It’s hard to say ‘no’

How good are you at saying ‘no’? Me? I’m usually pretty good. As other nutritionists and dietitians will attest, we are often the bearer of bad news:

“Mikki, wholemeal is better than white bread isn’t it?” (No)

“Mikki, we use Olivani spread, that’s good isn’t it?” (No)

“Mikki, agave nectar is a natural sweetener, that’s way better than sugar isn’t it?” (No)

But sometimes, saying no to certain people or in certain situations is harder than others. I really struggle to say ‘no’ to Laurie, my twin sister. Not when we were younger: She was always rubbish at it but me? I was REALLY good at i:

“Mikki, can I have a bite?” (No)

“Mikki, can you lend me 50c till we get our pocket money?” (No).

But like most siblings, as we moved into adulthood and our relationship changed, saying no got much more difficult. Up until now it’s not really been an issue – pretty much, if we are able to help each other out then we will do it – but, in reality, the situations have been few and far between as to how often we’ve had to ask. For the most part, one of us will offer if we see we can lend a hand. It’s only really been in the last few weeks where I’ve really had to exercise my right to say ‘no’ to her. And, god, it’s hard.

As those of you who follow my Facebook will know, Laurie is almost four weeks into a new, healthy approach to food and health. This all came from an unexpected meeting I had with her in Cromwell after the Ancestral Health Society of New Zealand meeting. Truth be told, I got a bit of a fright. High cholesterol, high blood pressure and heart issues run in our family. We had a grandparent that died young of heart problems and a second-degree relative also suffered from a heart attack at around 38 years old. At around the same age, Laurie looked to be the spitting image of her. Even though I’d seen Laurie in January and we talked most weeks on the phone, the picture I have attached to her number is one that is perhaps five years old – so the Laurie I spoke to was (in my mind) younger and fitter than the Laurie that was dealing day-to-day with the health issues that would have been obvious to me had I seen her. So when I approached her about doing something about her health, I did it in a manipulative way that only siblings can get away with: I took advantage of the fact that Laurie isn’t good at saying ‘no’ to me and made it about me and not her. Previously when I had raised it with her (ONLY after an offhand comment about how tired she might have been feeling, or how she wasn’t feeling very good about herself – never unsolicited*), she got angry at me. She was tired, stressed out and got annoyed (to put it mildly) that I would even talk to her about giving up foods that were staples in her diet. How could I possibly understand? She had to organise her household in the morning, go to work   in a job which is largely unsatisfying but pays the bills from 9am-3pm, then rush to pick the kids up after school to drop them to soccer or Karate to then pick them up, feed them, do their homework and make sure they were in bed early enough so they could get up and do it all again the next day. She has neither the time nor the money to invest in herself and her health. Telling someone that their future health is at risk if they don’t do something now is often not enough to make a change. Trying to convince them that doing these things will actually make them feel better now is hard to believe when the very idea of trying to change ingrained habits is exhausting. I had to take a different approach – therefore I told her I needed a case study for my business and she was the best person for the job. It doesn’t take a genius to see right through that, and Laurie did in a heartbeat. Truth be told, she had wanted to do something for a while but didn’t have the energy to do it. Now I was taking the role of the bossy twin (easy) and made it about me, It seemed at the time that I took the responsibility away from her and placed it firmly on my shoulders. Which is great, I can handle that – most of the time.

Where I struggle though is having to say ‘no’ to her. Right now we are working together to help Laurie make the best decisions possible – and obviously some things that are just common sense to me are completely new to her. She made these awesome scotch eggs from the Well Fed cookbook, and sent a picture to show me how they turned out. They did look great, but I then saw the sweet chilli sauce that occupied a good part of the plate (we Kiwi’s love our condiments). How had I overlooked telling her about the sauce?? We had talked in depth about looking at ingredient lists and going for as minimally processed as possible – and one of the highest sugar products that is in anyone’s refrigerator had made its way to her plate. No big deal, right? Of course not – but I notice I’m far more delicate with her than I am with anyone about putting her right. This week has been especially challenging. Laus text to tell me she was going around to a friend’s house for a BBQ where she was likely to have a few drinks and my heart rate immediately picked up about 60 bpm. She drinks once in a blue moon, and her friend had a bottle of vodka that she wanted her to share. Laurie enjoys her vodka with orange juice, so when we talked on the phone   she was tired from a long day and didn’t want to hear me tell her that she maybe she could try instead have her vodka with soda water and a low calorie lime juice.**  As sisters get, we were so annoyed at each other but I knew I had to try and stay calm and not bite when she was telling me I was ruining the one fun thing she had planned. I just told her (in a really calm voice) that I wasn’t trying to ruin anything and she had to make the best decision for her. Then I made an excuse to get off the phone so I could fume by myself.

I said earlier that I took the responsibility away from her and placed it on me. That’s not true, and that small exchange made me reflect on that this week. Like all of my clients, it is up to me to provide the best tools possible for her to make changes, and up to her to decide whether to use them or not. I find it so, so difficult. I said before that I took the role of the ‘bossy’ twin. Actually – that’s the only role I’ve had in our relationship. Being bossy only gets me so far now we’re adults though. I am so scared that a harsh word from me, or when I say ‘no’ to her request to have a coffee after dinner, is going to make her fed up enough that she’ll throw in the towel and the hard work she’s done to date will be lost. Some might think that I need to lighten up and these small things don’t matter in ‘the big scheme of things’ as – I say this often – ‘it’s what she does typically that counts.’ Because it’s Laurie I feel (rightly or wrongly) that those rules don’t apply. It’s just the way it is.

So, I’m having to say ‘no’ to her more often than normal and I’m not feeling overly good about it. It’s fair to say that neither is she.

*well, by ‘never’ I really mean, almost never unsolicited and not in the last few years

**yes, of course there are many reasons why Laurie could absolutely be fine having vodka and orange. But I’m not a fan of the alcohol and sugar mix and her reason for liking that drink was that ‘she couldn’t taste the vodka’. I’d rather she drink a drink where she was all to aware of the alcohol in it.

Laurie and I. For some reason I have always thought we've worn ties in this picture.

Laurie and I. Me: bigger and bossier.

Another mindset shift: (lack of) training for the marathon.

Another marathon ticked off. And this is the first one that I’ve completed as an LCHF athlete. More than that though, it’s the first one I’ve raced on a smaller training load than I thought I needed. And while I say ‘oh, I don’t race’ – in reality, when I step up to the start line and the gun goes off, I am racing. It’s a race against the clock and myself, and not the people around me, though I did earmark one dude on the start line as my nemesis that I wanted to take down – and this had nothing to do with his running ability.  This was purely because he was in a tutu and as soon as I saw him I thought ‘there’s no way I’m letting anyone in a skirt, guy or girl, beat me.’ Rational? Obviously not.

I entered the Queenstown marathon at the start of the year purely because the early bird deal was so good. As a new event, they took $50 off the entry fee for the marathon and, like anyone who likes a bargain*, that was enough for me to sign on the dotted line. Inevitably, though, life and limb gets in the way of any decent build up period for a race and more often than not I’m left with 8-10 weeks to go and starting to panic that I’m not going to have the time for an adequate preparation period. Now any coach would look at that length of time and say that it was ridiculous to think it wasn’t enough time. Physically, of course it is – particularly as it’s not like I’m going from a couch potato to my first marathon; I’ve been running for over 20 years. Psychologically though: different story. Particularly when your compatriots are 6 -8 weeks into their 16 week build plan for an event and ticking off 8-10 km intervals on a Saturday, backed up with a 2h 15min run on a Sunday and I’m high fiving people for completing a 40 min easy run without any nagging sensation in the calf. I’m obviously excited to be running, but daunted by what is ahead in terms of ‘making up’ lost kilometres to get me on an even par with other runners of my ability. It’s easy to talk yourself out of a good race before you’ve even begun to train for it. I know I do. And, even when you do train for it, how many people do you know line up on the start-line with either a niggle, a virus, or lack of preparation to blame their less than ideal finish time on?  Not only do I battle with knowing that others have been able to consistently run at a time where I’ve only been able to do gym work and some swim sessions, but my main problem is that I have a fear of failure. This has been the hardest thing to let go of over the last few years – the expectations that I perceive others have of me and my running ability.  In some ways not having the ideal race build up let me off the hook; it’s a legitimate reason for running slower than others think I’m capable of – and just finishing the race is good enough. Bevan, though, didn’t let me off that easy. He guided my training for the Queenstown marathon and was adamant that 8 weeks was adequate to get me in pretty good shape to get around.

Previously, I would have tried to cram in as much running with intensity as I could tolerate, with a couple of rest days per week, so I would build my fitness faster that way. Bevan had a different approach. He pointed out that whenever I get injured in the past, it is from the combination of both longer runs plus interval training which places too much stress on my body. Hmm… good point. He predicted that, if I were to include intensity along with duration in my build up, I would break down at roughly 4-6 weeks in, leaving me in a spectator role come race day, as it has in the past. Needless to say, that put the kibosh on my grandiose plans of the interval/long run double that is the mainstay of any running programme. Instead, he suggested that I needed to focus on frequency. Just run. Everyday. The length of the runs varied from 25 minutes to 2h, and while I would lift the pace on some runs, there were no set tempo sessions, hill repeats or one kilometre intervals. It was just running. Part of me loved it – telling a runner that they can run everyday is like letting a sugar addict loose in a candy store. In addition to that, while I LOVE running, I actually really don’t like running those 2 1/2 – 3h runs which are another mainstay of a running programme. They to me are almost the necessary evil of marathon build-ups that sap your reserves, leave you feeling broken and ancient for the rest of the day, but at the same time almost perversely thrilled that you’ve ticked off the big miles that distinguish you from that half marathoner runner.**   A big part of me though was anxious that this preparation would leave me short on race day. How was I supposed to get around 42.2km when I hadn’t run for longer than 2h on any long run?

But I listened dutifully to what Bevan told me, switching it up a bit with my pace – some days it was closer to 6 min kilometer pace, something I would never have considered doing in the past but had become almost worryingly easy to do now. Others we would run a steady 20 minutes at around 4.40 kilometer pace as part of our long run. But, bar one run that was around 2.04 and in hideous weather at a hideously slow pace, I never went beyond those guidelines. I got up every morning and ran, once a week was 2h, once a week was 80 min and the rest were between 25-60 minutes – and, as Bevan said, I made it to the start line in one piece. And while I still wasn’t convinced that I had run long enough in any long run to get through the event and feel okay, you know what? I did. Other than that inevitable dip that occurs in ‘no mans land’ from around 27-32 kilometers, I felt comfortable, strong, I paced it pretty well (the second half was four minutes quicker than the first) and came in at 3.28 and some change. It’s not my fastest – actually it’s slower than my PB by 37 minutes, but I felt awesome. That I made it to the start line and finished in one piece on such a spectacular course are three wins in my book. As a runner, I love to be able to run and I think this approach will allow me to do that. This has provided me with the ‘proof’ I need that I don’t need to do the extra long training runs to successfully complete (and run pretty well) in an event. This is a massive shift from days of old, and the runner mentality. My goal in running these days isn’t to aim for another PB; I don’t have the mental energy required to do that, nor do I want to. I just want to be able to run, enjoy it, participate, push myself and enjoy the afterglow of a run well run. Who knew that you didn’t need to run hard and long to do that? This might not be a major for another runner – but for me it is almost as much of a mind shift as the LCHF approach to marathon training. Stoked to have made it.

PS The guy in the tutu totally took me out – so did another very talented woman runner in a Lululemon running skirt. At the risk of making myself wildly unpopular, I am not a fan of the ruffled skirt number.

*aka any runner because as a group we are known for being frugal – though anyone who runs will testify that it ISN’T a cheap sport

** no disrespect intended. I love half marathoner runners. In fact some of my best friends are half marathoners. 

Type 1 diabetes, endurance sport and the LCHF approach: Lewis’ marathon experience

Following on from Lewis’ post last week about life with type 1 diabetes and following a low carbohydrate high (healthy*) fat (LCHF) diet, here is a race report from the Auckland marathon:

I did my very first marathon (Auckland marathon) two weeks ago. As a reminder, I have type 1 diabetes, eating strictly LCHF for over a year. This is not a race report of the marathon, so much, but rather a detailed analysis of my blood sugar levels from before the gun went off to when I crossed the finish line.  I wear a Dexcom G4 Continual Glucose Monitor. I inject the sensor and carry a receiver with me. It gives me minute-by-minute live blood sugar readings, which I have downloaded for you. As a diabetic, my body is unable to regulate my sugar levels. If my sugar level is good, then the session is good.

The marathon itself, as my first, surprised me by how hard it was. Everyone says 30km gets tough but you have to really experience it to believe it. I could not believe how incredibly tough it was to keep going in the last 10km. My body was fine, but my brain was mush. I was trying to finish at 4hrs, and was on that pace until 30km, but then ended at 4:17. Definitely room to improve for next year. More physical training and certainly more mental toughness will help me last to the final 200 metres.

My sugar levels and my energy levels were excellent.

Interestingly, I tested my blood ketones (to test how “deep” in ketosis I am) before and after the race too, just to see what was going on. At the start, 05:30, my blood ketones were 0.5 mmol/L. This is pretty average for me. I really battle to get higher levels of ketones than that. After the race (11:00), my ketones were 1.5 mmol/l. This illustrated to me that my body is able to access fat burning when it needs it.

I have graphed it and the link below gives a good visual – however I’ve also provided it in detail below.

lewism

Background:

  1. Target range for blood sugar level is between 4mmol/l and 7mmol/l.
  2. During training/race, it is risky to have the sugar levels too low and if they drop below 4 mmol/l, then that causes all sorts of problems. At around 3mmol/l, you get reduced effort, an inability to push yourself, lethargy, and as it gets lower, I run the risk of passing out.
  3. Equally difficult for people with type 1 diabetes is the risk of the sugar level going too high. It is commonly understood that exercise reduces blood sugar level, but only if your blood sugar is below approximately 13mmol/l. Any higher than that, then exercise triggers a response that will increase the blood sugar level further. High blood sugars are extremely uncomfortable (not to mention dangerous), and exercise is not really possible.
  4. So during a race, my target range moves from between 4 – 7mmol/l to between 6 – 9mmol/l.

Race Day:

  1. Sugar levels were excellent during the night. Trending between 4mmol/l and 6mmol/l.
  2. There is something called the Dawn Effect, which causes everyone’s blood sugars to rise just at dawn. My Dawn Effect kicked off at 4am, and took my sugar (not caused by eating anything) from 4 to 7mmol/l.
  3. Before the race, my sugar level had stabilised. I take a cup of super-salty soup stock (taken from The Art and Science of Low Carb Living), and two coconut fat bombs (basically coconut oil, coconut butter sweetened with stevia). The fat bombs are to get in some good fuel from the coconut (which contain saturated fats) just before exercise – this is something you need to play around with, as everyone has a different tolerance level to coconut oil.
  4. You can see at the start of the race my sugar level then starts to rise again. This is a strange phenomenon that I have noticed. I think it is caused by the tiny amount of carbs in the fat bombs and soup stock, as well as the body utilising the last of the glucose stores in the muscles. This increase in sugar never lasts long. You can see here that it increased from 6am to 6:20am. The sugar level was taken from a stable 7mmo/l up to 10mmol/l.
  5. Then it becomes a waiting game. I take zero carbs, and wait for my sugar levels to drop. I know they will. It usually takes over an hour. I check my Continuos Glucose Monitor all the time. Blood sugar stays stable at around 9-10mmol/l for 90 minutes.
  6. Then, over the course of the next 60 minutes, my sugar level slowly descends from around 9mmol/l to 5mmol/l.
  7. I don’t let it drop below 5mmol/l, and therefore I take my glucose supplements that I carry with me. I use Dextro Tabs, where each tab is approximately 3g of carb. I end up taking 10 tablets as I am feeling my sugar levels dropping further. So I take a total of 30g carb around the 2:30 hour mark.
  8. You can see over the next 20 mins that my blood sugar levels stabilise and then drop again. At this point, I am feeling very poor on the marathon. I am not thinking clearly, and just trying to survive.
  9. Instead of taking more Dextro Tabs, I elect to take some coke at the water stations. I take a small serving of coke (100ml) at each of the last 3 water stations. This is a total of 300ml of coke or a further 30g of carbs.
  10. You can see what this extra boost of carbs did for my sugar level in the last 30 mins of the race.
  11. Immediately after the race, my sugar levels stabilised at 9mmol/l.
  12. About half an hour after the race, my sugar level started to increase again. I think this is a result of taking coke too close to the end of the race, and not having enough exercise to burn it up. I should have stopped drinking coke about 30 mins before the end.
  13. I corrected this high blood sugar by taking insulin, and then I treated myself to a binge meal (and beer – I did just complete a marathon after all 🙂 ) and that caused the last spike in sugar around 12:30pm.

So there you have it. 4 hours massive effort on 60g carb, and the 60g ended up being probably about 10g too much.

Comparatively speaking, 1 Gu gel is 22g of carb.

LCHF is the answer!

 *Dietitian and colleague Caryn Zinn aptly changed the acronym. It works.

Type 1 diabetes, endurance sport and the LCHF approach: Lewis’ story.

I first met Lewis about a year ago when he came in to see me for a consultation. He will explain his story below, but the crux of it was that he wanted to ensure he was on the right track with his food intake as he started on a low carbohydrate, high fat (LCHF) diet to help his blood sugar control and his endurance sport. In reality, I merely confirmed what Lewis was already doing. Lewis had some trouble finding a lot of information for people with type 1 diabetes who undertake endurance sport, so felt the more he could share his experience, the better it will be for others looking to transition to a low carbohydrate, high fat diet for their blood sugar control. Despite what you may believe, it is not dangerous to follow an LCHF approach to diet if you have diabetes (type 1 or type 2). In fact, it’s quite the opposite. Thanks, Lewis, and over to you.

I was diagnosed with Type 1 diabetes 30 years ago, aged 9 years. I have always been a well-controlled diabetic, (according to the ‘diabetes guidelines’). About 3 years ago, I started training daily. It started out being just gym, then moved on to training for triathlons. Doing exercise is a vital part of a control plan for someone with type 1 diabetes, but it isn’t always easy to balance the amount of sugar, exercise and insulin. It is this balance between the amount of sugar, exercise and insulin that they call the ‘three legs of a stool’. They all are vital, and without any one of them, the chair will fall over. I try and keep my sugar levels above 4 and below 8 mmol/L, what is considered ‘normal’ and is typically controlled by the body’s natural hormonal processes in a person without diabetes.

What I found as I was training was that I was having to supplement large amounts of glucose whilst exercising to stop my sugar dropping. Then, after the exercise, my sugar levels would sky rocket to 15 mmol/L or higher. I would have to take extra insulin to counter the extra high blood sugar, and that would drive my sugar right down low again. It is this extreme roller-coaster of sugar levels that I interpreted as being necessary if one wanted to participate in endurance training. I would typically require a Gu gel every 20 – 30 minutes to stop my sugar dropping. On a four hour bike ride, that would be a massive (and expensive) 8 Gu gels, taking in approximately 160g of carbs. My sugars would be ok during the ride but then would skyrocket afterward.

Also, I had no confidence what my sugar level at any one time would be. If it was in the “good” range, was it only temporary? Was it on its way up, or on its way down? After having diabetes for 25 years, I still had no idea at all. I was thin, muscular, getting fitter and fitter. But my sugar levels were extremely erratic. I was pre-occupied with food, and was always hungry.

Then, a number of things happened all in the same month, October 2013:

  1. I heard Grant Schofield speak about LCHF diets
  2. I watched a Youtube clip of Dr Troy Stapleton, an Australian doctor who developed diabetes and eats LCHF. He said his inspiration was Dr Richard Bernstein’s Diabetes Solution.
  3. I read that book, and it pretty much changed my life. Dr Bernstein is an engineer who was diagnosed with Diabetes in the 1950s. He was the first person to do “home glucose monitoring” and turned the industry on its head, saying patients needn’t go to hospital to check their blood sugar. He later became a doctor (in his 40’s) to specialise in diabetes, and further the cause for good blood control.

He was, and remains, and engineer at heart. His basis for blood sugar control is one only an engineer could come up with. In a nutshell, you can’t predict what your sugar level will do. You can’t get the balance right between sugar and insulin. You will always be wrong. If you happen to be right, it is only by accident. He was describing me, and my rollercoaster sugar control. He explains that if you don’t eat carbs, then you don’t need as much insulin. If you don’t take as much insulin, then you don’t need as much carbs. I switched to LCHF in October 2013, and did my first Half Ironman in Jan 2014. I had submitted a detailed race report to Grant about this race.  Fast forward a year later and I have never looked back.

In terms of the food, eating becomes easier and easier. I do the cooking at home, which is quite useful!

My typical breakfasts now comprise an omelette with 3 eggs, chopped mushroom and chopped tomato. Alternatively, I soft boil 3 eggs, and have them with an avo and tomato salad.

My typical lunch would comprise a green salad with left-overs from the night before. I take care to make enough supper to leave something for lunch the next day.

Typical suppers in our house are below; it is all organic, whole food and high in fat.

  • Spaghetti bolognaise with low carb mung bean pasta (less than 5g net carbs for a big bowl of pasta). covered with olive oil and cheese.
  • Pizza on pizza base made from 1 cup almond flour, 1 egg, 1tbs olive oil, 1 tsp salt. (makes enough for 2 pizzas. very filling)
  • Hamburger on a bread roll made from 1/3 cup almond flour, 1/3 cup ground linseed, 1tsp baking powder, 1 egg, 1tbsp olive oil, 1tbsp cream, 1/2tsp salt. Baked in a mini-round tin, comes out like perfect soft bread roll.
  • Creamed mushroom soup (lots of mushrooms, cream, soup stock) served with Almond bread toasted slices. I make a large almond and linseed loaf once a week, slice it and freeze the slices for ready toast.
  • Bangers and mash (using cauliflower mash)
  • Fried chicken thighs (fatty and juicy) served with a green salad laden with olives and cheese
  • Fish fingers and “chips”. The fish finger batter is coconut flour and seasoning. Fried in Coconut oil. The chips are the same recipe as the pizza base but rolled thinner. Baked until brown and crispy. Add salt and the kids love it.
  • Butter chicken and rice (using cauliflower rice)
  • Taco night where it’s all the Mexican trimmings on either cauliflower tortillas, or large fresh crisp iceberg lettuce pieces as tortillas.

I try keep the level of protein at every single meal the same. Approximately the size of a deck of cards.

With regard to my sugar control and insulin levels during the year…

There is a test called HbA1c, which measures the average blood sugar over the last 3 months. The traditional diabetes practitioners (such as where I go at North Shore Hospital) have this range up, and the red oval shows where the practitioners try to have you aim your sugar levels.

hba1c

A non-diabetic is supposed to be 5%. The reason the practitioners want us diabetics to be at an average of 8-10. (which is too high, as the non-diabetic body wants to be at 5%, is that (as a diabetic) when you eat regular carbs, you blood sugar will always rise after a meal. It can rise to 10 or 12, and then come back down again. This is “normal”. So, if your sugars are always rising to 10-12 after a meal, and your average is sitting at 5, it can only mean one thing. You have many many dangerous low blood sugar hypos.

I take 2 different insulin types. I take a long acting insulin called Lantis, which processes the natural sugars the body creates. (nothing to do with food). I also take a short-acting insulin (purpose made to handle carbs in food) each time I eat. My long acting Lantis dose has not really changed since going LCHF.

Now, when I was eating my traditionally healthy high carb low fat diet, I was taking between 10 and 12 units of short-acting Humalog each meal. My sugar would absolutely rise after the meal, then I would more likely than not correct it, then it would fall too low. Hence the terrible roller coaster. I assumed, as does the Diabetes Clinic, that to achieve non-diabetic levels of blood sugar control, it required a lot of low blood sugar hypos. I would have had to correct my low blood sugars hypos 3 – 4 times a day.

Nowadays, eating LCHF, I would typically take 1-2 units per meal. This is only for the hidden carbs in vegetables etc. If I was stricter in my eating, I could reduce that dose even further. I have since had to buy a “paediatric” insulin pen, which allows me to dose in half units. Which is quite something. My sugar never rises after a meal. Then, because I am taking very small insulin doses, it doesn’t drop down low either.

My last HbA1c reading was 5.6 and then 3 months later 5.3. A cause for celebration really, as this is approaching non-diabetic levels. The Diabetes Clinic sister on duty was extremely unhappy, and had to call a supervisor. They were not happy letting me drive home. They could only deduce that for my levels to be so low, I must have been having many many dangerous hypos.

I took it upon myself to explain diabetes to them. “If I take no carbs, then my sugar won’t go up. If take no insulin then my sugar won’t come down”. I can manage my sugar in a very accurate range. I have very few hypos, and when I do, their intensity to slight (ie, not powerful caused by large over-doses of insulin). And that by following their protocols, I would have many more.

lewis

Lewis completing the Auckland Marathon last weekend (November 2nd, 2014). Note the glucose monitor on his left arm.