Thursday, July 19, 2012

Post-retro numbers June

For some reason I wasn't focused on summarizing my results when June ended, so it's taken me till now to get this stuff wrapped up. I'll just blame it on the lack of rain. We just had our first real thunderstorm last night and I feel motivated to get caught up.

The reason I write up a health summary every month isn't because I think my readers are really interested in the minutiae. I have found, over time, that I forget how things have changed for the worse or the better. Having monthly check-points helps me to look back and see if I'm moving in the right direction.

Because my memory is impressionistic, I only vaguely remember what June was like in the BG realm. I uploaded my data and saved it for this reason. So, I'm now digging into that data I saved.

Average BG for June was: 123 mg/dl.

Standard deviation for June was: 43.
I'm pretty sure this is one of the higher ones I've recorded. It means I had a decent amount of variability in my blood sugar levels and that I was swinging a bit more than usual. I think July will be even worse because of the impact of blood donation, and less routine in the summer lifestyle.

In the second half of June my average insulin usage per day was 25 units, with 17.5 being basal and  7.5 being bolus. On my most physically active days I have used as little as 19 units.

I did not do an at-home A1C test in June.
I don't think I will continue to do them monthly because the data is redundant with my sensor data. Also, the cost for them at the pharmacy has gone up to $25 per test. As long as there are some questions to the accuracy of the test related to hemoglobin status and red blood cell life, I think sensor data is more valuable. I don't think it will be too many years before other tests and data types eclipse the A1c.

Other factors: 
Exercise: In summer I have been able to go for walks twice a day, which has added some stability in the meal and insulin department. It has helped to rapidly correct rises that I've had. It's also produced a few mild lows that had to be corrected. The standard deviation reflects some of that business.

Food: I have been eating breakfast more often during the summer. Taking an AM walk will often get me hungry and cause BG to drop a bit. So, this required me to watch the post-prandial readings for 3 meals most days instead of 2. I love breakfast, so I'm not complaining...
I have experimented with non-wheat carbs after exercise. I have read that after you deplete glycogen, your body can use a ready source of glucose for replenishment. It's the best time to have your glucose. I have used a small amount of potato, sweet potato and the occasional corn tortilla for this and it has usually worked out okay. Sometimes my body still responds too quickly to fast-acting carbohydrates, regardless to the time of day or exercise context.

Sleep: For the month of June I woke up from sun hitting my eyelids, which was generally about 6AM. I generally got enough sleep, but whenever I stayed up past 10PM with the summer family, I was getting less than optimal sleep. I have found that it shows in my BG average the next day or so when I skimp on sleep.

Symilin: I am still using Symilin with every meal. A couple times when we had special meals (Father's Day steaks and Anniversary dinner out) and I took Symilin before the meal I was disappointed when I sat down to eat and could barely stand to eat anything. I've started to take Symilin half way through the meal or just after if I plan on eating a lot. When I've skipped Symilin with breakfast I've noticed a rise that seems disproportionate to the meal. So, I think once your body is used to having Symilin with food, you are acclimated and should be consistent with it.

Weight: I plan on writing a separate post about weight management soon, but I have arrived at my weight goal that I set last summer. I am staying stable at 150 lbs. I am doing some work to gain muscle, but I have gotten to the level of leanness that is appropriate for my frame. It took me almost a year to lose about 18 pounds. I think some of my success in this area has had to do with every factor discussed above, plus daily sun exposure.

Tuesday, July 17, 2012

Nice! (and I don't mean Walgreen's generic brand)

 Transdermal Glucose Sensor- non-invasive CGM

It's pretty awesome that we might have a painless, puncture-free option for getting constant readings. It's like... THE FUTURE.

But, right now there's a lot of future I'm waiting for...
  1. low glucose suspend feature on pump
  2. a louder, lower beep on my pump that I can actually hear
  3. enlite sensor
  4. closed loop system
  5. smart insulin

I'll pass on the diabetes alert dog, my CGM has been sufficiently accurate lately.

Well, let's get real... I'm not really waiting for anything. I might even go low tech for a couple weeks and see how going untethered from my pump goes. The unstructured days of sweating and swimming are a great time for that. Despite diabetes, we have to enjoy the moment, right?

Monday, July 16, 2012

Trying to figure out "diabetes advocacy" to the public

Some of the blogs that I read seem to be mainly focused on diabetes advocacy (sometimes whining?). It's about telling the world about what it's like to be diabetic. I'm not entirely sure why this matters, the readers are probably mostly people with diabetes.

As a 27 year diabetic, I don't have much interest in the plight of people with other diseases. I'm sympathetic, but, I'm not driven to learn everything I can about them. I guess I'm self-centered, and I have a limited amount of time for research. If someone is shouting it from the rooftop, how hard it is to have a particular disease, I feel kind of perplexed. What, specifically, do they want ME to DO?

As diabetics (or People With Diabetes if you like that term better), we have our problems that we have to overcome and deal with, but what does it matter what other people know or think about our issues? To me, it seems like another way of making our disease someone else's problem. "It's a hard disease, because no one understands..." It's like being a teenager again, "Nobody understands me... " Will we ever be satisfied with what the average person knows about diabetes? I don't think so...

 If we tell everyone that we can eat whatever we want if we dose properly, do we get more research funding? If we tell everyone that hypoglycemia really stinks, do we improve our chances of better insurance coverage? If we get indignant when someone mixes up Type 1 and Type 2, do we get access to better medical devices?

I wonder if sometimes we are distracting ourselves from learning more and being proactive because we focus so much on getting the word out about how d-ifficult it is. I hate to say it, but diabetes is unique among many chronic diseases, in that we have the power to make our lives quite a bit better. I've improved my health over the years, and while the disease still dominates much of my life experience (and, in fact, inspires this blog), I don't see myself as a victim. I feel lucky that diabetes has taught me a lot about myself, and human health. I feel lucky that I have a disease in which choices you make can help you live a better, more normal life.

It's been years since a person that I was with questioned what I ate. In fact, more often than not, people are offering me foods that I choose to gently turn down. That's a subtle advocacy for self determination and showing the non-diabetic public that we can take care of ourselves. I'm usually the first to share about my diabetic experience with people I meet.  I try to portray a picture of a person that has learned about the body and that I can take steps to make the most of a life with a chronic disease, which is a important part of my life experience.

For me, the connections that are made with other PWDs are more beneficial than anything that we can forge with the non-diabetic public. We understand each other almost automatically. I love the opportunity to share ideas, results and success with people who are living the same condition that I am.

Don't get me wrong, I want the medical community to know what's important to me as a Type 1 diabetic. I want my voice to be heard and understood to the people that matter.

Wednesday, July 11, 2012

Conflicting studies on blood donation and insulin sensitivity

After posting about my experience (so far) with blood donation I did some searching and found two published studies that seem to have opposite conclusions.

One found that blood donors with lower iron stores did not have any different response to glucose tolerance tests. The other found that those with lower iron stores had higher insulin sensitivity and lower insulin secretion. And a health blogger talks about these issues in depth. Hmmm...

It was hard for me to really tell if they used the same glucose tolerance test. I will keep an eye on my blood sugar measurements over the next couple of weeks and probably donate again in August. I am curious about this.

As a side note: I know that a glucose tolerance test would destroy me (and most T1 diabetics?). Non-diabetic people who eat low-carb/ketogenic often fail glucose tolerance tests. When eating a ketogenic diet you develop a type of insulin resistance in the tissues that spares glucose for the tissues that absolutely need it. For instance, parts of the brain can only run on glucose. So in the scarcity of glucose the tissues will down regulate their glucose absorption to make sure that the glucose is reserved for the tissues that need it. Because of this mechanism, I don't handle changes in my glucose intake very well. I run well on fat and protein, and if I throw more carbs or sugar into my diet I get a disproportionate rise in BG. I have to take more insulin than my carb factor indicates to control fast-acting carbs. I know that I could become acclimated to a higher level of glucose in my system, but I prefer to keep things ketogenic because it's the only way I have been able to achieve stable blood sugars.

What would you do to handle 75 grams of liquid carbs?

Tuesday, July 10, 2012

Blood Donation

Last week I donated blood. I had never done it before, because I had always assumed (hoped?) that Type 1 diabetics would be excluded. I decided to give it a go because I had read that there can be some potential health benefits. It's summer and feeling tired for a day or so isn't the end of the world. Plus, saving a life is pretty cool.

The experience went smoothly. I was questioned a bit about my a-fib, but the beta blocker that I'm taking wasn't on the list of prohibited drugs. I wasn't excluded.

I thought the process was pretty easy. It's strange to see a bulging bag of your own blood, but I felt fine during the procedure, and afterwards.

I did make a T1 mistake. I arrived with a BG of 150 mg/dl, to make sure that I was in a comfortable spot as they took a pint. During my donation I saw my blood glucose go down by about 40 points, according to my sensor. It made me a bit jumpy, because I thought it was from the donation, but it was probably just from nerves. People usually have some snacks after giving blood to make sure they feel well. I had a glucose tablet right before donation. And afterwards, I accepted a gluten free snack bar that had 21 grams of carb in it. Even with a bolus, my BG shot up higher than expected, and incredibly quickly. After that I was chasing it, trying to keep it stable.

Blood donation has been known to lower insulin resistance in Type 2 diabetics.

I did not experience any clear benefit in my insulin sensitivity. If anything, I have found that I'm more sensitive to the impact of fast acting carbs. In the week that followed donation I went to camp with my kids and consumed foods that were different than my usual fare. I found that my blood sugars were much more volatile than I expected. There were several factors at play, but it seems like things have been a bit more jumpy. Maybe some of that could be insulin sensitivity coupled with faster absorption of glucose. I'm not a fan of the change. It's been much more difficult to keep things stable. Even as I am home, eating normally, I am still experiencing some strange and unpredictable trends. I will probably need to watch my sensor data and see if there's a basis for adjusting basal or carb/correction factors.

Anyone else know any tricks for post-donation management?