Who Knew Sunlight Could Be Life Saving?

We know that lack of sunlight can cause depression called SAD (Seasonal Effect Disorder) but I didn't know that not having enough Vitamin D in our body could shorten the diabetic Lifespan.  What gives?

There's been much evidence that lack of sunshine is somehow linked to the increase in Type 1 diabetes, especially populations residing in the northern hemisphere. 

A study by Mohr and colleagues who looked at 51 regions world wide,and examined the link between Sun (Ultraviolet B) exposure and the incidence of Type 1 diabetes. This is what they concluded:

An association was found between low UVB irradiance and high incidence rates of type 1 childhood diabetes after controlling for per capita health expenditure. Incidence rates of type 1 diabetes approached zero in regions worldwide with high UVB irradiance, adding new support to the concept of a role of vitamin D in reducing the risk of the disease.

If you prefer a visual aid to illustrate the above:

A recent article written by Joergenson and company published in Diabetes Care, May 2011 issue studied the possible link between low levels of Vitamin D with Micovascular complications and Mortality rates in Type 1 diabetes. They concluded:

In patients with type 1 diabetes, severe vitamin D deficiency independently predicts all-cause mortality but not development of microvascular complications in the eye and kidney. Whether vitamin D substitution in type 1 diabetic patients can improve the prognosis remains to be investigated.

So do we supplement or not?  This study by Lee and colleugues not only explains the multiple benifits in having adaquate levels of  Vitamin D in the body but adds this regarding supplementation:

A study of 340 children ages 10 to 17 years found that increasing the intake of oral vitamin D 10-fold, from the currently recommended dose of 200 to 2,000 IU daily, was required to reach a 25(OH)D level of 30 ng/ml (the lower end of the optimal range)  The investigators concluded that doses equivalent to 2,000 IU of vitamin D3 daily were not only safe for adolescents, but also necessary for achieving the desirable vitamin D levels.

Time to stock up on Vit D and move somewhere south of my current parallel.  Any ideas?

Trev


Sources:

S. B. Mohr & C. F. Garland & E. D. Gorham & F. C. Garland
The association between ultraviolet B irradiance, vitamin D status and incidence rates of type 1 diabetes in 51 regions worldwide.

Christel, Joergenson, MD, Hovind, Peter, DMSC, Schmedes, Anne, PHD, Parving, Hans-Henrik, DMSC, Rossing, Peter, DMSC. Vitamin D Levels, Microvascular Complications, and Mportality in Type 1 Diabetes Diabetes Care 34:1081–1085, 201.

Lee et al, Vitamin D Deficiency; An Important, Common, and Easily Treatable Cardiovascular Risk Factor? Journal of the American College of Cardiology, 2008.

Post Lab Visit - What Ifs...

Well, I decided since I was booked to see my Physician on Monday it was time to get my blood work done.

It has been harder and harder to get this done.  Not the act of getting the blood drawn, but finding the time to get to the lab, wait, fast, etc.  I always find excuses not to get it done.

I did manage to make it to the lab, pee in a cup, get the three vials of red stuff sucked out of me, and back to work with my morning coffee in tote. 

Diabetes, and its time suckers I tell ya. Normally a trip to the lab takes 1-2 hours out of my day. Today was a good day, in and out in an hour. I am glad to get it done, but a little worried about the result. I haven't been a well behaved PWD over the winter. Oh well, we shall see in a couple of days.

It is the what ifs that haunt me while I wait for the results.

Like What if....

-I'm spilling protein in my urine, called Microalbuminuria.....
-my Lousy Cholesterol(LDL) is increased.....
-my HgA1C completely blows...
-my kidney function (tests) worsens

 I pretty much worry about every single lab result and what it means and how it could potentially effect my lifespan.

When you've had the big D for a long time, these things start to seep into the thoughts, and consciousness, as you contemplate mortality with diabetes.

One things for sure is the DOC has numerous stories and people who have been dealing with D for decades and are living proof that it is possible to live a long, complication free life.

 I know the research(DCCT Trial Info) states it is possible to reduce complications, but I want to avoid complications not just reduce.

Well until Monday the fingers are crossed. 

Have a great week-end!

On a funny,  not so serious note, check out my new VLOG below of my toddler providing music on my daily commute. Note this is on the way there and the way back.

Top Ten List: Things We Are Told Not to Do But Do Anyways

1.  Over Eating to Correct a Low

2.  Leaving the Infusion Set in "Just one More Day"

3.  Leaving the Lancet in your Finger Poker for Waaayyyy toooo Long.

4.  Re-Using Syringes, to the point where it really does hurt

5.  Eating when High - y'all know it's best to wait

6.  Chasing Numbers - AKA treating a food reading with another bolus of insulin

7.  Making spontaneous basal changes - Like I'm low, I'll just shut it off for a bit.

8.  Ignoring alarms - both mechanical and internal, pump, CGM, and our own lows.

9.  Eye Balling Gargantuan Amounts of Carbs, even though we know how to use the scale.

10.  My favorite, licking the blood drop off the finger post prick!  Makes me feel really rebellious.

What are some of your "Things You've Been Advised Not to Do"

Have an Awesome Day!

Trev

My Mind is a Garden

I used to say this to myself on occasion when I was younger, like 20's younger. I can't say I came up with the concept, because I picked it up from a book I read back then called, The Monk Who Sold His Ferrari by R.S. Sharma.

It was one of the concepts he presented in his book. I honestly can't find the book.  But to this day it proves to be a good mantra.

Think about it.  We need to protect our mind from the constant bombardment thrown at it daily from the outside world.  Media, movies, and negative people we may encounter in our daily travels.  My post called Help or Hinder I wrote a while back about those who can be called hinderers and those people who we call helpers is an example of the filter we need to use to protect our "Garden" of a brain.

Where am I going with this? 

I think we all have a tendency to go on "Auto Pilot" the daily grind so to speak but a meeting I had today made me ponder life.

 This post was prompted by an elderly gentlemen I met in my daily travels. He is 94, almost 95. Sharp as a nail, an absolutely amazing person.  He has been on this planet since 1916.  I listened to him tell me about his life and I was in total awe for well over an hour.  Now that's a feat for a guy who's nickname used to be the road runner.

He said to me life is a blessing.  It is a gift. To be able to experience the joys of love, laughter, children, and of course golf.  Now I am not a golfer, but this fellow still hits the course once or twice a year. Amazing or what!!!  He stretches every day. He has lived all over the world and as he says "My wife and I were to busy having fun to argue, she was an amazing woman!"  What an amazing outlook on life.

Needless to say I left this interaction pondering the journey of life. People we love, people who love us. Places we live, the magnificent world we live in. Life truly is an amazing journey. Often over shadowed by our daily routine.

I just wanted to share this interaction. It inspired me to look at all aspects of my life. Where I've come from, where I am, and where I am going. Most importantly to appreciate all of it.

In the grand scheme of things Diabetes was only a small part of the over all picture.

Oh, back to the "Garden".... Basically;  I need to focus on the positive things that nurture my mind, let it grow, and keep it healthy.

I am off to go water my brain---kidding.

Trev

FIRE The Easter Bunny!

"My 3 Middle Children
Rowan, Grace & Abby"

WARNING:  Parental Advisory.  Do Not Let Your Child Read the Content.

YES, I said it.  I have been pissed at the Easter bunny since I was nine years old, the year I was told I had to "cut" out the candy. "D" Day, the year of Diagnosis.  That's what they did 28 years ago. They weren' t into letting patients control their diabetes. Carb counting wasn't promoted, it was basically, here is your exchange meal plan diet, good luck.

So when we got home(28 yrs ago), and these notorious holidays swung by, my parents took the meal plan to heart.  HAPPY freakin EASTER!  Instead of the basket with the huge chocolate bunny, I got a toy, and a bag of peanuts. If I was exceptionally lucky I also got a can of Diet Tab.  What's Up with that!!!

I asked my parents "Why did the Easter bunny not bring me chocolates this time?"  They told me he knows I have diabetes.  I thought, crap, even he knows.  That means, Santa will definitely know. This really sucks! 

Now fast forward 28 years to the land of Intensive Insulin Therapy and Carb Counting.

These holidays are still happening, as you all are well aware. Now I have learned to just take huge amounts of rapid insulin to "Have my Huge Chunk of Chocolate"  and so can my 2 type 1 kids.

Needless to say, I still to this day, have this secret grudge against the Easter Bunny. I almost feel bad about it, but it exists.

"Enjoying the Good Stuff"

These Holiday Occasions all involve the over consummation of "High Fructose-Glucose, anything Sugar-ose containing food in large quantities. Now for us living with a pancreas on permanent hiatus we are kind of screwed!  Y'all know what I am talking about.  No matter how hard I try even with intensive therapy and the use of rapid acting insulin, my blood glucose level for the 24 hrs during the "Holiday Occasion" is a jagged looking mountain of a graph. Naturally my children share this same graph. 

I still leave the key in the mail box for the Easter Bunny, but I really wish he'd bring us a new pancreas or at least call Santa and maybe they can both get together, swap magic and make it happen.

Even though Easter is easier then 28 years ago, I still wish these holidays were a little easier on the blood sugar control.

Trev

Cool Gizmo Machine AKA CGM

"Meet Mr. CGM Man!"

I am really wanting to initiate some serious CGM (Continuous Glucose Sensor) sensing in da house full of Diabetics.  My drawbacks were financial, basically couldn't afford the 200 for 4 sensor equation. But we now have a "Flex Account" meaning, I could, if I wanted to, get them covered. Hence my new dilemma.

The new barrier is not the cost, but the size of the Medtronic Sensors.  They could be used to hang up the cork board in my kitchen. Seriously, that BIG!  So I did some research to try to sway me into making a decision. Just Skim it. Thought since I read it I might as well share it!

My Take: 

Battelino and crew took 120 people with type 1 DM. (Randomly - which makes the study better) split them in half, one control group, one treatment group. They followed the groups for six months and concluded the following:

“In conclusion, the results of the current study demonstrated significantly shorter time spent in hypoglycemia in children and adults with type 1 diabetes who used continuous glucose monitoring compared with standard SMBG, with a concomitant significant decrease of HbA1c.”

In a nutshell:

CGM is a good way to stay out of the hypo zone.   It also has an effect on over all control shown by a lower A1C.

 Here is very informative article discussing some “don’ts” with RT-CGM(Real Time CGM) use and insulin pumping, written by Howard A. Wolpret, MD.

Here is the Link to the Article Titled; The Nuts and Bolt of Achieving End Points with Real Time Continuous Glucose Monitoring.  Here is the Article Link  Lots of cool graphs, talks about things like not shutting the basal off to treat lows, and not pre-maturely bolusing for highs. Good stuff!

Another Study published by the Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group.  The authors randomly assigned 272 PWD to use CGM over a period of six months.  This is what they found:

“After 6 months, near-daily CGM use is more frequent in intensively treated adults with type 1 diabetes than in children and adolescents, although in all age-groups near daily CGM use is associated with a similar reduction in A1C."

Once again the results show that there is a benefit from frequent use of CGM for PWD of all ages.

"MedTronic"

I think there’s a trend here.  Well on a personal note;  in our house full of diabetics  we are the proud owners of  two insulin Pumps with CGM capabilities.  We own one sensor (2800 bucks) and we don’t currently use it. For the aforementioned reasons.

"The Dex"

Unfortunately the Dexcom CGM isn’t available in Canada(I hear from the DOC that it's mucho better) and I have yet to hear anything back from my numerous emails writtem to the company.  I love my Medtronic Pump, and the built in Sensor thingy, but the needle is ginormous! Like Hammer and Nail large.  I can barely stomach it let alone my wee one.

If anyone reads this and knows anything about the Dex and when it is going to immigrate to Canada, please keep my clan posted. 

Trev

Sources: 

Another Study published by the Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group.  Factors Predicative of Use and of Benefit from Continuous Blood Glucose Monitoring in Type 1 Diabetes. Diabetes Care 32:1947–1953, 2009.

http://care.diabetesjournals.org/content/32/11/1947.full.pdf+html?sid=4c7cc395-3b1b-48c1-b381-6a43aa732cd5

Tadez Battelino, MD, PHD, Moshe Phillip, MD, Natasa Bratina, MD, PHD, Revital Nimiri MD, Per Oskarsson, MD, PHD, Jan  Bolinder, MD, PHD. The Effect of Continuous Blood Glucose Monitoring on Hypoglycemia in Type 1 Diabetes.
Diabetes Care 34:795–800, 2011

Howard A. Wolfert MD.  The Nuts and Bolt of Achieving End Points with Real Time Continuous Glucose Monitoring.  http://care.diabetesjournals.org/content/31/Supplement_2/S146.full.pdf+html?sid=21e0bbe2-9439-45b6-825b-69b69aca3cc3

Pickled Diabetic Melon - Proof

Good Day!  I am so happy to hear from Y'all! 

As promised I did a review of some literature to check into the "Pickled Brain Syndrome" I blamed my recent act of stupidity on.  Here are a few I found to chew on.

Malone and colleagues did  a study  using rats that showed the following in support of  the “Pickled Brain” theory.

Hyperglycemia, but not hypoglycemia, was associated with adverse effects on the brain polyol pathway activity, neuronal structural changes, and impaired long-term spatial memory. This finding suggests that the hyperglycemic component of diabetes mellitus has a greater adverse effect on brain functioning than does intermittent hypoglycemia.

In other words the brains pathways involved in memory access is hampered when PWD experience high blood glucose. Gee I could have used this information years ago for all sorts of evil means.

 

Perantie and company performed a study that set out to determine whether hypoglycemia or hyperglycemia resulted in cognitive impairment in Type 1 children.

What they found was the following:

 The group with T1DM had lower estimated verbal intelligence than sibling controls. Within the T1DM group, verbal intelligence was reduced with increased exposure to Hyper, not to Hypo. In contrast, spatial intelligence and delayed recall were reduced only with repeated Hypo, particularly when Hypo episodes occurred before the age of 5 yr.

What the hell. Like we Parents want to read this.  I think I turned out okay, I managed to complete post secondary education, but I remember having “good” exams days, and “bad” exam days, and in retrospect the bad ones were the “My Sugars Out of Whack Days”

As my wife constantly says in our house, “Protect her little brain”

Sommerfield and colleagues examined a group of adult type 2 diabetics and found strikingly similar findings as the above two studies. 

Speed of information processing, working memory, and some aspects of attention were impaired during acute hyperglycemia. Subjects were significantly more dysphoric during hyperglycemia, with reduced energetic arousal and increased sadness and anxiety.

The findings above support the pickled brain syndrome. Not only memory but mood as well, which for children who are already emotionally challenged makes for a challenging scenario.   Damn high blood sugars!

Kubiak and his folks reviewed some research and discussed this the effect of post meal glucose spikes on memory.

 If you link to the publication near the end there is discussion about post meal blood sugar highs impairing memory in Type 2 Diabetes. Interesting, and something else to consider when dealing with our own management.

Article Link  - To Discussion.  

This information certainly reminds me of  the importance of maintaining tight glycemic control. Not only to prevent the typical, frequently spoken about complications we constantly hear about; blindness, vascular disease, kidney failure, feet issues, penis issues, heart disease, etc. But the "Pickled Brain" issue.

Well I wish you all a fab Easter weekend!!!

Trev

Sources:

Malone, John; Hanna, Suzan; Saporta, Samuel; Mervis, Ronald F; Park, Collin R; Chong, Ling; Diamond, David M. Hyperglycmia not hypoglycemia altners neuronal dentrites and impairs spatial memory.  Pediatric Diabetes. 9(6):531-539, December 2008.

Perantie, Dana C; Lim, Audrey; Wu, Jenny; Weaver, Patrick; Warren, Stacie L; Sadler, Michelle; White, Neil H; Hershey.   Effects of prior hypoglycemia and hyperglycemia on cognition in children with type 1 diabetes mellitus.Tamara.Pediatric Diabetes. 9(2):87-95, April 2008.

Sommerfield, Andrew J. MRCP; Deary, Ian J. PHD; Frier, Brian M. MD. Acute Hyperglycemia Alters Mood State and Impairs Cognitive Performance in People With Type 2 Diabetes. Diabetes Care. 27(10):2335-2340, October 2004.

Kubiak, Thomas; Hermanns, Norbert; Preier, Michael; Kulzer, Bernhard; Haak, Thomas MD.

Memory Impairments Associated With Postprandial Hyperglycemia and Glycemic Control.
Diabetes Care. 27(2):634-635, February 2004.