Bright Spots and Landmines of Living with T1D

3/13/19
FacebookTwitterEmail
 

Editor’s Note: ‘Bright Spots & Landmines’ is now available on shopthedrop.org


 

Adam Brown has been an influential voice in the diabetes community for several years, since launching his popular advice column ‘Adam’s Corner on diaTribe. In 2017, Adam released his first book: Bright Spots & Landmines, which discusses his advice for living your best life with diabetes. Adam took the time to chat with BT1 about his own experiences and insights living with Type 1 diabetes, and the motivation behind publishing Bright Spots & Landmines

At what point in your life did it become clear to you that a book of this nature was needed in the diabetes community?

I began writing my diaTribe column, ‘Adam’s Corner’in 2013. The goal was to share actionable diabetes tips related to food, mindset, exercise, sleep, habits and more. I thought it would be fun to write about these topics – the kind of stuff I would want to read. The feedback on these articles was amazing. In late 2015, my incredible mentor and colleague, Kelly Close, suggested I compile all my best diabetes tips into a single guide. Initially, I wasn’t sure – did we need another diabetes book, and did I really want to write it? But as I tiptoed into the project, I got really excited.

I set a goal to write the most actionable, uplifting diabetes book possible – and to give it away free on diaTribe and sell it on Amazon. I cannot believe we’re at over 100,000 copies now! It’s clear that there was – and still is – a very big need for this kind of toolkit.

Growing up, did you ever envision yourself becoming a published author?

Definitely not! In fact, when I applied for a summer internship at diaTribe in 2010, I was terrified about having to write every day for a summer job. I was always stronger in math and science, and my college major was pretty quantitative. Steve Jobs’s famous commencement speech put it well:

“You can’t connect the dots looking forward; you can only connect them looking backwards.”

Looking back, it all makes sense – from my diabetes diagnosis to where I am today. Looking forward, I never could have guessed that this would be my path.

Did you have anyone in the diabetes space that was particularly influential and helpful to you in the same way that you are now impacting others?

Beyond Kelly Close and our amazing team, the biggest influence has been my day-to-day job – following researchers, scientists, non-profit leaders, advocates, and champions at many diabetes companies. Their collective wisdom and support have absolutely shaped my career.

What are the most common misconceptions about everyday life with diabetes that you would like to see rectified?

  1. “Diabetes is easy if you eat healthy, take your medications, and exercise.” In reality, there are at least 42 factors that affect blood sugar. Many of these factors are barely talked about (e.g., sleep), and others are impossible to measure in any given moment (e.g., stress, infusion set function). There is staggering complexity in diabetes, especially with behavior, relationships, and life stress layered on top. Most of Bright Spots & Landmines is about minimizing the impact of those 42 factors. But perfectionism is impossible, given the tools we have and the environment we live in. CGM, coupled with experimentation and reflection, has been an amazing diabetes tool.
  2. “You can eat whatever you want, as long as you take insulin for it.” This is the advice I was given at diagnosis, and I think it’s the worst diabetes food advice regularly shared. The reality is that “eating whatever I wanted” made diabetes extraordinarily difficult – especially in 2001, when CGM did not exist. I wish someone had explained that there are “eat-whatever-you-want” tradeoffs – chasing highs and lows, tremendous diabetes effort, insulin dosing complexity, and constant frustration.

What would you tell someone that is considering reading Bright Spots & Landmines about the most important things that they will walk away knowing or learning after reading it?

My #1 goal was to make this book actionable, meaning anyone can pick it up and immediately improve some aspect of his or her life: more time in an ideal blood glucose range; less time managing and worrying about diabetes; less stress and guilt; better relationships and energy and sleep; and a happier mental state. With that in mind, I hope readers learn some useful diabetes tips related to food, mindset, exercise, and sleep. Everything in Bright Spots & Landmines has made a positive difference in my life, and most things include a small step that can be taken immediately. The advice has resonated with people who are newly diagnosed all the way to those with 50+ years of diabetes.

Beyond tips, the framework of “Bright Spots” & “Landmines” is a game-changer for many people. Bright Spots are so often overlooked and undervalued, but they are far more impactful than Landmines. A “Bright Spots” orientation puts wind in your sails, rather than constantly tearing them down.

How different would Bright Spots & Landmines have been if you had written it in the 1970s, 1980s, or any other decade?

The food and exercise chapters are heavily informed by continuous glucose monitoring – a technology I’ve now worn for over 70,000 hours (since 2010). Without CGM, many examples and tips wouldn’t be in the book!

That said, much of the food advice was around in the 1970s and even before – a focus on real food, lower-carb and lower-glycemic choices (especially vegetables), high-fiber, and low sugar. It’s funny how we often relearn approaches decades later; now, we just have better tools like CGM to document why they work.

Mindset has been critical in every decade of diabetes, though I think it’s gained more focus in the past ten years. Bright Spots & Landmines weaves together many recent books and frameworks – e.g., I only learned about the concept of “Bright Spots” from the incredible 2010 book, Switch: How to Change Things When Change is Hard.

The sleep chapter might not exist at all; that field has really gained momentum in the past 15 years. I just published a lengthy diaTribe column on the importance of sleep.

Do you think all of your advice in the book can apply to both Type 1 and Type 2 diabetes?

Yes – it was intentionally written with both groups in mind, and the feedback has been equally positive from both Type 1s and Type 2s. We’ve even heard good things from people with pre-diabetes, which really surprised me.

What has been the biggest surprise since you published the book?

The feedback has blown away my expectations – we’ve heard stories of 1%-3% A1c reductions, hours more time-in-range per day, 20+ lbs of weight loss, reductions in medications, massive improvements in stress and diabetes outlook, and more. I cannot believe how much impact it has had.

If you were re-writing the book now, would you change anything?

I would put a much bigger focus on the importance of sleep. As I just shared in diaTribe, I think lack of sleep (less than 7 hours) is probably the most destructive Diabetes Landmine. But that’s also a wonderful opportunity – there are many levers to pull that will immediately improve sleep (see 16 tips here).

I would also shorten the exercise chapter, which probably focused a bit too much on tips to manage insulin and blood sugars during activity.

What age were you diagnosed? Do you feel that was a particularly difficult time in your life to receive the news?

I was diagnosed at 12 years old, and I think that was a very fortunate time – I was old enough to take on my own diabetes care (my mom was amazingly hands off), but not so old that habits had been ingrained. I’ve now lived more years with diabetes than without.

As the oldest of six kids, responsibility has been part of my identity from a young age. I think that really helped me take the reins of my own diabetes.

What are your thoughts on making sacrifices vs. not letting diabetes get in the way of our lives and goals?

Sacrifice: “an act of giving up something valued for the sake of something else regarded as more important or worthy.”

That definition sums it up – what are my worthy goals, and what am I willing to give up to obtain them? I aim to:

  • Maximize my time-in-range (70-140 mg/dl), which elevates my energy, mood, relationships, thinking, quality of life, writing, and impact; AND
  • Minimize the amount of diabetes effort required.

I’m always on the hunt for things that do both.

Low-carb eating is a great example – it maximizes my time-in-range and minimizes my diabetes burden. I’ve found a long list of tasty foods that I’m excited to eat – even things like waffles,  pasta, and “mashed potatoes”can be made low-carb with a little effort.

Initially, this might have felt like a mealtime “sacrifice,” but over time, it’s become an automatic habit. I don’t feel like I’m “missing out” on dessert any more, since I place more value on the goals above.

What are you the most excited about for the near future of diabetes technology/research?

CGM continues to get better and better, and I’m excited for it to get less expensive, more widely available in the pharmacy (FreeStyle Libre is the leader, but G6 is following), and more useful. Dexcom’s G6 is outstanding and G7 looks even better. FreeStyle Libre 14-Day and LibreLink are terrific, and Abbott has a lot in the pipeline. Medtronic and Senseonics are working hard too. Every person with diabetes deserves access to CGM – to see their glucose levels in real-time, to learn from them, and to make changes.

I’m also excited about automated insulin delivery, as many new systems are expected in the next two years – Tandem’s Control-IQ (launch this summer), Tidepool Loop (study underway), Bigfoot’s Loop (pivotal study later this year), Insulet’s Horizon (pivotal study later this year), Beta Bionics iLet (pivotal study later this year), Medtronic’s next-gen MiniMed 780G (launch by April 2020), and Lilly’s Hybrid Closed Loop (launch in 2019-2021). Many of these systems will go direct-to-phone, some will add automatic correction boluses, and all should be more user-friendly (e.g., pre-filled insulin cartridges, simpler startup, simpler meal entry, more customization and aggressiveness, simplified ordering). I cannot wait! My experience on Loop is posted here, just to give you a sense of what’s coming.

For people on injections, smart pens are going to be a game-changer – enabling insulin dose capture on the phone and smart dosing advice. Companion Medical’s InPen is the first on the market, Common Sensing is in a beta launch, and Novo Nordisk and Lilly are bringing smart pens to market in the coming year or two.

What are the common perceptions or misconceptions about life with Type 1 vs. Type 2 that you would like to clarify?

Most people focus on the differences between the types of diabetes; I try to focus on what we have in common. We have many similar needs – finding foods that keep our blood sugar in-range, learning from glucose monitoring, finding the motivation to keep going, getting enough sleep, minimizing stress, fitting exercise into life, living with a chronic disease in an acute healthcare system, etc.

I often wonder if the diabetes field would be stronger if we focused on similarities, rather than differences. Big-time change only happens when many people are rowing in the same direction with the same voice and priorities. A staggering 30 million Americans have diabetes, but most of the time, much smaller health conditions get a larger share of public attention. Can we do better?

What’s next for Bright Spots & Landmines?

I’m working on a very cool reflection practice that will help apply the framework to daily life. Every day with diabetes is different, and it’s vital to never stop learning, testing, and reflecting. My goal is something that takes two minutes per day. If you would like to provide feedback on an early version, please fill out this form.


TAGS:

Adam Brown joined diaTribe in 2010 as a Summer Associate, became Managing Editor in 2011, and now serves as Senior Editor. Adam brings nearly 15 years of experience with Type 1 diabetes to all of his work at diaTribe, especially in testing out new technology like glucose meters, CGMs, insulin pumps, automated insulin delivery, and mobile apps. Adam also writes an acclaimed column for diaTribe, Adams Corner, which focuses on actionable tips for living well with diabetes. Through his work at Close Concerns and diaTribe, Adam has brought a patient perspective to numerous venues, including FDA meetings, scientific and industry conferences, and patient events. Adam graduated summa cum laude from the Wharton School of the University of Pennsylvania in 2011 pursuing concentrations in marketing and health care management & policy. He is passionate about exercise, nutrition, psychology, and wellness, and spends his free time cycling in San Francisco.