Remedying blood sugar always trumps intermittent fasting and keto



I was recently talking with a friend who was bemoaning the fact that she hates it when she has to break her nighttime or morning fast to treat a low blood sugar. So do I. And just these past two nights I’ve had to do it. I was around 78 mg/dl at 11 PM both Tuesday and Wednesday nights. I waited and watched my CGM til midnight, but no movement. Drat! I have to get up now and eat something, double drat!

Of course I hate it when I have to eat and I don’t want to. I’m not hungry and all I can see is the extra calories I wouldn’t eat if I didn’t have to raise my blood sugar.

Now that many of us are doing very low carb diets, keto or intermittent fasting, there’s even more chance your blood sugar may go low and you’ll have to remedy it with sugar.

I have to accept that’s diabetes and that’s just how it is. Getting blood sugar in a safe place, ESPECIALLY BEFORE GOING TO BED, ALWAYS TRUMPS maintaining your particular style of eating. We just have to not worry about those calories. They’re not much and if they’re worrisome you can eat a tiny bit less the next day.

Of course if this is a daily or nightly event for you, then it’s time to readjust what could be off. Did you take too much insulin? Did you exercise? Are you sick? Did your neighbors paint their house pink? You get it, there are so many variables at times you’ll have no idea.

But I think the reason I’ve been going too low at night this week is, even after 47 years with type 1 diabetes, I periodically, habitually forget that I am extremely sensitive to the action of insulin in the evening. So while it might take me 1 unit to cover a prune in the morning, it will take 1/2 unit at night or even less.

Then there’s also the, geez, how’d that happen? Tuesday night I treated my low with a prune which should have raised me 20 points. I ended up going up 60! Wednesday night I warmed 1/4 cup of almond milk and stirred in a teaspoon of honey. The results the next morning were a satisfying 95.  Suffice to say, you won’t always win this game either.

But that extra prune or peach or spoonful of honey or two glucose tabs is not going to turn you into a glutton or gorilla or put on 20 pounds. And you can always eat a wee bit less the next day. But not waking up in the morning, now that’s something I’m never, and you should never, be willing to risk, as best you can.


New nasal glucagon spray approved by FDA




Baqsimi, (yes, where do they get these names from?) has just gotten FDA approval and that’s great news. Great news. Now, for the first time ever, there will be a fairly easy solution for a severe low.



Baqsimi is glucagon in nasal powder form, delivered in a puff through a nasal spray bottle. No difficulty mixing up dry and wet ingredients like today’s glucagon, much reduced nervousness from the person who is going to spray this in your nose as opposed to stick a needle in your body.

It’s supposed to be on the market in retail pharmacies in a month. Eligible commercially insured people with diabetes can pay as little as $25 for up to two BAQSIMI devices (1 two-pack or 2 one-packs) if you use the savings card. That’s all I know about the pricing. I don’t know if Medicare will cover it but I do intend to find out. And I don’t know if it only has a one year shelf life. If anyone does know, please do tell.

Baqsimi is being brought to market by Eli Lilly after acquiring Locemia, the small start up that began work on the product four years ago. At the time I was helping with the copy and branding. So I am personally delighted to see this product green lighted.

For more information.


Congress takes action on soaring price of insulin

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Two emails popped into my inbox pretty much within minutes. This was the first from the American Diabetes Association. This gives me a bit of hope we will see insulin prices come down. The second email was from JDRF making the same announcement. It’s very rewarding when you see the advocacy organizations that represent you really in there for the fight. Of course, if you were part of the fight, maybe writing your congress person, pat yourself on the back too. (Since below is a screen shot, the links aren’t live but you can google the appropriate web sites.)

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Be careful of extreme temps. They ruin your insulin.


Just a gentle reminder that in these dog days of summer, it’s in the high 90’s in New York and tomorrow will be 100 F, insulin can go bad. The same is true if insulin freezes.

You can see above that I keep my two insulins, Fiasp on the left and Tresiba on the right, in separate vessels. Given how much the pens resemble each other, separating them helps. I also store them upside down so I can see the color difference that also helps distinguish them.

However, I don’t normally keep these containers where you see them. Normally they’re on my kitchen counter. But since I spent the better part of today baking – keto rolls and biscotti – I realized my insulin pens would stay cooler in the living room where they’d also be nearer the air conditioner. So, that’s where they are, and where they’ll stay until this heat wave breaks.

If you’re curious, the little blue and white houses behind them are ceramic gifts you get flying business class on KLM. They contain Geneva, a Dutch gin. Given the husband has flown back and forth to Holland on business the past 17 years, although he normally flies coach, we still have managed to erect a small town ;-). I can’t tell you about the gin however as we’ve never opened one.


The first 24 hours of the Dexcom G6 are different than the G5


Dexcom G6 CGM. From left to right: inserter, receiver, transmitter in sensor pod, iPhone app, apple watch.

The G6 is not new, it’s just the latest iteration of Dexcom’s continuous glucose monitor. There are lots of reviews online about how people like it. Basically, it’s an upgrade and the big advantage cited is it doesn’t require calibration. However, I still find I can’t let go of checking it against my meter now and then, and sometimes it needs to be calibrated. I was told by a Dexcom rep to do so if there’s more than a 30% discrepancy.

Other than that, for me, the G6 pluses are not terribly significant – yes the sensor and transmitter make a slimmer and sleeker package, the sensor is easier to insert, but that humongous insertion device pains me to discard. It’s got a predictive alert which I like – it warns you at 70 mg/dl that in 20 minutes you’ll be 55 mg/dl, but I don’t care for the pastel colored screen (I only use my iPhone to see my readings).I wonder if that is to keep us calm looking at our numbers?

Three times last week I had to call customer service and get Dexcom to send me a replacement sensor, which they do without argument. First, I bled under the sensor pod, likely due to a too heavy-handed insertion, and the sensor stopped working. I’ve forgotten why I needed to replace the second sensor, but why I had to replace the third sensor came as a complete surprise. With the G5 you can put the sensor on and wait a day before you activate it. If your first day numbers are not accurate, as mine never were, letting the sensor sit on your body for a day before you start a new session helps. When you activate it, its had some time to read its new environment, you, and it’s more accurate. This way you don’t waste the first day of use.

So, I did the same thing with my G6 sensor. I put it on and didn’t “start new session” until the next morning, when it told me I could not reuse my sensor and needed to put on a new one. Of course I’d not activated it, it had only been on my body a day. But when I called Dexcom to ask about this, I was told as soon as you put the G6 sensor on your body it starts starting up, even though you haven’t clicked “start new session.”

So, a tip to the wise – if you’ve done this with your G5 you cannot do it with a G6. If you use the G5 and never heard of this tip, it’s a smart move if for you your first 24 hour readings are not trustworthy.

American Diabetes Association conference 2019 highlights

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The ADA conference, the largest scientific U.S. diabetes conference, took place last week in San Francisco. I wasn’t there but diaTribe and DiabetesMine, run by Kelly Close and Amy Tenderich respectively, were. They posted highlights from the event that I followed and now share with you. The recaps cover new technology, trials and medicines.

DiaTribe – “The Biggest News in Diabetes Technology, Drugs, and Nutrition: Highlights from ADA 2019”

DiabetesMine Healthline – “What’s new in Diabetes Research”

The joys of yogurt as part of keto

After years of avoiding dairy, I think only because everyone seemed to be and we always heard how fattening it was, cheese and yogurt have come zooming back into my life. Eating Keto, these higher fat foods are back on the menu, and I’m loving them. So it was with some nostalgia I read Catherine Newman’s article in this week’s diaTribe about yogurt.

Yes, I well remember the days when Dannon was the only yogurt on the shelf. I even remember when I worked for a few months during college at my neighborhood Waldbaums as a supermarket cashier, I was privy to grabbing a yogurt out of the refrigerator section for my lunch break. Dannon cherry and coffee were always in my hands.

These days I only eat plain, whole milk yogurt. I want the fuller fat and don’t want the extra carbs. It’s part of eating keto and delicious. I’m enjoying various brands including Brown Cow (very fresh with cream on top) Fage 5% (thick Greek yogurt with more fat than their other yogurts), Icelandic Provisions (thick, thick, thick) and my latest pick up, Organic Valley Grassmilk. Also cream on top and 100% from grass fed cows. It’s produced by a consortium of farmers in Wisconsin whose mission is to create healthy products. I have learned, from a little investigation, that when a label says “Grassfed” the cows are not necessarily only eating grass, they can be ruminating on grass and being fed grain back in the feedlot.


Whatever your preference, today there are so many different yogurts to try and each has its own uniqueness. Eating keto, I’m especially grateful full fat products like whole milk yogurt is available. When the husband first came over to live here from Holland almost twenty years ago he couldn’t believe everything in the supermarket was low fat.

As Newman says in her article, check the carb count on any yogurt you pick up, and you’re better off adding your own toppings than getting yogurt with fruit and add-ons already in it.

My simple yogurt bowl is a few heaping spoonfuls of yogurt with tahini and almond butter. When I want more of a cereal concoction, I add flax and chia seeds, roasted nuts, coconut flakes, salt, stevia, cinnamon, tahini and almond milk.

And like Jerry Steinfeld, there are many days I’d rather eat this breakfast cereal for dinner than dinner. 😉


The absolute joy of eating a sandwich!

Mock me not. I cannot tell you the absolute joy eating something, anything between two slices of bread has brought me. No, I’m not crazy, I’m a person with type 1 diabetes who has been happily eating low carb for at least a decade. That means I don’t eat bread. Well, hardly ever. Perhaps only if I’m out to dinner and the waiter brings killer bread to the table.

Even when I found this Keto bread recipe (uses almond flour rather than white or wheat flour for minimal carbs) I didn’t fashion it into a sandwich. A sandwich was such a dreamlike remote memory to me. Instead I would toast half a keto roll and have the single slice with my lunchtime soup. It sat on the rim of the bowl sad and alone.

No, I would not make myself a sandwich, not even when I made it for the husband. Somehow I just couldn’t make the leap that I can eat this bread in sandwich form, until one day last week I did. And now the simple, humble two-slice, not Danish open-face, sandwich is back on my menu. Now that’s worth celebrating, maybe with a glass of wine 😉


Should you be curious today’s filling is melted Swiss Raclette cheese, artichoke, avocado and pesto with a side of half sour pickle.

Diabetes education program for mental health professionals


carousel-ada-apa-diabetes_tcm7-217577.jpgIf you’re a mental health professional interested in better understanding the emotional impact of diabetes, and being better skilled at working with people who have diabetes, you can take a two part course to do so and earn credit.

The American Diabetes Association (ADA) and American Psychological Association (APA) have partnered to offer up to 12.0 CEUs for licensed mental health professionals interested in providing mental health care to people with diabetes.

The program takes place in two parts – a 7-hour in person program followed by a 5-hour online course. The upcoming sessions for this year take place in San Francisco at the ADA 79th Annual Scientific Sessions and in Chicago at the APA Annual Convention.

The cost of the program is $300. It includes the live program (7 CE), the online program (5 CE), listing in the directory and 1 year membership to the American Diabetes Association. Credit from the American Psychological Association and the National Association of Social Workers is provided through the American Diabetes Association.

ADA hopes to expand the amount of providers who can help people with diabetes manage the emotional weight of living with diabetes by understanding how diabetes affects mental health, not just the everyday tasks of managing blood sugar.

For any questions, please contact ADA staff at