Hey everyone! Happy Saturday! Welcome once again to our weekly advice column, Ask D’Mine, with your host Wil Dubois veteran type 1, author and clinical diabetes educator. Today Wil’s tackling sources of quick-acting carbs in case of lows, and whether a certain (acne!) medication is connected to causing diabetes. Great questions, all!
{Need help navigating life with diabetes? Email your questions to AskDMine@diabetesmine.com}
Larry, type 3 from Virginia, writes: My type 1 daughter is 14 years old and an excellent tennis player. Yesterday she was in a very strenuous match which lasted over 2 hours. In anticipation of the match, one hour before she reduced her basal 50% and consumed some complex carbs. Thirty minutes before she suspended her basal completely. She started the match with BG at 185 but it quickly dived into the low 60’s. This was a USTA match, so the changeovers are timed and she has to check her blood and consume as many carbs that she can in a very limited amount of time. During the match, she consumed 4 bottles of Gatorade and about 12 tabs of glucose which amounted to approximately 160 grams of carbs. Her BG’s stayed in the 60 – 75 area throughout the match. Toward the end she felt bloated by the amount of Gatorade that she had consumed and it certainly impacted her play in the last game. Any comments about managing BG in athletic events would be appreciated, but my specific question revolves around what would be a better source for a high amount of carbs which could be consumed quickly and easily during changeovers?
Wil@Ask D’Mine answers: Short answer to a long question: Dex4 fluid. Why? Because it has 16 grams of very, very, very fast-acting sugar in only two ounces of liquid. Gatorade, by comparison, has less than 2 carbs per ounce. So for getting a lot of sugar into her young hide with a minimum of bloating, the Dex would be the way to go. (Now of course, some Gatorade for the electrolytes is probably a good idea, but not four bottles worth.)
As for how you handle
d her pump and complex carbs, I think you did great, so I’ve got nothing to add to that.
Now, I’m feeling the need for a bit of a disclaimer here because I’ve recommended Dex stuff before. Once or twice. But, I’m not on their payroll. I’m not a stock holder. In fact, I think the damn stuff is a little pricey. I spend way too much of my limited disposable income on Dex4 products each month as my frickin’ insurance company won’t cover glucose products. Apparently, it’s not a necessary medical expense.
But I love the stuff. It works and it’s saved my ass more times than I can count. It’s portable, fast, and effective. And most importantly, it keeps me from overdoing it. If I were using some tasty candy I’d eat five times too much, have a rebound excursion, plus all the unneeded calories would make me fat. (Frequent lows can = bigger waistline.)
Oh. One little tip before the first serve: Make sure you have the little Dex4 bottles open for your daughter in advance. Otherwise getting the tricky seals off the top of the bottle will use up her whole changeover!
Michelle, type 3 from Massachusetts, writes: I appreciate your weekly column and look forward to learning more each time I read. I’ve been with my fiancé for 3-1/2 years now (we will be getting married next year) and he is a very “keep to himself T1” so it’s hard for me to ask him questions and get anything more than a rushed answer or just have the subject changed. He was diagnosed his senior year of high school and blames Accutane for getting diabetes. Since we’ve started dating I’ve done a lot of research, but really only found one article that briefly mentioned that Accutane could impact blood sugar. Do you think that Accutane could be to blame, or could there be more to the story? Thanks again.
Wil@Ask D’Mine answers: Not to blame, no way. Part of the story? Perhaps. But no more than a brief prologue or maybe a foreword from an outsider. But just so everyone’s in the loop, Accutane is an acne drug. Well not just any acne drug. Sort of a drug of last resort when all else has failed. It’s powerful stuff with a host of side effects.
According to the prescribing information sheet there’s a “high risk” that the med can cause miscarriage, still-birth, or birth defects. It can mess with your head, causing depression or psychosis in some people. And suicidal behavior. It can dry out your eyes and rob you of night vision. It can make your skin hyper-sensitive to the sun. Make you more prone to scarring. It can screw up your bones, sometimes making them weak, and other times making them abnormally thick. It can cause nosebleeds, change the color of your skin, slow down healing of wounds, raise your triglycerides, and create unwanted hair growth. It can trigger pancreatitis. Frankly, it’s one hell of a scary-sounding drug. No wonder your guy blames his diabetes on it.
And hidden in practically the last line of this long litany of terrifying side effects is the off-hand comment that “some patients receiving Accutane have experienced problems in the control of their blood sugar. In addition, new cases of diabetes have been diagnosed during Accutane therapy, although no causal relationship has been established.”
So there you have it. Straight from the Accutane horse’s mouth. It can cause blood sugar problems. And it has been associated with new diagnoses of diabetes. But does that mean it caused his diabetes?
That’s the 64-million-dollar question, isn’t it?
First, consider that Accutane has been prescribed to over 13 million people (the name brand, made by Roche, was pulled from the U.S. market in 2009 under the weight of over 5,000 personal injury lawsuits, but generics still remain available). And there’s what? Around 3 million type 1s? If Accutane were a primary cause of type 1 diabetes, I’d expect there’d be a hell of a lot more of us!
Given the wide-ranging side effects of this med, one has to wonder if there’s anything that it doesn’t cause. But the key thing to consider here is that we really have no clue what causes type 1 in the first place. So that makes it kind of hard to know with any degree of certainty what hand Accutane did, or didn’t, have in your guy’s diagnosis.
Here’s all we really know for sure: in those of us with type 1, the body’s immune system goes bonkers and attacks the home team. Our immune system gobbles up our insulin-producing beta cells like they were M&Ms.
And that’s about all we know. Period.
Why does it happen? What’s the trigger? No one knows. Some people think a virus. Some people think environmental pollution. At least one guy believes it’s the Accutane he took for his acne in high school. But it could just as easily be contamination from aluminum in TV dinner trays, preservatives in foods, holes in the ozone layer, global warming, or sunspots. Who the hell knows? I spent almost 30 years working in photographic darkrooms and laboratories and have sometimes wondered if all those toxic chemicals we carelessly dipped our hands into played a part in my health destiny.
But I know a lot of ex-lab people (no more labs, everything went digital) and none of them have diabetes. Still… did the photo chemicals play a role? Even for just a few people like me? Maybe.
But so what?
I’m sure I’ll get flamed for this, but I believe that for individuals the cause of our diabetes is meaningless. Hey. We got it now. Time to put on our big boy and big girl pants and deal with it. Now, for the greater good of all the yet-to-get-it folks, I do think science needs to figure this out so we can prevent future cases. The fifth generation to survive since the discovery of insulin is developing type 1 every day. It would be nice if there wasn’t a sixth generation.
But for me, figuring out if there is one cause of type 1 or 100,000 causes—and figuring out what caused mine—really doesn’t matter. It won’t reset the clock. It won’t change what happened to me. I think that spending too much time on “why did this happen” is unhealthy. It’s counter-productive. An energy suck. Best to move on.
Controlling… well, ha! Trying to control my diabetes takes all the energy I’ve got to spare. Worrying about how I got here?
I don’t have the oomph for that.
Disclaimer: This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.
I haven’t purchased the Dex4 glucose shots because they are way too expensive, in my opinion, to use regularly. Shockingly expensive.
There is a new product on the market which is cheaper and may work just as well. Level Life is a 15 carb glucose gel that is in a tiny pouch that you tear open (maybe easier than the Dex4 shots?).
I met the founder of the company Ethan while at Friends For Life and he was very enthusiastic, not to mention incredibly nice!!
And as a side note, if you use a flexible spending account ask if you can use it for quick acting glucose. They might approve it, but you’ll need a prescription and receipts. If you are going through a ton of it, like your athletic daughter is, it might be worth the extra paperwork for the tax savings.
I use Dex4 tablets a lot but those liquids are so overpriced that I can’t see how anyone can afford to use them regularly.
I carry honey around in several refillable “leak-proof” bottles that are sold for bringing shampoo with you on an airplane. Refill them as I need from a big bottle of honey, and have one in each bag that I carry around. If you are very active and try to keep your BG in control, you’ll probably need to take a swig of quick carb several times a week if not more often….and it’s easy to get used to measuring the amount in one “gulp”
also easy not to overdo it, honey is so concentrated and sickly sweet that it’s one form of sugar I never find tempting to snack on.
Hope this helps
For sporting events, energy gels like Clif Shot can give a very fast boost. Each package typically has 25 g carbs and can be downed very quickly. I’ll take a swig of water to help wash it down. If you buy in bulk they are about $1 each but they are portable, very easy to open and more palatable than some of the glucose tabs/drinks (to me anyway). They also make solid gel-like blocks with 8g carbs each.
I’m concerned that your daughter NEEDED 160 g. Try minimizing carbs at meals prior to the match. A long tail on a bolus is probably pulling her down. For example, for an after school match, eat a nice normal carb breakfast, but a low or no carb lunch…
Yes, if your daughter needed 160 grams to cover, there is definitely an issue with insulin dosing.
I would want to see her being somewhat stable so she knows she has to take about 5 grams of carbs every 15 minutes during an activity. So, she would pop a dex 4 tablet every 10 to 15 minutes based upon her output of activity.
No doubt, this is a difficult thing to manage. You have to compensate for the long acting insulin. In addition, if you take fast acting insulin, that insulin becomes so much more active during the activity.
For example, when I run 5 miles with some intervals, where this activity lasts 1 hour, I just drink coconut water (which as 15 grams of carbs and all the electrolytes I need). This usually covers me so I do not have to take 5 grams every 15 minutes.
But I will add, if I have taken fast acting insulin in the 2 hours before the activity, things become hard to predict because the insulin becomes so active.
What I have learned is that I try not to do any activity at least 2 hours after I have taken my apidra.
Managing blood sugar during exercise is the most challenging job around. It is extremely difficult.
But 160 grams of carbs to cover anything means too much insulin as front loaded leaving with you having to play catch up. In addition, those 160 grams of carbs are really just wasted calories.
Thanks Will for the Dex4fluid tip. Definitely worth carrying in the pocketbook for those whooper low blood sugars that we never know when they are coming!
I agree with the others that 160 g of carbs is a lot of carb loading.
When I trained in boxing and mma (I’m type 1, have been since I was 7, on short and long acting insulins) I used to chug a blended juice– Naked or Odwalla- before the 2 hour trainings. About 45-60 g carbs. I rarely had to have more than another 10-15 g half way through.
Two things factor in that haven’t been mentioned: the amount of training/exercise the day before (thigh muscles suck up carbs for up to 18 hours post exercise) and time of the month. Hormones can also affect (understatement!) blood sugars.
I, too, came down with diabetes (type 1) while on Accutane. I don’t know how you can state “Not to blame, no way”. That’s pretty definitive and I wonder how you can possibly be so confident of this.
We use the
Oops, hit the return button too fast:) We use the 100% juice boxes. Average carbs are 23-25 grams per box. Easy to carry, measured and quick. Down side may be the 100 calories per box, but those are easily burned.
I took Accutane in my 30′s and became type 1 diabetic. hmmm…. Research Retnoids/Retinol/13-cis-retnoic acid! It’s a Chemotherapy drug for rare cancers it’s pure poison!