Season Two: Episode Six

MARCH 28, 2021

This week I had an eye appointment for my new glasses. My eyes have gotten a little worse in the last three years. In the past year, I’ve been getting headaches from wearing my glasses so I knew I needed a new prescription. I’m glad I’m getting new ones.

My ophthalmologist said that the pressure in my eye is borderline high. I’m not sure how I can lower the pressure in my eye, but he said that’s the only problem he sees with my eyes right now, so I’m really glad that even though my diabetes still isn’t under control, it isn’t completely messing up my body yet.

On Friday, I had my appointment with my endocrinologist. Not very helpful. He wants to try and put me back on Ozempic. I told him that we were doing better financially but I don’t think we’re that great yet. I mean $800 per pen for only a month’s worth. Not sure how I feel about it but I said I would try. I’m not sure if he’s also giving me the fast-acting insulin too or if I’m even still going to be taking my Lantus with the Ozempic. I have to give his office a call this week to clarify my drug usage.

I’ve been feeling unwell the last couple of days. I haven’t been in to work much but I’m still working from home. I woke up with a sore throat a couple days ago and it went away, then the next morning it was worse and didn’t fully go away. Then this morning at 4:30 I woke up and couldn’t breathe or swallow and I was coughing. And I’m not going to lie to you, I thought I had COVID. I started crying and I couldn’t go back to sleep for a long while. But after sitting up for a while and drinking water, my cough got better and I was able to swallow a bit more.

My husband bought me cold and cough medicine when he came home from work and I took some and felt a lot better. I’m still coughing here and there but I can breathe. I’m still worried it’s COVID. We don’t have free COVID testing until Wednesday and that’s a bit too long to be out of work I think. But we’ll see what happens when I wake up in the morning on Monday, because apparently it happens while I’m asleep.

I’ll give you folks an update next Monday here on the blog or earlier on my Facebook page. I don’t know what’s going on with me, but if tomorrow I feel worse, I’m going to go to Urgent Care to see what the heck is up with my body. Wish me luck folks.

Why I Think Seeing a Dietician is Beneficial for Diabetics

Last year, I wrote a blog post about having your Diabetes Care Team and why it’s so important for you to choose the right people. Choosing the right people that support you and are helpful and sensitive to your current condition is so important. I’m part of a diabetes support group for women on Facebook and it’s always so sad seeing some women being mistreated by their doctors and wondering if what they’re doing is even right because their doctors make them feel dumb and inadequate. Having the right people by your side should NOT make you feel less than the amazing person you are.

Your Diabetes Care Team should consist of a Primary Care Physician (PCP), Endocrinologist, Certified Diabetes Educator, Opthalmologist, Podiatrist, Dentist, and a Registered Dietician. All of them specializing in fields that can help monitor and manage your diabetes.

Since I was diagnosed with Type 2 in February 2017, I have really slowly built my team. Like really slowly. I had my PCP who diagnosed me and started me on oral medication in hopes that by losing weight and eating better would naturally bring me back around,which it didn’t.

In 2018, I went to a diabetes education class with a diabetes educator. I learned a lot at that class and I’m really glad I went, but I don’t know if the lady that headed the class is still working there anymore. Also in 2018, I got my opthalmologist and podiatrist. They’ve been keeping an eye on how my diabetes has been affecting my eyes and feet, which so far has been good.

In 2019, I was referred to an endocrinologist who put me on insulin which I’ve been using ever since. My dose has gone way up to the point that he may have to prescribe me another insulin on top of that.

And finally in 2021, I got a dietician. My PCP was supposed to work it out for me but that never happened so I had to do it on my own. Thankfully I’ve been taking classes and other services from a local nonprofit that provides classes about diabetes, hypertension, and healthy eating among other subjects. They also work with dieticians and other specialists to bring their services to the Native Hawaiian population. I’m very grateful for their services.

Nonprofit organization that serves the Native Hawaiian health care system on Hawaii Island. They provide medical, behavioral health, and community education services.

Here’s why seeing a dietician is so important. Going to classes about healthy eating and diabetes will always go over what you should and shouldn’t eat. You can ask the instructor questions but you can’t have a conversation with them during class because there are others there as well. I suggest seeing a dietician so you can sit with them, one on one, and really get to the nitty gritty.

I saw my dietician for the first time yesterday and we talked about when I usually eat, what I ate in the last 24 hours, what my glucose reading was, what my concerns were, if there were any changes recently in appetite or anything really, and she gave me suggestions on what I could change. Talking to someone one on one is really getting the information to sink in better than during all of the classes I took.

I have to go back in and see her in a month to see if any of the changes I’ve implemented are working. The changes I’ve agreed to make are to eat brown rice instead of white rice, try whole grain bread instead of white bread, get more fiber in my diet is the big goal, try to incorporate more vegetables in to my diet, and continue to walk AT LEAST 15 mins for AT LEAST 3 days (the more the better).

I’m going to have to increase how many times a day I check my blood sugar which might now be about six times a day at least. I think my endocrinologist might also want me to check before and after I eat now too. But I’m willing to do this now more than ever! Why? Because I’m so close to breaking 200lbs! I haven’t been less than 200lbs since 2012. There was a short stint in 2019, but I gained it all back because of stress. I want to break 200lbs once and FOR ALL!

If you haven’t seen a dietician, I really suggest you do. They can come up with a menu of things you should eat more of as well as what kind of physical activity you can do to bring your blood sugar down. The one on one experience will also benefit you as well, I think.

I would love to hear your stories about your journey with diabetes. Feel free to submit your story. You can submit it anonymously if you want. I just really want to know that I’m not going through this alone, that others out there are going through similar experiences like I am.

The Journey: Episode Nineteen

SUNDAY, AUGUST 16, 2020

My blood sugar is looking a little bit better this week. I started drinking cinnamon tea about five days ago and my blood sugar has been in range more days than out of it. I’ve heard of the benefits of cinnamon tea on blood sugar levels and I’ve been wanting to try it out for a while and I finally got around to it. I’ve read that you can use either a cinnamon stick or one tablespoon of ground cinnamon, I finally found cinnamon sticks in a big container at my Walmart so I don’t have to do ground cinnamon.

One thing about cinnamon tea though, is make sure you’re not taking too much of it. It has a compound that could shutdown your liver if you ingest too much of it, but you’d have to take like either a lot or this one cinnamon that has a high amount of that compound. I can’t think of the name right now, so do your research before you start drinking this stuff.

It’s not so bad although if I let it sit for too long, like when I’m waiting for the water to cool down and I’ve forgotten it, it can get a bit spicy. One time I forgot it completely until the water was basically cold and the stick was sitting in the water and it was the spiciest drink I’ve ever had in my life it was a bit hard to swallow but I managed to drink it all. I think it works best when the water gets spicy.

My cinnamon stick stash

I’ve been using one stick twice a day, once in the morning and once before I take my insulin. Then I’ll take my blood sugar and prep my insulin. Man my insulin. I’m running low on funds to buy my insulin, fun times. So I’ve taken to using every drop of insulin I have. Before I’d throw away whatever was left in my pens if it couldn’t make a full dose, because I was afraid of sticking myself twice in a night, and for good reason too, it’s not fun twice in one night.

But since I won’t be able to afford it for much longer I’ve had to double up on needles every couple of days to make my 85 unit doses. It’s not fun and my left leg has already had to do it twice now. I’ve managed ten shots in my right thigh and I’m eight shots in on my left thigh with two nights doubling up. It wasn’t very fun, though last night it wasn’t too bad when the needles went in, but afterwards they both stung and the second one bled a little bit.

I’ve kind of come to terms with double shots some nights, anything to save money really. I’m just upset that I have two insurances and neither of them will pay for my insulin. I’m not sure if my insulin is a life-saving drug, but it’s so important to my health and they won’t cover it, like it’s some optional drug that I don’t need. They’ll pay for my cortisone cream for my eczema but not my insulin. Thank goodness for a manufacturer coupon that makes it cheaper for me, but at $100 a box every couple of weeks is still ridiculous.

This is so ridiculous. But hopefully with the cinnamon tea, exercise, and lower carb intake my blood sugar will be able to get under better control. I hope I can get another insulin or something that I can take a smaller dosage and maybe cheaper? Who knows. Here’s to hoping for a better future for myself.

Does Diabetes Affect Hormones?

In short, to answer that question, no, diabetes does not affect your hormones, however, your hormones have a massive effect on your diabetes and blood sugar levels. Hormones are released by various organs and glands within your body that affects pretty much everything.

Some hormones that affect your diabetes are insulin, glucagon, amylin, epinephrine, cortisol, and growth hormone. The most directly related hormones are glucagon and everyone’s favorite, insulin. However, even our own sex hormones can affect our blood sugar levels. In those who have ovaries, estrogen and progesterone levels can affect how well our insulin works, or doesn’t. Same with those who have testes, testosterone levels can cause insulin resistance.

Let’s work out our sex hormones first. Estrogen is the hormone that helps with the development of female sex characteristics. It can also improve insulin sensitivity, however, the loss of estrogen can also lead to insulin resistance.

Insulin sensitivity is when your insulin works properly. Insulin resistance is when your insulin sensitivity is low and your cells can’t use your insulin very well.

Progesterone is the hormone that helps the body prepare for the possibility of pregnancy. Progesterone levels go high in the middle of your menstrual cycle and decrease when you’re about to have your period. If you are pregnant, your progesterone levels go up in preparation for the fetus to protect the fetus and allow proper amounts of glucose. However, high levels of progesterone can lead to insulin resistance.

Testosterone helps with the development of male sex characteristics. Lower testosterone levels lead to insulin resistance.

To counteract the affect your changes in life stages on the way your body interacts with your blood sugar, you should:

  • Keep track of your blood sugar levels and show any fluctuations to your doctor to examine and make any necessary changes
  • Watch your weight, being overweight can lead to out of control blood sugar levels
  • Eat a healthy diet full of high-fiber vegetables
  • Exercise at least 30 minutes per day to help your body use its insulin more properly

You’re going to grow older and your body is going to change, keep up with its changes so you can better manage your diabetes. To learn more about how those life stage changes can affect your diabetes, check out this article.

The other hormones are listed:

  • Insulin – released by the pancreas, allows the body to use glucose for energy by helping cells absorb sugar from the bloodstream. Resistance to insulin will make it difficult for the body’s cells to absorb the sugar causing all that unabsorbed sugar to stay in your bloodstream.
  • Glucagon – produced by the pancreas to control glucose and ketone production in the liver. It gets released between meals and overnight. If you’ve had a high sugar meal, the glucagon won’t be needed as there’s already a lot of sugar in bloodstream which can lead to less and less of the hormone being produced. This low level could cause your blood sugar levels to go too low because there wasn’t enough glucagon to help produce glucose from the liver.
  • Amylin – released along with insulin. It decreases the body’s glucagon levels, this decrease helps to decrease the production of glucose in the liver and slows the rate that food empties out of stomach.
  • Epinephrine – aka adrenaline, released from adrenal glands and nerve endings to stimulate the liver to produce sugar.
  • Cortisol – type of steroid hormone from adrenal gland. Works to make muscle and fat cells resistant to insulin action and enhances glucose production from the liver. High levels of cortisol can lead to insulin resistance.
  • Growth Hormone – released from the brain’s pituitary gland and has the similar functions of cortisol.

All of these hormones help to keep our blood sugar levels in check or keep them out of control. I’m not sure what we can do about helping our hormones to help our blood sugar but there is hormone therapy for our sex hormones.

I don’t think diabetes directly affects our hormones like our hormones do to our diabetes, but having out of control diabetes and blood sugar levels can throw everything out of whack. I hope this post helps lead you to more answers down the line for you.


References

Viveve.com
WebMD
Diabetes Health


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The Journey: Episode Eighteen

AUGUST 10, 2020

So conditions have been unchanged since the last journey update. I went one night without injecting my insulin and the next morning I woke up and my blood glucose was 210 mg/dL. I’m not sure how it would have been if I had taken my insulin that night because we had dinner kind of late that night, after 7pm, and it was pretty carb heavy. But then there’s today. I ate dinner way before 6pm and it wasn’t very carb heavy. When I took my blood glucose at 9am, kind of late because I woke up late, it was 179! So that’s very frustrating.

I think my insulin injections aren’t working as well as they were when I first started taking them. They’re still working thank goodness, but not nearly enough. It’s only a slight change in my numbers between not taking and taking my insulin. So I’m basically paying $99 every two weeks or so for a drug that’s supposed to be helping me, but isn’t.

And that’s another thing. I have Lantus. It’s 5 pens of about 310units each. I’m at 85units now, I can only get three doses from each pen. I don’t use it all the way to 0 because I don’t want to inject myself twice, it’s bad enough doing one each night, plus there are always bubbles no matter how hard I try. I have a coupon card which helps me get my boxes at a discount, I’m not sure what the discount is, but I only pay $99. However, when I tried to fill my prescription on the last week of July, the Pharmacy said if they were to fill it then, I would have to pay full price, but if I waited until next week, it would be $99. Neither of my insurances companies cover my insulin, which completely fucking sucks, so I had to wait, thankfully I had enough left to be able to wait. But now I go through one box in two weeks and I wonder if they’ll be able to fill it at the discounted price. I think I might have to double inject this time just to make it stretch, which doesn’t sound fun at all.

Liliuokalani Park and Gardens – Hilo,HI

My next prescription of Lantus, I’m moving to another pharmacy where it will be hopefully cheaper for me. If not, then I have no idea what to do and I’m screwed. Unless my doctor can give me another insulin which would be a lot better, if it’s cheaper.

Yea the stress of not having enough money to buy my medication and the stress of my medication not working is very…stressful. I’ve been so stressed out lately that I had a breakdown, in front of my boss. Thankfully she was so kind and understanding. We worked out my schedule so I only work one to two hours a day from home and it’s been working a lot so far. I feel less stressed and I’m getting more work done.

I’m looking in to meditation to try and help get my stress levels down on the regular and take time for myself more often. I’ve got a lot of lovely scented candles that I’ve been lighting and it’s been lifting my spirits.

I hope if you’re facing these same hardships in your diabetic journey, that you’ll take some time for yourself. Your mental health is so important and we always forget to take care of ourselves. Go take a nice warm bath. Drink some tea and read your favorite book. Go take a walk outside in the sunshine today. Take some time to slow down and enjoy your life. Even though you have diabetes, that doesn’t mean you can’t enjoy this life you were given. Smile at yourself in the mirror and take a minute to love being you. I love you. I am here for you. We can get through this together. You’ve got this!

Possible Causes of Morning Highs

Do you ever just wake up in the morning and check your blood sugar only to find that it’s higher than 125 mg/dL? You were sure you did everything right the night before and yet your sugar is still high. Maybe it’s been high for the past week or two and you don’t know why. There could be a reason behind your morning highs. Two theories that scientists have come up with are the Dawn Phenomenon and the Somogyi Effect. Let’s begin!


The Dawn Phenomenon


Also called the dawn effect, is described as an abnormal early-morning increase in blood sugar – usually between 2AM and 8AM that occurs regularly in diabetics. The occasional high isn’t much of a worry, but when it happens almost every day, it’s an issue.

There is a natural overnight release of counter-regulatory hormones – the growth hormone, cortisol, glucagon, and epinephrine – that increases insulin resistance, causing blood sugar to rise.

High morning blood sugar may also be caused by not enough insulin the night before, low dosage of diabetes medication, or eating a carb-heavy snack at bedtime.

What You Can Do

If you suspect the Dawn Phenomenon, consult with your doctor. Your doctor may make some recommendations to help prevent or correct your high morning blood sugar levels:

  • Avoid carbs at bedtime
  • Eat regular meals (stay consistent with meals per day, times of day, etc.)
  • Adjust your dose of medication or insulin
  • Eat dinner earlier in the evening
  • Switch to a different medication
  • Do some light exercise after dinner, like walking, jogging, or yoga
  • Change the time you take your medication or insulin from dinnertime to bedtime
  • Use an insulin pump to administer extra insulin during early-morning hours

Personally, I have moved from taking my insulin at a set time each night to within one hour of falling asleep. Once I start feeling tired, I inject my insulin. So far my levels have been lower than when I take it at 9:30pm.

The Somogyi Effect

Also known as the rebound effect, is another possible cause of high blood sugar in the morning. Not all scientists believe this effect is real, but it happens when blood sugar levels drop too low.

If a diabetic were to take insulin without a bedtime snack or inject too much insulin, their blood sugar levels may drop during the night. The body then responds by releasing growth hormones that trigger sugar levels to go back up causing blood sugar levels to be high in the morning.

The Difference Between the Two

The biggest difference between the Dawn Phenomenon and the Somogyi Effect is that the Somogyi effect includes a decrease in glucose levels causing hypoglycemia which is then followed by a rebounding hyperglycemia.

The easiest way to find out which one is causing your high glucose levels in the morning is to record you blood sugar throughout the night. Take your sugar before bed, then again at 3AM in the morning, and then once more when you wake up in the morning.

If your 3AM reading is low, there’s a likelihood that the Somogyi Effect is the cause. If your 3AM reading is normal or high, then it is likelier to be the Dawn Phenomenon that caused your morning highs.

The only way to be sure is to do this process of at least three readings each night for at least one week. The longer you do it, the more familiar with your body you become. Then relay this information to your doctor and they will be able to work with you to correct these morning highs.


References

Mayo Clinic
Medical News Today


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How to Check Your Blood Sugar

Regardless of what type of diabetes you have, you need to know how and when to take your blood sugar. It is one of the most important aspects of diabetes management.

Find the Right Meter

First thing first is to find the right glucose meter. I am not familiar with ones used by Type 1 diabetics, but I can definitely help you find one for Type 2. I have used two meters so far, Reli On and True Metrix.

My Reli On was from Walmart. It worked well enough, simple to use and easy to read. I loved the lancer and the lancets I used for it. The lancer looked nice and the lancets came in ultra thin which didn’t hurt my fingers that bad. I loved it. However, in January, I tried to get more glucose strips for my Reli On and my Walmart didn’t have any. For a whole week, they were completely out. I couldn’t wait for a shipment to come in or restock or whatever, so my husband went to CVS pharmacy and bought a True Metrix Air.

When I say I love my True Metrix, I mean it. I HATE the lancet. It’s ugly and the lancets that came with it are definitely not ultra thin. It hurt like a mother when I first pricked myself. I decided to never use that lancer again. So I use my Reli On lancer and the remaining ultra thin lancets with my True Metrix. The best thing about the True Metrix is that it has bluetooth connectivity and comes with an app on my iPhone. I check my blood sugar open my app and it logs the reading. It gives me an average of all my readings, let’s me know when my blood sugar is in range (it hasn’t been yet), and I can take notes about the dosage and which side I inject on my tummy.

My Personal Glucose Meter

I love my meter. Super convenient to keep track of my readings with the bluetooth function. I think I want to name her Trixie.

The True Metrix isn’t super cheap or expensive. It was around $20. I haven’t gotten a prescription to get one, but I think you might be able to get one. I don’t know how that works, bring it up with your doctor. Maybe you could get a prescription on the glucose strips too.

When you go to choose your meter, price is definitely one of the things to look for. I feel like anything over $25 is ridiculous. It better be able to make me some morning coffee for $25+.

My second requirement is aesthetics. If I have to look at this thing every day, I’d like it to look nice. True Metrix definitely fits that bill. The meter, the lancer, the lancets, and strips should look nice to me.

My last requirement is ultra thin lancets. Anything thicker and it hurts, no matter how warm my finger is before I prick it, it always hurts. The less painful it is, the better.

When to Check

Some of the best times to check your blood sugar are:

  • Mornings, before breakfast
  • 1-2 hours after a meal
  • Before, during, and after exercise – just to make sure your blood sugar doesn’t dip too low
  • Bedtime
  • Whenever you feel the symptoms of hypoglycemia or hyperglycemia.

*** Also don’t forget: DO NOT reuse your lancets for more than one reading. If you didn’t draw enough blood the first time, I see no sense in using a new lancet for a second draw, but discard the lancet after you test your blood.***

Testing Your Blood Glucose

Before you use your glucose meter for the first time, you need to calibrate it. You should by calibrating solution for your meter and follow the directions in your device’s instruction manual.

After that is done, prepare your lancer and get a test strip from your bottle. Close the bottle immediately after removing a test strip and use the bottle within 30 days.

Before lancing, wash your hands with soap and warm water. The warm water will help to get your blood circulating so it will be easier to draw blood the first prick without having to lance again and use another test strip.

When choosing the spot to lance and draw blood, obviously choose your non-dominant hand. This poor hand is going to get poked and pricked a lot in the foreseeable future. Personally, I only use my middle, ring, and pinky fingers on my left hand, because I tend to not use those fingers as much as my index and thumb and it stings a little after lancing.

I suggest choosing a site on the sides of your fingers, avoid the pads and tips since they are the most sensitive.

Possible Lancing Sites

Choose the sides of your fingers (within the black circles) and avoid the pads and tips (the red areas).

Also be sure to remove any rings before lancing to maximize the blood flow in that finger.

Prepare yourself for the prick. Once you have lanced yourself, massage the palm directly below the finger and massage upwards so a droplet of blood comes from the site. Once there’s enough blood for the sample, put your test strip into your meter.

When the meter turns on, take the strip and put it up to the blood droplet. You don’t want too much that an error shows on your meter, but you don’t want too little either or an error message will show. If an error does occur, you need to get out a new test strip. Hopefully, you will be able to massage more blood from the original site. If not, you will have to lance again. Because my needles are ultra thin, it’s really hard to draw enough blood for a sample and if I don’t get it the first time, then I have to move to another site because it’ll be impossible to massage more blood from the same spot.

Discarding the Waste

Once the blood sample is in the strip it will take a few moments before the result pops up on the screen. Log that number down and what time it was that you took the reading. Once you’re done, remove the strip from the meter and discard it and the lancet you just used. Use a tissue to clean your finger of the blood. Once everything is put away, go ahead and wash your hands. Please don’t touch your face after drawing blood, you could have blood-borne pathogens and that would suck.

I use an empty laundry detergent container for my used needles and test strips. The plastic is hard enough that the needles won’t puncture and I don’t have to use one of those biowaste containers from the pharmacy. Whatever container you choose to use, make sure it’s made of durable plastic so the needles don’t puncture.

Congratulations, you just took your blood glucose reading. For a step-by-step visual process, feel free to check out YouTube. I like this video from Mayo Clinic. It’s a bit old but meters still work the same way. Maybe one day I’ll make my own video and post it on my YouTube channel but for now go ahead and find any one.


Related Content

What is Blood Sugar and A1C?
Some Signs You Might Have Diabetes


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How Exercise and Diabetes are Connected

Exercise is very important for those who have diabetes. By being active, you can reduce long-term health risks, improve insulin sensitivity, and enhance mood and overall quality of life. Most of the time, working out causes blood glucose to drop, but some exercises can cause glucose levels to rise.

Using your muscles helps burn glucose and improves the way insulin works. Some workouts like weight lifting, sprints, and competitive sports can release stress hormones like adrenaline. Those hormones can stimulate the liver to release glucose.

The food you eat before or during workout can also contribute to your glucose levels. If you eat too many carbs before exercising could cause your glucose levels to stay high regardless of exercise.

Here are some exercise tips:

  1. Choose moderate-intensity aerobic workouts or circuit weight training with light weights and high reps.
  2. Practice relaxation techniques like meditation before and during exercise to minimize adrenaline effect.
  3. Consider doing your workout later in the day than in the morning. Some people experience high levels of glucose in the morning naturally.
  4. If you are taking rapid-acting insulin or short-acting diabetes medications, consult your doctor about adjusting it prior to working out if they produce a glucose rise.
  5. Avoid consuming excessive amounts of carbs before and during exercise. Try some yogurt with nuts or peanut butter.

Keeping a workout log and checking your glucose before, during, and after each workout you try can help you see which exercise works best for you and what pre-workout foods affect your glucose.

If I had known what I know now back in 2010, I wonder if I could have helped my dad and support him in his diabetes. I never knew about diet and exercise when you had diabetes. I thought it was just take your meds and avoid sugar. It’s not that simple and it’s so difficult to do it alone.

I will release another post about which exercises would work best for diabetics and bonus, they can be done with others. You don’t have to go it alone.


References

Diabetes Forecast July/August 2019, p. 12