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

Tight Rope Act Getting Old ?

YUP!

I say give me a plank to walk on instead any day.

I totally think that managing Type 1 diabetes, and Type 1 diabetes in children especially is a constant tight rope balancing act. If you lean to far in either direction, or lose your concentration, then over the edge you go, sometimes landing on the safety net and unfortunately sometimes not. It really is a precarious balancing act of food, activity, stress management and insulin dosing. Not to mention the inevitable "curve balls"

I equate my house with diabetes to a tight rope walk while juggling three balls as there are three of us to manage. I must admit that the prospect of caring for my 2 kids was incredibly overwhelming at first and still is at times. Things in the house of syringes and test strips has stabilized to some degree, well at least the routine has, but the numbers could always use a little work.  The routine is ingrained, as anyone dealing with diabetes can attest to, testing, thinking, calculating, injecting or bolusing, testing to see if you guessed correctly, and so on and so forth. You adapt to the routine, but are never completely at ease, once again with children in particular. Like a tight rope walk, one screw up, miscalculation, mismeasurement, and over the edge you go. 

I try to imagine or wish that the tight rope could be more like a plank, not like on a pirate ship; where you'd eventually plummet to your death to be eaten by frenzied sharks, but wide enough to take some of the nervousness and precariousness away by allowing for a larger margin for error. I do believe the technology that exists today is widening the plank. Pumps fine tune basals to prevent lows at night and spikes in the morning. Continuous blood glucose sensors are allowing us to notice trends in our blood sugars allowing us to relax and let a machine do a bit of the brain work. Newer insulin analogues in the last 2 decades have really helped me feel more at ease resting my head on the pillow at night knowing I am far less likely to be jolted out of bed with a frightening low. Glucometers, where would we be with out them? We'd likely still be judging our control based on how much weight we've gained or urine sample showing glucose from hours long gone past. That being said; most days feel like I am tight rope walking while juggling.

Why is that? Well, because so many things mess up our sugars. A handful of those yummy skittles, a sleepless night, a rebound high after a night time low. Do you realize how hard it is to stop eating after treating a low with 15 grams of carb. It is like a dog not taking advantage of the piece of bacon dropped beneath it's nose during a breakfast frenzy. Ya, that bacon is gone with in a split second, along with your plate of eggs an toast. Alright, back to the point, which is everything can effect our glucose.

My teen Type 1 often forgets to test, and will arrive home with a glucose that would cause any Endo or Doc to drop, or prompth them to call the authorities. I don't judge my girl though, I remember the balancing act, I remember being a teen, and I can only gently yell remind her to test while at school. When I ask what could be the cause of her reading (trying to encourage critical thinking) she shrugs and says, "I had some of my friends chips" That's it, as simple as a bag of chips, not criminal just thoughtless, diabetes has obviously not entrenched itself into my daughters thoughts as it has mine, she has yet to be relentlessly governed by the big Mr D.

Now my little Type 1 who is 7 is frequently falling onto the safety net, close at times to the hard concrete floor, but has always landed safely, conscious, with her brain intact. The near misses have occurred; nights where I get up and randomly check her after having a low myself, finding her reading less then the desired range or after an activity that we neglected to feed her enough, another example of losing concentration.

It is these occurrences mentioned above that remind me that we're walking a tight rope, and the minute I lose concentration, put my guard down, relax a little, the potential to miss the net is ever so present.

Trev

Can Exercise Kill You?

Okay I must admit the title sounds a little ominous. But in my reality participating in physical activity can  in effect make diabetes harder to control and can cause serious fluctuations in blood glucose. As anyone who has been jolted out of bed at night (sweating, shaking and fumbling for a quick source of carbohydrate only to rebound the next morning into the high teens) with an extreme low due to exercise performed earlier in the day. Sorry for the run on but need to get my point across.

The Canadian Diabetes Association recently sent out a News Letter that had some stats about what type of support Canadians get from Province to Province. There was one number or stat that stood out regarding exercise and diabetes. "Ninety per cent do not have a fitness expert to consult with when they require specific advice about how exercise impacts their diabetes." Interesting.....but not surprising.

In the past 20 of my 30 years living with a dead pancreas, I know I sound melodramatic, I have found it extremely difficult to find a health or fitness professional locally to assist me in this area of my diabetes management. Sure you get basic guidelines, like feed your activity or reduce your insulin by a certain percentage prior to exercise, but I must admit that as usual, my approach and control is the result of self awareness and self experimentation using my trusty glucometer. 

As I age, and routines change; I am still learning new things about exercise and diabetes. For example; that if I perform a high intensity workout I often require extra insulin prior to the work out. Once again due to the stress response mentioned in the last post. Crazy, as I have always been instructed to feed or reduce for activity. I also understand that everybody reacts slightly differently to exercise, stress, food, etc.  So it is likely hard to narrow down specific exercise recommendations.

Back to the stat; 90 % of people - That's a high percentage who would benefit from a specialist in exercise and diabetes. I also notice that there's a  lack of detail out there on exercise and diabetes, and that any info out there is difficult to weed through and unfortunately these details and lack of accessibility can in some cases be crucial to all diabetics (Type 1 in particular) So hopefully in the future our health care team will also include an exercise expert focused on diabetes or the option to see one. I doubt it though, as my docs over the past few years tell me that active people are a rarity these days so if a person is doing anything remotely resembling exercise, that is good enough. But what about the select few of the Type 1's out there that require expert support in the area of exercise?  Trial an error is good but there are certainly tips I would have loved to know years ago that I know now regarding nutrition, glucose response to the different types of activity, etc.

What I have learned using myself and observing my kids in terms of exercise and diabetes:
-over training is not good, my limit is 2 intense work outs per week.
-If i train near my max heart rate I typically don't need to feed the activity and generally require a bit of rapid insulin
-If I train at a low intensity I either have to lower my insulin by 30 % (Thanks to my Nurse educator) and this seems to work, or feed the activity 10-15 gms of CHO for every 1/2 hour - keeping in mind we are all different and I am sharing what works for me.
-If I don't drink enough fluid or water during the time during and prior to the work-out then my sugar level tends to really spike with high intensity training.
-I get sick really frequently if I workout more the 3 times a week with high intensity training (circuit weigh training, Muay Thai Boxing, and never work out more then an hour (includes warm up)

Even with frequent testing and self observation, fine tuning etc, I still have the occasional low, and would still love a good guideline and expert advice and feedback on the specifics, like carb loading and intake on training days, specific tips to stay healthy looking through the goggles of a diabetic paradigm. Questions like; will a certain activity worsen or accelerate any diabetic complications?

Feel free to point me in the right direction. And overall I do believe that just the right amount and type of activity will keep up healthy but too much of any activity is damaging.

Cheers!

Trev