Wednesday, March 7, 2012

Tight Rope Act Getting Old ?


I say give me a plank to walk on instead any day.

I totally think that managing Type 1 diabetes, and Type 1 diabetes in children especially is a constant tight rope balancing act. If you lean to far in either direction, or lose your concentration, then over the edge you go, sometimes landing on the safety net and unfortunately sometimes not. It really is a precarious balancing act of food, activity, stress management and insulin dosing. Not to mention the inevitable "curve balls"

I equate my house with diabetes to a tight rope walk while juggling three balls as there are three of us to manage. I must admit that the prospect of caring for my 2 kids was incredibly overwhelming at first and still is at times. Things in the house of syringes and test strips has stabilized to some degree, well at least the routine has, but the numbers could always use a little work.  The routine is ingrained, as anyone dealing with diabetes can attest to, testing, thinking, calculating, injecting or bolusing, testing to see if you guessed correctly, and so on and so forth. You adapt to the routine, but are never completely at ease, once again with children in particular. Like a tight rope walk, one screw up, miscalculation, mismeasurement, and over the edge you go. 

I try to imagine or wish that the tight rope could be more like a plank, not like on a pirate ship; where you'd eventually plummet to your death to be eaten by frenzied sharks, but wide enough to take some of the nervousness and precariousness away by allowing for a larger margin for error. I do believe the technology that exists today is widening the plank. Pumps fine tune basals to prevent lows at night and spikes in the morning. Continuous blood glucose sensors are allowing us to notice trends in our blood sugars allowing us to relax and let a machine do a bit of the brain work. Newer insulin analogues in the last 2 decades have really helped me feel more at ease resting my head on the pillow at night knowing I am far less likely to be jolted out of bed with a frightening low. Glucometers, where would we be with out them? We'd likely still be judging our control based on how much weight we've gained or urine sample showing glucose from hours long gone past. That being said; most days feel like I am tight rope walking while juggling.

Why is that? Well, because so many things mess up our sugars. A handful of those yummy skittles, a sleepless night, a rebound high after a night time low. Do you realize how hard it is to stop eating after treating a low with 15 grams of carb. It is like a dog not taking advantage of the piece of bacon dropped beneath it's nose during a breakfast frenzy. Ya, that bacon is gone with in a split second, along with your plate of eggs an toast. Alright, back to the point, which is everything can effect our glucose.

My teen Type 1 often forgets to test, and will arrive home with a glucose that would cause any Endo or Doc to drop, or prompth them to call the authorities. I don't judge my girl though, I remember the balancing act, I remember being a teen, and I can only gently yell remind her to test while at school. When I ask what could be the cause of her reading (trying to encourage critical thinking) she shrugs and says, "I had some of my friends chips" That's it, as simple as a bag of chips, not criminal just thoughtless, diabetes has obviously not entrenched itself into my daughters thoughts as it has mine, she has yet to be relentlessly governed by the big Mr D.

Now my little Type 1 who is 7 is frequently falling onto the safety net, close at times to the hard concrete floor, but has always landed safely, conscious, with her brain intact. The near misses have occurred; nights where I get up and randomly check her after having a low myself, finding her reading less then the desired range or after an activity that we neglected to feed her enough, another example of losing concentration.

It is these occurrences mentioned above that remind me that we're walking a tight rope, and the minute I lose concentration, put my guard down, relax a little, the potential to miss the net is ever so present.


Friday, March 2, 2012

Can Exercise Kill You?

Okay I must admit the title sounds a little ominous. But in my reality participating in physical activity can  in effect make diabetes harder to control and can cause serious fluctuations in blood glucose. As anyone who has been jolted out of bed at night (sweating, shaking and fumbling for a quick source of carbohydrate only to rebound the next morning into the high teens) with an extreme low due to exercise performed earlier in the day. Sorry for the run on but need to get my point across.

The Canadian Diabetes Association recently sent out a News Letter that had some stats about what type of support Canadians get from Province to Province. There was one number or stat that stood out regarding exercise and diabetes. "Ninety per cent do not have a fitness expert to consult with when they require specific advice about how exercise impacts their diabetes." Interesting.....but not surprising.

In the past 20 of my 30 years living with a dead pancreas, I know I sound melodramatic, I have found it extremely difficult to find a health or fitness professional locally to assist me in this area of my diabetes management. Sure you get basic guidelines, like feed your activity or reduce your insulin by a certain percentage prior to exercise, but I must admit that as usual, my approach and control is the result of self awareness and self experimentation using my trusty glucometer. 

As I age, and routines change; I am still learning new things about exercise and diabetes. For example; that if I perform a high intensity workout I often require extra insulin prior to the work out. Once again due to the stress response mentioned in the last post. Crazy, as I have always been instructed to feed or reduce for activity. I also understand that everybody reacts slightly differently to exercise, stress, food, etc.  So it is likely hard to narrow down specific exercise recommendations.

Back to the stat; 90 % of people - That's a high percentage who would benefit from a specialist in exercise and diabetes. I also notice that there's a  lack of detail out there on exercise and diabetes, and that any info out there is difficult to weed through and unfortunately these details and lack of accessibility can in some cases be crucial to all diabetics (Type 1 in particular) So hopefully in the future our health care team will also include an exercise expert focused on diabetes or the option to see one. I doubt it though, as my docs over the past few years tell me that active people are a rarity these days so if a person is doing anything remotely resembling exercise, that is good enough. But what about the select few of the Type 1's out there that require expert support in the area of exercise?  Trial an error is good but there are certainly tips I would have loved to know years ago that I know now regarding nutrition, glucose response to the different types of activity, etc.

What I have learned using myself and observing my kids in terms of exercise and diabetes:
-over training is not good, my limit is 2 intense work outs per week.
-If i train near my max heart rate I typically don't need to feed the activity and generally require a bit of rapid insulin
-If I train at a low intensity I either have to lower my insulin by 30 % (Thanks to my Nurse educator) and this seems to work, or feed the activity 10-15 gms of CHO for every 1/2 hour - keeping in mind we are all different and I am sharing what works for me.
-If I don't drink enough fluid or water during the time during and prior to the work-out then my sugar level tends to really spike with high intensity training.
-I get sick really frequently if I workout more the 3 times a week with high intensity training (circuit weigh training, Muay Thai Boxing, and never work out more then an hour (includes warm up)

Even with frequent testing and self observation, fine tuning etc, I still have the occasional low, and would still love a good guideline and expert advice and feedback on the specifics, like carb loading and intake on training days, specific tips to stay healthy looking through the goggles of a diabetic paradigm. Questions like; will a certain activity worsen or accelerate any diabetic complications?

Feel free to point me in the right direction. And overall I do believe that just the right amount and type of activity will keep up healthy but too much of any activity is damaging.



Thursday, March 1, 2012


Change is the one constant in life that is inevitable. Be it the weather, relationships, jobs, homes, and the list goes on. Change can be self induced or in some cases imposed. It can be predictable and unpredictable. Change in any of the above scenarios can also wreak havoc on our diabetes control.

Fluctuations and Change are one of the things us folks with diabetes must contend with daily. The past few months we (my family) have gone through some Change. The change was imposed and we were forced into a decision and subsequent change. Regardless of what the change was, I just want to share some observations related to blood glucose control through this period of change.

Imposed change (to me) results in more stress when compared to self motivated change. I react emotionally first then intellectually second. It is the emotional reaction that messes with my diabetes control. Emotions tend to evoke a physical reaction, and before you know it my glucose levels become more difficult to control.

Why is that? It's that damn "Stress Response" I tell you it may have been handy for our Neanderthal ancestors, but it sure sucks for modern day folks.

In summary; I get emotional, my brain responds buy telling my adrenal glands to pump out adrenaline which basically tells my liver to produce more glucose and also conserves the glucose I have floating around, which as you can well imagine sucks for us diabetics. We don't need the extra energy (glucose) to run from the tribe up the river trying to steel our food - which was likely the scenario our ancestors faced on a frequent basis. Point is stress = crappy high sugars.

Needless to say that when the change passes the glucose gets easier to control and insulin requirements go back down to pre-change levels. I guess what I continue to tell myself and my kids with Type 1 is that change will happen, so test more often, correct more often, and listen, discuss, and address your emotional response because not doing so seems to make the physical response more turbulent.

I notice this (change - emotions - physical) reaction with many things. Sleep deprivation really messes up my emotional regulatory system or more easily put make me a very moody or as my kids would say a very grumpy dad. Sleep, I've learned is crazy important not only in stress reduction, but in decreasing insulin resistant, which is not as important to type one diabetics. We just crank up the dose to accommodate.I have also learned that getting enough sleep is the only solution to getting rid of that stubborn fat that hangs over the belt buckle.

If faced with change, and feeling emotional, get it out, talk it out, it will pass like all other things, and most important of all,  test that blood sugar A LOT.