This video is a bit long, and I can't quite decide whether it's a rant or a plea. I'm feeling proud that I managed to keep my $--t together until the final minute or two.
This video is a bit long, and I can't quite decide whether it's a rant or a plea. I'm feeling proud that I managed to keep my $--t together until the final minute or two.
This is an update based on a Facebook discussion about how successful Metformin is, overall, at reducing weight in the general diabetic population.
Note: Studies don't show consistent weight loss with metformin use, that's for sure. My hypothesis is that in order to experience successful weight loss on Metformin, you have to meet some very specific conditions. First, you have to be euglycemic virtually all of the time before starting the metformin. This is hard to do, especially when you're on insulin. You also have to remain euglycemic as you continue to take the metformin. And insulin dependents have to do this by adjusting (read: reducing) basal and bolus dose calculations. This is not easy. But starting metformin while euglycemic and remaining euglycemic throughout the treatment will, I hypothesize, result in weight loss, because it results in less sugar in the blood, which means less required insulin, which means less fat storage. I was a sample size of one, of course. And my experiment was driven by personal curiosity, not scientific inquiry. I will post this on the blog to make that part more clear. I would like find some research on whether metformin has caused weight loss in people withOUT diabetes. I'm sure it's out there, and that I just haven't found it yet.
Now, continue on to the article below.
Many of you are aware that I recently started experimenting with metformin, which is a medication typically prescribed to people with type 2 diabetes. But, according to many reputable sources, metformin can also help type 1 diabetics (along with insulin, of course, which is required for type 1s) with blood sugar management.
I wrote about metformin in my I'm using a diabetes drug recreationally article a few months ago. Feel free to read that at your leisure.
My main goal in starting metformin was to see if this medication could help stabilize and flatline my blood sugar levels during and after exercise.
Exercise had been so frustrating. Every time I went to an exercise class with a perfect blood sugar, my blood sugar would go up by 60 to 100 mg/dL. Yes, you read that correctly. Exercise *raised* my blood sugar.
Now, you might be wondering, "Why the heck did your blood sugar go UP during exercise? Isn't it supposed to do DOWN?"
Let me explain.
I take insulin. I take basal insulin, which is used to counteract the baseline level of glucose that's always hanging around in my blood thanks to my liver's gluconeogenesis. I also take bolus insulin, which helps the food I eat (mostly carbohydrates), once it's digested into glucose, get into my cells. I also use bolus insulin to treat incidental high blood sugars. Insulin moves sugar from my blood into my cells. My cells like this, because my cells use that sugar for energy (and some other stuff).
I did a bunch of experiments with exercise. More specifically, I wanted to compare my blood sugar's reaction to exercise while my cells were in a starving state vs. my blood sugar's reaction to exercise when I had bolus insulin on board (non-starving state).
I started capturing blood sugar data surrounding my exercise events.
RESULTS OF EXERCISING IN A NON-STARVING STATE
Let's say I eat breakfast at 8am, and take 4 units of bolus insulin.
The insulin helps my breakfast carbs get into my cells to give me energy.
Yay! Now, let's say I exercise at 10am, with a starting blood sugar of 140. I still have some insulin in my blood, and I have some very satisfied cells that are full of energy.
But, during the exercise, my cells start using up that energy. And my cells start to run out of energy. So my cells get hungry.
But guess what. There's still some sugar in my blood because my blood sugar is 140, AND there's still some insulin in my blood because, well, even short acting insulin stays in the blood for up to 6 hours.
So, my body uses the remaining insulin to suck as much sugar as possible into my cells to give me more energy.
At the end of the exercise, my blood sugar is down to 40, and I'm shaky, clammy and need a snack.
Naturally, because I feel so awful, I eat and eat and eat, which results in a high blood sugar a few hours later, and then I get to enjoy a blood sugar roller coaster for the rest of the day.
RESULTS OF EXERCISING IN A STARVING STATE
I'd wake up, and I would NOT eat anything for breakfast.
Then, at noon, I'd go to my exercise class with a blood sugar of, for example, 120. I'd exercise for the full hour, and then check my blood sugar immediately after the exercise. 200. My blood sugar was 200.
Here's what happened. My cells were hungry. Since I hadn't eaten breakfast, those cells didn't have much energy to start with. So, I started exercising and I pretty quickly used up all the energy in my cells. But, since I didn't have any extra insulin in my body, there was no insulin available to pull sugar from my blood into my cells to give them more energy.
But it didn't end there. Did you know that you liver is supposed to store glucose, and give you a few squirts of that glucose when you need it?
Well, one of the times you need glucose is when your cells become starving. So, noticing that my cells were starved of energy, my liver helpfully squirted a bunch of glucose in my blood, raising my blood sugar to 200.
And...guess what. I didn't have any bolus insulin on board to carry that sugar into my cells. So basically, my cells were starving, and there was plenty of sugar in my blood to feed them, but unfortunately, the insulin required to move the sugar into the cells just wasn't there. So I had starving cells and high blood sugar.
So, HOW THE HELL is someone on insulin supposed to exercise while keeping their blood sugar at a flat line (or as close to target as possible)???
I contemplated three potential solutions to this problem.
One potential solution was to do my exercise in a starving state, and then use Afrezza, the super-fast-acting inhalable insulin, right after exercise, to lower my blood sugar. This is something suggested by my friend Dr. Gaja Andzel, whom I trust completely to give me diabetes-related advice. But, my doctor here in Wisconsin is pretty risk-averse, so I'm still in the process of convincing her to let me try Afrezza.
Another potential solution was to try metformin, a drug that suppresses the liver's glucose-squirting activities and reduces insulin resistance, to see if I could exercise in a starving state without getting that extra sugar kick from my liver.
Another potential solution was to try experimenting with the timing of my breakfast, insulin doses, basal rates, etc. I've been there, done that. It's pretty hit or miss at first, but you can eventually get it right. I know some athletes who've been really successful with this method. If you need some coaching on this, Dr. Matt Corcoran from Diabetes Training Camp is a great resource.
My goal was to flatline my blood sugar during and after exercise. Since I couldn't get access to Afrezza (that's coming soon, I promise!), and since mucking with my dosing and rates is not easy and affects everyone differently, I decided to try metformin to suppress my liver from squirting a bunch of sugar into my blood during exercise.
I did some research. Then I did some asking around. Then I talked with my doctor and she agreed to prescribe me metformin. Then I did some more research and wrote the I'm using a diabetes drug recreationally article. And then I started taking metformin.
I decided to take the extended release version of metformin (marketed as ER or XR), because I'd heard horror stories about side effects from the "regular" metformin. The effects of extended release metformin apparently aren't as severe.
That's not to say there weren't side effects. For me, the side effect was pooping. Lots of pooping. It lasted about six weeks and then I didn't have the effects anymore. Other than that, I've experienced no other negative side effects.
My instructions were to start taking 500mg/day for a week, then increase by 500 each week until I reached the max dose of 2000mg/day.
During the dose increases, my blood sugars were all over the place. I was playing with basal rates, recalculating insulin sensitivity factors, adjusting bolus ratios, etc., and my blood sugars were all over the place. I was high, and low, and high, and low and on a total roller coaster for a few months. I decided to stick with 1500 per day, and do somebaseline testing.
Once I reached a dose of 1500 mg per day and did some baseline testing, I noticed three things:
1. I didn't need as much basal insulin. Due to the metformin, I had to reduce my original basal insulin by about 15%
2. I didn't need as much bolus insulin. Due to the metformin, I had to reduce my bolus insulin by about 10%
3. I had VERY little, if any, increase in blood sugar during exercise. Metformin solved my "exercising while starving" problem.
Once I reached 2000 mg per day, I noticed two more things:
1. I had to reduce my original basal insulin dose by 20%
2. I had to reduce my original bolus insulin dose by about 15%
So, overall, I'm getting exercise without screwing up my blood sugar. I'm also taking less insulin overall. Do you know what that means?
It means that since I finished the baseline testing and got the initial metformin-induced roller coasters under control, I've lost about a pound per week.
Why? Well, insulin is a hormone that helps glucose get into your cells, which your cells use as energy. If there's an overabundance of energy in your cells, your cells store that energy as fat. Yep. Insulin is a fat storage hormone.
You NEED insulin to survive, though. If you don't have insulin (either from a vial, a pen, or from your own pancreas), you will die.
Striking a balance among exercise, blood sugar levels, insulin, metformin, eating, and weight loss/gain is hard. Like, really hard. But I'm not going to complain about that.
What I will continue to complain about, however, is how much we have to FIGHT to get the diabetes supplies, education, and care we need in order figure stuff out like this.
Next up, Afrezza. They're marketing it all wrong. I'm going to run some experiments with it starting in May, and perhaps we can set Mannkind straight.
With Betic Love,
This video contains instructions for drawing insulin into a syringe from a vial.
Hey Betics! Three quick things:
A company called OneDrop just released a subscription service that comes with a glucose meter and unlimited test strips, and this is not a joke.
I'll write a full article later with more details, but I wanted to make sure you got the news right away. I will say that UNLIMITED does not mean as many as you are able to hoard (bummer). It means as many as you actually use.
Still, this could be really freaking awesome for those of you who
1. have crappy prescription coverage
2. have no prescription coverage at all
3. have a strict test strip limit
I got some great feedback after I sent out the Diabetic Thanksgiving Survival Guide last month. One of you kindly advised me that the survival guide can be used for more than just Thanksgiving dinner. I'm not sure why I didn't think of this, but apparently you can use the Thanksgiving Survival Guide for parties, special events, holiday dinners and any other way it works for you. So, in case you have upcoming special events, here's the link to download the Thanksgiving guide (again).
I've recently learned there's a great need for a diabetic-friendly meal plan service that tells you specifically what to buy, what to cook, how to cook it, and how many carbs are in it, etc. I need to know more about what that service needs to look like before I start working on it (confession: I've already started working on it a little bit). So, if you have some time today, can you click the link below and give me some direction, here?
Sure, I'll give you some feedback.
Sorry, Kara. I'm too busy to help you.
With Betic Love,
I gained a full percentage point.
I just checked my A1C and the results are very grim. My A1C increased by a full percentage point between September and December.
The reason? Well, I slacked off for about two months and stopped paying attention to my diabetes. And, as my A1C indicates, I am again forced to acknowledge (for the millionth time) that there is no time off from diabetes.
It is time to get my butt in gear and solve this problem. I know I can lower my A1C within the next month, but only if I start paying attention to my diabetes again.
Here's what I'm going to do.
1. I'm going to check my blood sugar more often.
2. I'm going to stop eating crap. Or, at least, I'm going to reduce the amount of crap-eating. This should be easier now that Christmas is over.
3. I'm going to reset my baseline blood sugar by doing a series of mini-fasts over the course of 3 days.
4. After I fix my baseline, I'll decide what to do next.
I'd like you to join me.
I'm inviting everyone on this list (type 1, type 2 and type 1.5) to join me for my next online Baseline Blood Sugar Challenge Event, which starts January 1. This is a 3-day blood sugar reset program.
Registration is FREE until December 31.
So, if your blood sugar is behaving badly thanks to the holidays, join me in setting our baseline blood sugars straight.
This is likely the last time I'll be offering this $59 web event for free, so if you haven't tried this yet (or if you did this in September and want to do it again), now is the time!
Will you join me?
Sure, I'd love to kick my baseline blood sugar's ass.
I'm not sure. Tell me more about it.
See you there!
With Betic Love,
P.S. If you'd like to invite a friend or family member, use one of the social share links below.
P.P.S. This course uses video, textual content and email. That means program registrants will get a daily email for 3 days. If you aren't available January 1-3, you can still register today and complete the course at a later date as long as you save the emails.
A few months ago, my little brother (age 34) contacted me and said, “I need to talk to you about something. I think I have insulin resistance.”
“Why do you think that?” I responded.
“Well, our entire family has type 2 except for you,” he said. “So I’m pretty much doomed to get type 2.”
“Yep. you’re probably right,” I agreed.
“And I’ve been slowly gaining weight since I became an adult, which could be due to my lifestyle, but it could also be due to the fact that I’m becoming more insulin resistant as I get older.”
“That’s usually how it works,” I confirmed.
“And as a response to my insulin resistance that’s been getting worse over time, my pancreas has been producing more and more insulin. Which causes extra weight gain,” he said.
“All true. Where are you going with this?” I asked
“Well, my fasting glucose and glucose tolerance tests and my A1C are all normal. So according to the docs, there’s no sign of diabetes.”
“Right,” I said. “No one actually tests positive for diabetes or pre-diabetes until they’ve become so insulin resistant that their pancreas can no longer keep up. Basically, the only time you’ll get an interesting test result is when it’s already too late.”
“So,” said my brother, “I could be very insulin resistant, but I wouldn’t necessarily see anything interesting on a test, because my pancreas could be chugging along like the little engine that could, squirting out an ass ton of insulin into my body to keep my blood sugar normal, all the while secretly petering out and basically dying a slow pancreatic death.
“Well, it's more complicated than that, but as a summary, it's close enough,” I said.
“So at some point, my pancreas won’t be able to keep up with the demand for insulin, and then my blood sugar will finally start going high, and then I’ll be pre-diabetic, and eventually I’ll become diabetic.”
“Yes. All of this is true.”
Then he said, “Well, wouldn’t it be better for me to know that I’m insulin resistant NOW, when I’m 34, instead of in 20 or 30 years when it’ll be too late?”
And this stopped me in my tracks, and my heart sank.
I started to think.
He was so, totally, absolutely, 100% right. If my little brother is doomed to become diabetic, wouldn’t it be better to know NOW instead of in 20 or 30 years? Yes. Yes, it totally would.
I started to think even harder. Here’s what I thought:
Fact 1: Type 2 diabetes starts with insulin resistance, which is, at least partially, genetic. Quite simply, your body stops being efficient about its use of insulin, and so your pancreas has to start squirting more insulin (a fat storage hormone) into your body, which makes you hyperinsulinemic (too much insulin in your body), which, in many cases, causes you to get chubbier and chubbier.
Fact 2: Over time (years and years), your pancreas gets so exhausted from all the extra work that it just can’t keep up.
Fact 3: Your pancreas becomes even weaker as your cells continue to become more insulin resistant, and finally your pancreas just can’t squirt out enough insulin anymore, and your pancreas starts to peter out, and at some point during this process, your blood sugar starts to go up and you become pre-diabetic or diabetic.
The next logical question in my thought process was this: Why isn’t everyone in the entire world getting tested for hyperinsulinemia on a regular basis? Because wouldn’t the presence of hyperinsulinemia be a pretty damned clear indicator that you have insulin resistance?
Yes. Yes it would.
As it turns out, there are a couple of pretty cheap blood tests that can diagnose hyperinsulinemia in a person who otherwise appears healthy.
I immediately got on the phone and called my good friend Ed, who is a family medicine practitioner in Phoenix, and is also a type 1 diabetic.
I asked him, “Why wouldn’t doctors just test everyone for hyperinsulinemia, which, in many cases would indicate early-on insulin resistance and then we could better predict and ultimately prevent type 2 diabetes?”
Ed said, “That’s an interesting idea, but I’m not sure we can guarantee positive outcomes by telling people they’re insulin resistant. We already have tests for pre-diabetes and metabolic syndrome, which are known precursors to diabetes. And, there’s no real compelling evidence that a metabolic syndrome or pre-diabetes diagnosis is going to cause someone to implement the life changes they need to implement to avoid becoming diabetic.”
[interjection: Ed agreed that the diagnoses of these diabetes precursors typically occur when a diabetes onset is imminently likely, or, in other words, these diagnoses typically occur at the tail end of the insulin resistance duration. You know. Once you’re already old and set in your ways].
Then Ed asked, “If an actual diagnosis of metabolic syndrome or pre-diabetes doesn’t result in a lower eventual diabetes diagnosis rate, then what good will come of an even earlier insulin resistance diagnosis?”
My friend Dr. Ed has a good point.
But I still wanted to believe that a clear early predictor of type 2 diabetes would cause a younger person to take steps to prevent the eventual diabetes diagnosis. Wouldn’t it?
Ed said, “We don’t actually know the answer to that, because there’s no data. That would have to be a really long and expensive study, spanning many decades.”
And then, I started doing more random thinking. And here’s what I randomly thought.
Fact 4: People get diagnosed with metabolic syndrome or prediabetes only after their pancreas has had years to slowly peter out from exhaustion.
Fact 5: Most medical professionals will tell you that your goals in preventing diabetes are to eat right and exercise while ensuring that your blood sugar stays in target range.
I’d like to pick apart these facts. First, I think, “eat right and exercise” is a fine thing to say, but I have two problems with this advice.
The first problem I have with this advice is the TIME at which we’re giving it. Once you have a prediabetes or metabolic syndrome diagnosis, it’s almost too late. You’ve probably already gained a bunch of weight over the years as a result of your insulin resistance, you probably feel like crap, you’ve probably spent years developing habits to compensate for how your body feels as a result of the insulin resistance and, essentially, the barriers to “eat right and exercise” are unbelievably high. If you say “eat right and exercise, because you are going to get diabetes” to a 65 year old with insulin resistance, this advice is likely going to be far less catalytic than if you were to tell a 35 year old the same thing.
The second problem I have with the common “diabetes prevention” advice is that it isn’t focusing on outcomes more specific than “not getting diabetes.” The outcomes that a hyperinsulinemic normoglycemic at-risk person should instead focus on are, in my opinion, these:
[Note: If you are type 1 and at risk of insulin resistance, don’t bother getting these tests and don't bother preserving pancreatic function. Just work on reducing insulin resistance.]
And certainly, “eating right and exercising” can contribute to both of these goals. But the “eat right and exercise” advice is nowhere near specific enough to actually help someone who wants to reduce insulin resistance and preserve pancreatic function! There’s also a whole bunch of other stuff (besides “eating right and exercising”) that you can do to reduce insulin resistance and preserve pancreatic function. And, there’s a bunch of stuff you can do to ruin your progress toward these goals. As a diabetic community, we aren’t giving at-risk people the tools they need to reduce insulin resistance and preserve pancreatic function (But I will! I promise! That’ll be another blog post!).
So, if you have a family member who is at risk of diabetes, telling them to “eat right and exercise” just isn’t likely to work. Here’s what to do instead:
What’s my point, here? I have several.
As it turns out, my brother is indeed hyperinsulinemic. But he’s also 34, so there are steps he can take NOW to reduce insulin resistance and preserve pancreatic function and potentially delay or even prevent a diabetes diagnosis. My next article will be for him and for everyone else who needs to do the same.
I’m sure he’s really excited to have his big sister boss him around and tell him what to do. It’ll be just like old times.
Our people are dying, senators. We must do something quickly.
Below are 60 of the 3,445 Google searches from the last month that resulted in traffic to my article about how to take matters into your own hands when you can't afford insulin.
It's reckless. It's dangerous. And unfortunately, it's necessary to prevent death due to lack of insulin.
Here's what more than one hundred people per day are searching for:
Please forward this to anyone who might be able to help.
If your family is anything like mine, you’ll have ample opportunity to completely skyrocket your blood sugar levels tomorrow.
When I was younger, here’s what my Thanksgiving Day experience looked like:
My family starts Thanksgiving day drinking mimosas and eating something luxurious like quiche with fruit while wearing our pajamas.
Then, after breakfast, we munch on the pre-thanksgiving appetizers.
There’s usually a cheese & cracker tray, a relish tray, cookies, at least three different kinds of chips, dip, salsa, pigs in a blanket, and, well, you know the drill.
By the time Thanksgiving dinner is ready, I’m usually too full to eat anything, but that doesn’t stop me from eating a full plate of food or two, after which I’m so exhausted and stuffed that I have to lay down and go to sleep.
An hour or two later, I wake up and eat some pie. And ice cream.
By this time, one of two things happens. Either my blood sugar goes extremely LOW because I took way too much insulin for all the food I ate, or, my blood sugar goes extremely HIGH because, even though I took the correct amount of insulin, the insulin just can’t catch up with all the food I’m eating.
Now, over the last few years, I’ve figured out how to protect my blood sugar from imminent annihilation by employing blood sugar stabilization techniques that I’ve compiled into my new Thanksgiving Survival Guide. These techniques will work whether you take insulin or not.
Photo credit: http://nerdywithchildren.com/wp-content/uploads/2012/11/banner1.jpg
ALERT (November 12, 2016): THIS POST HAS BEEN UPDATED TO:
1. REFLECT A RECENT ANNOUNCEMENT BY TRUMP
2. MORE THOROUGHLY DESCRIBE THE HISTORY AND POTENTIAL IMPACT OF USING HIGH RISK POOLS TO COVER PEOPLE WITH PRE-EXISTING CONDITIONS
Trump definitely wants insurance companies to cover pre-existing conditions. Someone is going to have to pay for it, and it might be you.
Today is Friday, November 11 and the sticky, sweaty shit storm of election dust has not yet settled, but, I’m going to chill the heck out for a few minutes here so that I can share what the reversal and replacement of Obamacare might mean for people with diabetes.
Despite the fact that Donald Trump has said that he wants to continue to cover people with pre-existing conditions, his policy makers, according to his website, have decided to make it extremely difficult for people with pre-existing conditions to get insurance coverage if they've had a gap in coverage. Here's what's on Trump's website as of November 11, 2016:
The Administration also will work with both Congress and the States to re-establish high-risk pools – a proven approach to ensuring access to health insurance coverage for individuals who have significant medical expenses and who have not maintained continuous coverage.
Now, the way this is written, to the untrained eye, it sounds kind of good, right? Sounds like Trumpcare is going to cover people with pre-existing conditions.
But, to the well-trained eye, this statement is a half-assed squirt of Febreze on a rug saturated with cat piss.
To be clear, as a policy, BootCamp for Betics doesn’t argue ideology or have political opinions except as it directly relates to people and communities affected by diabetes.
And boy, does this ever.
The imminent repeal and replacement of the ACA could affect your diabetes care and coverage in a very undesirable way. So listen up, folks.
The first thing I'm going to do is translate Trump's website's policy statement for you to make sure you understand what it really says:
The Administration also will work with both Congress and the States to re-establish high-risk pools. A high risk pool is a group of sick people who need more medical care than other, regular, healthy people, and these sick people cost insurance companies a lot of money. So, with the new Trumpcare plan, people with pre-existing conditions will be taken OUT of the regular group and put into a high risk group. This means that regular people who aren't sick can pay less for their insurance premiums, while people with pre-existing conditions will either have to pay for a private plan at a much higher rate than regular, healthy people OR that people with pre-existing conditions can apply for insurance through their state risk pool. - a proven approach to ensuring access to health insurance coverage for individuals who have significant medical expenses Sounds great, right? If you can't afford the jacked up private insurance rate for your pre-existing condition, just sign up through the high risk pool! Wait. Wait. Let's talk more about that. Risk pools, back in the day (before Obamacare), were largely run by the states and they operated at a loss. Funding came from various sources, some state, some federal. Often, there wasn't enough money in the high risk fund to subsidize everyone, so people with pre-existing conditions had to go on a waiting list. So, your ability under Trumpcare to procure an insurance plan from a state high risk pool may be limited depending on what state you live in, what type of care you need, and whether or not the state pool even has the money to subsidize you. This creates risk and uncertainty. The truth is, we have no idea exactly how Trumpcare plans to cover people with pre-existing conditions. and who have not maintained continuous coverage There just isn't a way to actually pay for pre-existing conditions for people who've had a gap in insurance. That's what's missing from Trump's plan.
Ok, let's move on.
The next thing I'd like to do is provide encouragement to our president-elect, and to congressional leaders, to continue to find a way to provide affordable, and not prohibitively expensive, healthcare coverage for people with diabetes (and for other sick people) as they work through the imminent reversal and replacement of Obamacare (or whatever Trump & congressional republicans decide to do).
Do you want to write your senator or representative? Scroll down to download and print my letter templates.
Finally, I'd like to help those of us with Diabetes hedge against insurance loss so that you don't get totally fucked. Read on, my friends.
Cool. Check your email soon for my guide to better blood sugars, along with a few other things.
Hi, I’m Kara. I’ve been type 1 diabetic since 1986. I’ve been attending diabetes camp since 1987. I’ve been a camper, a counselor, a staff director and training director at diabetes camps for the last 30 years. I have a regular day job as a technology consultant, and even though I like my day job, diabetes is my true passion. My late maternal grandmother had diabetes, and died from complications related thereto. Both of my grandfathers have diabetes, and so do my dad and my uncle. My little brother is hyperinsulinemic, which means that his pancreas is already overproducing insulin to counteract his body's insulin resistance. I hate diabetes! But guess what. Diabetics aren't doomed. There is a way to have diabetes and still live a long and healthful life, but, at times, it can be hard as hell. Like, really, really, insanely hard. But I’ve finally figured out how to lower my blood sugars and keep my A1C at a reasonable level. And it's not easy, and sometimes I screw up, but my method is totally workable for anyone who wants to fix their blood sugar, including you. And I want to share what I’ve learned with you, so that you can be healthy and feel better, too.