Diabetogenic

A not-so-radical idea

March 7, 2023 in Community, Food, Health, Social media | 4 comments

Is it really all that radical an idea to suggest that there is no one size fits all when it comes to people with diabetes and what they choose to eat? Surely any reasonably minded person would say that no one should be forced to follow a specific diet, in much the same way as no one should be told which diabetes tech they must use.

But in the last couple of weeks, and after a couple of different incidents, I’m realising that reasonable doesn’t play into the attitudes of many people when it comes to what can only be termed as diet wars. I don’t bait anyone with tweets about food. I really don’t. I’ve no interest in defending what I eat. It’s my business and mine alone.

My position is very clear on this, but I’ll state it again. I genuinely believe that people with diabetes should be able to eat the way they want. I also believe that it is incredibly privileged to get all preachy about what people should be eating when there is a lot that goes into how that decision is made. For some people, that decision is made for them in a lot of ways. It’s pretty ridiculous – and showing just how out of touch you are – to demand someone eat specific foods if they live in a food desert, can’t afford whatever they are being told to eat or if those foods are not culturally considered.

But let’s, just for a moment, pretend that we are living in some utopia, and everyone has access to, and can afford to buy, whatever food they choose to eat. We’ve taken out the factors that may make it difficult to afford and access the widest, freshest, healthiest variety of foods. Let’s now add to that and say that everyone is fully informed and has a high level of understanding about the different types of diets and earing plans available. This is as level a playing field as we can get.

Guess what? People will still make different choices and decide what works for them.

And that’s because there is no one way that works for every single person. That’s the bottom line. I think that’s a balanced starting point – understanding that not everyone is the same, not everyone wants to eat the same, and different things work for different people. That’s the way I think.

I want to make this position clear, because what comes next is perhaps not quite so generous.

After some pretty boring encounters in the online diet space, (I say boring, because haven’t we done this all before?), I decided to do something that I shouldn’t really do. But jet lag, too many long-haul flights on WIFI-enabled planes and, well, some sort of desire for self-sabotage, made me do a bit of a deep dive into the some of the people offering the more aggressive and downright nasty comments.

It will come as no surprise to anyone that the comments came from people who are very vocal about following a low carb diet because isn’t that where these comments usually come from? In my experience, the only people who have been critical of comments I’ve made online about food are those who are deep into the low carb community. I am not in any way tarring all those who eat low carb with the same brush. Of course I’m not. But there are ratbags in that community (as there are in all communities) who seem to take pleasure in seeking out and coming at those who have decided to eat a certain way, or comment about food in a certain way. And come at them they do. It gets personal, nasty, and downright horrid.

It is one thing to suggest people eat in a certain way. It’s another thing to refer to someone’s weight and fat shame them. A reply to one of my tweets that dared suggest that people with diabetes eat how they want, included a reference to ‘an obese nurse’. That tweet was followed by another low carb advocate (a physician) naming and adding a video of a diabetes educator and asking if she was the nurse. In what situation is this kind of behaviour okay?

Who are these people? I skimmed through the feeds of some of the people who commented on it being their low carb way or the high (but obviously not high carb) way, and it was unsettling. There was a lot of anti-vax sentiment. Along with anti-mask sentiments. One of two of them had an unhealthy obsession with Anthony Fauci, and wishing something terrible would happen to him. The Aussies in the mix had the same pre-occupation with Dan Andrews. I want to be clear – not everyone had these pretty extreme views, but a significant number did. It does the low carb movement no favours when so many of its members hold these types of views. It makes it easier to dismiss the whole community as being ‘cookers’ or anti-science, and I actually don’t believe that to be the case.

There are people who regularly comment on my posts and share balanced experiences about eating low carb and why it works for them. I always, always welcome discussions like this. It’s a great opportunity for me to learn, and I have adopted some of what folks like this have shared into my own diabetes management. I have also come to understand the frustration among some low-carbers because they feel that keto is not readily highlighted as an option and how many of them have been met with resistance by their HCPs when they’ve said they want to eat low carb.

But you know who else has been met with resistance? People using DIY automated insulin delivery systems. In fact, some people using a DIY system have been told what they are doing is dangerous and have consequently been ‘sacked’ by their HCP. But I am yet to see a single person from the #WeAreNotWaiting community shame anyone who has decided to not use a DIY system. Or ‘tech shame’ them. Or tell parents of kids not using a DIY system that they are the reason their kid will develop diabetes-related complications.

I’ll break this down again, by saying that I think low carb is a great option for people with diabetes. But it’s just that – an option. I know and see people with diabetes absolutely thriving, sharing in range A1cs and high percentage time in range each and every day on low carb, high carb, moderate carb and moderate-to-low carb (that’s generally where I fit in), vegan, vegetarian, carnivore, keto, Mediterranean, and every single other diet you can imagine.

I have a really simple wish and that is for people who are doing low carb do be left to do that in peace, and at the same time, they afford others the same respect and courtesy. It’s really not that radical an idea at all!

A photo of a short macchiato on the bench of a cafe. — Surely we can all agree that this is a thing of beauty!

Want more on this topic? Here’s heaps I prepared (i.e. wrote) earlier.

The one where I was fat shamed after a TV interview.

The one where a fundraiser for kids in under-resourced countries was almost cancelled because of Easter eggs. (Still makes no sense!)

The one wher e a bloke hijacked an online discussion about menopause by demanding I explain why I don’t advocate low carb.

The one that was a plea for respecting choice.

The one that was in response to the storm after a chocolate cake recipe was shared.

The one where I shared the start of my own experiences of eating low(er) carb. And a follow up post.

Can you hear the groundswell?

March 1, 2023 in Advocacy, Awareness, Community, Diabetes | 1 comment

I’ve just returned from Berlin, where I attended the ATTD Conference for a week of super busy meetings, information gathering, collaborations and advocacy. At every turn, people with diabetes (many attending after being awarded a #dedoc° voices scholarship) were discussing how community advocacy is key to driving change. I heard about remarkable efforts from people across the globe who are genuinely improving the lives of people with diabetes in their part of the world. And when anyone had a question, or asked for advice, people were only too happy to offer and share.

Right now, if you’re in Australia and live with diabetes, especially type 1 diabetes, you may have heard the kerfuffle about Novo Nordisk’s Fiasp being withdrawn from the PBS after Novo Nordisk made the decision to withdraw Fiasp. The Government can’t compel them to keep it listed.

So what now? Well, now is the time to rally the troops. Already, grassroots advocacy efforts by people in the Australian diabetes community (and friends across the globe thanks to the #dedoc° network) are making a lot of noise. There’s a petition (with over 6,000 signatures) and there have been blog posts. Social media groups are lighting up with comments and questions. This is how a groundswell starts.

You can also get political by reaching out to your local MP. I know that many people think that this is a daunting task, or believe that nothing will come of it. I counter that suggestion by pointing to any significant change in diabetes access in Australia. I’ve been in these trenches for decades now and know the effectiveness of people power. Community advocacy is often the starting point of rumblings that, combined with strong advocacy from diabetes organisations, leads to policy change. I can’t tell you how many letters I wrote back in the early 2000s before insulin pump consumables were on the NDSS. (I thought that the PM and health minister were going to take out restraining orders after I wrote to them both a couple of times each week for three years!) At one point, back in around 2002, I was invited to a meeting with Julia Gillard (in opposition at the time) who asked to speak with a group of diabetes advocates (did we even use that word then?) who had been regularly writing about the cost of pump therapy.

I also think of the incredible community efforts that lead to the Carers’ Allowance being changed back in 2010 so that the parents and carers of children continued to receive payments until their child was 16 years old, rather than being cut off when their child turned ten. Or the numerous letters I wrote, along with thousands of other people, to have CGM added to the Scheme. There have been other issues too – diabetes seems to mean one after another that needs attention.

Right now, the issue is Fiasp and you may be thinking about sending an email, but wondering where to start. Start with your story. Because only you can do that.

You can tell your story and write whatever you feel comfortable – your diabetes may vary and the way you advocate will too. I have some ideas I’m going to share below and I think they are worth considering when you are writing to your local MP. My philosophy is always to keep things short and sweet. I bring the heart with my story and add limited data to win over minds. Hearts and minds remains a central basis to my advocacy ideas. So, if you’re wondering where to start, here are some ideas that may help:

They don’t know diabetes and don’t know details, so start with the basics and keep it to the point: I am writing about an issue affecting me as a person with diabetes and that issue is the withdrawal of Fiasp from the PBS. Fiasp is the only ultra-rapid insulin available in Australia and there is no comparable and easy swap to be made.
Be clear about the issue: Fiasp is being withdrawn from the PBS. While it may be available on a private prescription this will make it too expensive for many people with diabetes, meaning a management option is being removed.
Explain how that impacts you: As a person living with type 1 diabetes, I am required to take insulin every day. Fiasp is the insulin that works best for me and if I am no longer able to afford to use it due to it being removed from the PBS, my diabetes management will be negatively impacted.
Be clear about your ask: I am asking for you to advise what the Government is doing to address this matter, and how it is working with Novo Nordisk to resolve the concerns of many people with diabetes who are worried we will no longer be able to afford the best treatment option for our diabetes.

Don’t ever believe that you are not going to be part of the movement that makes change. Just a minute in the Australian diabetes community right now is enough to see how a movement has already started. It’s organised and collaborative and the noise is already beyond a rumble. And you can add your voice.

Disclosure

I have worked in diabetes organisation for the last twenty-one years. Recently I joined the Global Advocacy Team at JDRF International as Director of Community Engagement and Communications and until earlier this year I was Head of Community and International Affairs at Diabetes Australia. My words on this blog are always my own and independent of my work and the organisations where I am working. My individual local and global advocacy efforts are in addition to my ‘day job’. I am also Global Head of Advocacy for ##dedoc°°.

Spare a Rose – by and for the community

February 13, 2023 in #SpareARose, Advocacy, Awareness, Community, Diabetes, DOC, Social media | 1 comment

Like clockwork, the beginning of February heralded a sea of red in every retail store, with cutesy cupid motives and love hearts adorning shop windows. Valentine’s Day was the next big merchandising opportunity and, friends, it’s time to buy up.

At the same time, the diabetes community also starts to be sprinkled with red – this time red roses. Because once again, it’s time for Spare a Rose, Save a Life. It’s the complete opposite of consumer culture. And it’s something that is very close to my heart.

This year marks ten years since Spare a Rose was first launched by a group of diabetes advocates from the US. The story has been told many times but it’s worth repeating, because it says a lot about this community. These advocates wanted to do something that supported others living with diabetes, specifically those in under-resourced counties. And so, Spare a Rose, Save a Child (now Spare a Rose, Save a Life) was created, with a vision to bring together the diabetes community, uniting in the collaborative goal of supporting those who need it.

The simple equation of ‘sparing’ one rose and donating the $5 saving to a diabetes charity was tangible. That face dollars provides insulin for a month. That’s how it has worked for ten years now. Close to one million dollars has been raised in that time, which is truly remarkable when you think about it. It’s people in the community reaching into our pockets to help make a change.

This year, donations are once again going directly to Insulin for Life, a charity that continues to support people with diabetes in countries where there is most need. Insulin for Life has been running for many years and their work is significant. Last year, as war broke out in Ukraine, the charity was able to rally their networks within days, getting critical diabetes supplies where they were most needed. That support continues, and a big part of that is due to the generosity of the diabetes community getting behind Spare a Rose for Ukraine.

As soon as the war started, the diabetes community were desperately looking at how to help and almost immediately, people dug deep. With $400,000 raised in months, so many in the community showed just how committed we are to focusing on others. That’s the diabetes community I know and love!

And so, this year – the tenth anniversary of Spare a Rose – we’re asking again for people to dig deep and help if they can. Leave egos at the door and do the simple thing of supporting community efforts by sharing links, encouraging others to learn about Spare a Rose and, where possible, donate. The only people who benefit from this campaign are people with diabetes who need it. By the community, for the community. Truly the best way to celebrate Valentine’s Day.

Here’s your Spare a Rose, Save a Life refresher for how it works. It’s super easy, and if you click on the image, it will take you directly to the donation page. (Donations are made directly to Insulin for Life.)

Postscript and disclaimer

I have been a community volunteer for the Spare a Rose campaign for a number of years, involved in promotion and communications. I’ve taken a step back this year (for a bucketload of reasons, including this), but am no less involved behind the scenes. I have just started a new job and much of the focus is supporting people with diabetes in low to middle income countries which means I’ll be supporting efforts of many different diabetes charities, including Insulin for Life and Life for a Child (previous charity partner of Spare a Rose), A4D, CDIC and others, as well as the brilliant community groups lead by advocates on the ground.

Stories

February 3, 2023 in Advocacy, Awareness, Community, Diabetes, Lived experience, Real life | 2 comments

Manhattan’s East 41st Street is Library Way. Patience and Fortitude, the grand lions that stand guard outside the New York Public Library gaze down the street, keeping an eye on people hurrying by, and those who stop to admire the beautiful and imposing building.

Library Way is paved with bronze plaques engraved with literary quotes. I’ve walked the street between 5th and Park avenues a number of times, just to read the inscriptions.

The other day, as I hurried home to our apartment, this plaque caught my eye:

I stopped, made sure I wasn’t blocking any one’s way (lest I attract the wrath of Fran Lebowitz who is living rent free in my mind after I watched ‘Pretend it’s a City’), and I snapped a quick photo with my phone.

‘Isn’t that true,’ I muttered under my breath as I picked up speed and walked at the only pace I’ve come to accept in this gorgeous city – ultra fast.

This blog has always been about stories. Mostly mine, sometimes mine intersected with others. My advocacy life is about sharing stories and encouraging others to understand the power and value of those stories. It’s stories we connect with because we connect with the people behind them.

My time in New York is wrapping up and I’ll be back in Melbourne soon. I’ll be home, starting a new job and I’m so excited. And part of the reason for that excitement is that I will still be working with people with diabetes and their stories.

In the world of advocacy – in my advocacy life – lived experience is everything. I can’t wait to hear more stories, meet more people and learn more. And keep centring lived experience stories. Because, after all, that’s what the universe – and the diabetes world – is truly made of. Just like the plaque says.

The battle is over

January 7, 2023 in Communication, Diabetes | 6 comments

I don’t know when it was that I decided that I wasn’t fighting diabetes anymore. Maybe it had something to do with paying more attention to language and words, or maybe it was just accepting that no matter what the strategy, no matter how much I fight, diabetes is there.

Everywhere I turn in the diabetes world, I see words that invoke battle. It is, quite frankly, exhausting. We use terms like warrior, fighter and army and challenger. We are urged to fight the good fight and battle to beat everything diabetes throws at us.

But if this is a war, I was enlisted with no option of being a conscientious objector. I feel defeated a lot of the time because no matter how much I fight, diabetes is still here, coming at me. An in range A1c, or high percentage TIR, or screening check that comes back with ‘no changes’ doesn’t mean I’ve overcome diabetes. Diabetes remains, despite what the metrics say.

We’ve all read legends and seen enough movies to know that there are winners and losers in battles and wars. And understand the good guys are meant to win. But there is no defeating diabetes. It is always going to be there. Does that make me a loser? Does that make me the bad guy?

When I started to examine the militarised language in diabetes, I realised that those very words and ideas that I’m sure were meant to motivate ended up doing the exact opposite. How was it that despite all my efforts in the trenches – and my dogged, gritty determination – I still found myself just as challenged by diabetes as when the battle started? In fact, in some ways, I felt more challenged. I wasn’t advancing in ways that made me feel like I was heading to victory. Instead, it just felt like a static, never-ending, Groundhog Day of lather, rinse, repeat (or check, bolus, repeat).

Asking me to fight puts the responsibility – more responsibility – squarely on me and me alone. How unfair that rhetoric about diabetes requires more from us.

To be at war with diabetes is to be at war with myself. I can’t divorce myself from my diabetes – it is me and I am it. We are a tag team, a group package, a two-for-one deal. I don’t get a say in that, and no one else does either, no matter how much they implore me to fight.

It’s not a battle with diabetes that I need. In fact, it’s the complete opposite. It’s finding peace. That’s what I want to work towards – a peaceful existence that doesn’t add more burden.

Photo of writing on the side of a wall that reads ‘War is Hell’ — Seen on the streets of New York.

Interweb jumble #41 – highs and big decisions

December 24, 2022 in Uncategorized | 2 comments

When I look back over 2022, it’s been a year of remarkable highs. From improved access to diabetes tech in Australia, extraordinary community alliances for initiatives such as spare a rose for Ukraine, and community-based activities reaching new heights, I feel that I can say goodbye to the year feeling that big things happened! And so, a little Interweb Jumble of this year’s highs. As well as some endings and new beginnings…

Tech access in Australia

After almost fifteen years of advocacy, Australians could celebrate with the introduction of CGM for all people with type 1 diabetes in what must be one of the most equal and simple access programs around the world. I’ve written before about the hoops required PWD need to jump through to get access to tech – even when it should be simple. With the NDSS CGM Initiative, there is one hoop and one hoop only – a form signed, and signed once only, by an HCP.

As if that wasn’t enough, some sort of miracle occurred, and Omnipod was added to the NDSS. I have been involved in discussions about Omnipod for well over a decade now, trying to massage models of access to fit a system that simply didn’t comply. Congrats to the Omnipod Australia team, and truly remarkable community engagement to make funded Omnipod a reality for Australians with type 1 diabetes.

These celebrations are all worthy, but it’s always worth remembering that there are still huge numbers of people with diabetes who would benefit from tech and are not eligible. Those cohorts need advocacy and community support to make it a reality, and I can’t wait to see just how that all rolls out – hopefully sooner rather than later.

And now we turn to NZ…

Great to see efforts increasing in New Zealand so our friends across the Tasman have access to funded CGM. Just before I flew to New York, I presented (virtually) at the ‘Transforming Lives: 100 Years of Insulin’ event held in New Zealand Parliament about community, grassroots and organisation advocacy to make the dream a reality.

#LanguageMatters keeps going from strength to strength.

The language matters movement has continued to grow, with new statements and documents launched across the world. I spoke at so many different events and webinars about language and communication and how to do better. Every little improvement, every little step towards reducing stigma is a step in the right direction.

The Diabetes Language Matters website is a brilliant resource that pulls together what’s going on around the world in one place. Massive kudos to Jazz Sethi for coordinating this work and keeping it updated – which is more than impressive when you consider just how far reaching the movement is now!

Home page from Language Matters Diabetes website. There are five coloured speech bubbles and the words: Language Matters Diabetes
Language Matters Diabetes has slowly evolved into a global movement that discusses the language we use when dealing with different types of diabetes. These guides provide practical examples of language that will encourage positive interactions with people living with diabetes and subsequently positive outcomes.'

Ah, so that’s what you look like in real life?

As the world opened up again, and international travel slowly returned, face-face conferences started up again. It was with a mixture of fear, anxiety, and excitement that I jumped on a plane for my first international flight after a long time to chair the first ever lived experience symposium at ATTD. What a treat to be back around peers with diabetes who I’d only seen through Zoom screens for well over two years. I was just thrilled people recognised me without the rainbow bookshelf as my background.

#dedoc° spearheads lived experience presence at diabetes conferences

The #dedoc° voices program meant that most diabetes conferences had a visible, vocal, and very real lived experience presence not only roaming the corridors, but also on stages, in meetings and across social media more than ever before. It was truly remarkable to see people from across Europe, Asia, Africa the US, and Australia dominating social media leader boards, and building networks for collaborations, many of which are already delivering. See the #dedoc° website for more.

By the community for the community

Spare a Rose returned this year with a new name (Spare a Rose, Save a Life) and a new charity partner. And once again, we saw people with diabetes dig deep and jump on board to be part of the campaign. With war breaking out in Ukraine at the end of Feb, the SaR team pivoted quickly and literally overnight with a new, refocused operation to support people with diabetes affected by the war. Over $400,000 was raised by the community, all through social media promotion, and so, so many with diabetes doing the right thing and getting behind it.

And over November, #dedoc° led the charge for another community campaign – the Blue Balloon Challenge, which resulted in €100,000 donation from Medtronic to Life for a Child. If you want to see how amazing the community can be, all you need to do is see the hundreds of social media posts featuring blue balloons. It also is a great way to flag people who are doing things for others, uniting the community. Want to know who to follow? Follow those supporting community campaigns.

New communities

I know I have written about the weekly Diabetes Chat before, but I’m going to do it again, because any initiative that is welcoming, inclusive and fun for people across the community deserves a mention. You just need to see how diverse the weekly participants are to know the agenda set by Tom Dean and others behind the scenes – and that agenda is to create a safe space for all. I was beyond thrilled to be asked to speak at one of the first Spaces events, and even more thrilled to meet Tom in person at the #dedoc° symposium at ATTD. I know a number of people who said that they returned to participate in DOC discussions because of the weekly Spaces Chat. How special is that? Details on the Diabetes Chat website.

Global happenings

The WHO Global Diabetes Compact Forum has continued this year, ending on a high with the team publication of an article about language. It’s really worth commending the WHO for the way they responded to earlier criticisms about diabetes comms. They listened and engaged the community and this year for WDD, delivered a brilliant campaign, and hosted a terrific Spaces event they kindly invited me to be part of. I feel really lucky to know James and the WHO team working in the area of diabetes and know that they are just warming up!

IDF Congress

The conference year ended with the IDF Congress in Lisbon, which saw the Young Leaders in Diabetes Program return to the force it once was with some of the most incredibly young advocates I’ve ever had the pleasure of meeting. I can’t wait to see what they get up to!

The greatest honour …

The high to end all highs for me professionally this year was giving the Living with Diabetes Stream Award Lecture at IDF and I was so pleased to be able to use the lecture to recognise the importance of lived experience, and share how #NothingAboutUsWithoutUs became the basis of my own advocacy.

But it wasn’t only those with lived experience that I acknowledged in my lecture. I took the opportunity of standing at the lectern in Lisbon recognising the incredible allies who have supported me, and others. I started with Greg Johnson, CEO of Diabetes Vic and then Diabetes Australia whose simple words ‘If we’re talking diabetes there must be people with diabetes in the room’ have resonated each and every day in my advocacy life. And then, I moved onto people like Jane Speight, Taryn Black, Partha Kar, Sof Andrikopolous, Nat Wischer, Tadej Battelino, Chantal Mathieu, Ann Morris, Marg McGill, and the late, great, and so, so missed Tricia Dunning, who have elevated the role of lived experience, making space on stages, handing over microphones and creating places so that people with diabetes are able to influence in real, meaningful and significant ways. It was an honour to look up and see many of those people in the audience.

… and a big decision

In amongst all the highs, I decided it was time to make some big decisions. After twenty one years working in Australian diabetes organisations, I have decided that it is time for me to move on. Diabetes Australia has been my home for the last seven years, and Diabetes Vic (part of the Diabetes Australia family) launched my diabetes advocacy career fourteen years before that. My roles at both organisations have shaped my advocacy so much. They gave me a true understanding of the value of grassroots advocacy and just how vital community is in that advocacy. Greg’s words continue to ring in my ears, and I doubt there will ever be a time they don’t. And it’s those words that helped me make decisions about what I need to do next.

I walked into Diabetes Vic not knowing what diabetes advocacy was. I thought I’d spend six months doing the job while I worked out what I really wanted to do with my life after deciding that being a classically trained flute player really wasn’t it.

As it turns out, diabetes advocacy and activism is what I wanted to do with my life for those six months, and the twenty plus years after that. And it’s what I want to keep doing now. In the new year, I’ll finish up at Diabetes Australia and then take on a role that will see me working beyond Australian borders, and, most excitedly, with a focus on community advocacy and engagement. I simply can’t wait.

But for now, I’m celebrating the big year that was in NYC for another couple of months, hugging my family, hoping for snow, visiting holiday markets, listening to jazz, and finding warm corners of historic hotels to write and drink tea. All while looking forward to bigger and brighter things to come.

DISCLOSURES:

I work for Diabetes Australia and have been involved in advocacy efforts for CGM for All.

I was invited by A/Prof Ben Wheeler from University of Otago and Te Whatu Ora Southern to speak at the New Zealand event about CGM funding and volunteered my time.

I am Head of Advocacy for #dedoc°. Flights and accommodation for attendance at ATTD and EASD was covered by #dedoc°. Press passes were covered by the conference organising committees.

I am a volunteer for the Spare a Rose campaign.

I am a co-author for the WHO journal article mentioned. I volunteered my time to be involved in this work.

I was an invited speaker at the IDF Congress. I was also invited to speak at the Young Leaders in Diabetes Training Summit. I was not paid for my work with the group. Flights and accommodation were covered by the IDF.

Happy December, friends!

December 2, 2022 in Conferences, Diabetes, Real life, Travel | 6 comments

How was your Diabetes Awareness Month? I celebrated by taking a step back from most online activities and burying my head in the sand. Because, as always, Your Diabetes (Awareness Month) May Vary. #YDAMMV – get it trending!

I got COVID at the beginning of November and that was the definition of Not Fun. I was lucky in a lot of ways – I managed to take my first dose of anti-virals an hour after the ‘you’re positive’ lines came up on a RAT and was able to recover at home mostly. I easily accessed care when I needed it, and, in circumstances absolutely not normal for most, had heads of diabetes, and infectious diseases, departments at city tertiary hospitals calling to check in on me and make sure I had all I needed. (I know this is a perk of the work I do, and I recognise the remarkable privilege my work offers.)

I also spent November making some big life decisions and some big life moves (We’re in New York for the next three months) and that has all been kind of…big. I have never been so grateful of my incredibly supportive family and friends and, especially diabetes friends who have been an absolute bedrock on helping me through this time.

But here I am. It’s December. And it’s cold. December and cold are not words that generally go together for an Aussie sun-lover, but I am more than happy to be living in a city where Christmas carols suddenly make sense. Humming ‘Baby, it’s cold outside’ when the aircon is blasting, wearing a tank top, and sweating in 40°C heat is all sorts of oxymoron. This year, I’m wandering the streets in boots, a giant pompom adorning my beanie and wrapped in layers of coats and scarves, just as Mariah Carey intended.

Next week, I’m leaving New York and travelling to Lisbon for the IDF Congress. I’m so honoured to have been invited to give an Award Lecture, as well as speak in and chair a number of other sessions. The best part of this particular conference is the Living with Diabetes Stream which is dedicated to recognising diabetes lived experience. I can’t wait to hear from diabetes advocates from all over standing on stages and bravely, authentically and honestly sharing their stories. I wish more professional conferences had this sort of focus. And I also can’t wait to meet up with diabetes friends, some of whom I’ve not seen since before COVID. The Congress will be big and there will be a lot of it shared online. Keep an eye out!

Oh, and if you haven’t managed to get your #dedoc° voices scholarship application in yet, now is the time. The deadline has been extended by a few days and you have until next week to get yours in. You’d be mad not to, because become a #dedoc° voice means joining remarkable diabetes advocates from across the world and becoming part of a network like no other. Learning from dozens and dozens of people with diabetes who are there to do nothing but build community and support each other is incredible. Come join us! (Disclosure: I am Head of Advocacy for #dedoc°.)

Kerri’s book

October 23, 2022 in DOC, Real life | 2 comments

I’ve been rationing.

I only allow myself one story a day from Kerri’s new book, because I want to rediscover her writing little by little. I skipped over the contents page, so I would to be surprised when I worked out which stories from her Six Until Me blog made it into this new collection.

So it was with delight (and then tears) when I opened up to page 56, three stories into the section called ‘Diabetes in the Wild’ and saw my favourite ever diabetes in the wild story.

Photo of a page of book with the chapter heading ‘PWD in the Wild’

Kerri tells this tale beautifully, and exactly as it happened. I know, because I was there. The general gist is that on one her visits to Australia, Kerri and I were sitting outside in the Melbourne sunshine enjoying a coffee. At the next table was a woman and her daughter. When she heard us talking about diabetes, she looked up and joined our conversation, hungry to hear about our diabetes lives, and sharing with us that her daughter had been recently diagnosed. It was only a short chat, but as is often the case with diabetes in the wild stories, it has stayed with me, and I thought about the woman and her daughter each time I walked by that cafe.

Reading the story again in Kerri’s new book, I remembered that day – the perfect blue sky, the frothy tops of our coffees, the way that we were talking a million words a minute as we tend to do when we are together. And I also remembered how five years later I had another chance encounter with the woman from the cafe. ‘You were both so lovely & made me feel so much better,’ she said. ‘I was so glad for your openness and the hope it gave me! I always wanted to tell you that.’

Kerri’s stories are full of the humanity of diabetes. It’s one of the reasons her blog was so popular for the 14 years she wrote it, and why her occasional posts now are so welcome and gratefully received by people in our diabetes community. Her writing is real and generous, and rereading each post is testament to why storytelling is just so damn powerful when it comes to healthcare. I may live on the opposite side of the world to Kerri, exist in an upside down time zone and have to navigate a completely different healthcare system, but there is a familiarity to every single word she writes.

If you’ve never read Kerri’s writing before, this book is the a great place to start. And if you have, the book is a brilliant collection to have on your bookshelf, to pull down every now and then, open at any random page and envelope yourself in her magical storytelling.

And so, Kerri: Congratulations on this book, my darling friend. I remember you once wrote about the friends that live inside your computer. I’m delighted that now, I have you living inside this book and on my rainbow bookshelf. You’ll be alongside the blue spine-d books of Helen Garner, David Sedaris and Jhumper Lahiri – some of my favourite writers. Which is exactly where you belong.

Front cover of the book 'Six Until Me Essays from a life with diabetes' The background is white and their is the outline of a flower in grey. — Click to purchase your own copy of Six Until Me.

Having a moment

October 20, 2022 in Awareness, Diabetes, Women's health | 1 comment

This week, my socials have been flooded with a topic that rarely gets much of a look in: menopause, and in particular diabetes and menopause.

It’s a welcome change! It was World Menopause Day on Tuesday, and with it came an avalanche of great content shining a light on this particular aspect of diabetes – something that really doesn’t get much coverage at all.

Square graphic with the words 'The Diabetes Menopause Project in black text on a pale pink background.

I shouldn’t be surprised that a lot of what I saw was people with diabetes sharing their own stories. These are the trail blazers who could see that there needed to be more awareness, more recognition, more attention to the issue and took matters into their own hands and shared their stories. (I’m looking at you Dawn Adams, you amazing woman!)

Here are just a couple of things that I’ve seen this week:

Dawn’s story at Diabetes UK about managing diabetes with menopausal hormone therapy (MHT, also known as HRT).

And Dawn again here at JDRF – UK with this gorgeous piece about how there are peer networks offering support for others going through perimenopause and menopause.

This Twitter thread from Diabetes UK, highlighting just how they’ve listened to the diabetes community and calls for more research and information about diabetes and menopause. Their Diabetes Research Steering Groups have made the topic a research priority in coming years. That’s what I call being led by the folks you’re representing!

Twitter has joined the chat with a new account focused exclusively on diabetes and menopause with this neat bio: Peer support for those with diabetes going through the menopause – all types of diabetes, all stages of menopause – we’re in it together. You can follow Menopause Mithers here.

Not diabetes specific, but worth a share, is this brilliant Instagram video from Dr Jen Gunter which looks at the origin of the word ‘menopause’ (of course I love this!). Oh, and there’s a whole chapter in her book The Menopause Manifesto about language.

First page of chapter 2 of Jen Gunter’s The Menopause Manifesto and reads ‘The History and Languages of Menopause: From a Critical Age to the Change’. Black text on white background. — Of course I love this too!

I’ll be linking all of these to The Diabetes Menopause Project post as a one stop easy place for links about menopause and diabetes.

The problem with ‘fix yourself’ messaging

October 12, 2022 in Awareness, Communication, Diabetes | 1 comment

If you google the words ‘diabetes public health campaign’, you will find myriad offerings from around the world. There are the good, the bad and the outright ugly. (Click on links at your own peril.) And many of these campaigns are the foundation of broader messaging about diabetes.

Why is it so hard to get messaging about diabetes right, and how do we fix years of getting it wrong?

The vast majority of type 2 diabetes messaging focuses on personal responsibility. It could be about losing weight, losing centimetres off your waist circumference, eating more fresh fruits and vegetables, being more active … you name it, it’s up to YOU.

It’s not just type 2 diabetes. Messaging aimed at addressing specific diabetes-related complications for all brands of diabetes also has a strong focus on personal responsibility: get screened/talk to your HCP/don’t miss appointments/don’t bury your head in the sand/look after yourself. The implication is that all accountability lies at the hands of the person with diabetes.

There are so many assumptions and that is one reason the messaging really hasn’t worked. There are more reasons, of course, and these are complex, multifaceted, and convoluted. You can almost understand why going with the easy ‘fix yourself’ messages are the ones that have been used.

The thinking behind so much of what we think and do about diabetes is misguided because too often we look to apply solutions that are medical in nature when we need to be considering social solutions. In a recently published New York Times article, writer Roni Caryn Rabin suggested a need to reframe (type 2 ) diabetes ‘…as a social, economic and environmental problem, and offer[s] a series of detailed fixes, ranging from improving access to healthy food and clean water to rethinking the designs of communities, housing and transportation networks.’

Telling people to eat better without establishing if there is affordable fresh food available and affordable, and the knowledge for what to do with a box from a farmers’ market, or to walk for half an hour a day without first asking about safe and accessible walking paths, leaves out a very big part of the equation. Assuming people have those structures in place is naïve, and yet that is what is assumed time and time again.

And telling people to not miss screening appointments lest they develop a diabetes complication is perfectly sound advice. Provided there are health professionals available, accessible, and affordable within decent timeframes. It takes only a cursory glance on Twitter to see that people with diabetes have difficulties when it comes to making those important appointments – and, for many, that’s been even worse with COVID.

Individual responsibility goes only so far when there aren’t the social and system structures around to support individuals. And it doesn’t go anywhere when generic messaging is the only messaging employed with the expectation that everyone will respond, and act as directed. Because there’s no time for nuance in a snappy campaign message.

We see time and time again that vulnerable people are disproportionately affected when it comes to health outcomes. In diabetes, we talk about high-risk groups, but what is the point of that if there are no solutions that are targeted for specific cohorts? Plus, if the at-risk messaging is thrown into the mix of the ‘fix yourself’ messaging, it gets very murky. Are people also now meant to be personally responsible for their backgrounds, age, family history…?

Messaging doesn’t only live on the websites and socials of those creating them. There is often a PR machine behind them that does its dark PR arts magic to get the message out there beyond those confines. News outlets pick them up and run, run, run with the messaging, dumbing it down to soundbites that often focus on anything that will get cut through. And often that’s the ‘fix yourself’ messaging.

And of course, the flow on effect of that is more blame, more shame, more stigma, more misinformation, more judgement, more discrimination. More people in the community not familiar and intimately connected with diabetes believing they’ve learnt something new, but really, they’ve probably only added more about how lacking people with diabetes are when it comes to personal responsibility. And on they go to perpetuate the myths about diabetes and personal responsibility.

The times the messaging is right is when people with diabetes are directly involved in developing and finessing it. We can predict the ramifications of messaging gone wrong because we’ve been on the receiving end of it. There’s never not a good time to engage people with diabetes, and I’ll always, always advocate that. It’s good policy because #NothingAboutUsWithoutUs.

But in the case of developing messages about diabetes, engaging people with diabetes can reduce harm to us. And surely that should be the starting (and middle and end) point for anyone doing anything about diabetes.