Atrial Fibrillation Triggers and Blood Donation

 A-Fib Triggers
Once in a while I discuss my latest medical condition, atrial fibrillation. Lately, things have been pretty quiet on that front. But, when you have a quiet baseline, you can start to see things stand out as problems. The suspects I have so far are all foods:

1. Yerba Mate Tea- I was drinking this all day long every day, and when I discontinued it, my frequent episodes of a-fib stopped abruptly. This is the main culprit. It's my fault, I'm moderation-challenged.
2. Dark Chocolate- When I had low blood sugar and indulged in some quality cacao I noticed some heart flutters. It makes sense, but it doesn't make me happy.
3. Gluten- I don't eat grains much. However, when I wandered outside my Paleo corral I noticed immediate palpitations from sampling some pizza and eating even just a couple pieces of penne pasta. Crazy small amounts, and very noticeable.
4. Black Tea- I'm still willing to experiment with this one. Once, when I tested out a new type of Indian tea that we picked up, I found my heart beating double time almost as soon as I had finished the mug. While it's a stimulant, that response was out of the norm. 
5. Alcohol- I consume moderate amounts of alcohol almost everyday, but haven't noticed problems consistently. I think my experiences with alcohol may be more related to gluten because beer was often the specific trigger.

Yes, most of those items, in moderation, are supposedly healthy things that provide antioxidants and other good polyphenols...

Oddly, coffee doesn't make the list. I have two cups of coffee every morning and my sporadic episodes are never anywhere around that event. I did some reading on an A-Fib site today and discovered that coffee and caffeine have been noted as antiarrhythmic, and shown to improve arrhythmia. That's not true for everyone, but it seems to be true for me, as well as many others.

Blood Donation
I've always steered clear of blood donation because I don't particularly like the experience of having blood drawn. Does anyone? I have always felt like my 2-4 blood draws per year was enough of a "donation", although it lacked the altruism. Well, this year during the blood drive at my school I almost gave blood, but I wasn't too crazy about returning to my classroom with the possibility of feeling woozy. So, I put it off again...

I have heard that donating blood can reduce insulin resistance temporarily. I can hardly resist an experiment (yes, still lacking altruism). I don't really expect much, but I have the luxury of messing around with these things in the summer time. On Monday I'm going to donate blood and see what happens, if anything. I'll report my results, as long as I don't get turned away for a medical reason.

Do any of my T1 readers have anything to share about donating blood?  Will I get an artificially low A1C? They say males might want to do it once in a while to keep the red blood cells fresh.

Cute posts?

If you saw a couple of adorable digital drawings (hearts and whatnot) posted on this blog with no explanation... well, that was our Penny. She found the Blogger app on the iPad and went ahead and created some content. She thought it was "just a drawing thing". Aw.

She told me to delete them because she had no idea how public this thing was. I didn't even know you could draw directly into blogger. I'm going to have to snoop around, that might be useful some day.

Negative for autoantibodies AND glasses this year...

They eventually learned how annoying dialated eyes can be.

 After the ordeal of getting the kids blood drawn in May, we were looking forward to finding out the results. It was supposed to take 4-6 weeks, and I noticed that we were pushing that limit this week.

Today we received the results from the Diabetes Trialnet and they were negative for all three kids. It helps that 1/2 of their genes are from my wife who has very few genetic health risks, and no autoimmune diseases that we are aware of. I'm like the clearinghouse of genetic health stuff in my family. We will repeat the test yearly.

We are glad. We can always use the extra time being open an positive about how I manage my glucose. When I interviewed them about diabetes in the winter they forgot that insulin treats high blood sugar and said that if your BG is high you might have to "rest it out". I guess that's how chill I am, I just rest it out (wink). Since then I've been more explicit about how I control my sugar levels. Exercising has been an obvious part of that lately.

As an added bonus, we had their eyes dialated and checked, at the optometrist. The younger two don't need any corrective lenses, yet. I've had a need for glasses since a young age. In fact, I managed to get bi-focals in 3rd grade. As a photography teacher, I can tell you, there are quite a few teens walking around with blurry vision.

Anyway, I'm having a great summer with these three and love the extra time I am able to spend with them during breaks from school. They are really fun, smart, and entertaining. Ellie is taking a trip to the Philippines to visit my parents in about 2 weeks, then starting high school in August. Simon is going to camp for 12 days with his cousins. We are trying to have as much fun together as we can before we end up all over the place.

Using exercise against itself

Today I got away with a few things that I normally wouldn't. It was like a triple cheat, triple win. And, I plan to keep doing it whenever I can get away with it.

1. Normally, when I go for a walk in the AM I can skip my 1/2 unit coffee bolus. But, even then, I might dip a little low upon returning from my walk, so I have to eat a glucose tablet or have breakfast with some berries, depending on how low I go. 
2. If I do a strength workout in the evening I normally see my glucose rise and have had to start taking a unit of insulin to keep it steady. 
3. My usual breakfast is low-carb, normally eggs and greens. The morning is the time when I have the least leeway with starchy carbs. During the school year I don't really even eat anything till after the dawn phenomenon is over, and it's usually around 11am when I "break the fast".

So, those are my quirky limitations that I have worked out for myself through experimentation. Here's how it worked out today, a symphony of quirks with a pretty good outcome.

Today, I woke up with normal BG at 94 mg/dl. I had my coffee without a bolus, and then went for a walk. When I got back from my 20 min. walk, my BG was headed toward lowish (70 mg/dl). I did a strength training routine (pushup, pullup, plank, overhead press) which redirected my trend towards normal/steady (104 mg/dl). Both of those activities left me feeling pretty hungry, so I made breakfast. I pondered whether the extra insulin sensitivity from the exercise might allow me to get away with some starch at breakfast. I microwaved a large new potato and then crushed it in the skillet, and drizzled it with coconut oil, and fried it till crispy. I added that to my eggs and greens. It was fantastic, I love potatoes, but rarely eat them because of the fast BG rise that I normally get from them. I used Symilin with the meal, and when I saw my BG starting to go up (at about an hour) I took insulin to cover the meal. It worked out rather well.

I got the idea to combine the walk with the strength training because I had heard that circuit training was sometimes a glucose stabilizing way to exercise because it combined aerobic with anaerobic work and resulted in a balance of BG lowering and raising activities.

I only do strength work about twice a week, so this won't be a daily routine, but it's good to know it works. I wouldn't want to get sick of exercising or occasional potatoes...

T1D Exchange Finds People with Type 1 Diabetes Don’t Meet Targets

I just read Jessica Apple's analysis of the problem with T1 diabetics not being successful in achieving the health that doctors and the ADA desire for them. It hit a chord for me, because I was one of those people "doing everything right" but not getting the prescribed results.

Basically, the  study found that a large proportion of Type 1 diabetics are gaining weight and not meeting recommended A1C levels. The question is, will the ADA change their recommendations on diet and insulin? Personally, with kids, I think a higher A1C might be more appropriate, but with adults it seems that if healthy A1C goals can't be achieved, we have to look to the diet in a more aggressive way. If you are keeping your A1Cs in line, not gaining weight, and maintaining your health, then you are doing well.

I added my 2 cents in the comments, but, since it sums up some of my experiences, frustrations and core beliefs about diabetes. I'm going to repeat it here.

Here’s the thing… if you have a kidney problem or a gall bladder removed you have a list of foods that you have to avoid to stay healthy. No one really argues with that too much. But, for some reason we have been reticent to tell PWDs (people with serious metabolic issues) that anything is off limits. Let’s get real. Let’s not treat PWDs like little children who might throw a tantrum and give them the info that they really need to be successful. I think, with more success, the issue of depression linked with diabetes could be moderated. Poor control, weight gain, the threat of complications and a constant sense of failure… that’s depressing.
I tried to meet the recommended healthy A1C requirements for years while cooking from scratch, eating all whole foods, but never sorting out the fast acting carbs part of the equation. I never got there. I gained weight, became insulin resistant, and had poor control. Once I started limiting which foods I ate, I was able to make progress in my health goals. It was wicked simple.
The fact is, anyone who uses/creates too much insulin, PWD or not, will have negative impacts in their health. Hyperinsulinemia is a real problem. The ADA needs to encourage people to use less insulin, and therefore eat less foods that require lots of insulin. Good control is within everyone’s reach, but it’s like we/they are afraid to tell the D-community that they can’t have anything they want, all the time. The mantra that we can eat just like everyone else is silly, especially when you see that the rest of the western world (everyone else) is having it’s own insulin related metabolic problems.

I'll take a flashy new pump with a Dexcom on the side.

After hearing that the tSlim pump would soon be available in the US market, I decided to go to their site and see what they had going on. I knew that they had updated their technology to a level that compares with other devices that we use, like iPhones, and the like. After looking over everything they had, I was pretty interested in their pump. The main things that I liked were the full-color screen, the type of info that is displayed on the home screen, and being rechargeable. But, the thing that most caught my attention was that they are working with Dexcom for sensor integration. I hope that they mean that the pump will act as a Dexcom receiver. That would be excellent.

I requested info from Tandem about their pump and also asked how soon the CGMS integration might be available. I received a reply (from a human being, no less...) and they told me that the work was, indeed, underway, and that it would be available as soon as possible. I know in FDA years that's probably still a while.

If Medtronic doesn't update too much during that time, I'll probably be jumping over to a more colorful display, well thought out design, and sensors that last longer and hurt less.

Meanwhile Medtronic is also working on patch pumps, and they already have a new sensor (also longer lasting, and less painful) going through FDA approval. If you like patch pumps, Omnipod is pretty well received and they are also rumored to be working on CGMS integration with Dexcom. I might like patch pumps, but my favorite infusion sites are places (buttocks!) where I can't discreetly wear a pod.

Anyway, I think it will be a pretty interesting year for some developments in the technology and I hope that the transition to new stuff goes smoothly for insurance, etc. You can only hope.

Broccoli breakfast

Eating from the garden is probably one of my favorite things in the world.  Some coconut oil and red pepper flakes just made the broccoli shine a bit more. When I eat breakfast, this is how I like to do it.

Sheepishly I'm a huge fan... of walking.

I can be pretty stubborn.

Something that I've been stubbornly wrong about it that walking is legitimate "exercise". I've always thought it wasn't strenuous enough or cardio enough to make a real fitness difference. Even with all the recommendations from "authorities" to walk more, I had my own theories about it. I thought that encouraging walking was just a "baby-step" to help unfit people get closer to being active. Maybe the thinking was if you could get people to walk more, they might really exercise someday.

Well, through a circuitous route I've landed myself in the "walking is better than" running, or cycling, or jogging, or _____________ camp.  When I take a brisk walk, I find that my insulin kicks in and works better, faster. If it can be seen on a CGMS I'm guessing the same things are happening in everyone that walks. For me, seeing the numbers at work has been very eye-opening.

What does walking have that other forms of activity might not?

It's low-impact. You aren't likely to develop injuries from repetitive actions that your body isn't ready for. Since you walk your whole life, it's the most natural way for you to get moving. (One summer I injured my achilles tendon from doing lots of dog-walking in flip-flops, but that was unusually foolhardy.)

It's accessible. You can walk in any clothing you have on (caution with flip-flops recommended). You can walk wherever you are. You can walk with people who don't normally "exercise". The barriers to getting it done are very few.

It's easy, and the heart rate is spot on. How many times have you done a serious run or bike ride and found yourself exercising at a level that makes you feel lousy and sore, and not look forward to doing it again? For me, if I exercise at a heart rate of over 155 bpm, I'm officially working too hard. I find it very hard to dial myself back to that level when I run or cycle. When I walk at a fast pace I don't think it's possible to breech the threshold into unhealthy exercise. We never return from a walk and think "Wow, I'm super exhausted!" From talking to others, I have found that most people tend to exercise above their target heart rate zone, and often are reluctant to get out there for another workout, because, frankly, it was uncomfortable. For this reason many athletes use heart rate monitors to keep themselves in check and keep from working at a rate that is too high. For me walking is always in the low end of the target heart rate window, and I don't need a heart rate monitor to tell me how fast to walk.

It reduces stress instead of causing it.
Excessive or overly strenuous exercise can cause you negative stress that can oftentimes be worse for your body that better. Cortisol (stress hormone) release from strenuous exercise is conter-productive to most people's fitness goals. Walking has very little risk of working against you this way.

Conditioning. 
Contrary to what I had previously thought, walking regularly this season has improved my readiness for other activities. Last summer when I began stand up paddling I found that I could only go out for 15-20 minutes before my legs got too shaky to keep going. This year, on my first day out I was able to go out three different times for about an hour without feeling fatigue in my legs. I think it has a lot to do with the regular activity throughout the winter that prepared my legs for long periods of balance work. That was unexpected. 

I'm not saying that everyone should stop doing the exercise that they find stimulating and fun, but that for baseline activity walking is safe, easy, accessible and useful. I began exercising much more frequently since I moved walking onto my exercise menu. If I could cycle, rock climb, cross-country ski, stand up paddle, hike, and kayak everyday I would be ecstatic. Until I retire and live in such a paradise, going for one or two 20 minute walks a day has been incredibly helpful in increasing my insulin sensitivity and correcting BG that is headed out of range.

High intensity muscle work, a new tricky project...

I've been doing some sporadic strength training, but the frequency has been spotty because the effect on BG has been hard to predict and balance. The first time I did a 30 min. workout before dinner (a couple months ago) I ended up with my BG at 300 after dinner. Geesh, talk about counter-intuitive results...

Yesterday, I took a unit of insulin before working out and then had dinner, and saw it rise to 170 mg/dl before I took a walk and another correction and it began to descend.

I also threw in another variable which was that I had a glass of milk with dinner, which is usually "off my list". I understand that the carbs and other parts of the milk might be useful post-workout to help with recovery and muscle building. It's likely that I didn't bolus enough for the milk and the meal together. I was shy on the bolus because of the insulin sensitivity that often comes after exercise. I normally think of a glass of milk as 12 grams of carb, which is about what I usually eat for my whole meal. I only bolused for 15 grams.

In the end, I spent the 7pm-midnight window out of range, and a correction at about 9:30pm brought things back to normal overnight. I looks like I needed about 1.5 more units somewhere in the mix. The caveat... I'm not sure I would want to bolus much more in this situation because my wake-up BG was 50-60 mg/dl. I think the exercise impacted my overnight basal. There are surely a few moving parts here.

I may try working out earlier in the day so that I can isolate the impact and get it straightened out before it gets tangled in meal and bedtime factors. It's a bit tricky because the AM isn't probably the best time to do strength training because of the dawn phenomenon, but the pre-dinner window is also less than perfect. Well, just until I get it sorted out... and I will.

Getting Outside!

 School's not quite out yet, but we've been pretending. We got out for a weeknight bike ride on Tuesday. I like getting in some activity and having it not be so clinical. I haven't been on the elliptical machine in weeks, and the fresh air is really welcome. Hopefully, I'll be able to keep the kids interested all summer, skinned knees and all! Luckily, Penny is the toughest and the most resilient.

May Numbers and Whatnot

Our strawberry patch really kicked out some fruit this year.

Another 30 Days
I think according to my sensor data this past month was one of my best for glucose control. I think getting confident with using Symilin and using regular exercise to become more insulin sensitive has helped a lot.

Numbers
My 30 Day Average BG is 120 with a standard deviation of 39. This means I'm staying mostly between 100 and 140 mg/dl. I would say this is accurate, based on my (somewhat obsessive) CGMS watching.

The at-home-A1C showed 6.3 which comes out to an average glucose value of 134 mg/dl.

I expected a lower A1C value, but I'm coming to the conclusion that I might be at that point where running the numbers any lower would have me in hypo territory much more often. As it is, I'm using a glucose tablets about every other day to keep myself in range.
  
Insulin
I have adjusted my basal so that my total daily dose is at it's lowest at 23-26 units a day, and sometimes it still seems to be a bit too high. I have lost a few pounds since starting Symilin, so I think insulin sensitivity and less body weight play into that equation.


Exercise
I've found that taking 1-2 brisk walks a day has given me the best return on investment with exercise. I usually take one in the beginning of my work day and then another after dinner. When this has been regular, I see the most consistent BG levels and lowest need for insulin.

Also, in the past, the arrival of warm weather has also tended to lower my insulin demands, so that's probably going on too.

The End of the Yerba Mate Experiment
I was excited about the possibilities that Yerba Mate might offer for metabolism, etc. After drinking it throughout the day for about 6-8 weeks, I decided to stop using it. Why? Well, it started with vanity. It was staining my teeth. But, one of the things that improved when I stopped using it was that my episodes with rapid heart rate reduced in frequency, by a lot. I guess it doesn't take a genius to hypothesize that consuming a stimulant might impact heart rate/rhythm, but I've never claimed to be a genius. So, I went to the dentist and had my teeth buffed back to their normal hue and I'm rarely noticing my pulse being out of whack. It's a win-win. My morning coffee and moderate exercise don't seem to have any impact on my heart rhythms.

Thyroid Questions
Last month I was a bit peeved that my doctor wasn't more aggressive about finding out why my TSH levels were high. I began taking a supplement (Thyroid Energy) and during that time I was also having more noticeable rapid heart rate. I decided to take way less, way less often. So, now if I have a day where I'm feeling really sluggish, despondent, or low energy, I take the supplement the next AM. It seems to help. I've only taken a low dose of it about 3 times in the last month. My energy has been good and I've been feeling good overall. I think it's right that we didn't mess with anything major, and I feel it's wise to use the supplement at the lowest possible dose. 

I'm finding it really useful to have these monthly  notes so that I can go back and review where I have been. I have already looked back at the previous 4 months a few times when I want to verify my progress. I recommend keeping health summary notes for yourself if you haven't done it.