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.

Trev

Diabetes explained. Search for diabetes treatments at a private hospital in nottingham.

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.

Cheers!

Trev

Are We Making Things More Complicated?

"Me Looking Confused"

I have to tell you,  sometimes I think we make things more complicated then they need to be.

What am I getting at?

I am not talking about relationships.  I am referring to technology, blood glucose testing, CGM's, and the hundred new meters and pumps that battle it out for a piece of the economic pie.

I have always tried every new meter, and reverted back to the simple design.

Mentally it is taxing, for me anyways.  Let me explain a little further.

I have talked about Flip-Flopping back and forth from Pump to MDI, and insulin to insulin. But in all this Self Experimentation, it all comes down to behaving my self in the diet department.

I can achieve decent control on just about any insulin regime, with the exception of the old fashion two shot a day regime. AS LONG AS; I measure smaller amounts of carbs accurately, don't cave to the temptations of cookies and milk, and cover my fasting states with enough basal insulin.

I see so many folks (myself included) that chase numbers, or make changes to quickly, before waiting for a trend to occur. Thus creating a serious yo-yo effect in the blood glucose readings, or some rather erratic readings in general.

I have driven myself bananas in the past doing the above, only to end up back where I started.

The best A1C I ever achieved, I say achieved cause that's exactly what it is, was 6.2.  It was a result of exercise and diet. Surprisingly before the use of fancy pumps, CGM's and super computer meters. Good old fashioned injections.

Now I am an advocate for doing what ever works, and these devices have increased my and many others quality of life in other ways, like; flexible bolusing, more accurate basal profiles, and less injections, but for me it has never really improved my control.

I find we live in a world where we look for an easy solution, I've been searching for one my whole life with diabetes, but with anything you want to be successful at, it comes down to our choices, actions and work.

Devices, as complicated, neat, and effective as they appear, can work well but;  if we don't measure our carbs, pay attention to trends, plan our exercise,  our diabetes control will inevitably waver.

Just my humble take on things.

Trev

Self Experiment - Does Diet Effect Your Mood?



"Me Fired Up!!!"

 This was also Posted On My Sister Blog Diabetes Mind Game yesterday, but is relevant to all.

Good Day All! Boy do I have something I want to share!!!  I have not been this fired up in a long time. No I am not manic. This is some really revolutionary stuff. I didn't invent but check it out!!!

Not sure if I mentioned this,  but my last A1C was 8.4 % which, in my opinion for myself, pretty much sucks!!!

So I took a hard look at my current diabetes regime and self management.  By hard I mean honest, like; can I do more, am I measuring, trending, tracking, counting, am I consistent. To answer myself; as to whether I've been a well behaved PWD. I'd have to say, NO. I haven't been consistent in doing any of the above.

The result,  a shitty A1C.  Time to do something radical. Time to make a plan, and stick with it. Time to smarten up, and as you all know, I have 90 days.  At which time I will repeat my A1C and have a check-up with my physician.

Over the past four days, I know, not long, but I have to share this, I have been doing the following:

-Off my Pump, back on the Multiple Daily Doses.

-Re-Read Dr Bernstein's Diabetes Solution , for the second time in 4 months(This time I took notes)

-I have been eating the following portions daily:
Breakfast:  6 grams Carb and 3 oz Protein(Measured using a scale)
Lunch: 12 grams Carb and 4 oz Protein(Pre-made the evening before)
Dinner: 12 grams Carb and 6 oz Protein

-I have been taking the following insulin:
AM: Levemir 15 Units (split into 3 separate injections as per Dr B's Suggestion)
AM: Apidra 5.5 Units
Lunch: 4.5 Units
Dinner: 6 Units
Bedtime: Levemir 5 Units

Broken Down:

Correction Factor = 1 Unit will drop my BG by 2 mmol
1 gram of Carb increases my BG by approximately .3 mmol
1 unit of insulin for 1.5 oz of protein
1 unit of insulin for 6 grams of Carb
2 units to cover the Dawn Phenomenon (2 hrs after waking)

-I write everything down
-I tested every 2-3 hours for the first 3 days
-I discovered Sugar Stats a website that allows you to log your numbers, graph them, and so much more. Get this! If I am out, away from my computer I email my blood glucose reading using my phone to the site and review the numbers later. It really is awesome!(No I am not an affiliate, so I don't get anything if you visit the site)

Okay, so what?! 

I am going to tell you, the first day sucked!  I felt low(hypoglycemic) because I wasn't used to having sugars in the normal range. I felt hungry, I had a massive headache. Day two, still feeling headachy, but slightly better. Day three, better. 

Today, I feel fantastic!!!  I have no headache. I have no post meal spikes, my range yesterday and today has been close to that of a non-diabetic.  I never in my 28 years of being a Type 1 have seen numbers, I mean stable, steady. 

My mood and my mind is clearer then I ever thought possible. I am not exaggerating. I post my numbers publicly on Sugar Stats if you want to check them.  It's really encouraging to eat a meal or take a shot and knowing exactly what the outcome will be.  I admit I was really hesitant to take 1 unit for 1.5 oz of protein. But seriouly, it's totally possible!

The only downfall is it is a rigid regime,  but I feel great and that is motivation. I don't feel edgy, like I am on an emotional roller coaster that I would get with spikes and drops in my blood sugar.

Stable numbers (Stable Carb and Protein + Stable Insulin = Stable mood ) 

That is my conclusion thus far.  I know it is only day four but I am onto something life changing. I just feel it!

Trev


PS:  Yes this is my official plan, I am not Flip-Flopping as stated two posts ago.

Ketones - are they bad?

Well another hot topic in the diabetes and weight loss world.

Ketone:  A waste product in the body when it is burning fat for fuel, instead of carbohydrate.

Are they Dangerous?  Good question.  In the wrong quantity yes. In small quantities I would have to say no.

Let's look at some definitions, then go from there:




http://www.worlddiabetesday.org/

 Diabetic Ketoacidosis:  Is a medical emergency, it is when the quantity of ketones in the body become high enough to make the bodies inner environment too acidic on the Ph scale, and results from not having enough insulin on board.  The body essentially goes into shock. So if you have Type 1 diabetes, and you are unable to get your blood glucose down, start to vomit, feel confused, can't quench your thirst, this is a medical emergency, seek medical attention immediately.

Ketogenic diet:  This is where I feel the controversy starts, people automatically link Ketoacidosis with Ketogenic, and therefore they conclude that having a small quantity of ketones in the blood is a life threatening thing.  Which it is not, in my opinion. Actually it is very common when fasting for over 12-15 hours to have a small amount of ketones in the blood or urine. 

The question arises, as usual with science is; what are the long term consequences of being in a semi-ketogenic state while dieting?  Good question; and there are studies, many of them, and I have yet to find a negative one.  I am not a scientist, however, but I like to believe I have common sense.

It has been noted in many popular weight loss books using the ketogenic diet principals, that the heart and brain prefer the energy derived from ketones as opposed to Carbohydrate.  Interesting.  In the book titled Advanced Nutrition and Human Metabolism, Sareen and colleagues provide evidence of what the body prefers during a 40 day period of starvation.  Basically the brain and the muscles convert to using ketones as an energy source, not out pf preference but necessity.

There is once again, a lot of controversy, or perhaps confusion, about ketones, or more specifically Ketogenic diets.

So are ketones bad? My opinion, not in the right quantity with the appropriate amount of insulin.

What do you think?


Trev


Sareen S, et al,  Advanced Nutrition and Human Metabolism  (2009)Page 263, table 7.2.

Accidental Overdose

I have now done this three times in 28 years with Type 1 diabetes. 

My house is, let's just say a little, no, a lot crazy in the morning;  five kids running around, lunches, breakfast and three diabetics to test, bolus, calculate, and inject.  Not using this as an excuse, but it describes the setting for you.

So I am asking my daughter on the pump what her sugar is, and she is yakking to her sister about princesses or something and I am simultaneously dialing up my Levemir(so I thought) to 16 units, and I gave it.  I then removed the needle tip to discard, and my heart sank, oh crap....I knew immediately that I just injected myself with 16 units of rapid acting not my Levemir. It is the same kind of the feeling you get if you have ever shut the car door and thought crap my car keys are in there.

Of course I had already taken my rapid acting dose of 4 units, so I now had to chase 20 units of rapid with an enormous quantity of carb.  Lovely (Sense the sarcasm) Normally I would eat 5-10 gms Carb in the am.

What to do?

First time I did this was like over 20 years ago and I went to the ER and they screened me for being suicidal for which I was not.  Back then they jammed the intravenous in my vein and filled up the tank with a dextrose drip. 

The 2nd time I just drank a gallon of regular pop, not good, can we say nausea.

The third time they say is a charm, but not in my case. I had to head to work, drop kids off, basically remain some what functional for the remainder of the day.  I am definitely going back on my pump!

I decided to fill up a 1 litre mixer bottle(the ones you make protein shakes with) with milk and 10 tbsp of liquid chocolate milk, you know the yummy stuff (in the right quantity)

I guzzled that down, took 10 units of Levemir (triple checked this time) so I wouldn't rebound later in the day. Off to work I went.  One  hour later I was sitting at 11 mmol, or 198 in the US.  but  still waiting for the peak.

Lesson learned.....Always triple check your insulin vial, especially with a house full of kids!

Trev

To Pump or Not to Pump

Over a month ago we decided to give Rowan (our 6 Year old Pumper) a vacation from her pump.  The decision was not an easy one to make because her "Mr Wizard" is truly a wonderful device.  For those new to insulin pumps the wizard feature basically figures out a bolus calculation based on what her glucose level is and how much carb we want to feed our princess.  In other words it saves my brain cells.

So off came the pump.  Next we figured out her pump totals, and started her on multiple daily doses.  To my surprise Rowan was in great spirits! I can relate, as it is nice to take a pump vacation, you can roll around, wrestle with the kids, and not worry about snagged tubing, or a knee in the old "site"

It went well until Monday, the first day back to school.  She was now requiring a lunch time insulin shot to cover her lunch.  The school team have been absolutely fabulous and fully Pump trained but not injection trained.

Oh, why did we even take her off the pump?  Sorry getting ahead of myself.  Rowan's tiny arms, and hips/buttocks, were getting swollen, as the infusion set cannula(needle) is not small.  We needed to give her body a break.  Now we are giving more injections using a very tiny(4mm)needle and can rotate to different areas.

Okay lets get to the point, we all miss her pump, strangely enough Rowan doesn't.  She like the freedom, and doesn't mind the multiple daily injections.

In order for the school workers to give her needles, they need a physician to sign forms, we see the endo in March.  As much as I have enjoyed spending my lunch hours with Rowan, it is very cool for Rowan to eat lunch at school with her dad, it is not a good long term plan.

So "Mr Wizard" we miss you and want to formally invite you back.  Your brain is far better then mine, and I can visit Rowan for lunch for fun not out of necessity.  Rowan's arms and site areas are looking way better and are now pump ready again.

So if given the choice for school age diabetic control I would definitely go with the pump.

Trev

Diabetes and Puberty Don't Mix

I have been told many times that when my tween Type 1 hits that time, you know that time---Yes,  I am talking about Puberty.  The big P word.  By the way I did mention I have five daughters living in one house who will eventually all experience this transition.  Fun, Fun, Fun...I plan to pick up lots of overtime.

Well that time has come, well it is actually in passing as she just turned 13.  I was forewarned about the increased need for insulin and rollar coaster blood glucose levels, but wholly crap there is way more to it then glucose and insulin.

Someone or some thing I believe has abducted my daughter and replaced her with a replicate from another planet.  The old one comes to visit on occasion then returns to the mother ship.  Okay, perhaps I am being a bit too harsh.

The challenges of raising a teenager with diabetes is a daunting, and very tricky task.  To her, her friends are now way cooler then us, and she would prefer to be with them instead of under our careful watch. Let the autonomy struggle begin!

We ask her daily to track her readings, count her carbs, take her insulin.  But all she wants to do is be a teen, free to hang out at the mall, socialize with friends and talk about the latest movie.  Notice how I didn't mention boys, yes I am in denial and I'm totally OK with that.

This got me thinking about when I was a teen with Type 1 diabetes.  It sucked. But I survived.  I was active, so is she.  I survived with no testing, and 1 shot a day.

This amazing alien that was sent takes her own shots, counts carbs better then most adults, knows how much to take to correct her highs, and usually tests a minimum of 4-5 times a day.  All this stuff and has a thriving social life! A promising track career, and she is passing school. What more could we ask for, really.

Even though Puberty and it's surge of hormones has made it extremely difficult to manage her diabetes I think she is doing Great!

The only major issue (which I will blog about next time) was a recent trip to the emergency department.  It wasn't DKA or a Hypo.

Oh and another thing, I like it when the mother ship leaves her for more then a day.

Later,

Trev

Insulin Pumping for Toddlers–Rowan’s Story

As I mentioned in my profile and previous blog I have 2 children with Type 1 diabetes.
Here she is:

Rowan was diagnosed when she was 20 months.  She exhibited the typical signs of onset like; unquenchable thirst, frequent urination, increasing irritability, and she generally looked unwell. 

We decided to use my meter to confirm what we suspected---and her blood glucose reading was 32mmol.  We were emotionally shocked----yet intellectually aware of what was going on.  My personal thoughts were “my damn genes are responsible for this”

We proceeded to the hospital to confirm the diagnosis of diabetes.  They re-hydrated her little body with intravenous fluid, sent off some blood work, gave a dose of rapid acting insulin, and referred her to the Pediatric Clinic the following morning. 

This forever changed her little life and also ours.  When you have a child with insulin dependent diabetes you really never truly sleep (especially the moms) or stop worrying.

The following morning we went through the standard curriculum for pediatric diabetes; diet, insulin injection teaching, targets, and hypoglycemia/hyperglycemia management.  We met the Social Worker, Nurse Educator, Pediatric Endocrinologist, and Dietician.

My wife and I were still experiencing the shock, so needless to say we didn’t retain nearly as much as we would have liked.  Nevertheless we did attend subsequent follow-up visits and did a lot of our own research on type 1 diabetes and children. 

Rowan was absolutely amazing! She took everything in stride.  It was three long days to us adults, but to a little child it probably felt like an eternity. There were two other families present during the education sessions.  Both were older children more typical for the onset of diabetes.  Rowan was so tiny, so innocent, and so brave.

What changed in our life?

Mental Health:  We were very overwhelmed in the beginning and really did not have time to deal with the emotions that we were feeling.  This subsided with time, increased knowledge, and new habits.  This aspect should always be addressed and is often not.

Food:  everything had to be measured with precision (we were told a small amount of error has a huge impact on her blood glucose) in order to avoid wide swings in glucose levels.

Insulin:  she did not like needles (go figure) every injection was met with resistance (Let the chase begin) Rowan didn’t know why we suddenly had to “poke” her 2-3 times daily. It broke our hearts.   

Blood testing:  Rowan didn’t mind the finger tests. Thank the lord.

Challenges:  

Toddlers are the most unpredictable eaters, so even though we’d carefully measure her meal and give her injection pre-meal we struggled with her to eat all her food, and this often resulted in last minute substitutions---usually less desirable choices.

Hypoglycemia is the “thorn” for us, and based on our own research and self discovery children under the typical onset age of 7-9 often do not feel the symptoms of hypoglycemia (The neurological system is too immature) Rowan is now 6 and is just beginning to recognize when she feels “low”

What did this mean for us?  Well a lot of sleepless nights and a complete change in her insulin regime. 

We struggled for months with her insulin regime.  There were nights she would drop low and other times where she would maintain normal readings.  There was no obvious pattern despite having the same routine and insulin/food amounts.  Very discouraging….

Then came the pump---and this greatly improved our quality of life!  The pump provided Rowan with continuous amounts of insulin 24 hours a day and required a “poke” or plastic catheter needle to be inserted every 3 days.  It provided us with the ability to safely give smaller doses of insulin to more closely match her requirements. It has also been proven to lower the risk of night time lows---which we can contest to.  

In summary: 

-Deal with the emotions----or they will deal with you.

-Learn all you can about your particular type or your child’s type of diabetes

-Consider the best therapy (insulin pump, pills, combination) for your diabetes. 

-In the beginning it may seem insurmountable but with time, effort, understanding, trial       and error, you will manage to effectively cope with diabetes. 

-Do not blame yourself if the numbers aren’t normal----simply ask “why, and what”

Why is the reading low?  To active, to much insulin, didn’t finish eating….

What caused the off reading?   Sick, stressed, forgot to bolus….

Most often you can attribute it to something and learn from it. 

Day-to-day life with diabetes is a challenge, and that’s how I view it, a challenge, something to beat, or manage successfully to avoid long term complications.

Yours in Health,

Trev