode. Over this past weekend, I noticed that although my mood wasn't bad at all - maybe a three out of ten - there were other indications of something going on: sleep disruption, crankiness, and struggles with focus and memory.  I've also felt astonishingly tender-hearted: I'll think about a friend (old or new) or a happy memory and feel like I want to cry. (Soft heart, soft head.) I'm a bit like this anyway, but this has been very strange.

All of these things I was experiencing bore watching, because I find that depression is much more damaging when I don't know it's there.

Yesterday morning, the storm hit: high levels of anxiety, sadness, internal anger, inability to effectively organize myself: all of it adding up to perhaps seven out of ten with gusts to eight. I've written before of how depression can come in on little cat feet: this episode arrived in disguise, like the sports talk caller who wants to rant about the nationality of the local team's players.

I know I'll be okay: now that I know that I'm having an episode, there are various strategies I can implement. I work hard on being gentle with myself. I try not to let my mind spin out long stories based on hypotheticals. At work, I focus more on the routine aspects of my job than on those things requiring creativity or planning.

And now, of course, I have the entertaining mental image of my depression wearing "Groucho glasses."

Filed under: Mental Health 4 Comments
10Feb/127

A Needless Secret

This week's Diabetes Social Media Advocacy chat on Twitter was all about when and why we do or don't disclose our diabetes to those around us. This got me thinking about the distinction between simple confidentiality and secrets, the latter in my mind being those things that we fear sharing and -may- under some circumstances be corrosive to our emotional health.

Later that night, again on Twitter, I was talking with a friend about sushi. I mentioned that I couldn't believe that I'd be able to make acceptable sushi rolls. My friend noted that it didn't seem to all that hard with the right equipment. I felt compelled to explain that, due to an incident in childhood, I have substantially less than normal dexterity. When asked - gently - if I'd elaborate, I found myself sharing something I'd told almost no one for many, many years.

A Non-Shameful Secret

When I was about six months old, I stopped growing, both physically and developmentally, for between six months and a year. My parents were terrified (especially perhaps my mom, who had worked as a nurse in a polio ward). According to the correspondence that I've seen, my pediatrician was also deeply troubled and didn't know what to do.

I don't know what steps were taken at the time, especially since my growth and development eventually restarted. However when I was about five I was taken to the University of Iowa Hospital for extensive testing. (This would have been around 1965.) The conclusion?

Cerebral palsy.

Although that's a very dramatic diagnosis, the doctors believed that the damage had been minor and that my brain had been able to build new pathways around the affected areas. The prognosis was that though I was behind developmentally, the only noticeable affect would be slight limitations to my manual dexterity: one doctor quipped that the only professions that would be closed to me were professional golfer and watchmaker.

In practice, I have found the impact to be a little more profound than that, though nothing like the image I think many of us would have of a cerebral palsy patient. Although I no longer fall down the stairs, as I frequently did as a young child, I am clumsier than most. When we did square dancing in school, I could sort of participate, but it was deeply stressful as my brain tried to carry out its sluggish dialog with my muscles fast enough to keep up with the music. I played piano as a child, though I hit a wall when my lessons began to call to do anything beyond the simplest chords if they involved both hands. Beyond neighborhood baseball, which I liked when very young, I've never played sports with any success or enjoyment. I couldn't ride a bicycle until I was ten.  My hands and fingers just aren't very dexterous, leading to my skepticism about being able to make sushi.

I realize that none of these effects are all that exceptional. Many people are clumsy, many people don't dance vary well, and many people can't play the piano. Nonetheless, I grew up with a sense that my body wasn't a whole lot of good to me. I've never had much in the way of physical courage, having learned long ago that a lack of caution hurts. I've lived my life almost entirely between my ears with my body being mostly an irrelevancy  like a movie alien chagrined to discover that it had made a poor choice in selecting a host to take over.

I don't remember having been very concerned with the CP itself: I don't know for sure that I even knew about it before I was a teenager. I do recall feeling very perplexed when two women came to our house one day when I was around eight. I answered the door, and they told me that they understood that there was a handicapped child in the home. As I was telling them that there wasn't, my mom came up from behind, invited them in, and asked me to go read in my bedroom. The implication of that wasn't lost on me.

But Why a Secret at All?

As I told my briefly told my story on Twitter, I felt very conflicted about doing so. I felt that I was Telling a Secret, one that perhaps I ought not to be telling at all. At the same time, however, I felt a relief, almost a giddiness, to be talking about it.

But why should I feel that my brush with a serious condition should be a secret at all? It's easy to understand why I wouldn't discuss this frequently - it's not something that comes up in normal conversation. But my churning emotions told me that something much bigger than that was going on. Part of it, I think, is something like survival guilt, to have escaped so lightly from a condition that is so devastating for many others. Mostly, though, I'm guessing that I've felt somehow that having had this condition was a flaw in not only my body but my self, something that diminishes my value as a person.

This is ridiculous, of course. All of us have challenges, all of us have had things happen to us that have had far reaching affects. It is not the events but our responses to them that determine whether we are lessened or magnified.

And that makes me think I need to get myself a sushi mat and some seaweed.
Filed under: Uncategorized 7 Comments
7Feb/124

A Heart-to-Heart Conversation

I met with my doctor yesterday. Because I'd gotten so badly off track with my self-care at our last visit, we'd agreed to meet monthly for awhile so that I could use the accountability to get things in line again. It was a pretty good visit. My blood pressure was good and I've been doing great on keeping up on my meds. I remembered to ask about a pneumonia shot, which was given.

 

Additionally, though I'd not planned to, I found myself telling her that I'd been having...

 

...um...

 

Not very often, you understand, or severely...

 

*cough cough*

 

(chest discomfort).

 

(Let's see here....A-Nile...B-Nile...C-Nile...ah! Here's the one I know so well -- "D-Nile"!)

 

And, of course, because I've been trying so hard not to think about this, I couldn't answer many of the questions my doctor had about what was going on when I had the discomfort. As we discussed it, we decided that the first thing to try is a stomach acid prevention medicine I can take on an ongoing basis. This makes sense because I've had a chronically wonky tummy as long as I can remember, at least back to Junior High School. I'm also to take notes on when I experience this. However, we also discussed the circumstances under which I'm to go back to see her, find an urgent care clinic, or go to the emergency room. My next appointment is in a month. Depending on what happens between now and then, we may consider a stress test or other tests.

 

Having had that conversation, I'm really not very frightened.  It's good to have a course laid out, and a possible alternative to the scarier alternatives. Just having raised it was a tremendous relief: most demons shrink when brought into the light.

 

It was about time I had that heart-to-heart conversation.

 

 

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