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.