Diabetes Mine - the all things diabetes blog

Preparing for the Worst

When it comes to natural disasters and other potential crises, diabetes makes me feel frighteningly vulnerable.  I mentioned before that the images of Katrina had me clacking my teeth, as I wondered how I might stay alive sans fresh insulin in the event of being stranded.  "Really quite my nightmare..." 

Well, that hasn't changed a bit.  And now this recent disturbing report from CNN could put any diabetic over the edge to paranoia: "an influential group of physicians has drafted a grimly specific list of recommendations for which patients wouldn't be treated."  The list includes, quite prominently, "those with a severe chronic disease, such as advanced heart failure, lung disease or poorly controlled diabetes."

Kassie was one of the first to point this out to the OC. And Michelle K over at Blogabetes was one of the first to ask, "Who's to say what exactly consitutes 'poorly controlled'?"  Is it enough, in the event of an emergency, for the doctor to know that you have diabetes in order to deem you un-save-worthy?  Or is it only those with an A1c over 7?  (Who's admitting to that in the midst of a flood or hurricane?)  Or anyone already experiencing any kind of complications?  What if you're sick as a consequence of the disaster at hand, and your sugars are out of control?  Does that render you not worthy?

The bottom line is, we don't want to wait to find out. My husband and I have this frontier-mentality (do-it-yourself-or-don't-do-it) friend who lives nearby, whose been bugging us for the longest time about getting our home disaster-ready.  In our neck of the woods, that mainly means Earthquake preparedness.  But no matter. A disaster is a disaster. 

So now our backyard shed is full up with canned turkey, bottled water, camping tools and paper towels.  And most importantly, in the outdoor fridge: my Diabetes Survival Kit, which my husband and Frontier Guy absolutely insisted on.  Yes, I know, the fridge will be of no use in the event of an emergency; it's just keeping my insulin cool until then.

The contents of this pack so far are as follows:

2 vials of Lantus insulin

1 pack of 4 NovoLog pen cartridges

1 Novo Nordisk Junior insulin pen device

1 pack of 10 sterile syringes

1 baggie full of about 45 pen needles

1 OneTouch Ultra 2 meter with lancing device & quick start guide

3 vials of 25 test strips each (see, now that IS a problem - there should be MORE in each vial)

3 packs of 10 Glucose Tablets (grape, raspberry and orange)

Enough to keep me alive for about two months I guess -- without being able to test too often, and depending on how warm the weather gets, of course.  Better than nothing, but I'm still feeling vulnerable.

Anybody have any solid D-disaster-prep advice they'd like to share?

Suddenly Celiac

Back in 2003, when I was diagnosed, nobody seemed to know anything much about the connection between Type 1 diabetes and celiac disease.  Or at least it wasn't mainstream, certainly not for my doctors at the time.  Celiac is of course and intolerance to gluten, a composite of proteins contained in wheat, rye and barley.  Having it therefore means eating no foods that contain those grains.  Picture that!

But my point was that suddenly, I seem to see the topic of diabetes & celiac popping up all over.  I was amazed to find an article in this month's edition of Diabetes Forecast, called "A Tricky Diagnosis: Why You Should Learn About Celiac Disease" that explains the classic and atypical versions of this disorder:

* Classic = nasty gastrointestinal (GI) problems when you eat gluten

* Atypical = mild or no GI symptoms, but a skin rash (dermatitis herpatiformis - yikes) that can appear on your face, elbows, knees or tush

The article notes that the latter may in fact be the more common presentation. And they cleverly note: "Because grains find their way into all kinds of products, always read labels on foods, over-the-counter medicines, and supplements. Ask your doctor about the ingredients in prescribed medicines."

Well yes, I had to learn all of this the hard way.  Like when we stopped at the drug store for some allergy pills, and later my lip swelled up like a ubangi.  That was a nice look at Disneyland, I'll tell you.

If you are in this boat, see this nice new Boston Globe piece about how to find gluten-free products. If you're in Europe, it might cheer you to know that a new 2,230-meter factory has just been opened in Wales to pump out gluten-free goods.  In Seattle, "Gluten-Free Girl" Shauna James is doing great things with rice and corn pastas. Personally, I prefer Quinoa. It's not so heavy and dry.  But if you happen to have diabetes as well as celiac, you will REALLY want to watch the pasta, anyway; it's carb-noxious.

Here's a list of research on the connection between celiac and diabetes, including one study indicating that the disorder was discovered in 12.3% of children with Type 1 diabetes.  New research on "the double life of proteins" may help scientists understand this all better.

Meanwhile, you are not alone.  Mark your calendar for May 28, when DiabetesTalkFest will be hosting a chat with Catherine Oddenino, editor of "A Gluten-Free Guide."  This woman knows what she's talking about, because she's not only an expert in gluten-free gourmet, but she also manages her Type 1 diabetes with an insulin pump.

Tarpal Cunnel Syndrome - Ouch

No, that's not my cat walking on the keyboard again, typing crazy things (although she does that often).  It's me.  My carpal tunnel syndrome is acting up again, and I'm hating it.  Who would have thought a little cramping in your forearms could be so bad?

Even though I've spent most of my adult life typing like a maniac, I didn't actually get carpal tunnel until my 3rd pregnancy (when everything just seemed to fall apart).  In fact, I found out I was pregnant after going to the doctor complaining of severe pain and cramping in my wrists and hands.  I'd wake up over and over in the night with my hands so numb that I thought they were going paralyzed.  Once, we called my physician father-in-law in Germany at 2am California time to ask for help.  He thought it might have to do with funky way I was propping myself up on pillows at night (?), or maybe it was hormonal.  Bingo! No. 2 turned out to be the trick.

It's pretty common knowledge now that carpal tunnel is associated with pregnancy.  I was given lots of handouts on the topic.  But here's the bummer: after baby came, my carpal tunnel didn't go away.  It got so bad, in fact, that for a while I was wearing splints on both hands and taking 800mg tablets of Ibuprofen several times a day.  I was so desperate, I dragged all three of my kids along to the orthopedist for help. 

"Did anything change recently, other than having the baby?" he asked. 

"Well I was diagnosed with Type 1 diabetes a few months ago, but it can't be related to that, can it?"

"Everything's related to the diabetes," he replied. 

Aaargh!

Sure enough: "Most studies now strongly suggest that carpal tunnel syndrome is primarily associated with medical or physical conditions, such as diabetes, osteoarthritis, hypothyroidism, and rheumatoid arthritis."

And it's a bitch (if you'll excuse the expression).  I never imagined how painful or disabilitating it can be. At its worst, I could literally not make toast for my kids in the morning, let alone help them button their sweaters. I could barely hold my blow drier up straight, and was wiped out from being up all night with the pain.

I happen to know that the editor of Diabetes Health magazine, Scott King, suffers from a severe case of carpal tunnel himself.  He was diagnosed 10 years ago, and just underwent arthroscopic surgery in both hands on February 5th. (Those are his hands in the photo above.)  I know many people are leery of "going under the knife," because these procedures aren't always successful.  But it seems Scott's was a great success. He writes to me, in shorthand:

"I have only one little hole in both wrists, almost healed now
but scars are still sensitive
and i can TYPE gain with no pain!

that was the worst part

after the surgery

hands hurt horrible for the 1st 2 days

(they should have given me better pain drugs, as I was in so much pain, i had to chew up 3 vicadins just to get some relief)

but by 1 week i was flying out on a business trip, everything was great!

I DO WISH I had the surgery earlier

as i still have tingling in my left hand, damage to the nerve"

In case you're hit with this malady as well, Scott shares a few related articles from his publication to check out:

"Diabetes Masks Signs of Carpal Tunnel Syndrome", July 2002.

"The Canary In My Coal Mine", February 1996.

"Carpal Tunnel: Readers Respond In Droves", January 1996.

"It All Started With Tingling Fingers", November 1995.

Anybody else out there suffering with carpal tunnel?  What have you done about it, if anything?  Sure makes it hard to test your glucose, no?

Filling Your Glass

A lot of people write to me explaining how they sometimes feel so blindingly angry about having diabetes.  They're just pissed off, and I can't blame them.  Living with this thing is inconvenient and aggravating, to say the very least.

So I spent some time recently taking stock of what helps me the most when I just get down and out.  There are lots small things that help the diabetes seem less daunting, and if you add them up, the sum can be greater than the parts -- if only you're willing to take a "glass half-full" look at your life.

Check out this month's Straight Up column over at dLife for my personal list of 9 Things that Help the Most.  This includes everything from my favorite BG testing devices to carb counting aids to where to find a good laugh (required).

I noticed there's a new meme going around about "Five Things You Won't Find in a Book." I'd wager to say you won't any of my "9 favorite little diabetes helpers" in any book either (not even ours).

Really: we all know that the best D-advice we ever got wasn't from some book or institution, but mainly from each other.  So have a look my column, and take a minute to jot down a half-dozen things that help YOU when you're diabetes is really getting to you.  I'd love to see us all share some great lists.

btw, the one thing I forgot to mention was the magical power of music to energize and soothe.  Somewhere in the back annals of my iPod I just rediscovered Freddie Mercury's Miracle and These Are the Days of Our Lives, and Beth Hirsch's You Make It Easy, for example. 

Those help.  And you won't find that in a book.

Life Without Email? Wassup, Doc?

So a diabetic walks into an endo's office and says, "Hey Doc, can I get your email address in case I have any follow-up questions?"  And the doctor replies, "Sorry, we do medicine, not email."

I made that up myself.  No, really... I did.

But don't laugh too hard.  There is actual proof now that doctors who are willing to email with their patients are a rare breed indeed.  I'm very lucky to have found one -- well, a few actually -- here in the tech-savvy SF Bay Area who were willing to take the plunge.  Why isn't email contact with your healthcare provider more common across the country, what with it being so darn convenient, and let's face it, pretty much the lifeblood of the business world these days?  In many ways, email functions as our portal to the world, no?

What's standing in the way is primarily fear, apparently. Fear of being overwhelmed by yet one more responsibility, of not being reimbursed for time spent answering emails, of patient privacy concerns, and of course, of legal liability if patients are unhappy with email interaction, or if anything said there should result in negative health consequences.  Fair enough.  Those are legitimate concerns.

But electronic communication is now a fact of life. It's used for virtually ever other aspect of commerce in this country.  "People are able to file their taxes online, buy and sell household goods, and manage their financial accounts," says Susannah Fox of the Pew Internet & American Life Project. "The health care industry seems to be lagging behind other industries."  Ya think?

But doctors will continue to resist as long as they have no support on the concerns mentioned above.  So once again, all arrows seem to point back to the need to reform our healthcare system, in this case to address and support the way people interact in this century.

Oddly enough, the pharma industry hasn't wasted too much time finding ways to use email to reach out to doctors -- bombarding them with "ePromotions," and more recently, electronic drug alerts.  Meanwhile experts have been touting the benefits of email to the physician-patient relationship since the year 2000 at least.  But doctors are still holding back, for all the practical reasons mentioned (read the comments on that post).

According to this story ("It's no LOL"): "It's not the first time the medical field has been slow to embrace technology. When the first telephones became widely available in the late 1800s, doctors were concerned about being swamped with calls."  But the medical establishment is expected to come around on the email issue eventually.  Hmm, I wonder how many more decades before they embrace Social Media?

So, how many of you actually exchange emails with your doctors?  I can't tell you how happy it makes me to receive my lab slips as an email attachment in two minutes, rather than waiting for them to arrive via Snail Mail, and then misplacing the envelope.  Even my daughters' pediatrician sends me quick replies, usually with a nice side query as to how we're all doing.  How lucky are we?

Smokin'

Who remembers cloves?  Ooh, I am so dating myself.  I think that song 1985 may have been inspired by me.  Anyhoo, I noticed that the other big campaign underway among the diabetes educator community, at least in California, is a big push to get PWDs to quit smoking.

Now mind you, smoking's pretty much anti-social in this state anyway. It's illegal in practically all public places, and you get dirty looks just for doing it outdoors.  I was shocked a few years ago to discover how many young people were puffing away in New York, inside stuffy clubs where it felt like we'd all die of heat prostration anyway.  They'd just flick their smoldering butts out onto the street, without bothering to put them out.  Being a California (tinderbox) native, it took all my restraint not to run and catch 'em, with a Smokey Bear speech ready to go.

But I digress.

We all know that smoking is bad for your health. Very bad indeed.  If you have diabetes, it's a killer combo of bodily damage.  The ADA can give you at least 11 good reasons not to smoke.  The two that jumped out at me were: smoking makes you 3x as likely to die of cardiovascular disease as non-smokers with diabetes, and impotence. It's all bad.

So do you cAARd?  That's the theme of the campaign that the California Diabetes Program is running right now to assist CDEs in helping people with diabetes to quit smoking.  AAR = Ask, Advise, Refer (they have a penchant for cutsey acronyms).

The idea is to encourage educators to:

• Ask every patient, at every visit: “Do you smoke or use tobacco?” 
• Advise them to quit. "Make it a priority to quit; it's important for your health."
• Refer them to the California Smokers’ Helpline (1-800-NO-BUTTS) with the “Take Charge” Gold Card -- a cute little marketing piece that looks like a credit card and urges smokers and other tobacco users to call the Helpline)

They offer materials and helplines in a half-dozen different languages.  And they even offer educators some intervention-speak, all scripted out:

"I know quitting smoking is very difficult. Most people who want to quit are successful.Sometimes it takes more than one try. I know you can do it.  Let me refer you to the cessation quitline, they can help you quit.”

Corny, but at least they're using the Home Depot method of patient engagement (You Can Do It. We Can Help!)  So kudos for that.

Honestly, I can't remember any of the myriad endos or educators I've seen ever once asking if I smoked. Or "used tobacco."  Or otherwise "used."  Glad I got diabetes this late in the game, because as a college student, I'm sure I wouldn't have fessed up anyway. 

I've watched family friends struggle with quitting, so I have a sense of how hard that can be.  If you're dealing with all this diabetes crap, too, well that's just got to make it that much harder.

Anyone out there trying to quit?  Or managed to quit?  Or have thoughts on smoking they'd like to share?  I'm keeping an open mind here, despite being from very close to Belmont.  Smokers are people, too. And as it turns out, the attraction may be genetic.

All About LADA (Adults with Type 1)

Today is a special day for the diabetes community, and hopefully for those around us to hear our voices and gain better understanding of our plight.

Honestly, I try to raise my voice to this challenge every day.  But for that little something extra, today I'd like to extend a special welcome to all the LADAs of the world -- a little-recognized or understood subgroup of our PWD community:

Who here got diagnosed with Type 1 diabetes in their '20s, '30s, or even '40s?  If so, you are (like me), a victim of Latent Autoimmune Diabetes in Adults (LADA), once considered exceedingly rare but less and less so each year.

LADA is also referred to as "Slow Onset Type 1" or sometimes "Type 1.5" diabetes.  Note that lots of physicians are still unfamiliar with it (!)

Often, because of their age, patients with LADA are automatically assumed to have Type 2 diabetes.  That's what the doctors told me during my initial hospital stay.  I was 37 years old, and had lost 20 pounds within less than three weeks.  (I was close to going into ketoacidosis and diabetic coma, although I didn’t feel that sick.)

It is now thought up to 20 percent of patients with apparent Type 2 diabetes really have LADA.  Read the basics on LADA over at Diabetes Monitor.

A few essential things to know if you've been diagnosed with LADA:

• The Viral Theory -  Why did you suddenly develop Type 1 diabetes at this "late age"? Many researchers believe that "one or more viral infections may trigger the disease in genetically susceptible individuals."

• Insulin Honeymoon - For a happy period right after diagnosis, your pancreas is still able to put out some small amounts of insulin, so your necessary doses will be low, and you'll likely achieve very good BG results.  Unfortunately, the honeymoon will end within a few months -- or at the latest, a year or two down the road.  Be prepared.

• Complications Clock - Diabetic complications (you know, the nasty stuff) are the result of months and years of high blood sugars, or simply having diabetes for a very long period of time.  For LADAs like us, the "complications clock" has just been switched on.  So if you keep your blood sugars in range, your chances of developing complications are low.  Also, people with Type 1.5 usually don't have same high risk for heart problems often found in high-cholesterol and high blood pressure Type 2 patients.

• A New Way of Life - You probably already figured out that you need to rethink your life as you know it.  It is now your prerogative to carry monitor, glucose tabs, insulin pump/pen and needles at all times; learn to inject yourself throughout the day; navigate the American healthcare system; and ward off the feeling that you're somehow being punished.  Don't think for a minute that you can ignore this thing.  (I'm here to help.)

• Finding Your Community - You may have checked out the American Diabetes Association (ADA) website and also the Juvenile Diabetes Research Foundation (JDRF) website, and still not felt like you've found a "home" for adults newly diagnosed with Type 1.  This is indeed a gap that needs to be filled. But if you've found your way here to DiabetesMine.com, then you've discovered the Diabetes OC (online community), where you'll meet many kindred spirits.  I am also excited to announce that I'm soon to become community manager of a new online meeting place called Diabetic Connect, where I hope to welcome as many LADAs as other types of PWDs (people with diabetes). 

Take this day to feel good about yourself, and maybe share this post with some friends or Loved Ones having trouble getting their heads around your distinctive kind of diabetes.

Please know that you are not alone in your LADA-ism.  You are not a freak.  And your life is NOT over.  It has, in fact, in many ways, just begun. 
 

Infusion Site "Handles," aka Diabetes Belly Love

Did you know that you get little rolls of "insulin fat" on your frequent insulin injection/infusion site spots?  Yuck!  Maybe I'm just naive, but I thought those little bulges developing on my otherwise-gratifyingly-flat stomach were just advancing age. Or too much cheese. 

But my endo took one look at my tummy a few weeks ago, and said, "Those sites are overused!  Can't you see the damage?  It's plain as day."  She took out a ballpoint pen and actually drew circles just like these:

Furthermore, when I had some catch-up OmniPod training with the Insulet rep a few days later, she just shook her head.  "Clear to see, but it's not that bad.  I've seen some patients who have little baseballs of fat in the spots they keep using."  Ooh, too much information.

She says my spots are still "fresh" enough that I might be able to reduce the puffiness by applying warm compresses regularly in the evenings.  If I ever got around to sitting down quietly for more than a few minutes at a time, that is.  Usually by the time all the kids are quiet upstairs, I flop on the couch for a very short TV respite before going to bed, and there ain't no way I'm getting back up to prepare a special "warm compress" for my belly.  Not unless it's life-threatening, that is.

Anyone else experiencing these "diabetes love bulges"?  If so, what have you done about it?  (Other than the old cover-up with clever fashion selections...)

A Lifetime of Troubleshooting

Back in the days of working full-time, this used to be my career motto: "Always be a troubleshooter."  That was the advice I gave all the newbies I met about any job they were taking on, whether at McDonald's or on Wall St.  Words to live by... little did I know.

Since being diagnosed with diabetes, I feel like a Meister Troubleshooter.  It's not just some watchword for the workplace anymore, it's a lifestyle.  It's what is known as diabetes management -- just a fancy term for trying figure out what's going wrong with your blood glucose control every day of your life and how to fix it.

Basal programs, temp basals, insulin-to-carb ratio, that tricky carb-counting (see yesterday's post), infusion site rotation, wacky readings, warning arrows, high alarms, bum test strips, hidden carbs, dual wave bolus, ... weigh & measure!  It never stops...

When your blood sugar suddenly soars and it won'€™t come down, as was the case with me for four whole days last week (!), you run through every scenario:  Is my pump malfunctioning somehow?  (maybe this pod or that one isn'€™t connected right?)  Or is the insulin fried?  Am I even getting accurate readings on my meter?  Or am I just on my way to developing a nasty cold?

If you think about it, these are the four basic points of failure:

• The insulin delivery device
• The insulin itself
• The blood glucose monitor
• The human body

The trouble is, the human body is more complex than all the other factors combined.  That means no matter how well the technology works, you can always have blood sugar control issues that seem to escape logic.

Nevertheless, it sure would be nice if we knew we could rely on the technology 100%, but we'€™re just not there yet:

* There'€™s been a lot of talk about failure rates in pumps and pods. The fact is, these things do malfunction more often than any of us would like (the manufacturers included).

* Insulin is sensitive.  If it's been stored at too high temperature, or even been jarred around too much, I have learned, it becomes ineffective.  But there’s no gauge to tell us that -- other than crazy-high BG readings. Yipes!

* Meters aren't all that accurate.  For traditional fingerstick meters, the FDA tolerates (in)accuracy levels of up to 20% (!), and for new CGM systems, up to 30%.  That's a huge margin of error!  On top of that, these devices are prone to failure too sometimes, and/or test strips go bad at times.

Let's be realistic: technology is immature when first introduced, and vendors have to rely on early-adopters to 1) help work the bugs out, and 2) provide the revenue to recoup past R&D costs and secure funds for future R&D. The customer -- aka the patient -€“- literally has to pay the price, but what other options are there?  At the same time, I think most of us are enormously grateful for the strides the technology has made towards better diabetes care.  We're all living freer, healthier, and longer because of it.

Still, all of this is what makes diabetes management so frustrating.  Can you believe that all this was going through my mind last week as I got on the phone to troubleshoot with the Insulet reps?  Yup, I was running in the 200s and even 300s, changing my pod over and over, injecting while still wearing it, having some success coming down and then soaring again.  What was wrong now?!

Together we walked through every possible failure scenario, and eventually determined a cause of action --€“ without any finger pointing or blaming.  Turns out I'd been delivered a rather large shipment of "dead" Apidra.  Somehow the contents of at least 3 vials had gone bad before they got to me.  Luckily, my wonderful endo convinced my mail order supplier to replace them without a fuss.

But Insulet was wonderful, taking a ton of time to talk with me and follow up, and follow up again.  And this is how it should be: while we cannot yet expect flawless diabetes technology, we can expect that the drug and device companies do their very best to support us in a crisis. 

My experience has been that I've always been able to count on them when needed.  But yes, I know, I'm a prominent blogger, so maybe I get pampered a bit...  What about you?  What has your customer service experience been when your life of troubleshooting hits a high note?

Teaching Patients to Carb-Count

I always find it fascinating to have a window into diabetes "from the other side" -- i.e. what doctors and healthcare providers are doing and talking about.  Something that caught my eye in the latest issue of the AADE's journal, The Diabetes Educator: a new 10-step guide to teaching carbohydrate counting, called (oh so cleverly!) C-O-U-N-T C-A-R-B-S.

It's apparently a program to help nurses teach diabetes patients diet tactics with more confidence, which is "shown to produce better behavioral outcomes that the didactic strategies commonly used in hospitals at present."  Well, that sounds good.

Staff nurses are first encouraged to explore each patient's "individual medical and motivational factors."   Right, no one size fits all!

Then -- after a number of other preliminaries -- they are encouraged to implement the following steps, based on Gray's evidence-based teaching strategy.  Here are the 10 steps in shorthand:

1) Create a typical meal. The nurse is supposed to talk through the details of an ordinary meal the patient eats on a regular basis, including sauces, condiments, and beverages.

2) Offer information.  Here the nurse defines carbohydrate, and explains which foods from the previous step contain them.

3) Use food lists and labels.  A quick lesson in reading food packaging labels, including paying close attention to Serving Size, and the idea of 15-carb "units." 

4) Now it's {the patient's} turn.  The patient is next asked to try to estimate the total carb value of their typical meal in Step 1.

5) Take time.  I quote: "Answer questions and provide clarification and performance feedback. (This step could last several days for many of us :)

6) Compare patient choices to written dietitian recommendations. The nurse is encouraged to be constructive and focus on the positive.  (As in, "I see you enjoy your tortilla chips...")

7) Adjust meal. Talk about ways to alter meal choices based on dietitian recommendations.  Here's where the nurse can use "visualization" for portion sizes, etc.  I'm guessing they mean those plastic chicken legs and such.

8) Recalculate, record, reinforce. (Sound like a contest entry?) The patient gets to recalculate their initial meal as a sample entry in a food diary.  The nurse demonstrates how to record BG readings and insulin doses.  Learning is reinforced using "case scenarios."

9) Bolus. I guess they're actually practicing eating the meal at this point, 'cause the nurse is supposed to assist with administering an appropriate bolus.

10) Support learning.  The nurse is supposed to provide resources for the patient to consult later on, like web sites, support groups, and customized food lists based on the patient's preferences. (Man, I need a list like that!)

So, my question is... how did you learn to carb-count?  Did the person who taught you use anything like the method above?  If you're like me, do you sort of "have it down" now and yet still feel like you're just eeking by most of the time?

Diabetes Alert Day 2008: Making it Ours

Today marks the 20th annual ADA national Diabetes Alert Day, a day set aside to spread the word about taking steps to prevent Type 2 diabetes.  See this nice little article on all that, including risk factors and a quiz to help people identify early signs of metabolic syndrome.   

But every year, I ask myself: What can this day actually do for those of us already living with Type 1 and Type 2 diabetes?  How can we make it our day, too?

So here's my Diabetes-Alert-Day Challenge, a three-step procedure:

1) For those who already have diabetes, why not consider today "tell-a-friend day"?  Talk to someone in your life about what it's like to live with diabetes -- ideally someone who doesn't yet know the basics, like the difference between Type 1 and Type 2.  If everybody "told two friends, and they told two friends," we could do a lot towards eradicating ignorance.

2) Make a donation. I don't care if it's just $5 or $10.  Maybe today is a good day to go to the JDRF site and show them that we still stand behind them, despite recent tribulations (a travel reimbursement scam).  After all, it was they who identified the internal thievery themselves and ousted the guilty parties, without any outside intervention.

3) Do something "mentor-ish" today -- maybe sign up for Sanofi's A1c champions program, or check out your local programs, like the one mentioned here in North Carolina. The idea is to help somebody new to this thing. (Diabetech recently illustrated what a difference mentoring can make -- especially when augmented by technology -- with its GlucoPALS program.)

Let me know what you've all done, and if you have any other ideas how we can "claim" this day to help our community, either this year or next.

btw, today seems like a good day for a few additional D-community public service announcements:

* Producers of dietary supplements that supposedly "cure your diabetes" have been taken to task. They are facing federal fraud charges for their bogus claims. Right on.

* Are you a female athlete with Type 1 diabetes?  "The Sisterhood of Diabetes" Editor Judith Jones Ambrosini is expanding her latest essay "Sisterhood of Female Athletes" into a book. "If you would like to tell your personal story as a part of the collection, whose purpose is to inspire every young girl, teen, and woman with diabetes to live the life of their dreams," please contact Judith HERE.

* Ever feel like your doctor is just "treating the numbers"?  Is he or she just honing in on trying to get every patient's test results into a certain target range, without fully understanding the health or life implications?  Listen to this excellent NPR radio story on challenging that approach.

Happy D-Alerting today!

Protein, Carbs, Whatever...

Sometimes you just don't know what spikes your blood sugar.  So you've been a "good diabetic" and gone low-carb and high protein all week long, and you're STILL running over 180 too much of the time?  Aaack!

As I was complaining about this lately, a number of commenters jumped in to point out that some of the protein we eat gets converted to glucose as well.  Turns out this is correct, but with a number of caveats, that make it unlikely to be the cause of an SUS (sudden unexplained {blood glucose} surge).

In particular:

* protein can convert to carbs in your system through a process called called gluconeogenesis. This takes place in your liver, and to a smaller extent, in your kidneys, I've read.  But this process is generally kicked off only in extreme cases of glucose debt, such as during fasting, starvation, or intense, prolonged exercise (none of those would be me)

* according to blogger/diet expert Jimmy Moore, people on extreme low-carb diets do experience BG spikes for just this reason.  "If protein is consumed in excess of energy needs, then some of that extra glucose that is created by the liver through the breakdown of protein can indeed lead to the same kind of spike in blood sugar as eating a slice of white bread or white sugar would," he tells me.

* but it takes much more protein (in terms of grams) to raise your blood sugar than it does carbs. I really don't eat THAT much protein, in terms of pure volume of food...

* and if you eat protein along with carbs (as I typically do), the GI impact of those carbs is reduced by the slower-absorbing protein.  So why should I spike so much after just a few mostly-protein meals?

* sometimes the fat's at fault. "For example, if you ate pizza the previous night.  The fat causes a delayed rise in glucose that could last until the next day, yes," my co-author Dr. Jackson tells me.  That seems like an awfully long lag time!

OK, so I get it: "A high-fat diet, in the absence of carbohydrates, typically results in weight loss. Yet your blood glucose does not drop too low, because your liver continues to convert some of the dietary protein into glucose."  But since my diet is not consistently low-carb/high fat, and I'm bolusing painstakingly what feels like 14x/day, what is UP with the highs?  I know I should be more consistent with my meals, but what's a busy and active PWD to do out in the Real World?

Some sensible advice: 

"Opt for a healthy ratio of 30% protein, 15% fat, and 55% complex carbohydrates."  Because too much protein may affect your kidneys.  (Authorities claim there is simply not enough information about the long-term effects of a high-protein diet.)

Man, all this data is creating some diet anxiety over here.  As usual, Dr. J had a nice way of bringing the whole discussion down to Earth: "Just think about it in a food sense, think about meals with a little bit of each type of food.  You eat the calories, your body makes glucose, and that's the energy you run on."

"Yes," I replied.  "That sounds simple -- if I just didn't need to dose for every gram of carb!!"