Month: May 2014

This is Type 1 diabetes, high and low blood sugars

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This was on Facebook. This is not my Dexcom, but it could be. What struck me is how so many of us are compelled to put our numbers up and share them looking for comfort, camaraderie and someone else who “gets it.” For when it comes to getting it, I believe much of the health care community is in denial. 

We cannot “control” blood sugars in people with diabetes who use insulin. That’s everyone with type 1 and some with type 2. But that frustrates health professionals; after all their job is to cure us, short of that to fix the problem – our up and down blood sugars. 

But that is the very nature of diabetes – fluctuating blood sugars. And even with 24/7 oversight, no matter how hard I work at it, trying to do what a normal functioning pancreas does, I fail. My brain simply cannot replace a normal functioning pancreas.

I wrote about this recently on The Huffington Post in “Type 1 Diabetes Fully Explained.” It went viral in hours. Hundreds of fellow Type 1s wrote to me saying how I had perfectly captured how impossible it is to perfectly control type 1 diabetes. 

It is time for us to agree that the norm of diabetes, intrinsically, its very nature is up and down blood sugars, especially for T1D and insulin-dependent T2s. 

It is time to accept this and stop trying to fight it and control it. I hate that word control. This doesn’t mean that we shouldn’t work at having blood sugars as often as possible in our target range, but let’s agree it’s hard and let’s agree we can’t be perfect at this and let’s sigh a collective sigh of relief. We deserve it.

Furthermore, creating goals is the wrong way to manage diabetes. Goals reinforce the idea that if we only work harder we can lick this beast. But we can’t. Goals reinforce that there is a perfect standard and we just aren’t working hard enough if we haven’t achieved it. 

Rather, what we should learn is what to do with our numbers in the moment, keep breathing, and have the knowledge and no self-blame to do it – and then smile because we did something good for ourselves.

Funny thing, but given that blood sugars fluctuate all day and all night, we are much better off to befriend our efforts, both strong and weak, and behead the doctor who tells us our numbers “should” be better.

I want people with diabetes to hear from their health professional:

“This is tough. You have a condition that requires a lot of work and vigilance. Some days you’ll do better than others. Don’t beat yourself up, instead do your best as often as you can and know that the very nature of diabetes is up and down blood sugars. You cannot do this perfectly because your body will be doing something unpredictable a good deal of the time. Just know this, accept this and keep breathing. I for one honor what you do living with this everyday.” 

Best diabetes blogs of 2014

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Every year Healthline, committed to providing health and medical information, tools,  technologies and doctor-reviewed resources to patients and providers, votes for the Best Diabetes Blogs.

I think I’ve been awarded this honor each of the past several years for this blog right here on DiabetesStories. 

My kudos to the fine and notable company I keep. All of these people and organizations are out there to help you, whether you have type 1 or 2, to learn, connect, commit to and improve your diabetes care. 

Here’s the list and a few sentences description of each – it’s a great group to follow.

Thank you Healthline.

“Fed Up” a movie about childhood obesity

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I have never been a fan of Katie Couric, particularly. But last night my husband and I saw her film,“Fed Up.” and appreciated how she is bringing to light childhood obesity. While everything I heard in the movie I already know, it was still great to hear it again. 

The plot of this documentary is the pure evil perpetrated on us by big food companies. Their mission is to make money for stockholders and they do it at the expense of our health. They push products out into the marketplace that are unhealthy but earn their shareholders megabucks. Featured in the film are the experts who have for decades alerted us to this situation includingGary Taubes, Dr. Robert Lustig, David Kessler and many others. 

The devil is sugar. We eat it by the bucketful and it is hiding in practically everything we eat.  While we know it in its natural form of table sugar, it’s also in bread, pasta, rice and hidden in foods like ketchup, yogurt, spaghetti sauce, Hot Pockets, Pop-Tarts, waffles and on and on, well, it’s just about everywhere, including the majority of our processed, refined food products. 

It’s truly a travesty and tragedy that the American government has sold itself out to the food lobbyists. How short-sighted is it that we allow people to eat foods that down the road will cost their health and their lives. And we will all be paying for their healthcare. The obesity rate has risen in parallel with the removal of fat from our food when we once thought fat was the culprit for obesity. But, you know, it is not. And, as everyone would like you to believe, “a calorie is a calorie,” it is not. Different foods work differently in our bodies. The biggest take away is unused sugar turns directly into fat in your body. A calorie in is not a calorie out. Start eating healthy fats and stop eating refined, processed food-like substances as Michael Pollan will tell you. 

The real tragedy is when you see what it is doing to our young people. When I went to school lunch in the cafeteria was homemade meals and my favorite, tuna fish sandwiches. Today, kids at school get 80% of their lunchtime food from fast food franchises – Pizza Hut, Taco Bell, McDonalds …they are truly up against it to find a healthy meal. Shame on the American government. 

Food manufacturers know the earlier they hook a child on their food, they will form a lifelong customer. Thus, TV commercials and characters like Ronald McDonald are marketed to kids. It is criminal what we allow food manufacturers to do and put in the marketplace. It is simply immoral. It is costing all our health. To live healthy in America you have to be extremely vigilant.

If you’re lucky enough to have an independent theater in your community, see the film. Then make a pledge to eat healthy – real foods. Stuff that doesn’t come from fast food restaurants or out of bags or cans. It’s not more expensive to buy a whole chicken and some vegetables to cook for dinner, than fast food chains would like you to believe. 

I’ve said it before: food is medicine. Eat healthy, feed your family healthy, real food and let’s not let the big food companies steal our health. This is our generation’s battle just as tobacco was the battle before us.

Help get Nagbot on his feet – a virtual caregiver from Lifebringer

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Herb Meehan lost his vision in one eye due to diabetes. “I was a TERRIBLE diabetic,” he wrote me. “I didn’t test regularly and when I lost my vision something inside me snapped.” Herb’s snap caused him to spend two years creating an intelligent software and voila Nagbot was born – an avatar buddy currently helping hundreds of people with diabetes. 

As Herb wrote, “I created Nagbot because way too many diabetics need encouragement to test regularly. I engineered this avatar into the application to be caring, like my wife, because not everyone has someone like that to help them.” This cute little avatar Nagbot reminds people to test, stores blood sugar and a1c results, gives positive reinforcement and as Herb says, is just bad ass. 

Below is some more info from Herb, including a bit of his story, and, Nagbot’s future is hanging in the balance on Herb’s Kickstarter campaign that you can be a part of. 

Message from Herb

My name is Herb Meehan. I’m a type 2 diabetic and the creator ofLifebringer, a free diabetes management tool available to anyone with an internet connection. 

Lifebringer is a web application that is at home on your computer, tablet, and mobile device. Lifebringer goes beyond simply storing data. It’s a diabetic journal, blood sugar test reminder system, test strip inventory manager, report viewer, and encourager. 

What makes Lifebringer unique is Nagbot. Think of Nagbot as your virtual caregiver. Nagbot helps you remember to test. Nagbot talks to you in plain English (no medical jargon used). And if your blood sugar is too low or too high, Nagbot suggests what you should do. If it’s within range, Nagbot happily encourages you to keep it up, as in keep checking. Nagbot also sends reminders and reports to you if you ask him to.

My Story

I was diagnosed back in 1999 and was on oral meds for the first few years. I eventually had to ditch the pills and go with insulin to manage my diabetes. It wasn’t enough though. A few years ago, I lost vision in one of my eyes due to complications with diabetes. Simply put, I didn’t do enough. After that event, I became the model diabetic. My wife and I began eating healthy, home-cooked meals, and I now test regularly.

Why we don’t like diabetic journals

Let’s face it – data entry sucks. One of the chores of using a diabetic log is that data input isn’t fun. Lifebringer is easy and streamlined. Lifebringer doesn’t just collect your blood sugar information but will also forecast your A1c (a snapshot of the last three months of your blood sugar control). Here’s a look:

We have turned to Kickstarter to fund this dream and we’re hoping to continue to help everyone else with diabetes.  Please take some time to meet Nagbot.  My wife, Maryam, and I would be incredibly grateful if you would and also share or tweet this news. 

Travelin’ Tips with Diabetes

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                                      At a garden in Tokyo with friends on a rainy day

Last week I received an email from the American Association of Diabetes Educators offering 8 travel tips, “Have Diabetes, Will Travel.” I thought I would post them.

I also asked AADE why there’s no mention of how to adjust your dose if you take a long-acting insulin like Lantus or Levemir. You’ll find that recommendation at the bottom after we had an email exchange.

Have Diabetes, Will Travel

No Reason You Can’t Enjoy Seeing the World – You Just Need to Plan Ahead 

Just because diabetes is your constant companion doesn’t mean you can’t enjoy traveling, whether traversing America in an RV or flying to the far reaches of the globe. Ensuring you stay healthy and keep your glucose levels on an even keel does require a little bit of organization and planning ahead, though.

The American Association of Diabetes Educators suggests a plan of attack for ensuring your next travel adventure is safe and successful.

1  Over-pack your medications – Gone for a week? Pack two weeks’ worth of your diabetes medications in case of travel delays or misplaced supplies (insulin, syringes, testing strips, extra batteries for your pump, a first-aid kit, glucagon emergency kit, etc.). If you use a pump, ask the company if you can bring a backup in case yours fails. Have a prescription from your doctor for insulin or oral medication in case of an emergency.

2  Protect your supplies – Keep your medications and supplies close at hand and don’t put them in checked luggage or in the trunk, where they can be exposed to harmful extreme temperatures (too hot or too cold). If you’re flying, keep them in the original packaging (so no one questions they’re yours) in a bag separate from your toiletries, as requested by the Transportation Security Administration (TSA), which manages airport security. Don’t worry, the TSA allows you to go over the 3.4 liquid-ounce carry-on limit for diabetes medications and supplies.

3  Identify yourself – Wear your medical bracelet or necklace that notes you have diabetes and take insulin (if you do). Bring a doctor’s note that explains you have diabetes and lists your medications, as well as a prescription in case you need more. Carry a health card that includes your emergency contact and doctor’s name and phone number. Learn how to say “I have diabetes,” “sugar,” and “orange juice, please” in the language of the country you are visiting.

4  Carry snacks and low blood sugar treatment  – Low blood sugar (hypoglycemia) can strike any time and food access during travel is unpredictable, so be sure to bring plenty of snacks such as peanut butter crackers, granola bars and  trail mix as well as glucose tablets or gel.

5  Simplify flying – Tell the TSA folks that you have diabetes (they’re used to accommodating people with health issues).  Visit http://www.tsa.gov/traveler-information/passengers-diabetesbefore your trip to learn about current screening policies. If you plan to inject insulin while flying, be forewarned – the pressurized air can make it more challenging to draw up your insulin, if using a vial and syringe, so be extra careful not to inject air into the bottle.

6  Test often – New foods, increased activity and different time zones can throw your glucose levels out of whack, so be sure to test frequently, including before and after meals. If you take insulin, keeping your levels steady can be tricky when changing time zones, so make a plan to adjust your schedule for injecting. Before your trip, see a diabetes educator, who can help you with this challenging process.

7  Favor your feet – Wear comfortable well-fitting shoes and socks at all times – never go barefoot.  Check your feet frequently, especially after a hike or long walk.  Feet and ankles often swell during flights so consider wearing light knee-high compression stockings (20-30 mm Hg) or bring thinner socks to change into if your feet swell.  Wear a shoe that can be loosened if that occurs. Pointing and flexing your ankles during a flight can improve blood flow in your calf muscles and decrease swelling as well as lower the risk of blood clots.

8  Prepare for a health emergency – If you need medical treatment, ask your hotel to recommend a local doctor who treats diabetes. Prior to an overseas trip, get a list of local English-speaking doctors through the International Association for Medica1172l Assistance to Travelers at http://www.iamat.org/.

The secret to any successful trip is to take plenty of time and plan far in advance of your departure – and that goes double when you have diabetes. For more information about how a diabetes educator can help you plan your next trip, visit http://www.diabeteseducator.org/.

Sources: Centers for Disease Control and Prevention (CDC), American Diabetes Association and Joslin Diabetes Clinic

Regarding adjusting your long-acting insulin dose from AADE: “There are adjustments that many people make but we would not recommend any specifics. It’s better to have your HCP guide you. Ask your HCP how to adjust your background insulin to account for the shortened day.

You may also want/need to do extra blood glucose checks during your trip for information as you make insulin adjustments, as well as to account for possible variations in food and physical activity while on your trip.”

I concur. I’d also add, if you’re an old hand and feel confident about adjusting your dose, do a little experimenting. First, use your common sense. Second, keep checking:

If your day is going to be shortened, for instance, by 6 hours, take 1/4 less your normal dose. If your day is going to be lengthened by 6 hours, add an extra quarter. I take that extra quarter before I go to sleep after I’ve arrived somewhere because I take my Lantus at 9 AM. Then I start my usual dose again when 9 AM rolls around wherever I am. And yep, keep checking!

That’s what I do but in all things diabetes what works for me may not be right for you. Mind you, I only take 8 units of Lantus a day and I’m insulin-sensitive rather than insulin-resistant.