Welcome to the Diabetes Stories website

I just returned from two weeks holiday in London and Holland visiting friends and family. It was truly a fabulous trip, rich in every way, unfortunately also including the almost constant and frustrating lack of control I had over my blood sugar. 

I have decided perhaps there are five basics to managing diabetes: food, activity, medicine, stress-management and routine.

Here at home what I eat, including my carb load, and when I eat doesn’t vary very much, including an hour walk I usually take in the morning. Checking my blood sugar at home, usually four or five times a day, I pretty much get the blood glucose numbers I expect.

But, whoosh, get on an airplane and everything goes out the window. Just how do you manage your blood sugar when confronted with the following: 

- Airplane food, and I use the term “food” loosely. Coming home they called something oozing from its little box, “quiche” 

- Losing five hours in your day

- Jet lag that mucks up your mind

- Breakfasting on a cheese sandwich on varied by country slabs of thick dense bread (delicious but awful for my blood sugar). There's no way to know how many carbs it contains and I won't be caught dead paying 30 euro for a hotel breakfast ($47.40). I've also discovered the muesli I love that comes in bags with no carb count requires three times the insulin my at home oatmeal breakfast requires.  

- A two hour bicycle ride through eye-popping rural Holland that exhausted my blood glucose bank for two whole days causing constant lows

Well, you get the idea. Getting blood sugar numbers I did expect, checking pre and post every meal, was the exception, no longer the rule. I was under- or over-guessing my insulin with so few clues to go on. How do you shoot up for bread fresh baked next door at the bakery rather than bread at home that comes as a plastic-wrapped loaf from our over-refining processing factories? 

I have no great wisdom to share how to do this better for I don’t know. An abundance of restaurant meals and lack of routine will always be my Achilles heel and my only recourse currently is to test frequently and correct. Further, as much as long- acting and short-acting insulins have released most of us from having to eat at a certain hour, guessing the match between insulin and not your usual foods, for me is a Herculean mental task. 

Then, admittedly, when cows, sheep, ducks, pastures and canals beckon me to turn to my sister in law after 75 minutes of cycling and say, “Let’s go just another 45 minutes,” I now know better. That will require less insulin for the next 24-48 hours. Boom, those were mighty drops! Six years ago I stopped cycling when I removed my bicycle from my closet as my husband’s clothes moved in (there’s nowhere to put a bicycle in a tiny city apartment). And I realized riding around New York City was just as likely to get me killed as well toned.

So, I’m home now and while a piece of my heart is still in Europe, the piece of my head that’s going to make my morning oatmeal, spinach salad for lunch and fish and veggies for dinner is feeling so relaxed by merely not being on vacation. 

I always wonder how people get to where they are in their lives. Best I can figure my curiosity began when I was nine. At the diner my family went to for the occasional dinner out, I would scan the room and notice others laughing, animated in conversation, or a couple with not even a word passing between them.  Who are these people, I wondered? What do they really think and feel? 

It's not surprising that as I grew up I wanted to write the human interest features column for a newspaper, or that over the past few years I've interviewed more than 135 people with diabetes: I am fascinated by people's "stories." So here I share mine over the last several years since moving into this work. I hope it may offer you some clarity, or inspiration.

Warning: It's lengthy. Perhaps think of it as a chapter in a book if it helps, definitely not a tweet. We know I'm not much good at that. 

Modified from a contest entry for "Second Acts," that More magazine was running about changing one's life after forty. 

My Second Act

I was 48 years old, planning my wedding, (my first thank you) and going into the hospital for diabetic frozen shoulder surgery. As if that wasn’t enough excitement, I fretted whether I’d still have my health insurance coverage for the surgery. This was seven years ago and the dot.com I worked for was bankrupt; every month scores of people were being laid off. I was to be one of them—luckily it would happen two weeks after my surgery. 

On the cusp of fifty, I had lost my job, was going to physical therapy three times a week and the rehabilitation chair that moved into my small apartment, which I had to use to raise and lower my arm an hour a day, gave me a time-out: What did I really want to do with my life? I was in what my friend Pat refers to as “The Void.” I didn’t know what I wanted to do for a living anymore. In my heart I didn’t want to continue in marketing communications, I’d always wanted to be in a helping profession. Yet, I didn't want to go back to school for four or six years to earn a degree for the profession I’d toyed with – psychologist. While I wanted to help people, I wasn't convinced that listening to their problems was an effective means for helping them change their lives.

At this same time something else happened that set me along the path that would become my new work-- this work. I went to a diabetes educator. I have had type 1 diabetes since the age of 18, thirty years at the time, yet never had I been to a diabetes educator before, someone trained specifically to help people with diabetes manage their illness. After my first visit with the educator, I contemplated becoming a diabetes educator myself. I assumed it would be a six-month course. But this was not the case. I needed to first have a Master’s degree in pharmacology, nursing or social work. Then it was a two-year program and I’d have to practice 1,000 hours before I could become certified. So, I began looking for a copywriter job again. It was what I knew. Trouble was I also knew I didn’t want to do it anymore.

A year later in the midst of doing some freelance work, going on exploratory interviews and reading the famed career book, "What Color Is Your Parachute?" for the third time, my husband said, “You’re a writer and you’d like to help others who have diabetes, why don’t you write about what it’s like to live with diabetes?” I looked at him sweetly, rolled my eyes and said, “Honey, who’s going to buy a book about what I think about living with diabetes?!?” But five years later that’s exactly what’s about to happen. This July, my book, "50 Diabetes Myths That Can Ruin Your Life: And the 50 Diabetes Truths That Can Save It" will be published. And included along with knowledge and advice from diabetes experts and fellow patients is my own.

The road to here began with a roadmap. It wasn't the first, I'd been drawing them most of my life, but this one was more specific. After I lost my job my husband and I sat on a bench one balmy afternoon and wrote down my vision: To help educate and motivate others with diabetes to better manage their condition. That vision sat in the center of a large blank, daunting white sheet of paper. Then we drew colored lines coming out going in all directions: these were to be the steps to my dream: 1) Write a column for a diabetes magazine, which I do now. One day after reviewing the four major diabetes magazines, I called the editor of Diabetes Health, the magazine that felt like it best matched my voice. I told her I wanted to write a column and led her to my web site to see the work I was doing. Presto—she called me back and said, “Looks great, what would you like to write about?” If it hadn't happened, I would have told you, not possible. 2) Write and illustrate a book that would help people with the emotional management of diabetes. I did that in 2007 and self-published it. It was in the bookstore at the annual conference of the American Association of Diabetes Educators last year. This year it will be there again along with its Spanish translation. 3) Give talks to patients, and medical staff. I do that now across the country through an organization called Patient Mentor Institute (PMI). When I first heard about PMI, I immediately called but they told me they hadn’t yet scheduled their next training. Six calls, one every month, put me in the next training session six months later. Having my roadmap in place, and my heart, mind and body in sync with what I wanted to do, created the foundation I needed to keep putting one foot in front of the other. 

At the beginning of this road, when my husband first suggested that I write a book (and I felt that cold fear like a steel blade pierce my heart!) it didn’t hurt that a week later we met with my friend who worked as a copywriter at an advertising agency. She told us how miserable she was there. The next morning my husband said, “I couldn’t sleep all night thinking about you going back to that kind of work. Why don’t you interview other people with diabetes and write a book that shares many peoples’ experiences.” So that became my first real step: To interview others was so right it reverberated in my bones. I could capture a myriad of stories that would create a shared community and lessons learned. 

For two years I interviewed people. I still interview people. It's usually a phone call, sometimes a coffee in their house or a coffee shop. I bring a little tape recorder and they bring their story. All I have to do is ask, “How did you discover you had diabetes?” and a lifetime pours out of them. My very first interview I practiced with a good friend. My first "real" interview was with a couple who discovered that their three year old son had diabetes, and they will never forget the date, September 10, 2001. While in the hospital the following day experiencing their personal world collapsing, the World Trade Center towers were doing the same a few short miles downtown, the smoke visible from the hospital hallway windows. The gravity of this interview was a sign to me to keep going. I branched out to interview acquaintances I knew who had diabetes and asked them who they knew. My circle of fellow patients grew quickly as did a community of diabetes educators, nurses and psychologists. In capturing peoples' stories I have amassed a research library of sorts, collected a wealth of learning and understanding, and also a network of people I now know with diabetes, and in diabetes. 

But this book of interviews was not the book I would end up getting published, for I learned a lesson about publishing two years after beginning the interviews. While you may have what you think is a great idea, a publisher may not. I couldn’t sell the interview book. But the woman who was to become my book agent (whom I was introduced to having met her friend while on a train going to my brother's house in Connecticut for Thanksgiving—trust me, that's a whole ‘nother story) said let’s look for an idea you can sell. I shelved the interviews for the time being and we spent three months writing a new book proposal for my diabetes myths book and after shopping it to twenty publishers we had a deal—and I began all over again. As it would turn out, numerous nuggets from my interviews are featured in the book--so while we may hit detours in life, I know nothing is a waste. It’s been seven years now since I lost my job and embarked on this journey and five of those I’ve been avidly working in diabetes. I stopped freelancing two years into this venture because I knew if I didn’t jump in fully, I might never jump in at all. 

If you've been on this web site before, you may be acquainted with what I've been doing, if not, this blog began about two years ago and all my posts are archived here. I contribute regularly to Diabetes Healthmagazine. I've just been featured in Diabetic Living magazine. I’ve been invited to speak at the Mayo Clinic this September both about diabetes, and about my books. “Patient-expert” is a title I wear proudly now and I have earned it by putting one foot in front of the other and following my heart. I could not have told you with assurance that I would end up here, only that when I began I felt trying was worth the effort.

One of my messages has become that you can create an exceptional life--not despite having diabetes--but because of it. That it can be a catalyst to greater health, happiness, meaning and purpose. What's required is knowing how to medically take care of yourself and having the emotional resilience to weather the ups and downs. I don't mean that you become a "Pollyanna," but once you deal with the stages of shock and grieving, (and mind you they will re-visit you from time to time) that you will reach a crossroads that invites you to answer the question, "How am I going to live from here?" You will be better served if you can recognize that "What is, is," and choose to honor your life by managing this sometimes-beast as best you can, and embracing more spiritual qualities like appreciation, joy and giving back. This is where, after decades, I have arrived. It wasn't a quick trip, but I hope I can now shorten the passage for others.  

I knew in my late forties, as sure as I breathe, that it was time for me to finally nosedive into my dream of making a difference and create my singular road that would lead me there. With my husband’s financial support I could take a break from earning a living. With his emotional support I was loved and encouraged to keep going. The biggest challenge looking back was social: I missed having people to go to lunch with, and, admittedly, deadlines someone else gave me. What helped, however, and still helps, is having a routine: Taking a yoga class, my daily walk around the park and meeting my interviewees face-to-face as often as possible. And now seeing the early fruits of my labor. 

I say all the time now, “The universe keeps dropping gifts at my feet.” My husband says, “Don’t discount all the hard work you’ve done.” And I don’t. Yet I’m convinced that being on the right track, leading with your heart and following with your feet opens more doors than you can possibly imagine. Don't be discouraged if you can only pry the door ajar slightly now. Keep tugging at it. One day it will open.

Today I associate most closely with something Mahatma Gandhi said: “Happiness is when what you think, what you say, and what you do are in harmony.” From the very first bench meeting my husband and I had to when he recently told me enthusiastically, "We’re only two degrees of separation from Oprah!" it amazes me where I’ve arrived. We joke that one day I’ll be sitting on the Oprah show and she'll be holding up my book saying, “And everyone is going home with a copy of Riva’s book today!” 

You may laugh, most days I do too, but dreams have a way of turning into reality when you hold them fast and keep putting one foot in front of the other. 

I'm really a novice on social networking sites. Yes, I have a Facebook account, but only because everyone seemed to be emailing me telling me to have one. Then once I had one, people I never met started emailing me to be my friend. I don't know, if you have a million virtual friends, are any of them really friends? 

I created a Squidoo Lens because my husband thought it would be a good place to share my idea that spending more time energizing positive, rather than negative, emotions helps you take more positive actions to manage your diabetes. It took me weeks to approach creating my lens, reading the online handbook, futzing, experimenting, tearing my hair out, avoiding my computer...then weeks to create it. After all that, it's actually pretty good, but I haven't a clue if anyone has found my lens. 

If you were here a couple of weeks ago you know I tried twittering, but as my editor just wrote me (as I had to cut 200 words from my latest article for Diabetes Health magazine), Mark Twain said he would have written less words if he had had more time.

Where do so many people get so much time to Facebook, My Space and Tweet? I just don't know.

That said, since I want to be cool and hip and really understand this era of social networking, I've just joined Tu Diabetes. These last couple of days setting up the site, I admit I kind of like this one. It's not too hard to establish an account and it's just for people with diabetes. Now when I get a note from "a friend" it comes with the shared bond of diabetes. 

As the founder Manny Hernandez says, he started TuDiabetes so no one with diabetes will feel alone and people without diabetes will learn more about what it's like to live with diabetes. I can admire and respect that. 

So, if you're looking to talk with others who have diabetes, maybe TuDiabetes is the place for you. There's almost 10,000 new friends to be made. You'll find me there too.

Most days I take a one hour walk around Prospect Park which sits one and a half streets from my home. It's a majestic park, designed by the same landscape architects who designed Central Park in Manhattan, Frederick Law Olmsted and Calvert Vaux. The web site describes the park as a 526-acre urban oasis located in the heart of Brooklyn featuring a 90-acre long meadow, 60-acre lake, Brooklyn's only forest, the nation's first urban audubon center, a zoo, and the Celebrate Brooklyn! Performing Arts Summer Festival. Really, it's a great park. 

You might find one oddity about my walk: Weekdays I walk outside the park, along its perimeter, and weekends I walk a path inside the park. Being the results-oriented perfectionist that I am, and expediency being my major objective when I power-walk, I find the more level outside perimeter easier. And I still get to enjoy the foliage over the fence. 

Sometimes I walk elsewhere just to break the monotony of routine. I'll walk an hour to buy groceries (and then bus back) and once a season I head to another Brooklyn marvel, Coney Island. That's where I headed this past Memorial Day weekend. It was an exquisite day, 70 F, sunny with a cool breeze, the city was gentle and tranquil with everyone gone and so I hoofed two hours to the boardwalk along the Atlantic Ocean that distinguishes Coney Island. When I got there I desperately wanted an ice cream cone and to sit on a bench with it and stare out at the surf and sand. So I walked the equivalent of 15 streets along the boardwalk to where the famed 100 year old roller coaster is, the Cyclone, and there found the food vendors. Ice cream cone sought and bought, I retired to a bench and was joyously licking away at my cone when a voice broke into my reverie. 

A nice looking young man was inquiring where I bought my cone. After I told him he asked me some more cone-specific questions. Now I realized this was no longer a conversation about ice cream, but he was trying to pick me up. If you don't know the meaning of "pick up" as I discovered my Texas girlfriend didn't when I called her moments later to relate this remarkable event, she said after I explained, "Oh, you were being hit on!" During my pick up, my young man, unperturbed by my not knowing what a Big Dipper is (do you?), asked if he could bring me another cone. I did not divulge that one is quite sufficient for a diabetic, but instead that one was all I could manage. Not to be deterred, he asked if he could bring me a drink. At that point, I pleasantly waved away his offers and he went on his way down the boardwalk. 

I sat for another half hour enjoying the tranquility of the beach and then meandered back down the boardwalk to where I had entered to get the bus home. It was a perfect day: my walk, the view, an ice cream cone and a nice young man. Happiness really does come in the small moments:  a slice of sunshine, an unexpected human interaction, and not least of all a small, perfect scoop of vanilla chocolate chip ice cream in a sugar cone. When you see the cover of my new book this July, 50 Diabetes Myths That Can Ruin Your Life: And the 50 Diabetes Truths That Can Save It, (available wherever books are sold, including Amazon and Barnes and Noble online) you will smile and remember this story.

July 22nd I've been invited, among many other esteemed diabetes bloggers, to attend a Roche social media summit. Roche, a major pharmaceutical in diabetes care, is, as they say, "looking to see how bloggers and companies can work together to provide accessible content to the diabetes community." They are obviously seeing that more and more patients are talking to, learning from and informing other patients. 

Our benefit as bloggers is to see if we can help patients even more by providing even more information (I happen to know Roche sponsors many valuable informational seminars), and of course, it's also a nice opportunity for us, who mostly blog alone in our homes or offices to get out (albeit the conference is in Indiana, Roche headquarters) and meet each other. 

The fact that patients are looking more and more toward other patients for information, guidance, understanding and support is occurring at lightning speed for several reasons:

1. The internet has made this possible

2. Too many general physicians and health care providers are not very knowledgeable about diabetes

3. Even endocrinologists have less and less time to spend with patients

4. A chronic illness like diabetes requires ongoing learning and support 

5. A self-managed illness like diabetes requires the patient is made exceedingly knowledgeable to care for themselves, including both the medical acumen and ability to develop emotional resilience

6. A chronic illness like diabetes requires you get the knowledge when you're ready. A friend, who has type 2 diabetes, told me the first year of her diagnosis when free classes were available to her, her head was spinning so much she barely took in the information. Now a year later when she's ready, it will cost her $1,500 to repeat the classes.

Last month I gave my diabetes presentation to a group in Jersey, City, NJ. I spoke to about 30 patients with about as many pharmaceutical reps also in the room sitting behind their vendor tables filled with brochures and promotional items like pens and tape measures. I know there was also at least one endocrinologist in the room, who is an exceptionally caring physician, and a few diabetes educators and dietitians, also exceptionally concerned for their patients--otherwise they wouldn't have created this learning opportunity for the community.

At the end of my program, all the medical people congratulated and thanked me. Also, almost every pharmaceutical rep came up to me and told me what a wonderful program it was and how much more they understood what dealing with this disease is like. 

Then, as I was leaving, one young man grabbed me by the arms and said, "Please, I have to ask you a question. I only want to talk to you. You get it, you really get it! Not like my doctor!" 

I listened to his question and gave him my opinion, which I let him know was my opinion. I also offer him the sage advice that if he wasn't happy with his doctor he should look for another. He said he had an appointment next week with, in fact, the doctor in the room that night. Then he asked another question, and then another. And when finally he was spent, his eyes were tearing with little droplets of gratitude.

We have an edge over doctors. We live it, and there is an immediate, invisible bond. It will be interesting to see what Roche is thinking, and I do commend them for thinking, and wanting to and reaching out to learn from us. It will also be interesting to see what I learn. I certainly know patients learning from patients isn't going away and the more we can all reach out to others the better. 

I just gave my first virtual diabetes presentation -- and to the Mayo Clinic! I'm psyched. Will be hard to sleep tonight and will have to wait till tomorrow for feedback. But, reminds me why I do what I do.

character count: 166, getting there!

My hand’s in a stiffer wrist brace I bought on Amazon, and I have an appointment with the hand doctor Monday. Hopefully I’ll know for sure what this is, carpal tunnel, tendonitis, diabetes cheiropathy.

While I’m trying not to use the computer much, I’ve decided this is a perfect opportunity to twitter. You see, I don’t twitter. I’m still a dinosaur who remembers Bonanza, I Dream of Jeannie, and when I lost my job eight years ago and my husband said, “O.K., the first thing we have to do is set up a home email address for you” I said, “Why?” OK, I learned that lesson.

But twitter? I mean who cares what I’m doing, and following people sounds like I need a whole ‘nother 24 hours in my day to be in anyone’s posse. Besides, if you’re really doing something great, wouldn’t you be doing it rather than writing about it?

But, since I’m trying to cut down on keyboard time, here’s my first go:

Right now I’m drinking my second cup of coffee, just had to have it, and planning my morning walk.  Hoping avidly it won’t rain when I have to hustle myself out of the house tonight and go into the city for a friend’s birthday party. Does that make me a bad person?

I know, I know, too long, 205 words. I’ll get better, I promise.

Hmmm…what are you doing right now?

How sneaky is this? I recently received a letter from my former direct mail pharmacy, CVS Caremark-I seem to still be in their database. Thankfully, I am no longer in their plan.

The letter lets me know that they're making some changes in how they pack and ship insulin vials. I quote from their letter:

"Our new process will check the National Weather Service forecast for your area for the time period that we expect your order to be delivered. Based on the temperature range during that time, we will determine the best shipping method to use to protect your insulin. The chart below explains the different shipping methods based on the weather forecast." Their chart indicates: 

86 degrees or higher gets next day delivery with a cold gel pack

78 degrees to 85 degrees, gets second day delivery with a cold gel pack

32 to 78 degrees gets regular delivery without a cold gel pack

Now, what if we have a temperature snap, hot or cold, which happens frequently today? More critical, and likely, what if your insulin sits in a postal place overnight in a hot room with no air conditioning? Or a cold room and it freezes? While Caremark is checking the weather, are they checking the storage areas where insulin will sit before it is delivered? Hmmmm....no mention of that, I think not.

The best part of the letter for me was this: "Even though insulin manufacturers say that it is okay to store insulin for limited time periods at temperatures up to 85 degrees, CVS Caremark is taking extra care to make sure that your insulin is protected by shipping insulin with a cold gel pack if the temperature in your area is forecasted to be 78 degrees or higher."

In other words, aren't we great?  CVS Caremark is saying. Here we're going above and beyond what's called for to protect your insulin. Guess what? Before I received this letter, my insulin ALWAYS arrived with a cold gel pack regardless of the weather. 

I get it. The economy is contracting and here's another way to save bucks. But when companies begin fooling around with our medicine it's unconscienable.  

It wouldn't hurt to send Caremark a letter, especially if you received this one, letting them know how much you do not appreciate what they are trying to pass off as extra care. Now I think lack of "care" is what  "marks" Caremark.

I just returned from spending a week in Mississippi. It was a great trip: relaxing, lots of laughs, I've learned a few new great expressions and have come away with a much better understanding of why diabetes is an epidemic in America--to a great degree it's the ubiquitous fry up.

I was touring Mississippi with three  girlfriends. A kind of "Ya Ya Sisterhood" on insulin. When my New York friends asked before I left, "Why on earth are you going to Mississippi?," I told them, "Because I can." I have always wanted to see part of the South with a Southerner. One of our Ya Yas grew up in Mississippi, so that was it: four diabetic women in a car soaking up the local life, comparing blood sugars every few hours, noticing how differently we all react to food and exercise, and in-between being charmed by the South's hospitality and shocked, by how difficult it is to find healthy food. I didn't realize, but Mississippi has been ranked "fattest state" for three consecutive years.

Now hearing "Yes, maam," repeatedly is admittedly some compensation for the lack of health-friendly food. Trust me, you will never hear it in New York. And my favorite new expression, "Bless your heart..." I've learned is extremely useful when you're bad-mouthing someone but want to maintain a polite demeanor. And, yes, the pleasantries unrolled like an unfurling flag, and this troupe of women were lovingly and graciously hosted to lunches and toured through town after town. Tana, a fabulous cook, whipped up an incredible melange: cream of spring soup, shrimp Louie, southern mayonnaise biscuits with home-grown herbed butter and chocolate pots 'specially for this Yankee, and actually welcomed me with my own signboard, boa and special guest, Marilyn Monroe.

While I didn't know (or care) what we would do in Mississippi, other than soak up local life, I found our tours revolved around visiting university campuses and churches. Initially, I kept looking for downtown and charming stores to poke my head into, being the New Yorker that I am, and it took me the first several days to realize depressed downtowns were not where life was any longer. It was on college campuses and at church. 

I experienced my first Baptist service, complete with a children's choir, baptisms in what looked like the bell tower, singing, singing, singing and your requisite fervent preacher. Walking through a Presbyterian church, we lucked into hearing an amazing organist, and left with his CD gifted to us. We toured several antebellum houses learning about the history of the families that owned them and plantation life. Admittedly, when I walked into anyone's house afterward I expected a tour. 

I was introduced to the very funny and bawdy series of books, The Sweet Potato Queens by Jackson, Mississippi author, Jill Conner Browne. Our Tennessee gal-pal, Ann, read passages to us in her rich Southern drawl, with tears of laughter streaming down her cheeks, as we drove past tractors and catfish ponds. I ate one of the best meals ever at J. Broussard in Colombus, pecan-crusted catfish and a nutty buddy (you figure it out!). I sampled thirty different types of pecans (peecaaahhns) in a pecan (peecaaaahhn) store in Indianola, which was all of three streets long but seemed to be experiencing rush hour traffic while we were there. 

The friends and family of my native Mississipian asked me what I found surprising about Misissippi and I told them. It's much more rural and green than I expected...people are very friendly and welcoming...many have been to New York -- and love New York.. everyone goes to church, and the food, outside of a few truly fabulous restaurants, is growing our increasing population of diabetics. 

I, in fact, had a very earnest conversation about this with the President of Jones college in Laurel, Mississippi, Jesse Smith. Jesse Smith is a sort of President Obama--young and vital and making tremendous changes to the university to expand students' potential and opportunities, and that includes healthier meals on campus. But throughout our trip my companions and I had to work really hard to eat healthy. Fried in Mississippi is a food group: fried chicken, fried steak, fried green tomatoes, fried pickles, fried okra, fried crawfish and on and on. If it was edible, it was fried. Then of course there are the staples: biscuits n' gravy, chicken n' dumplings, overcooked vegetables in lard and sweet tea, 1/2 cup of sugar in 1/2 a gallon of tea. 

My eyes were open widest looking at the aisles in the little superettes at each gas station where we stopped. Aisle upon aisle of chips, crackers, fried pork rinds, soda, fried meats, and, perturbingly nothing else. Except in one, which harbored a stand of books. "Bible Cure for Diabetes" intrigued me enough to buy it but also made me think: Would we really need a bible cure for diabetes if there were more fruits and salads available?

So what will I remember from my trip? Outstretched hands and open hearts and the knowledge that all the segments I hear on the morning news about healthier food choices aren't going to happen where it's so hard to find them. As Dr. Smith explained to me, there was a time when the livelihood of Mississippi was based on people working the land. That required a lot of calories and a lot were burned off in their labor. Today, however, few people labor in the fields, yet the foods have not changed. Further, education about food and its consequence on health doesn't seem to have reached many people, including the young people I saw working in the gas station superettes. 

On the last day of our trip we talked about how much opportunity there is to bring education to areas like this where it's so vitally needed: A grass roots movement to teach people about the benefits of healthy eating like Governor Mike Huckabee is doing for Arkansas. So if anyone wants some wise women to consult on this, please do let me know, and, really, bless your heart.

Over Passover I left my Apidra insulin and syringe on my brother's dining room table where we had just finished the seder meal. We had all expected to go back in for dessert, but dessert happened spontaneously in the kitchen with everyone stuffing honey cake and chocolate covered strawberries into their mouths too engrossed in conversation to move back into the formal dining room. Thus, my insulin and syringe were left to themselves on the dining room table unnoticed, and I didn't realize it until I returned home hours later.

It wasn't a big deal as I had extra insulin at home so I emailed my brother and asked if he would bring my insulin and syringe to a family gathering, a baby naming we would both be attending, two days later. Sure enough, when I saw my brother again, he handed me a little plastic baggie and inside, safely nestled, were my insulin and syringe. You should probably know at this point my brother and I never talk about my diabetes, except on the rare occasions when his ad agency is pitching a diabetes product and he comes to me to learn something, or find out something. I was 18 and he was 13 when I got it, and I have always felt while he is certainly sorry that I have it, the resentment he felt as a teenager who all of a sudden had his parent's attention removed, started his drift away from me, and it has remained, and with it he has adopted a comfortable ignorance. 

However, as I took the baggie from his hand, I saw that little plastic container as a sign of tenderness, and concern. I imagined that his having to handle my insulin and syringe gave him pause to think about what it's like for his sister to live with diabetes: To take injections several times a day, check her blood sugar throughout the day, and do all the other things I have to do; whether he really knows what they are or not, he knows there are things I have to do in order to live. I wondered too if it created a conversation for him with his two girls, 14 and 17 years old, who've never talked with me about my diabetes, but have seen occasional signs of it, whether it's taking an injection or asking their mother what's for dinner so I can figure out my carbohydrate intake and my dose.

Maybe you're thinking, so why doesn't she just start a conversation about it? Some habits are hard to break, and some familial patterns, harder. And while I go across the country and talk to patients about managing their diabetes, there just never seems to be an appropriate opening to start a conversation about diabetes with some family members. My work is rarely a topic of conversation when we're together and when it is it is more like, "So, did you finish the book yet?" 

One day, however, I do think a real conversation will come along about living with diabetes, maybe it will come with his girls when they are old enough to get to know me on their own, not just the seven times a year they see me at holidays. 

Yet, unknowingly leaving my insulin and syringe behind, perhaps began a conversation, perhaps between my brother and his girls, perhaps between my brother and myself, just without words. And right now that's O.K. For rather than get in anyone's space, I prefer to just recognize that my lifeline came thoughtfully wrapped when my brother handed me my insulin and syringe in a little plastic baggie.

A few weeks back I mentioned that I read an article in Diabetes Health magazine, Medical ID Bracelets: The $15 Lifesavers that made me realize it was a foolish move on my part not to wear a medic alert bracelet, especially since I have enough lows to warrant it. Granted, I haven't had a low yet in 37 years I couldn't remedy myself, but why take chances?

So I did a lot of web searching looking at various bracelets trying to find the right one. One that would say, "Yes, I have a medical condition!!!" if need be, yet be somewhat attractive, in other words not make it look like I was a goner, or be downright ugly. My first choices, could easily be missed as an attractive piece of jewelry, beaded and dangly, pretty, but who would know I needed help? So I settled on this one from American Medical ID. They have a large selection of bracelets and offer engraving for free and will fit a lot of it on your bracelet as opposed to some other vendors. I chose a sterling silver plaque, $59.95, and I just received it in the mail. It took about three weeks from order to delivery and is engraved on the back with:

T1 Diabetes IDDM

Riva Greenberg, NYC

Call Mom below:

Mom's phone number

I'm quite pleased with my bracelet so far, it's small and shiny. My friend who makes jewelry volunteered to make me a lovely chain for it. I think I've managed to hit the right balance of "Look, I have a condition that needs care" and an unobtrusive, simple and fine piece of jewelry. The plaque does come with a free chain or you can select from three chains all priced at $6.

Stay tuned. I'll show you the whole thing once done. I'm actually looking forward to being able to wear this, and intend to leave it on my wrist once I put it there. 

Just a bit of news: Apidra, a rapid-acting insulin used before meals like Humalog and Novolog has just won FDA approval to be packaged in a prefilled disposable pen, to be called " SoloSTAR®." They'll be available in pharmacies sometime this year.

Apidra and Lantus are both Sanofi-Aventis products. If you use the Lantus pen SoloSTAR®, (Lantus being long-acting insulin most patients use once or twice a day to cover the fasting state), the two pens will come in different colors to help tell them apart. And trust me, there are endless accounts of patients mixing up their rapid and long-acting insulins because the pens or vials look so much the same. However, I'll have to reserve judgment as what I saw didn't look that far afield from the Lantus pen: a grey blue vs. a blue grey? What's so hard about making it in green or orange? 

I'm an Apidra user after years of using Humalog. For me, Apidra works faster than Humalog which means I need to use less and its quicker action gives you the advantage of injecting during and sometimes after a meal depending on what you're eating. This takes a lot of the guesswork out making my doses a wee bit more accurate.