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“Why are you so harsh on yourself?” 😳

I got a DM on Instagram recently, where the (probably) well-meaning person asked something along the lines with “why are you so harsh on yourself when it comes to diabetes?” 😳

It was implied that I pay too much attention to things like blood sugars, nutrition and HbA1c, when “all you have to do is count carbs and cover for them with insulin.”

Well. I don’t agree. 🤷🏻‍♀️ To me, that is a way too simplistic way of looking at managing something as individual as diabetes can be. Check out the rest of my answer in this short clip:

Type 1 Thursday – Hanna Boëthius

👉🏼 What tools have you found that work the best for you in your diabetes management? 👈🏼

Disclaimer

The only purpose of this video and website is to educate and to inform. It is no substitute for professional care by a doctor or other qualified medical professional. This video and website is provided on the understanding that it does not constitute medical or other professional advice or services. Instead, we encourage you to discuss your options with a health care provider who specializes in treating Type 1 Diabetes.

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“What do you eat in a day, Hanna?”

On today’s episode of #type1thursday, one of my lovely Instagram followers asked me to make a video about what I eat in a day – so I did!

Find out what my food philosophy is, my insulin philosophy, see all my meals from Monday until Thursday, blood sugar values, and my guilty pleasure/secret food is!

“What do you eat in a day? – Hanna Boëthius – Type 1 Thursday

Now I’d like to hear from you, what’s your food philosophy?

Disclaimer

The only purpose of this video & website is to educate and to inform. It is no substitute for professional care by a doctor or other qualified medical professional. This video & website are provided on the understanding that it does not constitute medical or other professional advice or services. Instead, we encourage you to discuss your options with a health care provider who specializes in treating Type 1 Diabetes.

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Great sleep, great health!

Today on Type 1 Thursday we’re talking about the importance of SLEEP!

How can sleep improve your health? And what on earth does it have to do with diabetes and blood sugar management? 🤔

Find out in the sleep video below, check out my graphic for my top sleep tips or read the information below.

Type 1 Thursday – Sleep – Hanna Boëthius

My questions for you: Do you get enough sleep? What are your best sleep tips? Share them with me in a comment!

The graphic I’m talking about in the video, is this one. It’s a quick reminder of the things we can do to prepare, invest and do for great sleep. Share it with someone you think would need it!

Sleep Tips – Hanna Diabetes Expert

Transcription

Do you prefer to read about just how important sleep is for your health and blood sugar management?

Great Sleep, Great Health!

This super exciting topic actually has a lot to do with blood sugar management and diabetes, although we might not think about it. I asked on my Instagram Stories if I should do a Type 1 Thursday on sleep and the importance of sleep and an overwhelming amount of people thought that was a great idea!

We have to really step away from this old notion of that “we can sleep when we’re dead” or “we can sleep later” or “we can catch up on sleep later”. No, we really cannot. Healthy, proper sleep is actually super important for us, for our health, and for our well being. So no more pushing it til later! You should invest in your sleep and you should definitely make it a priority, because it is “no backsies” as Sheldon Cooper in Big Bang Theory would say. You can’t take it back and you can’t make up for it later. So it’s very important that you handle that.

Sleep science is growing exponentially right now and it is showing that sleep is actually essential to your health and to your performance. Even though we might not feel like it, or think we can push through and all these stupid things that we tell ourselves. No, sleep is actually super important for our health and performance.

How much sleep?

So how much sleep do we need then? Actually, we need seven to nine hours a night, not a week, not anything else. We need it a night in order to function properly and to reap all the benefits that sleep does have because it is quite astonishing. This is when sleep becomes restorative, when it becomes rejuvenating. I’ll go through a couple of types of sleeps, or sleeping patterns a little bit later. But first of all, please don’t think that you can survive on less than six hours of sleep a night (unless you are one of these 5% of the population that have a genetic mutation, which makes them able to survive on less than six hours sleep). Otherwise, it will lead to a lot of problems, such as cognitive dysfunction, and your immune system won’t work fully. The brain is trained actually to disregard sleep deprivation so you might not even notice if you are sleep deprived or not, or have had too little sleep.

Benefits of great sleep?

So what does enough sleep do? What are the awesome features that come with enough sleep? Well, one of them is of course, which is super important right now, is immune function. Your immune system cannot function without proper sleep. So if nothing else, it is very important for you to get proper sleep right now so that your immune system is on 100% and on top. Your energy and strength, that goes without saying and of course also blood sugar control. Yes, it does help with your blood sugar management because lack of sleep is a huge stressor for the body. And as I say all the time, stress is the blood sugar killer number one. So try to eliminate as much stress for the body as possible.

Also, it can aid in weight loss because your hormones are regulated when you sleep properly. It also leads to better skin, for example. And of course, things like coordination and flexibility are increased when you do sleep enough. As I mentioned, hormone regulation but not just hormone regulation in terms of weight loss, but also in terms of stress management, in terms of emotional regulation, in terms of everything. So sleep really helps there as well.

And it also leads to better recovery because your hormones are regulated, You can drain yourself and then recover better if you sleep better. And enough sleep helps with focus and creativity and this leads to better performance as well which is quite an important thing.

As I already said, emotional regulation, we react in a different way when we have slept properly than when we haven’t, I’m sure you recognise this! And sleep helps with longevity as some studies actually show that when we sleep better, we live longer and healthier. So that’s a good thing to keep in mind. Also, our resilience grows a lot when we sleep properly. So it’s not a bad idea to actually prioritise your sleep.

Something that is very in the air right now is that proper sleep also helps your metabolic function and there is a lot to do with the immune system right now, but also metabolic function and metabolic syndrome. So maybe there is something to the fact that you are not sleeping properly if you are suffering from something like that? This can, in turn, if your metabolic function is not optimal, lead to insulin resistance, both Type 1 and Type 2. So if you haven’t slept properly as a Type 1, you can get insulin resistant, or if you don’t have Type 1, you can actually start developing functionally insulin resistance and Type 2 diabetes. By the lack of sleep, and of course, other co-founding factors, but it can be a contributor. Lack of sleep makes you produce a lot of cortisol. As long as cortisol is high, it cultivates a bad gut bacteria in your gut and that can also be a problem because that leads to poor health and that’s poor immune system and it all goes in a circle.

That’s why sleep is so important. All of this goes in a circle and they go hand in hand. Good sleep also helps you become more effective when you think, improves your reaction time. Whether it’s sports or in traffic or just generally in life, your reaction time gets better. Sleep helps your memory function better.

Types of Sleep

So what are the types of sleep? Well, there are three main ones and we fluctuate between them all night every night. And that is light sleep, there is REM sleep, which is 20 to 25% of your total sleep, deteriorates with age and this is where you dream. This is where your memory improves. This is where you become or have creative thoughts because some of our dreams I can tell you, if you’ve ever paid attention to them, they are quite creative, if not crazy, but yes, a bit creative.

And then the third one is deep sleep, which is 0 to 35% of our total sleep, and it’s very individual depending on what you’re used to, and that’s where it’s very restorative and rejuvenating. And that of course is also needed for your body to regenerate.

Tips for better Sleep

So what are some sleeping tips? These are some sleeping tips that I came across myself and from other people. For example, no screens at least one hour before bedtime. This can be very challenging because what does one do without a screen nowadays? Especially when we may be on a lockdown, and we need to somehow entertain ourselves until it’s proper bedtime? What does one do? Read a book, read a magazine and do something just creative outside of the screen world. Make sure that you have a bedtime routine also on weekends. (I mean seriously, most of these tips make you sound like a really boring old person but I gotta say they do have a point to it because most of them actually aren’t that bad – they actually work!)

Make sure that the temperature in your bedroom and what you’re wearing and in your bed linen, like the thickness of your duvet is suitable to how you sleep the best. If we are too warm, we don’t sleep well and if we’re too cold we don’t sleep well. So we have to be like Goldilocks “just right” in terms of temperature in order to sleep well.

Don‘t have any big meals or a really strenuous exercise right before bedtime because that gets your pulse going. That gets your digestive system going if it is food and that it won’t have time to come back down in time for your sleep. So don’t have anything heavy to eat right before bed. And this also, of course, more diabetes specifically, helps with your blood sugar control throughout the night if you don’t do anything crazy, right before bedtime, and you know what the outcome is. Also, unwind, but that’s easier said than done in some cases, and especially now, but do unwind and make time for unwinding in the evening so that you can fall asleep swiftly and carelessly and get rocked away by your sleep.

Limit alcohol right before bed, especially and this of course also has a huge blood sugar benefit. Limit caffeine after 2pm, seriously, I sound like an old lady but this old lady has a point. It is very beneficial to cut the caffeine after 2pm and this also has a blood sugar benefit, like a lot of these tips actually do.

Move your body regularly, not right before bedtime but during the day and in the days regularly. Find out what you think is fun to do, and how you want to move your body and make sure that you get a little exhausted at times because that does help with your sleeping patterns.

Make sure that your bed is for two things: for rest and for romance, nothing else. Do not watch TV in bed, do not technically play with your phone in bed. It’s just for rest and romance. And you will thank yourself and maybe even your partner’s gonna thank you for having that new rule in your life. 😉

Yes, napping is fantastic, but they have to be well timed. So ideally not before 3pm so that it doesn’t impact your night’s sleep, either from the beginning or towards the end of your day. But naps can really help as well.

Use wearables. If you can measure your sleep, it’s actually quite interesting. You can do this with tons of providers out there but there’s for example the Oura ring. You can use Fitbit, you can use the Apple Watch, all of these things that you can track your sleep with so that you see how much you sleep and on which level and how you can improve it.

Now I want to hear from you: do you have problems sleeping or is sleeping a breeze for you? And what are your best sleep tips? Do share them with us in a comment somewhere on the interwebs. I’ll be happy to chat with you there.

Disclaimer

The only purpose of this video is to educate and to inform. It is no substitute for professional care by a doctor or other qualified medical professional. This video is provided on the understanding that it does not constitute medical or other professional advice or services. Instead, we encourage you to discuss your options with a health care provider who specializes in treating Type 1 Diabetes.

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Inspire – don’t judge!

“You give other people with diabetes bad conscience!”

The words of my Sweet Friend surprised me. I was gobsmacked, then I was amazed, then everything suddenly made sense.

“That’s soooo not my point”, I said, laughingly. “I know, I know it’s not, but if everyone knew how to take care of themselves like you do, then everyone would feel better. Not everyone has that motivation,” she continued.

My goal is always to inspire others, not to make anyone feel less worthy. I don’t want to be the one who makes you feel bad about your diabetes management, or yourself. I‘m not ever ”better than you!”

I want to inspire you, because higher powers know I would have needed it myself. When I was at my absolute worst, with double digit A1C’s and didn’t know my ass from my elbow in terms of diabetes management, I was trying everything out, one thing after the other and it all lead to the same shit… I wish, I wish social media would’ve existed, and I could’ve found some sort of motivation and inspiration in people who have walked the same path. And even when I had A1C’s of 7-8% I would’ve needed someone who I could look up to.

That’s who I aspire to be – I want to be your cheerleader, the one that cheers you on when the going gets tough! Me sharing my values and numbers, me sharing my lifestyle and tips, me sharing everything that I do on social media is NEVER about bragging. It’s about me being on the diabetes journey / just as much as you are. And I want you to see it as inspiration.

If I could get myself from double digit A1C’s to a healthy, healing, happy range of blood sugars, so can you. I promise And I’ll be there for you, to guide, inspire and motivate you. If you want me to, that is. Always rooting for you. 🙌🏼💗🌟

Post originally published on my Instagram account, @hannadiabetesexpert

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Type 1 Thursday – Why Real Food?

Real food is actual food, food that comes from nature and is not refined, made in a factory or tampered with by humans. And no matter of what way you choose to eat, be it keto, paleo, vegan or otherwise, we can all agree that real food is what is the best for our bodies, health and blood sugars.

But why is eating real food so important? And especially so if you live with diabetes? In this week’s episode, I outline a few quick points. Watch the video, or read the transcription below, and let me know your thoughts!

Ps. If you do like the concept of eating real foods, why don’t you join me and an amazing group of people at The Low Carb Universe 2019 in Mallorca, Spain in November? Incredible international health experts, amazing views, movement, joy AND 100% real food! You can book your ticket here!

Type 1 Thursday with Hanna Boëthius – Why Real Food?

Do you eat mostly real foods?

Transcription

If you prefer to read to learn, below is a text version of the video about real food above. You can also read why low carb is a great option for Type 1 Diabetics here!

Why Real Food?

Today I have quite an exciting topic, if you ask me, because my background is within nutrition. My topic for you today is the importance of eating real food.

I am so happy to hear your comments and ideas and thoughts about this topic or any other topic, actually, I’m easy that way! Jot them down in a comment below and I will be happy to chat with you there anyway, about real food.

If you ask me, that is the only topic where we can actually agree on, no matter what kind of diet we choose to follow or eat. I don’t really like the word diet, but I choose to use it anyway, as it’s normally the one used. The thing is, whether you are keto, paleo or vegan, or, well, maybe not the Standard Western Diet, actually, because the importance of real food may not be so, so big there. In any other diet that you may or may not be following, I think real food is the one thing that we can agree upon, that it is very good for us.

What I define as real foods is foods that don’t have a label. Real foods actually comes from nature, which is quite rare, if you think about the standard Western diet. It is foods like meat, poultry, eggs, fish, seafood, vegetables, and all these things that actually come from nature and from the earth and not through a factory, or from a factory or has been tampered with too much with by human beings. They’re just as clean and natural and real as possible. That’s my definition of real food, so that we’re all on the same page throughout this discussion.

The main point of this is that real food has no additives. What additives often do, is that they mess with your blood sugar. For example, maltitol is a classic example of this! It is a sugar substitute that still affects your blood sugar. Don’t be fooled and eat that, although it’s supposed to be great and “diabetic friendly”, can be labelled whatever you want to be labelled with whatever health claim. They still include things that are really not good for your blood sugar and really not good for your health. In effect, you’re not doing yourself any favours by buying these “health foods”. No additives, so that they can’t mess with your blood sugar, in this case, if you are diabetic, or live with a blood sugar problem.

If you are going to venture into that kind of a sphere with pre-made foods, I have as a rule of thumb for you. The food item can include five ingredients, and those five ingredients all have to be recognisable to me, I need to know what they are, without googling, because that’s cheating. Then, if I approve all of those ingredients, then yes, absolutely, I will buy it and consume it and enjoy it. But if that is not the case, it will most likely go back on the shelf! “I see it, I love it, I want it, I checked the carb count, put it back”, is pretty much like going to the grocery store with me. My poor husband, I mean, seriously… Anyway, 5 ingredients that are recognisable otherwise, to me, it is not worth the gamble of a possible really high blood sugar or a possible low blood sugar, because I’ve overdosed insulin. It’s just not worth the hassle for me.

What are the top my top three “watch out” ingredients for additives in food?

If you do live in the States, or a similar kind of an environment, high fructose corn syrup. Just stay away, that can really mess up so many metabolic markers within you, so much of your metabolic health can be ruined, because of the consumption of high fructose corn syrup. It’s just so highly refined and so highly tampered with that it’s not really worth it to consume in my opinion. It’s no longer food, it is just factory made.

Number two, trans fats, man made oils, trans fats, are really not good for you. They add a lot of unnecessary strain on your body and your metabolism (that you can just actually fix with eating real food). Adding real fat such as butter, avocado, olive oil, things that are actually not man made, but is made by nature, is a lot better for you than highly refined and processed fats.

Number three, and this can be a tricky one, I do admit it. So bear with me before you slam down the lid of your laptop or turn off your phone, but it’s artificial sweeteners. And with that I really mean the artificial sweeteners, the ones that have been made in a factory. Maybe stevia is fine for you, if you enjoy the the flavour of it. And monkfruit can also be fine. Erythritol to a certain extent, absolutely. But things like aspartame and things that we don’t really know what it’s doing with our bodies yet. It’s definitely not natural in any way or form, and that I would be careful with. I remember growing up, this was a huge thing, as long as there were artificial sweeteners, then, hey, this product is a go! I was raised in the 80s and 90s, when it was still a little bit more controlled what people with diabetes should be eating. I had to eat a lot of terribly sweetened things. It’s been shown in studies since that for example, fructose, which we thought back then was the holy grail for diabetics, can actually clog up your liver, so that it can’t do its job properly. Then your whole metabolism might be damaged.

There’s a lot to be said about this stuff, of course! These three things impact your gut health, they can have an impact on anxiety levels, they can, as I said, clog up your liver, so that can do its job properly. And other things like your skin and other things that are really important for us to work properly. These additives can make an impact on our health, and that’s not very good, is it?

I do want to sort of give a special warning, I did touch upon it a little bit at the beginning of this. For example, “keto foods” some of them or “vegan food” or whatever it’s labelled, heart healthy, don’t even touch this stuff is not healthy for you at all. Don’t trust the labelling on the box! Look at the ingredients, does it have five ingredients? Do you recognise them? Buy it, if you think you’re going to enjoy it, if it doesn’t, maybe you should rather leave it alone? “Foods”, such as salad sauces, sauces, spice mixes, soups, ready made things that you don’t think will have an impact can actually contain a bucket load of sugar and will impact your blood sugar. Stay with the real food is my opinion! It’s better for us, it’s healthier for us, and we’re going to feel a lot better.

If you’re just starting out from, for example, a standard Western diet, to going to more into the real food way of eating, then I really suggest you adopt the 80/20 rule, so that 80% of the time, on work days, you eat real food, and on the weekends, you can still have a bit of what you still think is fun.

I would love to hear from you. Do you eat mostly real foods? Let’s talk in the comments below and I can’t wait to see you next time.

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Type 1 Thursday – Weight Loss & Type 1 Diabetes

Today’s topic is T1D & weight loss, a hot topic!

I asked on Instagram what topics you wanted me to cover on Type 1 Thursday, and a good amount of people said WEIGHT LOSS!

So I took the opportunity to gather my thoughts on weight loss and Type 1 Diabetes in a short video for you! If you prefer to read about weight loss and T1D, I’ve transcribed it for you below.

Hanna Boëthius – Weight loss & Type 1 Diabetes

What are your experiences with Type 1 Diabetes and weight loss? What worked for you, or what didn’t work for you? Let me know in a comment!

Transcription

If you prefer to read this, please go ahead:

Weight Loss & Type 1 Diabetes

This is the moving party of a Type 1 Thursday! I have been doing Type 1 Thursday for 17 episodes over on The Low Carb Universe (my other project). I’m very, very happy to welcome Type 1 Thursday back to where it belongs – on the diabetes page (that would make more sense, right?!)

I am a Type 1 Diabetic since 34 years, and I am very, very happy that you are here with me, because today’s topic is super interesting. And it turned out to be a really hot topic! When I asked on Instagram a couple of days ago what I should talk about, a good few people said this topic. I am very happy that I have the chance to cover that for you today. And the topic is, not maybe completely unexpectedly, Type 1 Diabetes and weight loss and how that works together.

It can be really tricky when you are taking a lot of the fat storing hormone, insulin. The more insulin you take, the more weight you gain. It’s not always easy to lose weight with T1D. I wanted to try to describe a little bit what is going on in your body and how it could work for you as well. (And please, please, please do share your experiences with T1D and weight loss, or weight loss at all in the comments! I am very, very happy to talk to you more there!)

Weight loss has many reasons, there can be a gazillion reasons as to why you want to lose weight. There are two main ones, with the first one being you want to improve your health. And that can be of course a reason to lose weight, which is good, that’s great. Secondly, it can also be vanity. So I think, first of all, anyone who wants to lose weight needs to be honest with themselves as to why they want to lose the weight. Is it because of health reasons? Or is it simply because it would feel great to have those last 5 kg/10 pounds, or whatever else off the body and feel accomplished? It’s definitely an important thing to consider.

There are also two main weight loss theories. The first one is the hormone theory, which is that weight gain and weight loss is all about the hormones. It’s all about insulin, and it’s all about how insulin is the master hormone, and how that then impacts the other hormones. The other theory is the the old one, to eat less and move more, the kcal theory, which I feel like we’ve disproven this one? In my humble opinion, I feel that it is actually a combination of the two. Yes, your hormones have to do with weight loss, absolutely. But so do calories, I don’t believe that you can eat 15,000 calories in a day and still be losing weight. Unless that helps to regulate your hormones in some way. Your hormones need to be balanced for you to lose weight. And that actually requires a certain amount of calories, and a certain amount of the right macronutrients. Enough amino acids, enough fatty acids, because those are both essential for the body, there’s no essential sugar for the body. There is essential protein, and there is essential fat so that the hormones can become regulated. Those two for me (not saying anyone else!) but for me really go hand in hand. So it does require both of them to work to get there!

The old saying “abs are made in the kitchen” is true! I’ve heard several numbers on this, but there is an 80/20 thing going on, that 80% is the food and 20% is the exercise. So there you have this again: both go together for weight loss. And if you’re really overweight, if you just start eating the right things, you perhaps don’t even have to exercise in the beginning. That’s great, right? Generally, if abs are made in the kitchen, movement does also play a part in regulating your hormones.

What do I eat if abs are made in the kitchen? Well, there are, like I said, essential protein to the body, amino acids are essential. Focus on that. That is also what, for example, Dr. Bernstein talks about in his “Diabetes Solution” – to focus on the protein. And if you see someone really ripped, there’s a good chance that they are eating a good amount of protein. That’s also because protein is thermogenic. It actually it burns calories when the protein is processed in the body, shortly explained. Also have some fat for good measure, and to regulate your hormones. It may be difficult to get up to an OK calorie count in terms of protein only. So do have some fat. But when you get to stable hormones, and become a fat burner, you will use the fat that you already have on your body, which is actually a very simple way of weight loss, right? Then, of course, carbs; keep them to a minimum, mainly leafy greens. This also really helps your blood sugar, which does help in weight loss, as well. It’s incredible how much goes hand in hand in this!

What does this kind of eating, focused on protein, some fat, a little bit of carbs, what effects does this have? Well, it’s clearly that if you lower the amount of carbs, you lower the amount of insulin that you’re taking. And because insulin is the fat storing hormone, and the master hormone, if you use less of it, there’s a good chance that you will store less fat, as well. And, like this, you won’t really add too many calories on to your diet, which is also goes back to one of the two theories that the calorie, “eat less and move more”, (the 80s called and they wanted their nutrition advice, or weight loss advice back!). I do think it does play a role, I just don’t think that is the only thing that plays a role. Protein does repair your body and it helps to build muscle, which really does help you in losing weight, as well.

In order to lose weight, you also have to be motivated, and you have to find your WHY? Why do you want to lose weight? This is where my background as a coach comes in quite handy! Ask yourself why in three levels; why do you want to lose weight? And the answer to that ask why again? And then the answer to that as why again, so that you really know what is behind your choice of losing weight.

But could it be something else? Why did you gain the weight in the first place? And did you gain it overnight? Or did it take a while to accumulate? Because there is no overnight solution to losing weight. It is hard work! And it is a lot of trial and error, just as getting a grip of diabetes is, so is the weight loss process. Could it be something else than just “random” weight gain? Could it maybe be your thyroid? That also has a lot to do with hormones! Could it be stress, which is the hormones cortisol, adrenaline, and can really drive weight gain. Can be fluid retention? Are you retaining fluid for some reason? Maybe not enough salt? And could you be pregnant? Could it be some sort of medication that you’re on? For example, antidepressants are usually causing weight gain, so it’s corticosteroids. Antipsychotic medications and birth control pills can really, really make you gain weight because that also goes back to the hormone theory.

Please do share your weight loss success or questions in the comments, and I’ll be happy to chat with you there.

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Type 1 Thursday – Injections vs Insulin Pump?

Today’s topic is MDI (multiple daily injections) vs insulin pump – which is better?

This comes after a question I got on an Instagram post, where I was asked if it’s necessary to use a pump as a Type 1 Diabetic?

My short answer is DEFINITELY NO! If you achieve great results and reach your goals, it doesn’t matter what kind of insulin delivery system you use. The main point is that you have normal, healthy, happy blood sugars.

Watch the video (or read the transcription below, if that’s more your thing) to find out my pros and cons of MDI and insulin pumps.

I want this to be a conversation starter, so why don’t you let me know YOUR pros and cons in a comment below? And, what do you use to deliver insulin? Let me know!

Transcription

The age old question for most people living with insulin dependent diabetes, is the question I recently got on my Instagram post.

The question was about whether it is necessary to use an insulin pump, or if multiple daily injections, either though a pen or syringe is better for diabetic?

This is very difficult to answer straight off the bat, because this is a highly individual topic. In my opinion, the short answer is that it doesn’t really matter what you use to deliver the insulin, that you do need as a Type 1 Diabetic, as long as you do. If your diabetes is well managed with maybe a completely crazy version of either MDI or insulin pump or whatever, then hey, that’s fantastic. You found what works for you, and that is great.

Today, I wanted to have a conversation starter with you, which we can happily continue in the comments below. I wanted to outline my pros and cons for both MDI, which is multiple daily injections, you deliver your insulin by injecting yourself every so often with both basal and bolus insolence. And also pros and cons for the insulin pump that I’ve noticed for the past couple of years. Maybe this can help you make up your mind, maybe there you find out something that you want to try, and if you do, please let me know in a comment.

My own story in regards to my insulin delivery method has been a little bit jumpy. Well, I was actually flat out refusing to have an insulin pump for so many years. I had had diabetes for 27 years before I finally agreed with my diabetes nurse that now I was ready to try. And this despite health care professionals suggesting an insulin pump to me, for the majority of my upbringing, (well, maybe not in the 80s. They weren’t super common back then.) since they have become more common, they have been suggest to me every once in a while, and I’ve always refused. Because, and this was the biggest con for me the insulin pump back then, was that there’s something always attached to me. I was afraid that I would feel sicker than I have to be. And I was afraid that I’d be constantly reminded of that I am maybe not as chronically healthy as I would like myself to be or as other people may be. (I am, however, chronically awesome!)

So I was very, very hesitant and very afraid of getting myself my first insulin pump. I opted for a tubeless patch pump, which then changed into a tubed pump, about one and a half years ago, I took the step towards a tubed pump for a variety of reasons, which we can happily discuss, and maybe a little bit later. I’ve done multiple daily injections for a lot longer than I have lived with an insulin pump constantly attached to my body.

I wanted to outline few pros and cons of them each.

So let’s start with MDI, as that’s where I actually have most of my personal experience. I want to start with the pros. This is a biggie for me, and for very many other people who live with diabetes, the freedom factor you have with multiple daily injections. You don’t have anything attached to your body, unless you’re wearing a CGM, but they are a lot smaller and maybe you don’t want two things connected to your body at all times.

Hand with this goes also that it makes the illness more invisible. Because you don’t have a pager looking thing stuck to your hip or your clothes somewhere. It becomes a very much more visible illness to live with, with an insulin pump.

If you do multiple daily injections, you can also take a lot more different types of insulin, because different insulins act in differently during different times. For example, as Dr. Bernstein always recommends, is that you take regular insulin, or R insulin, to cover protein, and the protein spike that comes a few hours after you eat a lot of protein. This is easier to do if you are on MDI then having to remember to also have another shot when you’re on an insulin pump. You can also then take fast acting insulin, to which you have to correct high blood sugar or for covering for carbs. Finally, you can choose which long acting insulin that you combine this with in a way more flexible way. When it comes to types of insulin that you take, you can find a routine and a regime that works for you. And for your diabetes, to manage it properly.

MDI can also be seen as being a bit simpler, you take an injection and you’re done. Instead of having to care about every time you remove a piece of clothing or something that the tubing gets stuck or you snag the the infusion set… If you get the benefits and reach your goals with MDI, then why not stay with that?

I think it can also be argued that MDI is cheaper than being on the pump. With the pump comes very many things that you have to pay for, such as rent of the pump, for example. I have to pay rent every month for having my pump. All the supplies for it also cost a lot. It’s not just the insulin that costs! With MDI, either you use syringes that are reasonably cheap, or you have insulin pens that most people with diabetes actually get for free.

Also, from a very, from very superficial point of view, because sometimes you need to be that, too. On MDI, you can wear anything, and you won’t see any devices poking or sticking out, or being in the way, or there’s a seam or there’s something that is just obstructing either the pump or the tubing. With MDI, you are freer in that way too.

I would conclude that with the main point of the pros of MDI is freedom.

The cons of MDI! I find it in hindsight, it is quite inconvenient to be on MDI for myself. I can only speak for myself here! But every time I had to correct, every time it’s time for the the basal shot, I had to pull up my shirt, or pull down my pants… For me, it became quite inconvenient, because I had to inject myself about 10 times a day, before I swapped to the pump. That was a big sales argument for me, to be honest, not having to pierce myself with a needle 10 times a day, only do it once every three days, that sounded like heaven! That’s why I went for it, actually. You also have to remember to take your basal insulin at the right time. It became a huge effort for me to try to remember when and how and how much, which dose at this time of day…

What else I see as a con for MDI, in my opinion, is that you have a lot more to carry along with you when you leave the house. An insulin pump is always on you. So that’s it for the insulin thing. Then you need a blood sugar meter, maybe some glucose tabs and that’s fine. That’s a lot easier to carry then two types of pens and the pen needles and blah, blah, blah, for me it becomes a lot more carrying along. That being said, for most people is not a problem.

Another, slightly inconvenient part of MDI, is that you have to expose body parts. Usually this is not a problem at all, whether you’re female, male, whatever. But – imagine what is it really, really cold, and you have to like take up your shirt, and you feel that icy wind against your skin. Then you also have to inject yourself. I don’t miss that at all. I really do enjoy the fact that for example, if I am out and about around town or something, I can just take up my insulin pump, I can look like I’m texting (or whatever ignorant people choose to believe). That’s how easily I’ve saved my life with more insulin if that’s what I need, or turned down the basal if that’s what I need. But it becomes a little bit inconvenient for me to expose body parts here and there, especially when I’m out and about.

The importance of rotating sites becomes very, very big on MDI, because we all have those favorite spots that we like to inject ourselves in. And that’s fine. But you do have to rotate your sites! I noticed for myself, that it is a lot easier for me to rotate pump sites than it was to rotate injection sites. It even got so bad that no one could touch my upper thighs for a while because I had just injected so much long acting insulin into them.

For the MDI cons, in conclusion, inconvenient to me.

Let’s move over to the pros of the insulin pump. So the absolute highlight for being on an insulin pump for me is that it is very, very flexible. I can be very flexible with my basal rate, for example. If I notice that I’m trending upwards, I can change it, I can add on a bit of temporary basal to see if that’s the problem. And also with the bolus, you have the different bolus profiles. Instead of, as I was talking about in MDI, you can use different insulins for this, you use the same insulin the whole time, just in different profiles, so to speak. For me, it’s a lot easier to just remember that I have one tool to work with and I can do different things with this same one thing.

My second favorite pump benefit, it is micro-bolusing. I can take bolus’ in the size of 0.1 unit, for example. If I really want to, I can do a 0.05 bolus on some pumps, making it much more precise. This is not possible on MDI, because there you have the minimum is half a unit. So it depends a little bit on how tight you want to steer your diabetes ship. I really like the fact that I can really micro manage my blood sugars, to a certain extent, not overly so of course, because that becomes ridiculous on all other levels. But it is very nice that I can do a micro bolus every now and then. When I see the CGM trending up, I’m like, oh, let’s try with 0.X units and see if it comes a little bit down. If not, then I have to redo and recalculate. But it is a good check for me to see what’s wrong.

As I mentioned before, it is very easy to handle when you are on the go. You can even take care of your health and blood sugar during a business meeting (I have done that many times before), and when you’re out with friends, if you are in a busy street. Or imagine, for example, it’s rush hour at the farmers market and you feel or you get a notification for your CGM that your blood sugar is a little bit high, you would like to correct but you can’t really find a quiet corner. With an insulin pump, it’s a lot easier because you just click a few buttons and you’re done. You’ve taken care of the situation and you can move on with your day.

To a certain extent, I also find that it’s more efficient for me to treat and manage my diabetes with an insulin pump. I don’t use nearly half of the insulin as I do before. I also don’t spend as much time managing my diabetes as I did with MDI. Also, of course, if you are a data nerd, you have a lot of data to take care of and see and have insights and analyze and see trends. And the ever so important tech integration, more and more pumps now do integrate with a CGM, so that you can get both things at in the same device. And also, the looping possibilities that are coming up now that are very, very exciting to everyone who lives with diabetes.

The cons of insulin pumps (yes, yes, they are. There are cons with these ones too, it’s not all just roses and happy flower dances.)

I already mentioned one of them, which is that this is something that you always have attached to your body. And that can be very draining, both emotionally and physically and mentally, for some. It’s not always easy to always be connected in that way.

The tubing does, if you have a tubed pump, get caught on stuff like door handles, and other things, clothing, everything. It’s not really the most maybe smooth thing in the world to live with, you do have to watch out and make sure that your tubing is inside of your clothing, preferably, so that you don’t snag it somewhere.

I find that using an insulin pump produces a lot more trash than MDI. I’m not really happy about that, but as it is a lot easier for me to manage my diabetes with the help of an insulin pump, I keep with it, and I hope that the insulin pump provider companies will at some point really reconsider their recycling policies, so that you can maybe even send that stuff back so that they can take care of it. And not to mention Dexcom, please get your act together! But that’s another video. 😉

One problem with insulin pumps is that if it for some reason, malfunctions, and that can be the site malfunctions, the battery runs out, or the insulin goes bad or the machine get some sort of hiccup. If it somehow malfunctions, you don’t get any insulin at all and that can become dangerous quite quickly. That is one of the bigger cons for an insulin pump.

For me, airport security, or generally when you travel, insulin pumps can sometimes get a little bit interesting. They will want to swipe them for explosives. For certain airports, I do have to take more time into consideration when I travel through there because they just don’t know really what it is yet. It is unfortunately becoming more and more common, meaning it is less of a problem. But sometimes I could happily maybe be on MDI for a trip!

What do you have to add in terms of pros and cons for MDI and pros and cons for insulin pump? What do you use it to deliver insulin?

Please let me know in a comment below. I will be happy to chat with you there.

,

Type 1 Thursday – How to eat at restaurants

Is eating at restaurants difficult while trying to maintain normal blood sugars?

Not necessarily!

This is my little guide of how to eat at restaurants while maintaining the normal blood sugars all Type 1 Diabetics deserve and should strive for!

I share my top six tips for successfully dining out, what to focus on and how to build a meal. Check it out here:

I share my best tips for dining out with Type 1 Diabetes, while maintaining normal blood sugars.

What are your best tips for dining out with Type 1 Diabetes (or if you’re mindful of your sugar consumption over all)? Let me know in a comment!

Transcription

If you prefer to read, here’s an unedited version:

Hello, hello, hello and welcome to another episode of type one Thursday with me Hanna which is one of the founders of The Low Carb Universe. We organize Europe’s truly healthy hundred percent real food events. But that’s not what we’re here to talk to you about today.

Today is, of course, another episode of Type 1 Thursday, where we discuss all things, type one diabetes, and low carb and healthy food and healthy eating and all of that stuff that may not be talked about as much in other places. So I thought, hey, why not? Let’s do it.

I am a type one diabetic since 34 years this year, which is yay, you know, alive and stuff. Today, I will be sharing with you you how to navigate restaurants, and eating outside of your home with type 1 diabetes, and how to maintain normal glycaemic blood sugar levels throughout this. And do stay tuned, because I will be revealing my top six tips on how to actually make this happen properly, after a bit of an introduction and stuff like that.

Why are normal blood sugars so important?

This is I don’t know, like the 13th video I think I’m making in this series. So if you watched any of my previous stuff, I think you know why normal blood sugars are so important. And so also, of course, whether you are either treating yourself or don’t have another option, but to eat at a restaurant, where it is more difficult to figure out what they have added to your meal, which you may not have added at home. Yes, healthy normal blood sugars. All diabetics are deserve them. All diabetics should strive for them. And we should not be content and happy with anything else but normal levels.

That’s my opinion. And I’m sticking to my guns. And that’s why I’m making all of these videos. And of course, why it is so important is of course that you have to, well, I assume if you’re anything like me, you want to live a long, happy, healthy life with diabetes, despite diabetes, thriving in your life. And then normal blood sugars will keep you there for longer. Let’s just keep that as at as a baseline.

I am very, very happy now because this wasn’t the case before. But healthier options at restaurants are becoming more available more readily available. Just things like for example, a big normally very pasta focused chain has recently brought out noodles as an option. And that is great, of course for us who are trying to mind our glucose and trying to mind the sugar intake in our foods. For example, there’s a lot more vegetables on the menus, there’s a lot more that you can get sauces on the side and no one looks at you weirdly, you can substitute a lot of the the sides with vegetables, and no one looks at you weirdly, and side salad is a huge thing, which you can also of course, when you are fueled by other things but sugar in your body, then you can have that too without a problem and not feel deprived or anything.

So there are three things: first of all, when you see go to a restaurant, that is important that is of course, as always, no matter where if you’re all at a restaurant, but focus on the protein and vegetables, which can be solved, they can be changed. All the pasta, rice, potatoes, fries, all of these things that you know, don’t leave you feeling your absolute best when you eat a restaurant, substitute them for different types of vegetables. Here is a great tip actually, that I found out a couple years ago is that when you look at a restaurant menu, and you see, let’s take an example, a sirloin with mashed potatoes. “okay, well, the mashed potatoes aren’t great for me, but I see here with the with the seven on this menu, you serve asparagus, do you think I could swap the mashed potatoes for these asparagus?”, for example. Check what they have on the menu in other dishes, and what type of vegetables they have there. And maybe you can find your favorite there or something that is at least better for you than mashed potatoes that are currently being offered. And of course, then number three is keep all or most sauces on the side. Make sure that you get the source in a little couple of sites so that you can first of all taste how much sugar there’s in there. Even if someone tells you that they’re Oh no, it’s completely sugar free, there’s no sugar, you can taste it very quickly. And you can make your choices after that.

Easy restaurants to go to when you are minding your sugar intake and you do not have the metabolic capability of breaking these things down as effectively as maybe other people do.

This includes but is not limited to, for example, steak houses, burger places. Seriously burgers without buns with all the good cheese and bacon and maybe an egg on top and a side salad, you’re going to be full four hours. When your friends who ate a normal burger menu starts going on about “I could go for like a coffee and cake”, you know, just fueling up again, you’ll still be full, “I am winning at this game”.

Also, Italian places are fantastic for low carb you wouldn’t think it but and very very little of the Italian cuisine is actually pasta, pizza, all these heavy things. It’s more like fresh meats, fish, seafood, and a lot of vegetables. Italians eat a lot of vegetables, and the yummy yummy olive oil, of course. And that is a great tip for if you are out and about and see an Italian restaurant, if it is authentic enough, and hasn’t zoomed in on the pizza thing, because then you can just scrape off the toppings, but it’s not a great experience for anyone. So let’s not go there!

You can also go to salad bars, that’s a given. Or deli places, maybe somewhere that makes sandwiches and you can ask to have the sandwich feelings on a salad or on a plate instead.

Brazilian steakhouses are fantastic. You won’t be lacking protein after going to a Brazilian steakhouse, I can assure you that. French places are great, not as much bread as you would think. And also Greek places are fantastic, all the Mediterranean really Greek, Italian, Spanish, of course with all the tapas, and it’s fantastic. And then of course Italian as I mentioned before.

Mexican is also surprisingly good, because there you can have things like fajitas without the bread and the beans and all this stuff and the rice. You can have all of these things that are really, really yummy that people don’t quite realize are yummy, because they cover it up with all these carby things so that they don’t actually get the flavor of the real thing, which is the protein of course.

Even sushi places actually are quite great for low carb because, and bear with me, you can have a few edamames and you can have a whole plate of sashimi, which is of course the sushi without the rice, so if you’re minding your sugar intake, don’t despair if you only have sushi place at hand. There’s always always things that you can do. And I’ve seen now actually sushi places who make rice out of cauliflower rice, there is one place for example in Stockholm. I think it’s spreading, too, and this trend of maybe not wanting sugary rice is becoming bigger.

Alright, I promised you my six top tips on how to manage restaurant but the restaurant visit with type 1 and wanting to keep your blood sugar’s at a normal level, because this is what we’re striving for.

As I said before, number one, if you can do research the menu online so that you want you know what you’re handling, you can already make a couple of choices, you can have an overview of what the actually have, you can check the starters, the mains, the deserts, but seriously don’t have too much hope for the desert, because you probably won’t find much apart from maybe a cheese platter, which also is a fantastic dessert. This also helps you if you are a bit conscious about your spending.

Number two, of course, stay away from the starches. If you get offered a bread basket and you know you can’t resist it, ask them to take it away. Make sure that your dish does not contain rice, pasta, potatoes, fries, or mashes if you know you can’t navigate around them. And I’m not saying that you always have to be 100% – you do what works for you. And if tasting a bit of these things works for you, then good, keep doing that. But if you know that you can’t keep away from them, make sure you stop them from the beginning.

Number three, which I already mentioned in the beginning, but it’s very, very important: focus on the protein and the vegetables. That is the easiest thing that you can do. Even at a restaurant or at home or anywhere you are. If you’ve been invited to a dinner somewhere at a friend’s place, that is sometimes a little bit tricky. But always focus on the protein and the vegetables, and then don’t pay so much attention to the things that you can’t have. Of course, this is as much a mind game for you as anyone else. Instead, pay attention to things that you can have. Take it as a positive thing that you are doing something good for you, your body and your health. Because you want to stay healthy for as long as you of course, possibly can.

Number four, which is something I struggled with a lot. In the beginning, when I first went low carb, I’m often said, “oh, it’s okay. Don’t worry. Just bring this and this and whatever else. Like, take everything out of it. It’s fine!” No, no, no, actually, the proper way of doing it is Dare. To. Ask., make sure that you do find the option that works the best for you. Because no one else is going to be looking out for you. Dare to ask “what do you put in that sauce?” “Oh, is this gluten free?” (If gluten is a problem for you.) “Oh, is this sugar free?” Waitstaff should know this. If they don’t, they are very welcome to run back to the kitchen and check with their colleagues. It’s really important for you to know what the food that you eat actually contains. “Oh, is this thing breaded?” “Do you have bread crumbs in your Parmesan Melanzane?” There are so many ways of cooking food that should be “free food”. Not everyone does it the same way. Dare to ask. As I mentioned before, if you see a vegetable in some other dish, maybe you know they’re willing to swap that for the thing that you don’t want in the dish that you want, or with the protein that you have chosen. Dare to ask what’s in your food. How can you swap it? What can you do to make this work for you? At the end of the day at a restaurant, you are a paying customer and they generally would very much want happy, healthy customers that keep talking about their wonderful establishment and the fantastic service that they got. They will very rarely rarely be snarky about your dietary restrictions, because they want repeat customers too.

Alright, number five, you know what, if it doesn’t go perfectly fine, if something goes wrong, like you have a glass of wine too many than you expected, or if you’re eating a bit more of the starch than you expected – just don’t panic. It’s alright. You’re not going to die from screwing it up once, but it is a learning curve. So don’t panic, make sure that you remember it so that you know next time what not to do and what didn’t work for you. Work with the things that do work for you, and what you leaves you feeling the healthiest, best version of yourself.

And then number six, which is actually something that I did for myself, in the beginning. Now it’s just second nature, but in the beginning, I made every restaurant menu a game for myself. Everywhere I went, whether it was Chinese, (that is a tricky one, though, because they mix everything in sauces), or a pizza place, or Italian or burgers or whatever. Wherever I saw a menu, I made it into a game for myself to make a nourishing, sustainable dish for myself from any menu. That is my tip number six, make it a game. Oh, what can I eat at this restaurant? Uh huh. Okay, but if I swap that, with that, and then, instead of that I have that, and then I get a meal that works for me and leaves me healthy, happy and feeling fantastic. Even after my restaurant visit.

Those were my quick tips for you. Actually, let’s call it the little guide of eating at restaurants with Type 1 Diabetes. I hope you have enjoyed this video!

I want to know from you what your best restaurant tips are with type 1, or even without. If you’re just minding your sugar intake, what are the best tips that you have figured out they’ve seen someone else do that you’ve heard someone else do?

Share them with me in a comment and I’ll be happy to chat with you. Until next time!

Diabetes Lies

How do you feel when you find out that someone has been lying to you?

You feel cheated, stupid and end up having trust issues.

It doesn’t even have to be full-on lying, it can also be a few mis-truths, or not telling you the whole story so that you can’t put things into context.

For 26 years I believed a lot of things about diabetes that I now know are untrue. For 26 out of 30 years I believed that I knew less than my doctors, that I couldn’t trust my instincts and that I was just doing it all wrong.

And all along my mother has said that “you’re always your own best doctor”. Boy, oh boy is she right! But when you’re told, repeatedly by people who “know better” that this isn’t the case and that you should really be doing it their way, which is usually straight out of a medical textbook, you start losing faith in your own thinking, reasoning and ways. What about what works for YOU as an individual? We both know that diabetes is a very individual disease and there are as many options to manage it well as there are people who have it.

It wasn’t until I was finally brave enough to look my own health in the eye and decide to take it into my own hands that I noticed that I truly had the power to change my own health destiny. This was an incredibly difficult step to take, not to mention scary.

I had been told for far too long, and far too many times, that what I was about to do I would probably die from. Straight away. This was clearly a blatant lie, I’m still here and I’m doing better health-wise than ever.

But what I’m really here to do now is to stop the lies. Stop the untruths that are clearly ruining more people’s lives than they have to. They’ve had their time on stage, it’s time for the truth.

Do you ever feel like there has to be more to it than just “eat like everyone else and take more insulin”?

Have you lost a little hope to ever get diabetes more controlled?

Diabetes can often put you in a life or death situation. Sometimes more often than you’re willing to give it credit for. This is why it’s so important to stop being lied to, to trust your gut feeling and to realize that more insulin isn’t automatically the only answer there is for you to control diabetes better.

I know what it’s like to being close to giving up completely, just do what the doctors tell you (because-they-know-best) and deep down wonder “why me?”. To play a game of Russian roulette with your life at stake – every day. It sucks. It feels so hopeless and there’s no end in sight. At the same time, you don’t have the energy to do anything about it, either. Mainly due to your fluctuating blood sugars, where curves closely resemble something like a roller coaster. You’re stuck in a well, looking for the rope you need to get out.

In order for you to actually get out, and here comes the major suckage, you have to take responsibility for your situation AND your own health. You need to look your own health in the eye and show it who is boss. Plainly put, it’s about going from not giving a shit to giving tons of shits.

But you can only get there if and when you know the true facts. The real things that will help you feel better, be healthier, happier and more blood sugar stable. The information that takes you off the roller coaster and puts you in the spinning tea cups, if you will.

Diabetes will never be completely at bay, especially not if you have Type 1. But with a few changes of food, simple tricks and lifehacks it can get so much better.

You just have to realize how to make the shift of going from doing-it-by-the-book-but-it-doesn’t-work to ah-this-is-awesome. With this shift, you choose to be healthy and happy.

A great first step could be to join the webinar I’m hosting on Monday, 13th July 2015, where I’ll be talking about 5 major lies your doctor tells you about diabetes. This is your chance to learn how to help yourself to a better life with diabetes. It’s not hopeless, if I can do it, so can you.

Sign up for the webinar here.

Making Lists

Do you have to make shopping lists when you go grocery shopping, just so you won’t forget half of what you went out to get in the first place?

Or, have you ever underestimated the power of a to do list, and missed to call that one person you really had to speak to?

No? It’s just me then.

This is of course a super simplistic way of looking at it, but the main message stays the same: unless you write down what you want, it will be difficult for you to get it. Or get there.

How do you keep track of everything that needs to be done?

For me, it’s definitely the easiest to make a list out of it.

Until what needs to be done becomes a routine, it’s very difficult to remember all the things that require your attention. (Not least if you’re handling something like diabetes.)

And, if there’s something outside of yourself that you want and you don’t formulate clearly what it is, how will other people ever know how to give it to you? And also, how do you get a crystal clear view of exactly it is you want?

Before going on last month’s Low Carb Cruise, I felt a bit nervous about it. First of all, it’s a long trip and secondly, I was about to be in the same room as so many of my Heroes!

I talked to a brilliant friend of mine about it, and she told me to write a list of the people I wanted to talk to during the cruise.

“This is so silly”, I thought to myself, “what’s the use of a list?!”

But, as the excellent friend she is, she pushed me to do it anyway. And am I glad I did!

Lo-and-behold, when I found my list again a few days after we had gotten onto dry land again (but my body was clearly still on the ship, everything was swaying), I had accomplished Every. Single. Thing. on that list! I had talked to all the people I wanted to talk to, and a good few more!

This close-to-obsessive list writing of course doesn’t just apply to rather mundane things, like grocery shopping, or super exciting things, like making sure you grab the chance to talk to your heroes. It’s also absolutely useful for everyday things, like what to bring on your holiday, or things like where you want to be in a year from now, what you’d like your A1c to be and what kind of tools you want and need to simplify your life. For example. Not to mention the good old to do list!

Lists don’t have to be exclusively used for practical things, you can very well use them for things like your emotions and actions to. In that case it’s called a to be list.

What do you want to be like today? How would you like to act in certain situations? And, how do you want to feel?

If you know what (or who) makes you feel good, why don’t you ask for it?

And how do you formulate said wishes, thoughts, questions and desired actions? If you leave it at just a thought, you most likely will forget it. If you see it on and off it’s easier to focus on it. You and I both know that any goal you have is so much easier to reach if you know what you want and you state it clearly, making you focus on it.

Remember that goals like “one day I’d love to be able to go skydiving” just won’t cut it either. It’s too general! Your goal needs to be a SMART one, Specific, Measureable, Attainable, Relevant and Time-bound. The one about skydiving then becomes “In 3 months I want to have the appointment booked for skydiving, providing my doctor says it’s ok at least 2 weeks before”

Then the challenge is just how to get there.

What do you make lists of?