Tuesday, June 19, 2012

The Teenage Diabetic Brain

My Teenage Brain
I have one of these living in my midst. Yes a teenage diabetic brain. She is one of, the three to treat. I must discuss recent happenings in hopes to relate or get support. 

Okay I know that most teens have limited capacity to focus, as they are concerned about social events, sports, and in our case fashion and hair.

My daughter has really taken the diabetes thing in stride, seriously since 11 she has injected, tested, gone to appointments, learned about carbs, exercise and other intricacies in relation to managing diabetes. Is her diabetes well controlled? Well not perfect but well enough. I was never harassed about my diabetes from my parents. They kept me safe, ensured I took my shots, ate my meals and snacks, and that was it. Never nagged and therefore I never had any anger towards them. I could essentially be a kid with "D" in the background.

I must say that we attempt to do the same with our D kids. But I note that lately, I have to ask her to test, like in the mornings on my way out the door, I'll pause, and ask, "Did you test?" and she will put down the backpack and hair brush, and proceed to test. I really try not to lecture but this is happening all the time, like everyday.  She will go to her friend and forget her supplies, get home from school and say "I haven't taken any insulin today because I didn't eat" or my least favorite, she injects blindly, basically having know clue what her glucose is and taking a whopping dose based on her teenage brains strange calculation.

Scary stuff! I know. I have discussed this calmly, more times then I can remember. Still no change. Yes I've called off sleepovers and events as a consequence, taken her phone away, she still doesn't have it back, but I feel guilty as I know diabetes is a supreme pain and inconvenience in our everyday life. And I know it just isn't important to her.

Question is I am honestly at a loss....what do I do next, lock her in the house? Duck tape an insulin pump to her? What?!  Sorry just frustrated. I certainly can't be there to remind her every time she chooses to eat to remind her to count the carb and take the appropriate amount of insulin. Trust me I've considered it. There is the option of NPH, but then I fear lows and rebounds.

You'd think in a house full of D, my child would be a superstar, that just ain't so. I just want her safe. Any ideas would be very much appreciated.


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Thursday, June 14, 2012

Type 1 Diabetes and Weight Management

Over the past couple of years I've been teaching fellow diabetics how to manage their diabetes. You know, the basics like;  food, activity, medication, insulin use and adjustment, stress management, physiology, complications, blood glucose and health monitoring.

During this time I have noticed a trend, and that is;  the challenge of losing weight or better yet, just maintaining weight with type 1 diabetes.  The media as I'm sure you've noticed at most grocery stores and on talk shows (not naming any names of course) group diabetes (both type 1 and type 2) as being the same with little effort on the authors part to explain the difference between the two. They also advertise incessantly about weight loss and diabetes.
But what I'd like to explore is the topic of weight loss and maintenance when it comes to type 1 diabetes. I mean healthy weight loss, not the loss that comes from ketoacidosis and insanely high sugar levels. Why do I think this topic is important, well I also notice that Type 1 diabetics are gaining weight putting them into the insulin resistant abdominal obesity high BMI health risk category. And a lot of people I see with Type 1 have a desire to learn more about weight loss.

I feel that Type 1's  have very little guidance on losing weight and safely adjusting insulin levels to do so. When I have sought guidance on this subject in the past I get the usual verbal nonsense.  "Increase activity, eat less"  I begrudge that scripted response that seems to be ingrained in thought and promoted with out question by most world government health agencies. Fair enough, create a caloric deficit and lose weight, simple, right? NOT!

I am sure a lot of folks out their that have lived with diabetes long enough can tell you basically how to lose weight, but what about giving formal advice. I find that there are numerous studies and information for Type 2 DM with regards to weight loss.  But what about insulin dependent diabetes or more specifically type 1 diabetes?

Weight loss and type 1 is logical to me. Look up insulin in any Medical Physiology textbook and it will clearly tell you that this essential hormone is not only responsible for utilizing and storing glucose but it is also responsible for Fat and protein storage and utilization. Hmmmm.........What the heck am I getting at?
Keeping in mind that Lipolysis is fat breakdown (A good thing) and Adipose is fat tissue/cells (A bad thing)

Lower your insulin and lower your energy storage. It is common knowledge that when a person is started on insulin they usually put on weight. I know from personal experience that the more insulin I take the more weight I gain. The question is why and more importantly what to do about it.

This is not new info at all by the way. Most carb reduced diet plans rely on this to get results. Even weight watchers tend to promote products that are lower in carb, just looking at the bread products they market. Carbs increase blood sugar, blood sugar requires insulin to put it where it needs to go, into the cells for energy, and any unused energy goes to fat, liver and muscle for later use. Or something to that effect, I am by no means a biochemist. All I know is; when I reduce my insulin levels, I always lose weight.

The number one precursor to insulin needs is the amount of carb we choose to consume in our diet. Number two is how little activity we do in a day. Number three is stressors placed on our bodies.

Eating large amounts of carbs = taking large amounts of insulin = storing more energy as fat = weight gain

Inactivity = Less energy used = more insulin requirements = more stored fat and less stored energy used = weight gain

Stress = increased resistance = increased liver output of fuel (glucose) = higher glucose = more corrections or more insulin = more weight gain

Notice the trend: more insulin = more storage = more weight gain

Lower carb (not extreme) = less insulin = less fat storage = weight loss
More activity = lower insulin requirements = less fat storage = weight loss

Less stress or more sleep = less free floating glucose = less insulin (or correction doses) = weight loss

Easy,  right?  Well not always.  Here are a couple of other things to consider.

You need to have the right insulin(s) and or delivery methods. MDI or Pump. You need to be willing to test a lot,  I mean a lot. You will fluctuate at first but given time and good record keeping, things will even out. Try to eat the same amounts of carb for each meal. Eat protein for each meal, then carb free choices, then slow carb choices - More on the specifics later if any one manages to read this or expresses interest in knowing more.



Tuesday, June 12, 2012

To Snack or Not to Snack......

I have a hard time with the night time blood sugars, always have, call it fear from dropping low, or simply being unable to saw logs on an empty stomach, whatever the case this is come around once again in my life in my children's diabetes management.

I am comfortable bolusing or taking a shot of rapid for a snack, pretty much figured it out, if it is greater then 20 grams of carb, I bolus, if it's one hour before bed I take 50% of my ratio, if I've been active I likely won't bolus at all, and if I do it's 75% less then what I'd normally take, so lets just say I've figured it out.  My two dia-kids on the other hand, NOT THERE YET!

My 7 year old insulin user, sounds like I am making her out to be an addict, nothing could be farther from the truth, but she is definitely a user of insulin.  Snacking is,  lets just say, a little riskier.  But in our house full of people,  snacking is the routine. Like popcorn on movie night, ice cream when its hot, anything a non-d kid would eat, our d-kids eat too. The tricky part happens with warm weather, increased and/or unpredictable activity, late nights, and other life events that don't fit into the diabetic routine. These things usually lead to variable carb intake and a Vegas approach to calculating  an accurate carb to insulin dose. Sometimes we win and a lot of times lately, we lose, and when I say lose, it is usually sleep. We end up staying up until after the majority of the rapid insulin is done its job, and this as you are well aware takes a few hours.

This sucks, but we do it because that's what d-parents do, they watch over there lil ones thinking like a pancreas, checking levels, only able to sleep when they are certain their kiddo is safe for the remainder of the night.

It is still my biggest D-Fear for me to not test, or miss that low or high and do harm to our baby.

My heart goes out to all the parents out there who share this experience.