Welcome to the New Less Than 7

Tremendous thanks to everyone who follows the blog.  Because of your awesome support and the good vibes I've been getting from you, Linda and I have decided to launch a full-blown website.  Our goal is to continue the blog, as well as offer additional resources and products that will help us all to dominate diabetes.  Let us know if you have any requests!

Please subscribe to the new site to receive blog posts straight to your inbox and stay up-to-date with what's going on at Less than 7.  Thanks again for your support!  Check out the new website below; let me know what you think.

less than 7 (greater than low)
www.lessthan7diabetes.com

10 Factors That Indirectly Affect Blood Sugar

Even those that don't know the first thing about diabetes know that food affects blood sugar.  But anyone who lives with diabetes can tell you that food is not even half the story.  There are countless other factors that influence blood sugar in one way or another.  Here is my top 10 list:

1. Stress:  This illusive phenomenon has its hands in everything, including blood sugar.  Since stress can't be avoided, it's best to keenly observe trends and patterns in blood sugar while it's happening.  Then you will be able to develop a game plan for its return.

2. Activity Level:  Generally speaking, increased activity will decrease blood sugar, and vice versa.  See number 9 for possible exceptions.

3. Change in Routine/Schedule:  When you have a regular schedule and your medication is in rhythm with that schedule, any changes or disruptions in the routine have the potential to cause havoc on the blood sugar.

4. Hydration Level:  Medication, including insulin, is better absorbed if the body is hydrated.  This is one reason that drinking water is suggested when blood sugars are running high.

5. Medicine Mechanics:  We have to give our meds the best opportunity to do their job.  For instance, if our instructions are to take once daily, then we should be taking at the same time every day.  Additionally, pump users must be vigilant for tubing or site problems such as kinks or occlusions.  All insulin users must watch out for lack of absorption due to poor injection sites and lipohypertrophy.

6. Nerves:  I'm referring here to the sensation of nervousness.  For example, I find my blood sugar spikes just before I'm about to give a presentation.

7. Calculation Errors:  These can be carb-counting mistakes, insulin correction factor mistakes, or timing issues with medications.  Mistakes will happen, we just have to take note and adjust accordingly.

8. Illness:  Blood sugars will usually run high during sick days.  Remain hydrated and contact your healthcare provider about temporarily increasing meds.  Better yet, don't get sick ;)

9. Exercise:  Depending on the type of work-out you're doing, and the time of day you are doing it, you may have unexpected results.  For instance, I have noticed that doing high intensity interval training (HIIT) early in the morning will increase my blood sugar.  Cardio typically decreases it.  Again, you will have to learn your body and come up with a plan to prevent blood sugar swings.

10. Lack of Sleep:  This could be a sub-category of stress, change in routine/schedule, and medicine mechanics all at the same time.  When our sleep cycle is off, it's not only tougher on the body, but it throws off our circadian rhythm.  For someone whose livelihood is fostered by daily doses of medication, it's tough to know how the sudden change in schedule and added stress will affect the distribution of hormones and the uptake of meds.

What other things affect your blood sugar?  Let us know so that we can all be less than seven, greater than low!

An Example of False Hypoglycemia & the Truth Behind "High Normal"

The all-too familiar words, "We need to find a way to get these blood sugars down", can be a scary sound at times.  Not scary because of the time, effort, and vigilance it will take.  Not scary because we will actually have to stick to a plan and/or a diet.  Not even scary because we've heard these words in the past.  Sometimes this statement is scary because it asks us to purposely make ourselves feel terrible.

After seemingly hundreds of attempts to drive down our HbA1c, we conclude that the high numbers are just "our normal."  Sure, the average A1c should be less than 7.0, but that's just an average.  I'm an individual diabetic.  I feel atrocious when I approach that level....quite hypoglycemic, actually.  I must have a "high normal."

Without adequate education, I must admit that this argument is fairly logical.  We constantly have to listen to our bodies, and make insightful decisions about the way we feel.  However, this "high normal", while undeniably a real phenomenon, is actually a simple "threshold reset."  In plain English, we let our blood sugars run high for long enough to train our brains to rely on those levels.  When we suddenly try to drive blood sugar levels down, the brain resists by signaling that our blood sugar is getting too low.  Hence, the terrible "hypoglycemic episode."

Okay, nice to know; but that doesn't help me lower my HbA1c without feeling like a drunk chicken.


Right.  So, we've also determined that said threshold can be restored to default, if you will.  Generally speaking, this can take up to 2-3 weeks if blood sugars are well controlled.  One method is to just push through, and bear the symptoms until your body adjusts.  If you're not in to asceticism, the other option is to "treat" the episode with 5 grams of carbohydrate (or less) to simply rid yourself of the feeling, while not raising blood sugar enough to impede your progress.

Example: Feeling hypoglycemic, BG reading is 110 mg/dL.  Consume 1 peppermint candy (5g carb).  Retest BG in 20-30 minutes => 135 mg/dL. Hypo feelings gone.

It's better to be 110 rather than 135 mg/dL, but you also have to manage the symptoms.  As long as blood sugars are indeed coming down overall, this can be a reasonable method to discuss with your healthcare team about resolving the issue at hand.  In addition, we don't want this to be something we rely on long-term.  Should you continue to feel these symptoms well above 70 mg/dL for several weeks, you should again contact your healthcare team.

I hope this takes away any discouraging feelings for those who have decided that low HbA1c's are an impossibility.  Please note that there are other possible causes of false hypoglycemia not discussed in this article, including rapid acute BG reduction, illness, and meter malfunction.  Feel free to send questions or comments about your own experiences with this phenomenon.  Thanks for reading; and let's be less than seven, greater than low! 

Related article from Joslin Diabetes Center

Oh shoot, do I really sound like Eeyore?

I'll be the first to admit, I'm the king of complaining.  The funny thing is, until just a few years ago, I didn't even know it.  You see, I have this "Mr. Fix It" approach to life.  I am quick to find the negatives of any situation, so that I can entertain myself with trying to come up with solutions for them.  This is all fine and good; however, in the meantime, I sound like Eeyore to all those around me as I mull over the problems I've discovered.

Perhaps it can be partially attributed to growing up with diabetes.  Over the last 30 years, I've trained myself to procure a constant vigilance over my blood sugar and the endless number of factors that influence it.  It's a daily (sometimes hourly) routine to pinpoint an issue, identify a probable cause, and execute a reasonable solution.  At this point in my life, it's not negative or depressing, it's just a game of survival.

However, when I place myself in the shoes of someone without diabetes, I can understand how it might be less than desirable to watch and listen to this struggle......Sort of like hanging out with Eeyore or The Boy Who Cried Wolf.  Consequently, I've tried to make a conscious effort to notice those things (diabetes-related or not) that are running smoothly.  It's an awesome thing to do, because not only does it lead me to admiration and gratitude, it spills over into my language and habits.

The result is a cool drink of water for me, and pleasant interactions for those whom I encounter.  As I write this post, I can't help but be reminded of the fact that we are integrated and imperfect persons.  More often than not, difficulty controlling diabetes is just a symptom of a greater, deeper problem in our lives.  And sometimes that problem is not so obvious.  Therefore, it's good practice to frequently reflect on the big-picture-happenings that make us who we are, and how these events are affecting our mood, sanity, spiritual / physical / mental health, stress level, behavior patterns, and diabetes control.    

So keep your chin up, stay positive, and get to know yourself a little better.  It'll help in more ways than you think.  And then, let's be less than seven, greater than low!  Thanks, and God bless.

20 Very Low Carb Snacks

Linda here! Over the years, I have been asked several times by patients, (both people with type 1 and type 2 diabetes), to provide them with a list of low carb snack ideas.  Snacks are not always necessary, but they sure can help you to stay on track if you are trying to lose weight and/or control blood sugar.  As with all things, snacking should be done in moderation.  Below is a list of some very low carb snacks (less than 5 grams of carb per serving).  Some of them will contain more fat and/or protein than others therefore increasing the calorie content.  I listed them from lowest calorie to highest calorie (give or take a few).  I hope this helps.  Thanks for reading!

 

Carbohydrate Range: 0-5 grams Carb.

Calorie Range:  about 0-200 Calories.                                                                                                                                           

1.   Sugar free Jell-O (any amount)
2.   1 dill pickle*
3.   5 Pickled Okra*
4.   1 Sugar free popsicle
5.   1 Sliced Cucumber
6.   1 Raw tomato
7.   1-2 Cups Kale Chips (see recipe below)
8.   1 cup celery/bell pepper sticks
9.   1 cup raw broccoli/cauliflower/cucumber with 2 tbsp Ranch dressing
10.   5 black/green/Kalamata olives*
11.   1 hardboiled egg (or any egg cooked any way you like)
12.   1 slice of cheese (Swiss, Provolone, Cheddar, etc)*
13.   1 string cheese stick*
14.   1 Tablespoon Almond/Cashew/Peanut/Sunflower butter
15.    1 slice of cheese, rolled up in one slice of turkey*
16.    ¼ cup of sunflower seeds (in the shell)*
17.    ¼ cup of shelled walnuts
18.    ¼ cup of almonds
19.    ¼ cup pistachios without shell
20.    ¼ cup peanuts                                                                                                                                                                                                                                                 

*These items may be high in Sodium.  Read food labels.

Kale Chips Recipe

This Recipe is nothing new.  I did not come up with the idea of Kale chips all by myself.  But, I wanted to share it because these are very easy to make and are a great substitute for regular potato chips (which are high in fat and carb).

 

What you will need:

·      1 bunch of Kale

·      1 pinch of salt

·      1 tbsp olive oil

Directions:

Dried Kale (before cooking)

·      Preheat oven to 350 degrees Farenheit.

·      Remove Kale leaves from the stem.

·      Wash and thoroughly dry Kale.  (This step is very important. Make sure Kale is completely dry.)

·      Break Kale into chip sized pieces.

·      Line a baking pan with parchment paper and place Kale on the paper.

·      Drizzle the Kale with olive oil then sprinkle with salt.

·      Bake for about 10 minutes or until edges of brown but not burnt.  

 

Cooked Kale Chips

Colonel Mustard and the Fundamental Difference Between Types I & II

 Comparison is often a dangerous thing.  On the one hand, it somehow makes us feel as though we are better than the subject.  On the other hand, we feel the urge to imitate the subject, or "keep up with the Jones", as the saying goes.

Diabetics do this all the time.  We see another diabetic eating cake and we cannot even begin to understand how they could do such a thing, especially after that huge meal!.....And then we secretly wish we would have saved room for cake as well.

Nine times out of ten, there are explanations for the way we behave.  And so it goes with treating diabetes.  So before we accuse Colonel Mustard of being in the kitchen with the knife, let's look at the fundamentals of diabetes.  This will help us to understand why us diabetics and our lifestyles consist of such a motley crew.   

The Pancreas - what is it, and what does it do?
Nestled behind the stomach, tucked under intestines, and just below the gallbladder lies a gland called the pancreas.  It's primary job is to secrete hormones that aid in digestion.  The mac-daddy of those hormones is insulin, which pushes glucose from the bloodstream into the body's cells for energy.

Diabetes Mellitus is hyperglycemia, or elevated blood glucose.  Essentially, there is some phenomenon that is causing the glucose in the bloodstream to remain there, and not be taken up by the body's cells.

Type I DM - immune dysfunction.
For a type I diabetic, the physiological function that has gone awry is the immune system.  It mistakenly identifies insulin-producing pancreatic tissue as alien, and then does what it's supposed to do.....attack the foreign bodies.  Quite rapidly, the pancreas goes from functioning perfectly, to never producing insulin again.  As you might imagine, the only treatment is subcutaneous insulin, which the patient must use to try to mimic the secretions of the once-robust-pancreas.     

Type II DM - metabolic dysfunction.
The pathophysiology of type II is generally more complicated.  Ultimately, there is a problem with the actual metabolism of glucose.  It typically boils down to the patient either being resistant to the action of insulin, or having decreased insulin output from the pancreas.  Because there is still likely substantial pancreatic function, subcutaneous insulin is merely one of several treatment options.  Depending on the circumstances, one may even treat type II with lifestyle changes only (no medications).  

I hope this quick overview sheds some light on this pandemic, yet grossly misunderstood, disease.  With this knowledge, let us not compare, and cast down; but share, and build up.  And then, let's be less than seven, greater than low! 

Ain't No Thing But a Chicken Wing

Linda here!  I'm Derek's proud wife and am honored that he asked me to provide a little guest post for his blog.

Often, when I provide nutrition counseling to someone who has recently been diagnosed with diabetes, he usually tells me that he was advised to avoid all white foods (sugar, white bread, cake, potatoes, chips, etc).  While this advice is OK and partially true, I find it is inadequate. I think the more knowledge one has about the different foods in his diet, the better chance he has of staying on track with managing his disease.  (They don't call diabetes a self-managed disease for nothing).

So, where does one start?

Well, I think a good starting point is to know a little bit about carbohydrate foods, that is, the foods that turn into sugar when we eat them.

Most clients/patients I talk to know that sugar, potatoes, rice, white bread, pasta, and grits are carbohydrates, but when I tell them about wheat bread, fruit, milk, and yogurt also fitting in to this category, I am met with a good deal of surprise.  Before I go on, I want to mention, carbs are not bad; they are not the enemy; they are not evil.  In fact, out of the 3 main macronutrients carb, protein, and fat, our body most readily uses carb as a source of energy.  However, since diabetes can be defined as a problem with glucose metabolism, I think it is important to achieve the appropriate balance.

OK, so what are the foods that most directly affect blood sugar (aka carbs)?

Starches - this includes (but is not limited to) rice, pasta, legumes/beans, peas, corn, potatoes, bread (even whole grain, whole wheat etc), crackers, cereal, grits, oatmeal, hummus

Fruit - ALL fresh fruit, canned fruit, dried fruit, frozen fruit.  ALL juices.

Milk/Yogurt - Milk (all types, cow's milk, almond milk, soy, rice etc), yogurt, pudding, ice cream.

Sweets/Sugar - this seems like a no brainer, but this is a good time to mention that honey, agave nectar, brown sugar, sugar-in-the-raw, evaporated cane juice, and maple syrup are all considered forms of sugar, and they all affect blood sugar.

and lastly, a little something I like to call.....

Sneaky Carbs - these are the foods that many people think contain very little or no carbohydrate, but then are left with a big surprise when they check their blood sugar a couple hours later.

• Chicken wings, those delicious little bite sized treats, what are they covered in?  Some form of sauce that probably contains sugar (BBQ sauce, tangy sauce, sweet and sour, siracha glazed, bourbon maple, you get the idea).
• Other sauces - gravy, spaghetti/marinara, sweet and sour, teryaki 
• Salad dressings - while not all contain carb, think about honey mustard dressing and certain fruit based vinaigrettes.
• Carrots and other sneaky veggies - Vegetables are so good for you.  Most of us should eat more of them, but certain ones do contain significant carbohydrate.  
• Fried chicken/meat - the meat contains NO carb, but the breading does.  Bummer.
• Peanut butter/nuts - most will say these are very low carb foods, but if you eat a nice sized portion, and eat them often, they can be contributing to those higher blood sugar readings.

So, knowing the foods that affect blood sugar is the first step.  The next is knowing how to read the label and decipher how much to have.  But, not to worry, we'll have more on that another time.  Thanks Derek for asking me to blog this week.  I am happy to be your wife and little diabetes nerd/guru.  Aren't you glad you married a dietitian?! HA!

I tried to keep this post short and concise, however, I plan on elaborating more in future posts. Please feel free to ask questions in the comments.  Peace.   

          

Reinventing the Wheel: Resources Diabetics Should Know

Have you ever finished up a long, frustrating project, only to learn of a better, more efficient way of accomplishing the work you just completed?  Thankfully, this happens to me less and less as I have learned to simply Google it, or YouTube it.  As the old saying goes, there's nothing new under the sun. 

This approach, however, doesn't always work with diabetes.  How can we be sure that the information we receive is legit?  Furthermore, many times we get flustered with insurance rules on preferred medications, co-payments, and the list goes on.  Perhaps we are faced with a new situation concerning diabetes, and we simply want to speak with someone who shares a similar experience.

Wouldn't it be nice to have some support outside the doctor's office to provide guidance, discussion, and maybe even assistance with affording medications?  My friends, let's not reinvent the wheel.  There are great resources out there that are largely underutilized.  Here are a few of my favorites:
  

• JDRF (formerly Juvenile Diabetes Research Foundation) is the worldwide leader in funding research for type I diabetes.  Their website is excellent for staying up-to-date on current treatment options, devices, and research.  In addition, JDRF has organized local chapters that provide support and activities for children and adults with type I. 

• Type One Nation is JDRF's online social network where type I's, or friends and relatives of type I's, can create a free account that provides tons of professional and peer-to-peer blogs, forums, and groups.

• The American Diabetes Association (ADA) is an endless resource for news, diet, current trends, and education.  Membership includes a subscription to their top magazine, Diabetes Forecast.  The ADA also provides local support groups and events.  

• Diabetic Connect is a free online community of people living with diabetes (type I or II).  It's a great tool for connecting and conversing with countless diabetics of all types and ages.

• Cornerstones 4 Care is a service of the pharmaceutical company, Novo Nordisk.  It is a free online tool that allows patients to create an action plan for managing diabetes.  If you're someone who thrives on planning and structure, this site is for you.

• Lilly Tru Assist is a patient assistance program offered by the pharmaceutical company, Eli Lilly.  Most drug companies have a similar program.  Even if your medications are affordable, you may be missing out on coupons that could save you money.  It's worth your time to check into offers from the companies that make your meds and devices. 

Stick with the above mentioned, and you can't go wrong.  These are awesome resources for education, community, and support.  Don't get caught outside the loop.  Thanks for reading; and, as always, let's be less than seven, greater than low!

Sugar-coating Diabetes

Let's frolick through a meadow holding hands singing Kumbaya, while the forest burns behind us.  This is the image I get when people insist on using inclusive, or politically correct language.  I call to mind this image, because I read an article last week in one of the major diabetes magazines that advised against using the term "diabetic" to describe people with diabetes.  The article stated that this type of labeling diminishes a person's individuality, and it can be harmful to his or her self-image.

Folks, I'm here to tell you that this line of thinking is completely off the mark.  It is related to a "modern logic" that is infiltrating our global culture under the guise of inclusion and social justice.  It twists truth ever so slightly, then demands that everyone else do the same. 

However, for the sake of discussion, let's suppose that there is a kernel of truth to the statement.  Let's suppose that calling me a diabetic does indeed offend me.  Why is that so?  Why is it that I look like a duck, walk like a duck, quack like a duck; but you ought not call me a duck, because I may forget that I'm a mallard?

There are several answers that come to mind; but as a diabetic, only one jumps out as a game-changer.  One reason we may be offended at the term "diabetic" is because of the negative public image that it arouses.  I've mentioned before that we don't exactly have the best reputation.  When most people hear that someone they know is diabetic, it is tempting to assume that they must not take care of themselves.  They must not have any discipline or self-control.  That's certainly not a category that I want to be lumped into.

So how did we get this image?..........It comes through a long history of not taking care of ourselves, having no discipline, and having no self-control.  Essentially, we've shown up late to work for the past 50 years, and now we're getting mad at the world for calling us tardy.  There's only one thing we can do to change it now.......start showing up on time.  It's up to a new generation of diabetics to turn this word into respectful terminology.  And if you are reading this post, that means you and me.

The fight is not against the terminology itself.  It's against the meaning of that terminology.  So for those of you who are offended at being called "diabetic", I'm offended that you're offended.  Diabetes has taught me numerous invaluable lessons about life and love, and I am honored to be labeled diabetic.  It puts me in a community of people who are forced to either embrace or reject the struggle daily.  I don't like diabetes, and I don't wish it on my worst enemy.  But I'm here now, and I'm going to make the best of it.

I'd like to end with a quote from Theodore Roosevelt in his speech, "Citizenship in a Republic."  It has become my personal MO in the last couple of years, and I think it goes well with my rant.  Thanks for reading; and let's be less than seven, greater than low!

"It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat."

Breaking Down those Adult Beverages

"Do you drink?"........The question stumps me every time.  No doubt the answer is yes; but for an over-thinker such as myself, I know in south Louisiana the real question is, "Do you enjoy getting wasted every now and then?"  To this, the answer is no.  Now you see my dilemma. 

This tricky question is a good lead-in to the topic of alcohol and diabetes, a tricky combination.  Most resources will say that alcohol in moderation is okay for diabetics, but be aware that it can cause hypoglycemia.  That's certainly good to know, but it still leaves much to be desired. 

While it will take some individual trial and error, I want to offer some perspective for you by establishing two cardinal rules: (A) just as in all things, moderation is indeed king.  (B) alcohol can lower blood sugar, but what else is in the drink?

Intoxication and hypoglycemia have many of the same characteristics.  Practically speaking, that is why (A) is important.  On the other hand, we must remember that not all drinks will cause hypoglycemia.  In fact, many drinks will cause a spike in blood sugar because of other ingredients.  It's important to know what's in your drink before taking that first sip.  Here are a few general guidelines for common beverages:

1.  Beer.  Contains carbohydrates that will increase blood sugar.  Be mindful, however, that they tend to be digested slowly, like a complex carb or fat.

2.  Wine.  Little to no carb.  There is a good chance that it could cause hypoglycemia, even hours later!  It is wise to keep wine-drinking with meals.  See study.

3.  Hard liquor & mixed drinks.  For blood sugar purposes, liquor by itself can be treated as wine.  Mixed drinks, however, usually contain juices or other ingredients that can be packed with sugar.  These will spike the blood sugar very quickly.

Happy drinking; and let's be less than seven, greater than low! 

Nutrition facts & tips

So your diabetes must not be the bad kind, right?

"There's no bad diabetes, only bad patients."  This quote comes from the endocrinologist for whom I used to work.  I see 2 flaws in this statement.  The first is that it reduces diabetes to a simple process and is disrespectful to its complexity.  Secondly, I am unable convince myself that diabetes is not bad.

However, the overarching theme is a wise comeback to a remark that us patients and others tend to use as a crutch.  I've heard it a million times; "she's a brittle diabetic"; "he's diabetic, but thank God, it's not the bad kind"; "my diabetes has been bad this month."  The doctor's clever phrase simply reminds us that we are the managers of our disease.  If things are out of control, it's likely a result of poor management.  But if it's a tightly run ship, then let's give credit where credit is due.....to the patient.

Diabetes is a progressive disease, so this is certainly an oversimplification.  Nonetheless, it does debunk the myth that some types are worse than others.  The definition of all types of diabetes is a state of high blood glucose, or hyperglycemia.  Hyperglycemia, over the course of many years, causes vascular complications including nephropathy, neuropathy, and retinopathy (kidney, nerve, and eye damage, respectively).  Thankfully, we have determined that lowering hyperglycemia and living a healthy lifestyle has the potential to prolong the onset of some of these complications.

Ultimately, the point is that our medical providers offer guidance and coaching, but we do the heavy lifting.  And if we don't, then the journey will be long and difficult.

One other point of confusion that I would like to briefly touch on is foods that are off-limits for diabetics.  Generally speaking, there is no such thing.  While large amounts of sugar at one time is a good thing to avoid, it is nearly impossible to avoid sugar altogether.  In fact, even foods that have no sugar or carbohydrate will likely include some ingredient that gets converted to sugar in the course of digestion.

Therefore, carb-counting is the key.  The quantity of carbohydrate ingested is most important, while the type of carb (also important) is secondary.  This is by no means an endorsement of sweets.  However, I do believe in having all things in moderation.  Ask your dietitian about the amount of carb appropriate for your age, gender, and type.

Until next week, folks.......let's be less than seven, greater than low!  
Follow this link to uncover more myths about diabetes.  

How frequent hypoglycemia could be driving up your A1c!

There's a scene in the movie World War Z where the doctor, who is charged with the task of finding a cure or treatment for the virus, describes mother nature as a serial killer who "can't help but want to get caught."  He says that in her weakness, she leaves crumbs that are the clues to cracking her code.
As the plot unfolds, it becomes clear that this is simply a poetic way of saying that solutions often come from unlikely, or even unwanted, sources.

As diabetics, we certainly know this is true.  I find myself always on the lookout for clues to better control.  Since the advent of continuous glucose monitoring (CGM), there has been particular growth in the understanding of hypoglycemia and its relationship to A1c.  Traditionally, high A1c's have been attacked by targeting high blood sugars.  While this is obviously a logical approach, it may not be the best approach for those who suffer dangerous hypoglycemia. 

CGM research indicates that the frequency, duration, and severity of hypoglycemia are not reflected in an A1c.  This essentially means that it is possible for a person with an A1c of 8 to have more hypoglycemia than the person with an A1c of 6.

So what, exactly, does all this mean to us?  Well, the crumbs we find in this research lead us to believe that both reduction in hypoglycemia and A1c are not only achievable, but in some cases exist in a causal relationship.  Think about it; the first thing we want to do when we begin to feel a low blood glucose is to stuff our faces with simple sugar like it's Halloween.  Better yet, we'll eat anything as long as there's carb in it.  There are 2 reasons for this reaction: 1) our brain is telling us that it needs fuel NOW  2) this feels horrible, and we want it to stop NOW (and never happen again). 

Consequently, it's been my experience that most of us tend to over-treat hypoglycemia.  So what comes next?.....a swing into hyperglycemia.  Then we feel horrible again and want to take insulin, right?  Usually not.  The move to hyperglycemia is less noticeable to the brain, and thus tends to go untreated for longer periods.  This, in turn, drives up A1c.

Therein lies mother nature's code.  If we can reduce the number of hypoglycemic episodes, it is very likely that we can effectively reduce almost that same number of hyperglycemic spikes.  This, in turn, brings down A1c. 

All fine and good, but how does one reduce the frequency of low blood sugars?  Stay tuned for more tips in a future post; but in the meantime, I suggest frequent cbg testing, snacks or reduced insulin before and during exercise,  and not going more than 4 hours between meals or snacks.  If and when hypoglycemia does occur, do your best not to over-treat.  Then, test your sugar between 1-2 hours after treating to be sure it has not gone hyper.  Good luck, and let's be less than seven, greater than low!          

A Lesson in Technique

I would describe it as heavy.  It's that feeling you get in your stomach when hope is shattered, your sense of control slips away, and despair starts creeping into your bones.  258 mg/dL.......this was the reading on the glucometer after testing my 2 year old's blood sugar. 

Sure, he had just indulged in a peanut butter sandwich with honey, but 258 is still outside of the normal postprandial (after meal) glucose range.  I was 2 when I was diagnosed, and I began to believe that my son and I had more in common than looks.

After consulting with his pediatrician, we headed for the ER to have blood drawn.  Thankfully, they were not busy on this particular Sunday afternoon, and we marched straight back to the lab.  Several tears and a prized rubber lizard later, we trod right back the way we came and waited for the phone to ring.

Just 20 minutes later, the doctor called back with a stunning report.  His glucose was 98!
"No diabetes.  Could have been a number of things, but I would certainly calibrate your meter.  That's the most likely culprit."

An uncalibrated meter; there was no way that could be it.  I use that meter everyday.  It's more accurate than my wristwatch.  Then it hit me like a rigid palm swatting a mosquito: I failed to wash the boy's hands.  He just finished handling a sandwich with honey on it, and I tested his blood sugar without washing his hands!  Consequently, the sugar on his sticky fingertip transmitted to the test strip and created a false reading.

I recount this story as a reminder to myself to stick with the fundamentals.  Just as a baseball player in a slump must review his technique and return to the basics, diabetics must also audit their practices and stick with gold standard recommendations.  They are the result of much study, research, and hard work, and are a great resource to avoid costly mistakes like the one I made.

I will plug JDRF and ADA here, as I have before, as the best places to go for valid info and up-to-date resources.  Stay the course; and let's be less than seven, greater than low!                

The Human Pancreas

I've never heard anyone truthfully say that they've got life all figured out.  It's a journey that requires a constant vigilance to stay on course.  There are learning experiences, threats, and rugged terrain that make it a battle until the end.  

If our whole lives are this way, then it is no surprise that all of the intricate details of our lives follow this same model.  Diabetes is certainly no exception.  The following are 4 milestones I've identified in the life of a diabetic: provider discretion, seek and learn, trial and error, and the human pancreas.  They are not isolated steps or events, but rather weapons that can be acquired for the fight. 

1. Provider Discretion:  It is essential to have a medical team that is knowledgeable on diabetes.  I recommend having at least an endocrinologist, and a certified diabetes educator (CDE) or dietitian.  This will ensure that you stay current on medical recommendations for diabetics of your type, and in your age group.  The more experienced you become, the less you will rely on your team for daily care, and the more you will rely on them for your overall picture of health.

2. Seek & Learn:  If you want to succeed in controlling your diabetes, then you should be ready to obtain a degree in diabetes control-ology.  The more you know about how this disease operates, the better equipped you will be in managing it.  In short, know your enemy.  There are several trustworthy resources online, including JDRF and ADA.

 

3. Trial & Error:  No matter how much you educate yourself, you will find that still there are certain situations or outcomes that are very unexpected.  This is because you are a unique individual with unique life experiences.  And because there are so many factors that influence blood sugar, it is wise to expect the unexpected.  One way to shorten the learning curve is to keep a notebook of foods, activities, etc., and how they affect blood sugar.

4. The Human Pancreas:  This is the advanced level of diabetes control.  At this point, you are using the previous 3 milestones to dominate everyday.  You become proactive rather than reactive; your desire to have perfect numbers overrides temptation; doctor visits actually become enjoyable; and last, but not least, you embrace the struggle.  

All of this hard work is required to replace the work of your pancreas.  Since it doesn't work like it once did, you have to pick up the slack.  I don't know how to be my own pancreas, so I have to strap on my boots everyday and learn.  Join me in this journey; and let's be less than seven, greater than low.

A Sociology of Preventable Disease States

Some of us have more of it than others.  Sometimes it shows up robust and unexpected.  Other times we must search the depths just to find a sliver of it.  But many times even a sliver can change lives.  What is this illustrious phenomenon, you ask?......none other than motivation.

It is with this word in mind that I watch my kids grow and reflect with wonder on the generosity and sacrifices that my parents, my wife, and other family and friends have made to ensure that my diabetes stays in check.  I acknowledge the fact that this disease does not exist in isolation.  It's not a little pill that's taken before bed and forgotten for 24 hours.  It's actually a lifestyle that involves the help and coordination of those closest to the patient.  Frustration, excitement, fear, accomplishment, confusion, comraderie, and temptation are all present in this community from time to time.  The patient's goals become common goals.

This communal aspect of diabetes brings me back to my original thoughts on motivation.  Because complications can be either prevented or prolonged (And in some cases of Type II, this applies to the disease itself), we hold an incredible opportunity to show our gratitude to our loved ones.  The motivation to remain controlled flows like a fire hydrant under the perspective of continuing the hard work of my parents, and living a long and healthy life with my wife and children.  It is the only thanks they want, and the only thanks that will even begin to come close to sufficing.

Diabetics get a bad rap because we don't take care of ourselves, we take a bag of meds, we have 13 doctors, we're always in the ER, we all have the same excuses, and we lie through our teeth about all of it.  I dare say this is the kind of reputation we get when we live for ourselves.  It is only under the purpose of living for others that we are able to find the motivation to take care of ourselves. 

What's your motivation?  If you don't have it, then find it.  And then........let's get less than seven, greater than low!   

  

Testing....testing......1-2-3

"I'm sorry, sir, but the insurance will not cover you to test that many times per day."

"I don't have any other patients testing that much, there must be some other issues going on.  I know your A1c is good, but you shouldn't have to test that often."

I've heard these lines and many others just like them, discouraging me from doing the only thing that gives me hard evidence as to how to manage my diet, insulin, and lifestyle: ........testing my blood sugar.  But as the Bible says, ask and you shall receive.  Consequently, every return phone call has resulted in insurance coverage, doctors heeding my request, and suppliers coming through.  Is it really that easy?  Yes.  It is that easy because even though my request may be unusual, it is completely reasonable and logical.  I am asking to have a better record of my blood sugar readings throughout the day.  Isn't that the key to managing diabetes?  Isn't that what decades of research and development have created with CGM's (continuous glucose monitor)?  Isn't that what helps us to recognize patterns and tendencies?  Yes, yes, yes.  And ultimately, it is what helps us to reduce complications and live longer.  Here are my 4 absolute testing times:

1. Before breakfast / Upon waking in the morining.
2. Before lunch.
3. Before supper.
4. Before bedtime. 


Testing in between these times can also be very helpful to determine post meal glucose, reaction to exercise or stress, and variable schedules.  I also recommend testing during the night if the bedtime glucose is out of range.  This will help to prevent dangerous hypoglycemia or long-term hyperglycemia.  Let's get less than seven, greater than low.