Singing the Post Breakfast Blues

"Couldn't find any with five kids"

I must say that for us;  the hardest blood sugar reading to contend with in our house full of diabetics is the Post Breakfast one.

It is bloody relentless.

I for example take 50% more Novorapid to cover any carb with my breakfast dose of insulin. That's right, 50%. 

Rowan, is no different, and the most frequent calls from the school are when they do her mid morning glucose check and I get the text that reads; "Hi Trev, her readings say 25 Mmol,(Divide by 18 for US) should I ask the wizard what to do?"

This happened a lot in the beginning but we are starting to conquer the post meal spike.

Dr Berntein, in his book, The Diabetes Solution discusses this issue at length, and thus recommends eating only 6 gms of Carb for breakfast. I can do that, but tell that to a group or more accurately a pack of hungry wolf cubs ripping into a box of cereal.  He further explains in detail the increased hormones(Cortisol) that cause an increase in blood glucose readings in the first two hours after waking.  It is a good book, however, very rigid.

It is also recommended that taking your meal time insulin 20 min (for rapid) prior to that first bite as this lessons the 2 hours spike in glucose.  This I found scary when Rowan was 18 months, and throughout her toddler years. You all know how predictable small children are with eating(sarcasm).

Okay for the most part we try to adhere to the above recommendations, the key word here is try. Now if you have children of school age(or even know these little creatures), and you somehow forget to pre-make lunches, pre-put out the clothes, and end up doing what we do 50% of the time and wing the "Launch Sequence" out the door in the morning;  then you can hopefully understand how following Dr B's recommendations are tricky, and next to impossible most mornings.(I know that sentence structure sucked, never liked writing, lots to say, so little time)

However, I will say this:  When we do give the insulin 20 min before a meal, and we make the eggs or some other  good source of protein, I don't get any text messages from the school during the week, and we don't have any post meal blues on the week-end.

Trev

Why Worry if You Feel Great?

I jotted this title down months ago, in a little detective note pad I carry around everywhere, I know, a little geeky, but what can I say.

I was reminiscing about the early days of diabetes, well early is subjective, but for me it was when you were given one shot a day and they measured control with urine dip sticks and your ability to gain weight.  Scary, but I survived, and so did many others. Imagine dipsticks for control, crazy!

"Those were the days"

I didn't feel all that bad on one shot a day, and actually started to feel worse when my control tightened and was consistently near normal range.  The body is amazing, it got used to the high levels, and that was that, it equalized, so to speak. 

When the levels normalized, the body said "What the hell is going on!" and sent the signal to produce the good old epinephrine (fight or flight Response) and wham, you start feeling like crap with your good numbers. 

For some, including me, it  was discouraging not knowing that the feeling would subside in time.  Why torture my self, why shoot for normal levels when I feel shaky, and low all the time. That's where knowledge is power, and motivating!  It took one Diabetic Educator in 1990 to say, "you know it is only temporary, and then you will feel great!"  One moment, one snippet, is all it took! 

I get the above scenario a lot from patients and those with higher A1C's.  They say " I feel fine, why should I change anything" or "Well,  I took the night time insulin and my fasting is 5 mmol,  but boy I feel like crap" or they claim, that their normal is actually 10mmol (multiply by 18 for U.S.) The point is, they don't feel the need to change if they feel good. Of course I jump at the opportunity to share my snippet, in hopes to motivate them to keep there levels down just long enough to feel fab! 

Most folks have never been told the reason behind feeling worse with better numbers.  I am fortunate to be in a position to explain these pearls of experience with folks trying to better manage their diabetes control.  I hope anyone going through diabetes and feeling "great" and not worrying will take the snippet for themselves or a loved one, and shoot for those normal targets!

I did find one research article written by Gill Spyer and colleagues titled,  "Hypoglycemic counter-regulation at normal blood glucose concentrations in patients with well controlled type-2 diabetes."  They took 7 type 2 diabetics with a mean A1C of 7.4%, and tightened their control.  This is what they found:

"Symptom response took place at higher whole-blood glucose concentrations in diabetic patients than in controls"  and they also commented "This effect might protect type-2 diabetic patients against episodes of profound hypoglycemia and make the achievement of normoglycaemia more challenging in clinical practice."
Most of my experiecne is purely anecdotal.  But this study certainly supports the theory.

Have you ever Been High for a period and dropped low?
If so please share your comments. 

Trev

Sources:
G Spyer MRCP, Prof A T Hattersley FRCP, K M MacLeod MD, (2000) Hypoglycaemic counter-regulation at normal blood glucose concentrations in patients with well controlled type-2 diabetes,
Lancet. 356(9246):1970-1974.

Have your Cake & Eat it Too

Meet Dareian;  my older Type 1 in our  house of  Diabetics.  She is one amazing teen!


Dareian the baker!

This is her story, and how she has learned to manage her diabetes through carbohydrate counting, glucose monitoring, and MDI so she can live life how she wants, not how Mr Diabetes dictates. 
Sure she still occationally gets abducted by aliens (See post) but she usually returns the same day.

We partook in a study here in Edmonton called the Trial Net  to determine if any of our non-D kids had autoantibodies for diabetes. If  these autoantibodies are present  the risk of developing Type 1 D in the future is increased. So we took the remaining 4 children and had the blood drawn.  To our surprise, becasue you never really expect it, our oldest child(Dareian) had the autoantibodies.  Crap!

Anyhow, we proceeded with our day to day life, managing Rowan our youngest D and myself of course. Waiting, worrting, and uncertain if or when Mr Diabetes would attack. 

A little over a year later, after many random and fasting home glucose checks, he attacked! We went to the ER and had the blood work done to confirm what we knew.  "Your daughter has type 1 diabetes" There was that dreaded statement again. Once in a lifetime is enough but three times, come on already!

The next day we went through the same training we had with Rowan a few years earlier.  We felt like employees at the diabetes center since we'd spent so much time there.

Dareian was amazing, like her younger sister. She immediately caught onto to Carbohydrate counting, self injecting, I thought, man this kid is smart.  She took Mr Diabetes buy the horns.  We on the other hand felt overwhelmed, and once again went through a whole range of emotions, she was still our baby, even though she was 11 at diagnosis.

Upon arriving home, Dareian has her days, like all PWD where she is angry, sad, and in denial.  But she also has that essential quality or characteristic that I equate with success in diabetes management.  That is; she truly believes she can control it from the inside out.  She has learned and continues to learn about managing diabetes; what works for her and what doesn't. She is active and is a track star! I know I am bragging, but that's my job. She has learned, and managed well enough and knows that she can have her cake, and eat it too!  Great job Dareian!

The Cake she baked for her Moms B-day