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My husband is a management consultant who lives in Brooklyn and works in Europe. It's a heck of a commute but somehow we make it work. Last week he facilitated his first week-long management course in Connecticut, a mere two hours away -- Eastern Standard Time and no jet lag. But greater than that, in the world of 'wonders never cease,' his course participants, as is the company's tradition, elected a charity to make a donation to at the end of the course and they chose (all on their own, no coaching from my hubby) Juvenile Diabetes Research Foundation (JDRF). Now, what was even more remarkable  was not only do I have type 1 diabetes, but one of the other four course leaders has a 17 year old daughter with type 1 diabetes. 

Typically a guest speaker is invited the last night of their course to talk about the chosen charity, so it was not a stretch for my husband to call me and ask if I'd come up and fill the role. Knapsack packed, I hopped a train from Grand Central Station and was soon standing in front of twenty executives from ING and five executive management instructors to compress thirty-six years of living with diabetes, and the establishment and achievements of JDRF, into fifteen minutes. Oddly enough this is fun for me; while I may get white knuckles just before showtime, after I've gotten my first laugh, which I intend by the way, my knuckles open up and I feel my audience resting in the palm of my hand. 

It was easy to draw parallels between the topic of their course, leadership, and the leadership of the impassioned parents of children with diabetes who collectively wrote letters and called senators and created JDRF, now a world class cure-focused research organization. It was easy to liken managing systems in a corporation with managing our systems in diabetes: food, exercise, medicine, stress, illness. Toward my close, I talked about my own personal passion in my work, helping people develop the emotional resilience to get up each and every day and manage this condition again, and again and again, and how still after 36 years of living with diabetes I have no assurance that Tuesday will go the way Monday did, or Sunday did, or Saturday did. As I spoke those words in particular my voice cracked, tears came and I choked, I choked right there in front of 25 executives. My husband told me later it was a great moment of authenticity and they "got it." I've spied here and there over the past year of giving presentations, that no matter how much knowledge I possess or how well I speak, diabetes comes with an emotional suitcase, and while I thought I'd only brought a knapsack to Connecticut, that emotional suitcase had accompanied me unnoticed. But it's also O.K. because it was in opening that suitcase in that room that evening that allowed for a shift in my audience from head to heart. 

When the host asked me pre-speech how I wanted to be introduced, before I answered he said, "Is it true if you don't take insulin you'll die?" I would have never have thought of that in the moment, but I said, "Yes, actually it is." He asked, "Can I use that in the introduction?" To which I responded, "Sure, why not?" "O.K., great,"he said laughing, "I'll bring them down and you bring them up." A version of good cop/bad cop perhaps, and a brilliant game plan hatched in 60 seconds. But his question, is it true if you don't take insulin you'll die, unknowingly made me feel a little vulnerable and a little heroic, which truthfully I rarely allow myself to feel. So maybe that's where my tears came from 12 minutes later. In any event, the next day 20 executives went home to neighboring parts of Connecticut, Des Moines, North Dakota, Massachusetts, Atlanta and one to Amsterdam with a little better understanding of what type 1 diabetes is, how invisible this illness is and what all us invisible people are doing all day long managing round-the-clock blood sugars. And I'm pleased to say these executives who overpaid for mugs and hats and theatre tickets to raise money for JDRF raised $2,600 and the company matches half so all tolled almost $4,000. Not bad for a night's work and a free dinner. 

Well, I never set out to do a diary here but it's beginning to feel that way a bit. A blow by blow of my days and weeks. This morning at 8 AM the doorbell rang and two construction guys walked in to examine our kitchen ceiling. Over the weekend our upstairs neighbors had a small fire on their rooftop garden and over zealous firefighters unintentionally hosed the place down so vigorously her floor is curling, half her walls have been removed and she's been drying out her apt for the last week, and of course it's leaking into ours. 

So, our kitchen ceiling has to come down, humidifiers will run for three days, they'll check for moldy sheetrock etc. I ask the pertinent questions like will they replace the ceiling? My husband asks, "Will we be able to use our kitchen? My wife's diabetic and has her supplies here, her insulin in the refrigerator and has to get to food." So nice, I wouldn't have thought of it till they were half way through ripping out the rafters with buckets of water coming down. So here's a celebration to partnership.

I don't know how it's going to go, but I do see how one's diabetes life permeates life at large, the one that's not always neatly contained in our daily routine when all is going according to plan. So, my blood sugar meter's in the bedroom, a few syringes, the insulin's still in the fridge and if need be, I'll fight my way back into the kitchen to get it (in all honesty, they did tell me the kitchen would be accessible throughout the procedure, I'm not perfectly crazy) and, oh yes, we may have to move out for 3 days while the humidifiers run. We've just about lost a week's sleep from the drone of our upstairs neighbor's thrumming machines. I think this is true water torture, and now our own right will be happening in our kitchen, only 15 feet from our bedroom. Think I'll go pack my bag now. Sure could use one of those nifty diabetes bags now for all my supplies. Maybe my next birthday present, along with a new diamond wedding band to commemorate such a supportive husband.

Yesterday I had the great pleasure to deliver 50 of my TheABCs of Loving Yourself with Diabetes books to Dr. Gerald Bernstein at the Friedman Diabetes Institute, a free diabetes resource/learning center in Manhattan, and part of Beth Israel Hospital. Dr. Bernstein, Director of the Diabetes Management Program at the Institute, pioneered a major diabetes center in the 90's in NYC that was eliminated with almost all the others due to financial woes. Today Dr. Bernstein,   Dr. Leeny Poretsky, Director of the Institute, and attending staff, have created a dynamite educational resource above the city's clamor, where patients can avail themselves of exercise instruction, nutritional guidance, a dietician, educational classes, support and more, to better manage their diabetes. Did I say it's free?

Bernstein's Novo Nordisk rep, Stacy Kilkenny, was the little angel who ordered my books for the clinic as Dr. Bernstein wants to use them as an incentive, and reward, to motivate and celebrate patient's efforts and successes. What an incredible way to think! Bernstein's other passion, that he showed me, is an oral insulin dispenser that he's working on with a biotech company; it's now in trials. It works similarly to an asthma inhaler and, thankfully, is the same handy size too. It sprays a mist of insulin onto your inner cheek, the sprayed insulin is directly absorbed into your bloodstream and working within 5 minutes, it's also out of your system within 2 hours helping to avoid hypoglycemia. The prototype has already been approved in Equador, so exciting things to come. 

My heartfelt thanks go out to Dr. Bernstein and Stacy, and everyone else at the Friedman Institute, and my hope is that if you are in a similar position to use this book to motivate and reward patients' efforts, you might just do the same - and don't forget your purchase makes a donation to Diabetes Research Institute, one of the premier research institutes seeking a cure for diabetes. 

In a book I've just read, The Diabetes Lifestyle Book, by three PH.D.s Jennifer Gregg, Glenn Calaghan and Steven Hayes, they examine from a psychological perspective, how we can commit to achieving better health. They employ something called, "acceptance and commitment therapy (ACT)" to move patients through the obstacles that get in their way and talk about how you can overcome your own barriers. If you've a mind to do some mind-work, this is a good read. 

Here's an example of mind-shifting from their book-- it's a pretty simple, a gentleman had trouble committing to exercising. He, like many people the authors say was using "weather" as an excuse not to exercise. Ted is fifty-five with type 2 diabetes and cardiovascular complications whose doctors are asking him to exercise. Ted made it clear to the psychologists that he would only walk for exercise and that he wouldn't walk in the rain under any circumstances. 

The authors asked Ted how firm that decision was for him on a scale of 0 to 100. Ted said 100. Wow, that's pretty firm! Then they asked Ted why he was coming to their clinic. He said he'd been sent by his doctor so he could better manage his diabetes. Then they asked Ted why would you want to better manage your diabetes? Ted said somewhat confused, "to improve my health." The authors then asked Ted whether he thought he could do things to improve his health even if they were difficult, and Ted said "of course." The authors then asked Ted "So why would you be able to do difficult things?" and Ted said, "because I want to live a long life to to see my grandchildren, whom I have a special bond with, grow up. 

Hmmmm....O.K. Now the authors asked, "What if in order to see your grandchildren grow up you have to walk in the rain?" Ted thought a minute and then said, "I think I need to get an umbrella!" Eureka! The authors then asked Ted again how firm his belief was on a scale of 0 to 100 that he would not walk in the rain. Ted did not even pause before saying "about a 10." So what happened? The psychologists linked what Ted REALLY wants -- seeing his grandchildren grow up -- with how he could get it.  That's what was meaningful to Ted, as opposed to the abstract notion of just being healthier if he exercises.  The book is filled with exercises, examples, linkages and stories like these to help you see where you can make stronger links for yourself, more tightly connected with your desires and values, to better manage your diabetes.

When I give my motivational presentations I always ask people, "Are you spending more time focused on the everyday tasks of diabetes or what the tasks are giving you - better health, a longer life, more energy, more time with the grandkids, etc? It's important that we see the benefit of all the work we're doing. Look to the life you truly want to be living and see your diabetes work as the road. It can be smooth or bumpy, depending upon how you regard it. 

While you do the work shift your mind from looking down--it's hard, takes time, hurts, not fair, why me? to up--it gives me more energy to travel, I can wear that great dress at my son's wedding, and boy, I'm pretty amazing handling all this! You can only start where you are, so start there and don't resent or beat yourself up that that's where you are. Enough said, and keep Ted in your thoughts. Right now I imagine he's racing down the street in the drizzle with a smile on his face because his grandkids are waiting at the end.

For those of you in the New York area this Friday, April 11, yours truly will have 15 minutes of fame on WBAI radio, 99.5 FM on your dial. The program is called, 'Healthstyles' and we'll be discussing the emotional side of living with diabetes plus I'll be talking about some of the lessons from my book, The ABCs of Loving Yourself with Diabetes. 

While the show airs from 1 PM to 1:55 PM, I've already been told I'll be featured along with my pal and diabetes educator, Jane Seley, about fifteen minutes into the show. For those of you who can't make it to the radio at that time, or if you live beyond the tri-state area, the program will be available afterward on www.wbai.org and Pacifica Radio. If you can tune in, I'm sure it will be interesting, particularly since right now I have no idea what I'm going to say.

Last week I flew out to Spokane to deliver my A1c Champion presentation at a health fair. 1,000 people were expected for the event. You know the local staff from Rockwood Clinic were working mighty hard to pull this off. And they did, until the last minute when an unexpected snowstorm blew us all just slightly off course. 'Champion riva' at least got in from New York in time to enjoy a fine dining experience  with three of the hosts the night before. 'Champion Greg' who flew out from Virginia, hit a snag changing planes in Cincinnati, and arrived 5 hours later. But Greg has never suffered for energy, or spirit, and joined us for dessert. By time we all left the restaurant and turned the three blocks back toward our hotel, we were walking into the beginning of a snowstorm. Wide awake at 4 AM, peering out my hotel window, there was 3” of the pristine fluff on the ground already and falling flurries silhouetted against the street lamp across the street. At 7:30 AM when one of the hosts came to escort Cinderella (me) to the ball (health fair) I was hoping we weren’t going to crash en route due to the semi-blizzard conditions! But ya gotta love Spokaners, at least 600 people managed their way to us and got a little learning. I addressed about 75 fellow type 1s and Greg commanded the auditorium filled with about 250 type 2s. Now, head in the clouds, I looked outside to see the snow had stopped and was actually melting at lightning speed. 

Cinderella next caught an economy coach seat to Oakland, CA for 5 days of play. While there, I had the delightful opportunity to lunch with the editor of DiabetesHealth magazine. After we were seated at the Tadish Grill, great old seafood house by Embarcadero, he looked across the table at me with deep brown puppy eyes that said, “Tell me, goddess of diabetes, tell me all you know.” What more does a goddess need? So I listened to the sound of my own lovely voice as I gave him my pearls of wisdom. I reminded him to re-ignite his passion to manage his diabetes by remembering what he loves doing and doing it, to think back to the “can-do” spirit he had when first diagnosed and being rewarded for his efforts with an A1c of 6, by realizing healthy eating is a 'lifestyle' not a 'diet' and to appreciate that diabetes is an every day affair, but manageable. It was clear he appreciated the wisdom that flowed from this goddess.

Then returning from lunch late that afternoon I tested my blood sugar and it was 170! Once empty of expletives, I calculated my carb load from lunch - ahi tuna and salad and one piece of bread didn’t add up to leave me as high as 170, particularly since I'd covered the bread with my Humalog. Hmm...was it that little bit of mango hiding in the champagne dressing on the tuna? Was it being out of my routine? I haven't walked since I left New York. You know they arrest you if you do that in California. Mind you, with my ankle still in a boot cast, I'm not walking much, but I do manage to clop through a half mile or so at home. Was it the extra fruit I’d been eating at breakfast lured by California’s fresh and gorgeous bounty of strawberries, kiwis and melons that I never get in New York? I just didn't know. OK, take a correction injection. Before bed I was 120, fine, I drop about 20 - 30 points overnight.  7 AM - 170 again! Yikes! How can I be going up overnight when I always go down? What's going on?

I checked both my Lantus and Humalog vials to see if they were low which would mean I’d been using them more than a month. Nope, both nearly full. I scoured my mind for carbs I may have overlooked. Nope. I'm already over jet lag so those floating three hours that somehow have to be calculated for but no one really  knows how, no longer count. “Shite!” as the British say. Having gone through the check list, there was nothing more to do but hope these readings were aberrations, watch what I eat even more closely, monitor for corrections and hope once I'm home all goes back to normal. I am happy to report so far mid-way into my first day back I seem to be back to my "normal."

Pulling myself up off the floor, one should never put anyone else up on a pedestal for diabetes-care, because, I just about broke my neck falling off of mine. Diabetes is a daily affair, as I tell my audiences, our bodies are all different and there's no such thing as perfect. And boy do I hate that because "perfection" is my middle name. The tireless, everyday calculations usually turn out the way I expect, but sometimes, they just don’t. Come to think of it, maybe it's the canker sore I've had the last 5 days that’s raising my blood sugar... hmmm...could be, or the....or the......and on and on and on…………….

Today is something I just heard about a few weeks ago called 'Diabetes Alert Day'. Apparently it's the 20th year the American Diabetes Association has been recognizing this day about alerting people how to prevent type 2 diabetes. 

The reason I became aware of Diabetes Alert Day is because I was asked to give my A1c Champion presentation today as part of a larger diabetes health event  at a hospital in Brooklyn. A week ago I was told the event was canceled. Frankly, I don't know why but I do wonder why and think it's a sad statement that we're canceling more information getting out there about diabetes. 

I read on Amy Tenderich's blog, DiabetesMine, this morning that you might want to be your own spokesperson and today tell two people about diabetes. I think that's a great idea. Here's another: Since they cancelled Diabetes Alert Day, let's cancel our diabetes today. 

By that I mean, today do what Dr. William Polonsky, CDE, psychologist and founder of the Behavioral Diabetes Institute advises we should be doing every so often to avoid burn-out - take a "mini-vacation from diabetes." Put down your fears (that's my advice), maybe test once less today, have that bagel, and give yourself a break. 

Until we can cancel diabetes for real, I think we have to give ourselves a pink slip every now and then. 

A few months ago I interviewed a young woman who had type 1 diabetes, and then she didn't, and then she did again. She was "cured" of diabetes for a time through two islet cell transplants. She had an infusion of perky insulin-producing islet cells, which meant that after taking insulin for almost twenty years she didn’t have to take it anymore. Unfortunately, after 18 months the cells began to fail and she was back on insulin. When we spoke she had listed herself on the pancreas transplant list to get back what she called the “freedom” in her life, that of being insulin-free. I thought it extreme to undergo the knife in a risky procedure where you’d have to take auto-immune suppressant drugs the rest of your life and the transplanted pancreas would only be good for about 10-15 years, if lucky. She, on the other hand, had difficulty imagining how I live relatively harmoniously with my diabetes. And, she posed the question to me, “Would you give up your diabetes if you could?”

Before I go there I need to give you a little more background. I interviewed this woman several months ago. Then when I released my new book, The ABCs Of Loving Yourself With Diabetes, thinking she might profit from many of the lessons it contains, I emailed her a note. She sent me this email in return, “FYI - I have taken myself off the transplant list for the time being.  After meeting you - I decided to give it a shot being diabetic again. It is not always easy - ups and downs (as you know) but I am officially diabetic again.”

I was stunned frankly because at the time of our interview she had said, “If a new pancreas gives me only 5 years of insulin-independence I will take it. Five years of reversing complications makes the risk worth it to me, to be free." Yet now she was telling me she had reversed her decision to get a new pancreas. Before the islet cell transplants, this woman suffered from severe hypoglycemic unawareness - she couldn't feel when her blood sugar was dangerously low. She had countless episodes in the last ten years of nearly falling into a coma; it could happen walking to work, driving a car, while in a meeting or lying in bed. While the islet cell transplants didn't keep her insulin-free in the end, they did return her warning symptoms of low blood sugar. "Since the islet cell transplants,” she said, “my husband has not had to wake me up in the middle of the night to see if I’m still alive. He used to do that every single night.” So for her, the islet cell transplants created a dramatic increase in her quality of life. Of course I could understand the decision to have that done. But now that she gets the warning symptoms of low blood sugar and is like the rest of us ordinary type 1s on insulin, was a pancreas transplant worth it? There's the risk, and when you think about it, as of course I began to, who would you be without your diabetes? If you’ve had it a long time, like me it’s probably shaped your habits and become part of your identity. Early on in our talk she was adamant that the freedom of being insulin-free was worth the risk of a pancreas transplant. How giving up diabetes affects identity, we probed a little later.

She got type 1 diabetes as a teen and grew up in a house where she was not fussed over and so became hugely independent, responsible, hard-working, earnest and a perfectionist at a very early age. It serves her now working toward partnership at a prestigious Manhattan law firm. In fact, at thirty she has all the earmarks of a hard-driving, intelligent, ambitious fast-tracker. Sitting in an office high atop Manhattan, I felt utterly out of place in my opposite lay-back researcher and journalist mode, and faintly amused as she checked her blackberry every ten minutes. She was well-thread and somewhat officious. But there was also a little-girl quality, a kindness in her quick apology for checking her emails and an openness I wouldn’t have expected.

She gave me two hours of her time that morning, precious time, and it was toward the end that she told me she'd placed herself on the pancreas transplant list. At that point I asked, “Since you now get symptoms of low blood sugar why go through this surgery?" She said, “At least I could say I did what I could to be free of this disease. There’s something about being free from diabetes that gives you the courage to try again. I also want to be part of the research, to be able to speak about it and show kids that being-insulin free is possible. Since I was 11, when I asked the nurse, “Will I have to take shots for the rest of my life? and she said, “Yes, diabetes is incurable,” I thought, I’m going to prove the doctors wrong someday.”

Then she asked me, “Would you try to become insulin-free if you could?” Interesting question. I don’t suffer from hypoglycemic unawareness so I wouldn’t be a candidate for the islet cell transplant, but if I did I would have made the same choice to do it as she did, that's a no-brainer. However, if my diabetes then came back as hers did, along with the warning signs of low blood sugar, would I go further to be diabetes-free?  “No," I said, "I wouldn’t have a pancreas transplant. It's not worth the risk to me and the short shelf life.” And then I thought further: What would it mean to give up my diabetes?

A fellow A1c Champion told me last year if they could take away her diabetes she would not do it. She gets too much pleasure and sense of worth from her work now helping others with diabetes. Would I give up my diabetes? It’s a fantastic notion to one day not have diabetes anymore. To eat whatever I want, whenever I want or not at all. To not take shots or finger pricks. To not consider if I’m walking today. All kinds of thoughts tumbled into my head. Those were all pluses, but I also thought I would fear gaining weight if I didn’t have a built in reason to watch what I eat and exercise the way I do. My diabetes is now my work, I’d be giving that up. Then there are the friends I’ve made because of it. To be just like everyone else, no longer special from hefting this extra burden and feeling oh, so, virtuous. What would that be like? 

“When I listen to you,” she said, “I hear that you’re resolved with this disease. You say, “This is what my life is and I have learned to navigate this way. It’s interesting for me to hear your perspective, it makes me happy to hear someone can do this.” I knew she meant it, her voice became softer, slower, and I could see her thinking about a similar possibility for herself.

She also told me toward the end of our talk that diabetes had also given her something, “It’s so funny because I want to get rid of it so badly,” she said, “but it’s who I am too. It’s a hard disease but it’s changed me for the better I think. I wouldn’t be such a good person had I not had it. As much as it’s been an enemy it’s also been a friend. I don’t think I would have accomplished all that I’ve accomplished. I often say diabetics are typically more motivated, capable and amazing, because they have to overcome so much to achieve what they achieve, it makes one a better person. 

“I’m wondering,” she continued, “if you would want to experience being free from the disease or if the disease has become such a part of you that you would miss it in some way? This happened to the first transplant patient at my hospital. He just let the new cells die. It was like he lost himself when the disease was gone. The disease was who he was and he couldn’t deal when he didn’t have it. I wonder," she continued,  "if in my own life I had made the disease part of me more, maybe I'd be better capable of dealing with it. When I was younger I was embarrassed having diabetes because it meant I wasn’t perfect. I didn’t want to admit it even to myself.  But you probably can’t understand why I feel this way about a transplant.”

I said it was hard for me, and then I gave her my answer to her question, Would I give up my diabetes? “I don’t know,” I said. I suppose if you tied me to the train tracks and made me say “yes” or “no” before the train arrived, I’d give you a better answer, but for now that’s my answer. I don’t think of myself like the young man in the hospital she described who couldn’t let his identity as a diabetic go. I’m just not sure if the choice were really available what I would do. I can imagine my list of pros and cons might be of pretty similar length.

In any case, when this woman’s email crossed my inbox not so long ago and she told me she had taken herself off the pancreas transplant list, I was very moved that she found something in me and how I live inspiring enough for her to re-think her decision. I don’t pretend to know what’s best for her nor flatter myself that I alone was her motivation. I sensed although she presented a firm front that she was struggling with her decision when we spoke. But if I gave her a snapshot of life with diabetes where one can find peace, then I’m grateful.

Would you give up your diabetes? Your knee jerk reaction is likely “yes.” But when you think through it you might find a very intricate web of emotions that reveal just how much a part of you it has become. Anyway, something to think about, as I hope this blog always offers you. It would be nice to find out in a year how she feels about her decision. In the meantime, I’d love to hear what your decision would be and why.

In my last post I touched briefly on the importance of the systems in your life to support your diabetes management. Systems-talk is generally heard relative to companies seeking ways to improve  processes in order to increase profits and save time and waste. But doesn't it make perfect sense that the same holds true for managing diabetes? Our systems either make us successful with less cost in time and energy, or foil us. Back to the company analogy, no matter how dedicated employees may be, if they're working within a system that doesn't support their intentions and efforts, they won't accomplish their aim. Similarly, no matter how good your intentions, if your systems do not support your best efforts, success will evade you.

What does this really mean? We all have some kind of system we work within for the daily or weekly tasks we perform regarding our diabetes management. For instance, you have a system for feeding yourself - it may be skipping breakfast, eating a yogurt for lunch, then a candy bar in the mid-afternoon, and having dinner at fast food drive-ins half the week and pulling frozen entrees out of your freezer the other half. This system doesn't support having your best health, let alone a desire to lose 10 pounds. A better system would be having a healthy breakfast, a larger healthy lunch and skipping the candy bar, and, going to the supermarket once a week to bring home nourishing foods. You might cook a week's worth of dinners on the weekend, freeze them, and one day a week greet the loud speaker at Burger King, McDonalds, KFC or your fast food joint of preference. 

Trust me, you have a system for everything. Take refilling your meds. It may be you open your pill bottle and you notice it's empty, you grumble or shriek and then go to the pharmacy or call your doctor. Here's another system that might be less stressful: when a new bottle of pills come into the house, if it's for a 90-day supply for instance, write on a calendar 75 days from that day, "Reorder meds."  

Think about how diabetes fits into your day, or doesn't? Is it the last thing you always seem to contend with? If so, your systems are not very efficient or supportive for managing your diabetes. How about your emotional system? Do you let loved ones help you in some way or shoo them away? Do you do enough of what you love to replenish your energy and positivity? If not, can you schedule that into your week?

The good news is you designed your systems, consciously or unconsciously, and can change them with a keen eye, some creative thinking and practice. Look specifically at what you're having trouble with and then look at the system behind it. For example, if you forget to take your pill before lunch because you're always stressed at work, or running into a meeting, how can you remedy this? Can you put a note where you'll always see it just before lunch? Dan you keep an extra pill in your wallet if you carry your wallet or  purse into meetings? f you've been trying hard and not doing terribly well, don't blame yourself, blame your system and then revise it.

My Systems

My system for taking my blood sugar approximately 5xday includes keeping my meter always in the same place, on my kitchen counter, my test strips always in my meter case, my lancing device  always on my kitchen counter. I work at home and this works for me. If I'm out of the house, I take my smallest meter with me so I can always test. 

My system for eating is to buy mostly fresh vegetables, fruits, chicken and fish and do most of my own cooking. Every morning I make a bowl of steel cut oatmeal. Almost every lunch I have a spinach salad with an assortment of veggies, beans and some feta cheese. I mostly steam vegetables and broil or saute meats and fish for dinner. I eat beans in replacement of higher carbs, for instance, rice, pasta, potatoes. The few freezer products I use don't have any added butter, cream, etc. I use vegetables a lot as foods to fill up on, and crunch on, when I need something crunchy. I like nuts for this too, and yes, I have to be careful not to sit down with the whole jar. I notice when I run out of healthy foods, I begin to reach for less healthy foods (my husband's stock of crackers, licorice, etc) so part of my system is to always try as I can, keep an adequate supply of healthy foods in the house. I make sure I have 85% dark chocolate in the house and cocoa powder so when I need a sweet I can satisfy my sweet tooth and not go crazy. If I don't do this, I'll eat everything in my house and still feel unsatisfied.

My system for exercise is to every morning take a one hour walk around my local park typically from 9:30-10:30 A.M. Just after checking my email and before getting into any major project. If I miss my walk because I have an appointment, I try to fit it into the late afternoon. If my appointment is in the city, I'll walk 40 or 60 blocks when I get out of my appointment to a subway station so I fit my walk in that way. 

My system for emotional health includes doing lots of things I really enjoy that make me feel purposeful, and I get the rich reward of serotonin, the feel good brain chemicals from helping others. I spend time with friends who nourish me. I love reading and movies and indulge in both. When times are tough, I reach out to my partner who always listens and then see how much good I still have in my life. If all else fails I do something guaranteed to bring a smile, look at the pictures in my wedding album, call a dear friend across the country or just leave my house and go somewhere else from where life looks different.

I'm only telling you about my systems to give you an idea of how systems work. Admittedly, I have a lot of lattitude working for myself and working at home. I don't want you to compare what you to what I do. I want you to look at your systems and your life and see if your systems support your best efforts and if not what can you do to improve them?

Here are some questions to stimulate your systems-thinking:

Q: Where are my supplies? Are they handy? As I said my meter is always on my kitchen counter making it easy to find and grab, no searching that might lead me to say, "oh what the heck, I'll test later." 

Q: Am I always running out of my meds or test strips? Why? Can I guesstimate when it would be time to order more and work out a system for this? Is my husband or wife always at me about this and so do I put off reordering my meds just to bug him or her? Can I remedy this by having a heart to heart talk with my loved one and then do better for myself?

Q: How can I avoid all the tempting foods always at work from parties and meetings? Can I keep a healthier replacement treat at my desk, or give myself a reward when I pass up temptation like a movie or little trinket? 

Q: I only seem to be getting to the gym a third of the time I'd planned because work or family obligations get in the way. Can my family help pick up some of the load by taking over some simple chores? 

Looking at your systems, start with the assumption that it's possible to refine them. And remember, to improve you can't do what you've always done and expect different results. Sounds like common sense, but many people will often spend their energy trying harder in a failing system than change their system.