Life vs Diabetes

"Oldest and Youngest, Beautiful......"

We all know that "good" diabetes management takes a lot of effort and devotion to be effective. But we also know that all life's successes also require our devotion, our mental energy and basically our time. The trick lies in balancing the two areas successfully.

Life is full of change, un-imposed and imposed.  Diabetes is inevitable and also full of change. We can't turn our mind off when it comes to managing diabetes. Life is similar, we have to pay attention or life spirals out of control, we miss appointments, fall behind in the daily chores of life. The trick is balance, we know this, but my god this is not an easy task and I notice that when life gets crazy, out of control and overwhelming, my diabetes tends to loose its place in the balance of things. Basically diabetes fails to be my priority compared to life's commitments.

I see this in my self and most diabetics I meet. My 15 year old Type one would rather fit in socially at lunch then test and take insulin. I would rather just grab some take out, eat it, then take my shot of insulin after the fact. Why, because life, the social pressures, the time constraints take precedent over this thing called diabetes.

If I am happy, positive and feeling good about life, then I am highly motivated to take care of my body. This includes exercise, sleep, food, and diabetes management. If I'm in a low mood; the opposite effect occurs. For this post I guess I'm just "thinking" out loud, venting, so to speak.

I was on a flight to visit my home town a few weeks back. During the safety video, when the oxygen mask falls and the passenger places it on them selves first then the child I thought of this post. We need to make diabetes the first choice, as difficult as this is. Otherwise we get sick;  we damage our bodies, and life spirals even quicker out of control like a plane loosing altitude. If  we don't take care of our health, then we are useless to everyone else in our life.

Trev


  

Sure I Can Handle It! - NOT

"To School........"

Today I was left with the simple objective of getting my five kids off to their 3 different schools. Easy enough I thought. Some good strong coffee, a positive attitude, and easy peasy, no problemo! Bloody hell am I exhausted.

First off; I was on my own, no Mrs, just myself, she opted out to earn some dough instead, important yes, but boy did I miss the team today.

Now generally my house is chaotic, five girls, bathrooms, brush fighting, hair bret and attire comparisons, mirror gazing, and texting.  Now throw diabetes into the mix and add not having a clue who's teacher belongs to whom - You've got yourself a recipe for chaos. Oh and did I mention I forgot to register our youngest, minor oversite. Anyway moving along....

As I sit here pondering over the days events I think; I don't know quite how I pulled it off. Teen was pretty good, got up wwwwaaayyyyy to early to ensure a stellar look for her first day of high school, eagerly awaiting for her friend to show at our door as god forbid they be seen walking to high school alone, like oh my god, that would spell social disaster on day one, only the most important day of the year!  She tested her sugar, I think, well she didn't die at school as I personal witnessed her arriving home. Not sure how the diabetes went, but socially she seemed bright.

Upper two middle kids, if that order makes sense, going off to junior high. No diabetes = easy. Backpack; check, lunches; check, ride to school;  checks, slow down just enough for them to jump out the door; check. I'll let ya know how their day went later. But I didn't get any calls from the school.

Younger two, second youngest being the little Type 1.  Now this is where it gets time consuming and importantly so!  I arrive, they have reno'd the entire school so everyone meets in the Gymnasium with all the teachers semi-holding up signs like at an airport when the driver is seeking out his passenger after a flight. We ask around, all the while dragging the 4 yr old in a crowded gym full of screaming kids and finally track down her grade 2 teacher.  Who I might add was eerily calm in the midst of chaos;  I would have needed a heavy dose of some form of sedating anti-anxiety medication to remain calm in what I percieved as pretty much the scariest environment imaginable.

"Summer has ceased to exist"

We find her, I introduce myself and da kids, and we follow her back to the class room. She informs me that she is aware Rowan has Type 1 Diabetes and we will need to talk. During a quiet moment where the assistant reads the class a book, I give her the "Crash Course in Diabetes Management for Kids at School Presentation" She nods, and says would you be able to repeat that again to the assistant. I hand her my notes and state, sure thing. I leave, toddler in tote, return 1 hour later, repeat, test, leave, return and repeat, test, inject, ensured they understood.  Peering at the teacher, I could sense the apprehension, or fear, of "You are leaving this precious child with me to care for with this poerilous chronic illness called type 1 diabetes look, you know the one....if they don't have that look on their face then be concerned. 

I peered calmly at her and said, "I've had type one diabetes for 30 years; before the good insulin's, before glucometers, and back when they assessed your health and development on how much weigh you were gaining. I survived, not blind, no damage done. She'll be okay and you can always, I mean always text, email or call..........Anytime."

Wow what a day!

Cheers!
Trev

Running High Out of Fear

"Reminded me of the curves of diabetes management"

Why we do it and tips to hopefully prevent doing it. Diabetes definitely has its curves, and lows are by far the worst of them.

I have noticed a trend in my own diabetes management and those I see weekly in the clinic I work at.
That is, folks on insulin tend to run their blood sugars higher before bed to avoid being jolted out of bed in the middle of the night and will do anything to prevent that from ever happening again. Including eating a snack with too many carbs so they run high all night, cut back on insulin so they don't worry, but wake up with higher fasting blood glucose readings, which as we all know drives up our A1C percentage.

I have to disclose that I too still do this on occasion but not nearly as often. The newer insulin that lack a significant peak and the insulin pumps with continuous glucose sensing capabilities are proven scientifically to be safer in preventing nocturnal lows. But sometimes, lets say if I have a really intense endurance workout after 7 p.m., I will purposely run high, knowingly doing damage to my tiny vessels for the sake of a sane night's sleep. It is really quite frightening, kind of like the sign I seen on my recent camping trip.

Now, I notice we (my spouse and I) letting our wee one run a little high and being very reluctant in giving correction shots after 7 p.m. for fear that she will drop too low, not wake up, and suffer seizures or, the worst case scenario, death; see my earlier post about my Smallest Type 1 Kid not feeling her lows. Scary stuff; improved though. I mean, during waking hours, she sometimes comes and says "I feel low," which I am so happy about. It sounds strange to be happy when your kid feels a low, but it was really stressful for the longest time when she didn't. 

Okay, back to the theme of this post.  I still tend to let her glucose level ride higher then target, not crazy high but a little high, and I know this effects her A1C and long-term health. For now the risks of her not waking up from a nighttime low far outweigh the benefit of keeping her alive and a little high.  But what about us adults, specifically those who don't use a pump and CGS (Continuous Glucose Sensor)? What's my excuse? I wake up, so why run high?

Well, I think it helps to to know your normal physiological profiles, like; responses to stress, food, and exercise as these are key to preventing the sudden overnight lows and the associated fear.

How?  Well test like crazy, I mean before bed, every two hours. Borrow and or buy a continuous glucose monitor(CGM), or get an insulin pump that has one incorporated into the device. My experience with CGM's are good for finding out your profiles what your requirements are in a 24 hr period of time.  My trusted way is just trial and error, and using a meter to test yourself using the mindset that you are the scientist and also the Lab Rat  Yes you will have to set the alarm and test, yes you will figure out weird responses to things like high intensity training and rebound highs that later result in extreme lows, but that's my point.

With a lot of testing and record keeping, learn about how diabetes, food, activity, medication, and stress effect you body and more importantly your glucose levels. The more we figure that out the more trust we have in the shots we take and then hopefully we have more happy nights and less fearful ones.

Cheers!

Trev

Stinky Teddy Bears - Type One Bedwetting

One of the offspring

When I was a wee one I wee'd one too many times in the bed. I remember waking up wet and cold, getting up, trying to hide the blankets or simply grabbing a towel to cover the spot and go back to sleep. I felt terrible, ashamed, and I knew my mom got sick of the constant flow of laundry I was providing. It eventually stopped, I think around 10. I never gave it much thought until we created a wack of offspring. One of which wets the bed almost nightly.  Our teddy owner also has Type 1 diabetes, and I am certain there is a link. I wish I had of considered this back in the day instead I thought it was me. It would have nicer to blame it on D.

I checked the net quickly for info, and found this Link on bed wetting 

How many of you folks have issues in your house with stinky stuffies and diabetes?

We try to not push the fluids too much after 6 pm, unless she is high. We don't wake em up and carry her to the BR as this apparently trains the bladder, yes I know odd that our pee organ can be trained like a dog.  Yes I have resorted to using pullups, but am open to any good ideas, other then electric shock therapy.

Cheers!

 

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

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.

Trev