Our identity is the first to suffer the complications of diabetes. It changes how we see ourselves--normalcy and belonging grow distant. Limitations germinate quietly like mold beneath the occluded layers of personality we create every day in order to just survive. It's the hairline fracture in the foundation of who we are. The deeper it goes the worse it gets.
I started LivingVertical to share Project365--my goal was to change the story of diabetes and show that we don't have to accept the narrative of a predetermined outcome of victimhood. I still believe in that same message, but I don't think the best way to communicate it involves creating content about diabetes anymore. I'll always have diabetes and I'll always be happy to answer questions about my experience with it--if I can help, I will do so gladly. Where it's relevant, diabetes will still be visible but it's not going to be the focus of what LivingVertical is creating. It will always be in the picture but it won't be the focus. I believe it's more important to demonstrate that life with diabetes is about LIFE. This is the most powerful advocacy I can offer. It's also a choice I am making because I'm frankly tired of trying to pack my world into the topic of diabetes. I'd much prefer to make diabetes fit into the world I'm choosing to explore.
I've always had a hard time gaining a foothold in the diabetes online community. I suspect that's because my approach has been to encourage people to detach their identity from their diagnosis--because that's what worked for me. It's a tough sell though. A diabetes-free mentality is why I never stopped to think that I couldn't climb mountains as a teenager. It's why I thought it was perfectly acceptable to spend a month hiking the Appalachian Trail and take on solo adventures without trepidation in college. It's why I've driven across North America more than a dozen times (half of them solo) and I don't fret about changing my lancets daily. I didn't have olympic athletes and professional spokespersons with diabetes to assure me that I could do anything. I didn't see myself as a diabetic who climbed or who hiked. I didn't see myself as a person with diabetes. My identity had ZERO inclusion of diabetes--so why wouldn't I be able to do anything I put my mind to?
I wasn't in denial about my diabetes--no more than I've been in denial about brushing my teeth daily. I just never placed that task inside of my identity. Diabetes was a task--one that I realized was incredibly significant. I detached from it emotionally and executed it to the best of my ability so that I could have the freedom to pursue what I loved. Others might call this unhealthy, compartmentalization or repression. I call it freedom through discipline. I have staked my life on this philosophy repeatedly in the mountains and elsewhere. It's not a perfect science but it's been able to give me a winning average. I believe that it's the greatest value I have been able to share here.
Why is this all written in the past tense?
Sometime in 2012 I found that I had to include diabetes in my identity in order to reach others living with diabetes. I had to create space for it where it none existed before. I became the "diabetic guy who climbs things". I'd introduce myself to people that way. It changed the way I saw myself. It changed the subtext of the story I told myself about who I was. It wasn't healthy--literally. I know that many people have found value and connection through an inclusion of diabetes as part of their identity--and I don't begrudge them.
For all the value, impact and success that came with my diabetes advocacy, my own independence from diabetes atrophied. Spending 7-12 hours a day for the last 5 years writing, filming, posting, blogging, emailing, pitching, podcasting, publishing--all through the lens of diabetes--multiplied the weight of diabetes in my life. I wasn't just living with it--I was living IN it.
So what's the point?
Photography and adventure will be the focus of LivingVertical content moving forward. I believe this is the greatest value I have to give--unpacking the tools that have given me my life back. I think this is less a change of priorities and more of a return to them. There's a reason LivingVertical doesn't have "diabetes" in the name. It never occurred to me to put diabetes in the name of my endeavor when I arrived on the scene 5 years ago because it wasn't meant to focus on the problem but rather the solution. Walk the walk--even if it interferes with talking the talk.
I'm grateful for your readership up till this point. I hope you'll join me for this next chapter. I suspect that many of you who actually read my posts all the way to the end aren't here because of factual information I share as much as my interpretation of what I see in the world around me. If that accurately describes you then it's a good bet you'll enjoy what comes next!
I want to thank specifically Blake McCord, Ashika Parsad, Sysy Morales, Maria Qadri, Fatima Shahzad, Ryan Little, Matt Spohn, Andres Arriaga, David DuChemin, Rob Muller, Tyler Smith, Joel Livesey, Mark Yaeger, Carter Clark, Christine Frost and Nate Duray for inspiring me to have the courage to return to a diabetes-free mentality. There are many others who have contributed to my liberation--knowing or otherwise. Far too many to list here--but these folks have listened and shared in the deliberative process over a long time and I want them to know how much I appreciate their example and wisdom.
by Steve Richert
A little over a year ago I was bored. I was working in an office environment and not able to get out climbing. I wanted to try something to shake up my routine despite the obvious constraints. I decided to do an experiment with a vegan diet, which ultimately led me to try the complete opposite--a ketogenic diet. This bit of skylarking wound up taking off and got this humble blog ranked #1 in Google for the search terms "type 1 diabetes and the ketogenic diet". This happy accident has brought many of you here no doubt although it's left me with a burden of continuing to write about a topic that I feel has been wrapped up (at least in my life). The notable exception is the modified Ketogenic diet which I am currently following.
There is one loose end, however--and that is the issue of high cholesterol. I also have the dubious honor of ranking very highly in Google searches for ketogenic diet and high cholesterol--a pleasure that I'd prefer to postpone indefinitely. I am still working on sorting out the details on my high cholesterol and what it means for my adherence to a low carb, high fat ketogenic diet. There is a dearth of information available that gives simple, clear insight into the topic of cholesterol--and much less still when you add type 1 diabetes into the mix. Half of the discussion resembles this: "Cholesterol is not a problem! Eat more butter and stop listening to the man!" The other half resembles this: "Cholesterol is a HUGE problem! Eating that butter is going to kill you!" I would like to believe that a modified ketogenic diet could win the middle ground between these two viewpoints.
The ketogenic diet stabilizes and controls my blood sugar without technology. This fact alone makes it an asset that could revolutionize the impact of diabetes if given the chance--especially significant for the millions of people who can't afford higher tech solutions. It gives me the simplicity and freedom that allows me to live out from under the burden of diabetes about 90% of the time. Still, living with the cholesterol monkey on my back is a concern.
I feel as though I can choose to either optimize cholesterol or blood sugar--but not both.
I choose to optimize blood sugar because there is no lack of conclusive clinical evidence showing what uncontrolled blood sugar does. There is also no shortage of anecdotal evidence showing how much harder it is to be active, creative, happy and productive while riding the glucoaster. Without getting all morose, let me just say that I have chosen my priority. It's not an easy choice and it gives me a lot of stress and grief--but it's the best I know to do and I am prepared to live or die with the consequences.
Welcome to my life with diabetes and climbing. These types of decisions are par for the course.
What I have learned with the help of my doctor (he is an amazing endocrinologist who is supporting my blood sugar management despite its unorthodox approach) is that I am most likely a hyper-responder to saturated fat. This is a genetic anomaly that causes my body to produce exponentially more cholesterol in the presence of saturated fats. The detriment of that cholesterol is still undetermined--along with the possibility or being able to reduce it.
Thanks, genes! The diabetes was a sweet offer--but wait, there's more...
In light of this hypothesis, I am not abandoning a low carb, high fat diet but I am following a modified ketogenic diet. I believe that most people have to modify whatever diet they follow in order to accommodate their specific needs. A modified ketogenic diet can, of course, mean many different things--it is not imply any one specific modification. I am trying to add more unsaturated fats in place of saturated fats. In simplest terms that means that I am eating more olive oil, macadamia nuts and fish. I am eating less red meat, eggs and coconut oil. In a lot of ways it's closer to hybrid mediterranean diet. It's really hard to sell this approach since it doesn't fit with the self congratulatory memes of the vegan "path" nor the devil-may-care tropes of the ketogenic community. Oh well.
My cheese intake is still predictably unaltered. I will be buried with my block of Coastal Cheddar and a paring knife if need be. Nuff said there.
I recently started swapping out olive oil in my coffee rather than coconut oil. Before you gag and click away, I have to tell you that it's actually delicious if you put it in a blender. I'm still putting heavy cream in my coffee with the olive oil. Additionally I am eating more leafy greens and cruciferous vegetables (red cabbage, brussel sprouts) as vehicles for more olive oil and more fiber. I've cut out a lot of red meat--not to complete exclusion but I'll eat a steak or some lamb once a week rather than twice or three times weekly. Meat ends and deli meats which I love--have been largely replaced with macadamia and Brazil nuts. I am also increasing fiber intake through the vegetables and adding chia seeds to just about everything I can.
I'm not on statins currently--but I am taking fish oil, vitamin D and Berberine as part of my normal supplement routine of magnesium and potassium.
I don't have any solid numbers yet to indicate the effectiveness of the modified ketogenic diet on my cholesterol. In terms of its impact on my blood sugar and energy, I feel like it takes a little more olive oil to get into ketosis. It's lower caliber--but it still seems to be getting the job done. I've been taking more insulin recently--but I am not sure if this is because I am back living in Massachusetts or because of the dietary modifications. I have always found a dramatic decrease in my insulin dosage when I am out west (10-15% consistently). On the flip side, I have more time and space to focus on my diet and supplementation here than I did when we were living on the road.
If the project I'm doing is guaranteed to work then it's probably not worth doing.
I appreciate the tolerance shown by my readers over the last week as I have been unpacking the failure of the full time RVing experiment. I'm legitimately not discouraged by it. If anything I feel much better for having made a decision and being able to cross something off my list. This enables me to focus on the next project. It too, might fail. This fills me with excitement and yes, hope.
Risk and suffering are key ingredients in the process of creating art. I know that running and hiding from these inevitabilities is the fastest way to stop creating something that can change the world. Note my use of the word can in the preceding sentence. It might not work.
The important question is what is worth the risk, the likelihood of failure?
That is where my current struggle is taking place. I have things to say, things to share and show--but there is fear. Fear that a removal of the filter could destroy so much that I and many of you have labored to create through this community. Conversely, there is an intense curiosity about what change--what impact could be generated from no longer caring what people think? Better yet, what could come from challenging what people think with intention?
I know deep down what is worth doing. Waiting for permission is not a characteristic of something worth doing.
I feel as though what I do here is a lot like spinach. If you give it to Popeye it gets things done. Leads to action. Stirs things up. Alternately, if it sits in the fridge just a little too long it gets watery, soggy and limp. There's a really narrow edge I am walking between impact and drivel. The reality is that the world isn't changed by climbing.
The onus is upon me to make sure I am saying something that needs to be heard or the climbing just becomes fluff instead of a vehicle for an important message of change. Visibility for it's own sake is useless. What is on the billboard and is it worth reading?
This is a game of pursuing failure with intention. If I start playing my hardest, I just may win that game. That's partly what I'm afraid of.
I wanted to write a technical post about a question I keep getting regarding the ketogenic diet and hypoglycemia. Even if you're not into the keto diet, I think you may find some useful ideas to make low blood sugar less invasive in the short term. I recently shot a series of videos about the ketogenic diet and diabetes as part of my daily YouTube vlogging and you can check those out and subscribe here.
My general goal in my diabetes management is minimalism. Minimal intervention, treatment and daily impact. The most basic manifestation of this is to aim for the use of less insulin, which can create greater blood sugar stability. This strategy led me to a low carb diet. The need to have athletic performance in addition to the blood sugar stability led me one step further to the keto diet.
You can call me diabetic if that's what works for you. I won't call the language police to shut down communications. Silence doesn't help those of us living with this condition and it doesn't help the outside world deal more gracefully with admittedly difficult subject matter.
I'm not saying that words don't matter. Words do matter--not because of an inherent value in the words themselves but because of the context. Words matter because of how we interact with them. Trying to protect ourselves from terms themselves is asking the wrong question. Leaning into the effort of influencing context and controlling the narrative is proactive. It's something for which we can take responsibility. We can change what words mean through action. That starts with taking ownership in our own life. The point of this exercise is to change our perspective. The benefit to us is a better life, independent of the willfully ignorant.
Scrutinizing semantics shifts the focus outside of the things we control. Asking how we can break underlying ignorance seems closer to the mark. Person with diabetes, climber, diabetic, diabetic climber--are all accurate. None of those words makes me who I am. They don't define me--I define them. Doing that work is something I own--it's not something I'm willing to outsource. The heart of being successful with this disease involves questioning everything and being independent enough to formulate your own rules based on what works for you, not playing by rules handed down from internet authority figures or arcane medical tropes.
I'm aware that I'm asking you to freely reject my position as part of my platform. I'm no authority figure. I'm just one person. I'll choose to define the value of diabetes for myself, thank you. That includes all the words and the nomenclature that comes with it. It's my disease and I'll paint it any color I want.
We do a lot of measuring in diabetes--but are we measuring what matters? As you may know, I've been on the east coast for about a week or so and I've been doing a little "experiment" that I'd like you to participate in. I am sharing a video each day--on my YouTube channel. It's been a great opportunity to work on my video story telling (starting with some lighter "cat videos" to get warmed up!) as I prepare for a big climbing project this fall and it's the pathway I am following as I push the message of empowerment and redefining the limitations of life with type 1 diabetes. I'm still sharing blogs because those are good outlets for photographs, opinion pieces and technical discussion-- but the play by play of my adventures--well, that's moving to a different stadium with more seating. I truly hope you'll subscribe to our channel and be part of a new frontier (new for LivingVertical) that we are navigating. These forays are always way better with friends.
During my time in New York City, I had a chance to meet up with a good friend and we did an informal interview for the vlog. It got me thinking about some of the common complaints and touch-points that I've been noticing a lot in the community. There's a tension between a segment of the diabetes community who think diabetes isn't that hard--and others who think it's basically impossible. I have been looking for years for a way to bridge that gap and inspire those who are burnt out--and borrow from the success I have had in order to equip those willing to fight on.
I know that it's cathartic to hear leaders in our community say that it's impossible to control our blood sugar. While I don't disagree with this assertion, I believe it's an incomplete message without equal priority being given to the things we can control. Effort is the focus. Effort is good or bad. Effort should absolutely be judged--because effort is one of the things we can control. Clear black and white language must apply to our self-review or else we will create loopholes to escape our responsibility.
I write this as a flawed, lazy and impatient person who spends a good deal of creative energy trying to trick my "future-self" into doing the right thing from the comfort of what will soon be the past. I'm not advocating open season on judging each other--since that process is already working out beautifully on Facebook in this harmonious political climate--but I'm saying that it's worth holding ourselves accountable. We are not delicate snowflakes that will wilt under the duress. We will grind our teeth at times and soldier on, better off for having done so.
I would ask you to stay the hands reaching for your pitchforks and torches--because the quality of the effort is not determined by the outcome. You can do everything right and get the wrong results. I've seen it happen in climbing, in losing friends to their own demons, in diabetes too, of course--and the only refuge we have is knowing that our best effort was given in the fight. Sometimes that must be enough.
I'll give a quick example. When I started LivingVertical, I got some pretty hateful comments from people who were complete outsiders. They judged my desire to use climbing to empower and inspire as being a flimsy publicity stunt that would ultimately detract from getting funding for real, meaty solutions like a "cure". My initial reaction was to say "What the hell?! I show up trying to give people this gift and I get kicked in the teeth?" It's true that my critics were trolls and they were completely out of line. It's also true that encountering that judgement gave me a moment to pause and examine what I could be doing or saying to increase the clarity of my purpose. It made me that much more committed to examining my own intentions. I avoided a lot of pitfalls because I did not want to do anything to validate the trolls.
Adjust expectations and emphasis to favor the effort and let go of the outcome. Then, choose your battle and fight like hell.
I had pretty high hopes for a recent switch in my basal insulin. I've discussed it a bunch in my Vlog on YouTube and I promised to write about it here and give a full report. So here is my experience of Toujeo: it's Lantus in a different colored pen with an even sillier name. I didn't experience weight gain or an increase in the dose like some detractors had warned me about online. I didn't experience better or more stable blood sugars as some proponents had predicted. It was basically the same--same dose, same action, same stability. If there were any advantages gained in my switch they were imperceptible.
The one thing that this trial DID reinforce is the very perceptible benefit of splitting the dose of Lantus or Toujeo. I started off taking a full dose of Toujeo and found that it did exactly the same thing as Lantus in a single daily dose: lows up front then increasing blood glucose from hour 18-24. This left me chasing my numbers up and down the spectrum for more than half of the hours in a day. Once I returned to splitting my dose the stability in my numbers followed with it.
One needn't look very far on social media and diabetes forums to find people who will tell you that "injections suck" and that using a pump is inherently superior. I find that many of those who hold to this view never experimented with the nuances of basal insulin and failed to dial in their dosing. I readily admit that's why I didn't have a great experience on the pump. I took the "starter" settings and didn't get far beyond that point. Turns out that's a pitfall that occurs when using injections too.
My purpose in writing this isn't to compare shots vs pumps. I've already done that in this blog linked here. It's to share that in my experience, many times over, splitting a basal insulin into two half-doses daily makes a massive difference in terms of blood sugar stability. I have noticed more and more pumpers taking "breaks" and going back to injections and this technique could be very useful--and it's surprising to me how many doctors don't recognize that. I'd love to see a day when insulin that is advertised as "24-hour" insulin actually lasts that long. Come to think of it, I'd love to see a day when medication isn't wrapped up in marketing, period. In the interest of full disclosure, I am currently moving to trying Tresiba in hopes that it may at least be able to give me that full 24 hour duration. If there's anything to report, I will.
Ready for my disclaimer? Here goes: this blog post isn't paid content and all the opinions here are my own. I am 100% certain that the companies which manufacture and all of the drugs referenced here do not condone my blasphemy in the form of non-FDA approved usage of their products. They haven't asked me to provide an opinion nor have they paid me for this service. They also haven't paid me to shut up, so I'm still here ranting about how we can use older, cheaper therapies to get better results with a little ingenuity.
As we are concluding the hateful process of replacing the car and preparing to get back on the road after a MONTH of crazy pitfalls the question of "why" keeps coming up--as in 'why are we bothering to do this?' Is full time RVing really worth it? Is there a better way to enjoy travel and adventure--by balancing the spectacular with the mundane? These are tough questions because we knew from the beginning that there would be hard days--weeks even.These types of difficulties are the "stress-testing" of this type of lifestyle.
I don't know what the right choice is going to be for our family in the long run. I fully intend to ride this out and make a solid year of it before considering plan "B" (pull the ripcord and bail). It's totally possible that we just had a rough patch and will pull through it brilliantly and won't ever want to consider quitting again. The question always comes down to quality of time spent together on adventures--which is not always congruent with quantity of time spent in pursuit of adventure! If there is anything I've learned from the last month it's that being out on the road can actually slow you down and kill a lot of time when things go wrong. That's not just inconvenient and costly, it slows down momentum of climbing and creative projects that I am working on to change the landscape of type 1 diabetes.
Like most difficult decisions I believe the answer will be some form of compromise--choosing the downside that allows for the greatest upside. The option for no downside at all doesn't seem to exist. Accepting the realization that a sacrifice must be made under the best circumstances is the best way to make deliberate decisions rather than being victimized by mishaps. This is a major part of my view on life with type 1 diabetes. The time we have is an investment and death and discomfort will come to us all sooner or later no matter our choices or station in life. It's better to figure out what is worth suffering for than trying not to suffer.
It's always harder to come back out west to our tiny home from the east coast--losing time in the air and re-acclimating to a small space all contribute to the challenge. To some, the idea of flying back and forth across the country all the time and working on the fly may seem desirable. I wouldn't call it unappealing--but it definitely comes with certain sacrifices and challenges. I am thankful to be working for myself though--check out my freelance media work if you have a small business and need help getting your name out there!