Friday 31 August 2012
Thursday 30 August 2012
Agave: The Real Deal - Diabetes Daily Voices
For those of you that haven’t heard of agave, agave syrup (also known as agave nectar) is known to be sweeter than both sugar and honey making it a common substitute to sweeten recipes. While this product of the Tropical Americas and South Africa may seem hip and new to you, it’s been part of traditional Mexican and Latin American diets for years. You can read about DiabetesMine’s take on Agave, too!
Agave and Diabetes
To control blood sugar levels, a diabetic must use a combination of diet, medication, and exercise. The Glycemic Index (GI) has played a huge role in helping people with diabetes choose foods wisely as it indicates how a food will affect their glucose levels. Unless you’re trying to raise your blood sugar purposely, a diabetic would generally avoid foods with a high GI as it will raise glucose levels significantly.Because of their low GI properties, agave syrup products have become very popular among diabetics lowering their blood sugar levels. While ideally this would be a great tactic for choosing diabetic-friendly substitutes for sugar and honey, natural foods are still significantly unregulated in the US. Depending on manufacturer and manufacturing processes, some brands of syrup could potentially have higher GIs than others, making it an especially risky choice for diabetics trying to keep their glucose levels low. Because of this and other findings, both the FDA and the Glycemic Research Institute have expressed their concerns about agave syrup being labeled as diabetic-safe.
So Should I Cross Agave off of my Grocery List?
Not necessarily. I believe that agave nectar can be consumed as long you keep the following in mind:
- Read all product labels carefully
- Enjoy like other sweeteners, in moderation
- Choose brands that are minimally refined
- Choose brands that have the lowest GI possible
- Before making any drastic changes to your diet, be sure to consult your nutritionist or doctor. I cannot stress this enough! While the internet can be a valuable resource for information, it is no substitute to consulting a professional.
For other information, tips, and articles on managing your diabetes, I encourage you to check out my website at DiabeticSeniors.com.
References:
“What Is the Glycemic Index?” All About Agave. N.p., n.d. Web. 17 Aug. 2012. .
Zelman, Kathleen M., MPH, RD, LD. “The Truth About Agave.” WebMD. WebMD, 2010. Web. 17 Aug. 2012. .
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Fact or fiction you decide..
Wednesday 29 August 2012
This is so funny!
17 comments:
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This totally brought a smile to my face... Love it! An addition from my end: Not being a bag-lover myself, as I have one "boring" black meter case, it's a bright side bonus that Suzi can actually get as many bags and purses as she wants and use "carrying my D-stuff" around as an excuse. So, yes -> That's awesome, too! :))
ReplyDeleteSo, umm... what does it say about me that when my old standard-issue black meter pouch got all tattered and frayed, I called up the manufacturer and asked for a replacement? (And they asked me to send the old one back!). But, yeah, there is something bad-ass about showing someone my infusion or CGM site to someone and saying "Yeah, I did that myself, and I'll probably do it again tomorrow", just to see their reaction.
ReplyDelete
Tuesday 28 August 2012
Monday 27 August 2012
Shakshuka
By: Michael Aviad
Shakshuka is a traditional North African dish that is wildly popular in Israel. You can find shakshuka on the menu in just about every café in Tel Aviv. Shakshuka is generally eaten as a breakfast food, but makes a good meal at any time of the day. There are many shakshuka variation – some are spicer than others, some add sausage, some add cheese.
Traditionally, shakshuka comes with a serving of bread to soak up the sauce. As you can imagine, since I’m a serious low-carb dieter, I skip the bread altogether. I don’t find that I miss the bread, as the dish is quite heavy on its own and very satisfying.
This dish is about as versatile as it gets – you can add more tomatoes if you like, make it spicy or mild. Whatever you decide, you can be sure it will be delicious.
Ingredients:
5-6 Medium tomatoes, chopped
1 Medium onion, finley chopped
2 medium red bell peppers, chopped
2-3 hot peppers (use cayenne, jalapeños, Anaheim or any other according to your taste)
3 garlic cloves, crushed and chopped
½ cup olive oil
1½ tablespoons tomato paste
½ cup water
½ teaspoon cumin
salt to taste
1 tablespoon chopped parsley
Preparation:
Heat oil in a large frying pan over medium-high heat. Add onions and pepper and cook, stirring occasionally, until soft and starting to brown, about 6 minutes. Add garlic and cumin and cook, stirring frequently, until garlic is soft, about 2 more minutes.
Add the tomatoes, tomato paste, and half a cup of water. Reduce heat to medium, cover and cook, for 15 minutes, stirring occasionally. Add salt and stir.
Crack eggs over sauce so that eggs are evenly distributed across pan. Cover pan and cook until yolks are just set, about 5 minutes.
Sprinkle shakshuka with parsley and serve.
Serves: 2-3
Variation: Sprinkle ½ a cup of feta cheese on top of the shakshuka before serving.
Delicious
Sunday 26 August 2012
Pregnancy and Diabetes - Its all about the preparation
Written by Gary Scheiner MS, CDE
What you do before conceiving can make all the difference.
By Gary Scheiner MS, CDE
Think about the last thing you had to do that was really important. Perhaps it was making a key presentation at a business meeting. Or taking a major exam. Or running in a big race. Or maybe just keeping your dignity during the first dance at your wedding. In all likelihood, what helped you get through it successfully was the preparation you put in. Training, studying, practicing, and basically “doing your homework” are all forms of preparation. And preparation is what gives most people the confidence and skills necessary to perform even under the most difficult circumstances.
Now, it’s time for the performance of a lifetime. Bringing a new life into the world.
Sure, women with diabetes can conceive and go on to deliver healthy, beautiful babies. But before you start preparing the baby’s room and making lists of possible names, there is some preparation of your own that you need to tend to.
(Modest) Tightening of BG Control
During the first four to eight weeks of pregnancy, the baby’s major organs develop and the body begins to take shape. It is during this phase that serious birth defects can occur – particularly involving the brain/nervous system and heart/circulatory system. Paradoxically, most women don’t even realize that they are pregnant until this early developmental phase is almost if not completely over.
Elevated blood glucose levels during the early developmental phase greatly increase the risk for fetal defects and malformation. For this reason, it is essential that blood glucose be under reasonably tight control at the time of conception. Ideally, A1c should be as low as possible (without experiencing too many hypoglycemic events), but certainly below 7%, prior to conceiving. This will give your baby the best chance possible for healthy development.
In fact, the chances for conceiving in the first place may hinge on your blood glucose control. High glucose levels can cause problems with the endometrial lining of the uterus. If this lining is unstable, the fertilized egg may not “nest” properly, and the baby will never have a chance to develop.
Weight Control
Women who are extremely overweight (BMI greater than 30*) should receive counseling on weight loss before conceiving. Carrying excessive body fat increases the risk for hypertension, insulin resistance, pre-eclampsia and a more complicated delivery. The need for a Casaerean procedure is also much more common in women who are overweight.
Weight loss diets are generally not recommended during pregnancy due to the risk of malnutrition for the unborn child, so the time to lose weight is before conceiving. Losing 5-10% of body weight through a sensible nutrition and exercise program can produce significant health benefits for you and your future baby, and may also increase your chances for becoming pregnant.
* To calculate your body mass index, go to http://www.freebmicalculator.net/
Medication Review
If you have type-2 diabetes that is treated with oral medications, or type-1 and use medications in addition to insulin, you may need to discontinue the medications prior to conceiving. Most oral diabetes medications will be passed along to the developing baby and may pose a risk. Certain other medications, including ACE inhibitors (for blood pressure and/or kidney protection) and statins (for cholesterol control), are also considered unsafe during pregnancy and should be discontinued prior to conceiving. In other words, before you even think about becoming pregnant, speak to your physician about all of the medications you take and whether any should be halted.
Also, talk to your doctor about starting prenatal vitamins along with a folic acid supplement. Many prenatal vitamins lack sufficient folic acid for preventing birth defects (generally 400-800 mg daily). It is usually a good idea to start both folic acid and prenatal vitamins three months prior to conceiving.
Medical Care/Screenings
Make sure you’re up to date on your immunizations. Contracting a serious illness during any phase of pregnancy may cause you to lose your baby. Thyroid levels should also be checked before conception. Hypothyroidism is very common in people with diabetes, and the baby’s nervous system can be affected if your thyroid level is too low. If you already have thyoid disease, your dose of thyroid medication may need to be increased during pregnancy.
Carrying a baby places particular strain on the small blood vessels of the eyes and kidneys.
Be sure to have a comprehensive eye exam (including a dilated retinal screening) prior to conceiving. Any pre-existing blood vessel problems in the retina should be treated prior to conception, since eye disease can worsen quickly during pregnancy. Likewise, have your kidney function checked by measuring the amount of protein (microalbumin) in your urine. Significant kidney problems may make you a poor candidate for pregnancy.
Ask any painter, what’s the most important part of the job… the answer will always be “the preparation”. The same can be said about having a healthy baby. Just take a few basic steps to prepare for pregnancy: Get the blood sugars in good control, work to achieve a healthy weight, cut out potentially harmful medications, and receive the necessary medical screenings. It can make all the difference in the world!
Note: Gary Scheiner MS, CDE is owner and clinical director of Integrated Diabetes Services, a private practice specializing in blood glucose regulation and advanced self-management training for people with type-1 diabetes. A portion of his practice focuses on pregnancy and type-1 diabetes. He and his staff of CDEs offer their services remotely via phone and the internet for clients throughout the world. A devoted husband and father of four, Gary has had type-1 diabetes for 25 years and makes extensive use of both pump and CGM technology. For more information, visit www.integrateddiabetes.com, or call 877-735-3648.
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5 Biggest Diabetes Management Mistakes - Diabetes Daily Voices
Over seven years and millions of interactions on Diabetes Daily, we have seen many people make the same mistakes. Here are five of the most common ones along with potential solutions.
What mistakes are missing from the list? Share your experience in the comments and help spare your peers some difficult days.
Mistake #1: Thinking Only Food Impacts Blood Sugars
Carbohydrates, and to a lesser extent fat and protein, impact blood sugars. But food is just one of many factors.
- Stress – whether it is caused by pain, a fight with a loved one, or intense exercise – increases blood sugars.
- Activity typically lowers blood sugars, but many forms of exercise can also raise your blood sugar, such as strength-training and sprinting. Exercise that is causing negative stress on your body can also raise your blood sugar. Little known fact: if a 20 minute, pain-free walk regularly increases blood sugars and you haven’t eaten recently, call your doctor and ask for a stress test. This can be an early sign of heart disease. Something is causing that stress.
- Sleep patterns can change your insulin sensitivity throughout the day. Not getting enough sleep can make you more insulin resistant and lead to higher blood sugars.
- Hormonal changes can cause your blood sugars to rise and fall. These hormones could be from things like increased stress, growth-hormones, menstruation, and menopause.
As you learn about why your blood sugars change, it is critical to look at factors beyond food.
Mistake #2: Guessing Your Blood Sugars
People are horrible at guessing their own blood sugars. The key problem is that the symptoms of high and low blood sugars are not always consistent. Are you sweating and hungry because of a low blood sugar or because it’s 90 degrees out and you skipped breakfast? Are you irritable because of high blood sugars or a friend said something that’s irritating? The symptoms of a low on an exercise bike could feel very different than the symptoms you experience when you’re watching TV. If you want to know for sure what’s going on in your body, use a blood glucose meter to test strategically. (See Blood Sugar Testing 101: Why, When and What to Do.)
Mistake #3: Guessing Carb Counts
It is extremely difficult to guess how many carbohydrates are in portions of food. Studies have shown that we are lucky to be within 50% of the right answer. So it’s important to read labels and measure out foods until you get better at predicting how it will impact your blood sugars. This is especially true of foods that have hidden carbs. For example, many sauces are thickened with simple carbohydrates like corn starch. Even though it’s simply drizzled on your plate, that doesn’t mean there can’t be 15 grams of sugar in the sauce.
Mistake #4: Not Taking Responsibility for Your Own Success
Your medical team is important, but they can’t be there to make your decisions for you. You spend 99.99% of your time on your own. So take ownership of your diabetes. Learn what causes your blood sugars to change. Understand how your diet, medication, and activities fit together. Make sure that you are pushing your medical team rather than expecting them to push you. At the end of the day, this is your life to live.
Mistake #5: Embracing Extremes: Perfection or Failure
Diabetes is a marathon, not a sprint. Pushing too hard for perfection leads to burnout. Giving up altogether leads to certain disaster. Find a middle path: seek to improve your management processes, do the best that you can, and forgive yourself for being human. Nobody’s perfect.
What other mistakes should we put on the list?
Photo Credit: SiamEye
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Saturday 25 August 2012
Friday 24 August 2012
Six Until Me.: From Abby: Absolutely Not Medical Advice.
From Abby: Absolutely Not Medical Advice.
Like we said before, this is NOT medical advice. Not even close. But Abby has some opinions that are influenced by her years with type 1 diabetes, her nursing degree, and all the stuff she hears people saying about diabetes, and she wants to share those opinions here.
Myth #3: ALL METERS SHOULD BE ACCURATE ALL THE TIME - ALWAYS!
I love me some accuracy. I fully appreciate and take advantage of the photo opportunity that is a matching finger stick and Dexcom reading. That being said, I want people to remember something about the 20% frustration factor. Think about the fact that labs are little tiny experiments, whether a finger stick glucose reading or a lab draw for yearly cholesterol - it is measuring a small (like, really really small) sample of fluid and figuring out how many of that "thing" is in that sample. You try making technology that requires a micro-amount of capillary blood that will give you the same reading every time. The bigger problem here is that when you think about it there is NO WAY that the glucose concentration in your pinky finger is the same as in your antecubital as in your ear lobe. It's impossible! How could it be the same throughout your body?What helps? Using the same meter all the time, using unexpired strips, getting a new meter every two - three years, and only base your medication dosing on that meter. When you think about it, if your particular meter reads 100 mg/dL, but your venous blood is 120 it's fine because you're going to do the same thing every single time with that meter reading of 100, which will result in a consistent A1c that will match. See? Stop using 48 different meters and getting mad because they are 8 points off from each other. The key to science is consistency, and diabetes is science.
Note: if you feel low, and your meter reads an in-range number, get back to basics. Wash your hands, chose a new finger, and test again with an ample sample. Test strips are mass manufactured and they are not perfect all the time. Also, remember than any blood glucose reading is more accurate than a urine strip that gives a vague reading of "in between brown and greenish but more on the brown side" on it. There has been progress!
Myth #4: My hydration status does not effect my diabetes. Water is not insulin.
Okay, this is sort of kind of true and not true. Fact: Water is not insulin. Fact: Hydration has a HUGE effect on diabetes. Like, arguably the biggest effect of anything short of pasta. I actually heard a doctor say in a lecture a few weeks ago "I've seen people admitted with HHS (the type 2 version of DKA) whose blood sugar went from 1500 mg/dL to 800 mg/dL after two liters of fluids and no medication." Want more evidence of hydration influence? Think about the symptoms you have when you are dehydrated - thirsty, dizzy, nauseous, headache ... sound familiar? If not, you've never felt a high blood sugar. More fluid dilutes your blood, which lowers the ratio of glucose to blood, which is also known as mg/dL - which is how you measure your finger stick glucose on your tiny little meter. So, it's safe to say, that if you are dehydrated your "blood sugar" will increase. Thirsty yet?(Please note that water is not a substitute for medication. Ever. In any sense of the idea. Ever. Do not drink a bottle of water and think you don't need insulin or your pills. It's not true. It never will be true. What you can do, is if you have a stubborn high that you're afraid of rage bolusing into a low, drink some extra water and wait a little bit - it might not do anything, but a little extra water never hurt anyone right?*)
*If you have kidney, heart, or any other sort of medical issue PLEASE PLEASE follow your doctor's plans for fluids. I am aware that many people have a strict fluid intake limit. Again, this is Absolutely Not Medical Advice. Ever. Seriously.
* * *
Posted by Abby (the Person) on August 22, 2012 09:19 AM | Permalink
Comments
I'm guilty of comparing meters during BG tests (what can I say, I love to be frustrated?). But you make a valid point that I've been wondering in the past few days - it does make sense to stick with one meter for consistency! However I do have a problem with getting accurate results from that one meter. Yesterday for instance I tested at 83 mg/dL on my Verio IQ but 65 on my PDM. I don't usually feel my lows so I can't go based on how I feel. Had I not tested with the PDM additionally, I wouldn't have wondered if I was low or going low and may have went about my way unexpecting. That scares me.
Posted by: Stacey D. | August 22, 2012 10:09 AM
I was so excited when I saw the title of this post! I really love this weekly dia-myth-busting stuff! :) Keep it up
Posted by: Anonymous | August 22, 2012 01:14 PM
Love it
Thursday 23 August 2012
Take Stock and Give Thanks
There are times when I have been known to completely lose it…and it’s not pretty. Like when my son is wriggling so much that I can’t fasten him into his car seat, and by the time he’s eventually in it and I have taken his BGL for the third time, the glucose monitor reads ERROR yet again.
It’s certainly not pretty when I see Marley, our almost five year old son, imitate ‘angry mummy’. “Oh dear, time to take stock”, I think to myself. After I have calmed down a bit, and had a moment to reflect and get things into perspective, I ask myself what have I learned from not just being a parent, but a parent of a T1D child.
I’ve learned to be very thankful, because there are so many things to be grateful for.
Firstly, my partner Richie and I are immensely lucky to have such a wonderful boy who is normal and healthy in every other way. We are now a family of three, which is a dream come true.
We’re thankful for Marley’s diagnosis when he was only 19 months being made in time; the alternative is unbearable to think about. He had been ill for months.
We’re thankful to all those brave people that have gone before: people with diabetes, researchers and inventors, and carers and medical staff who have helped to develop the treatments we now use. Thank goodness we now have glucose monitors, pens, insulin pumps, and all the technology that makes life easier, and information more accessible…such as the JDRF website!
We’re also lucky to be living in a developed country with medical resources and education readily available.
Over the last three years I have gained a renewed admiration for childcare workers and medical staff. Like my late mother, who was a registered nurse, some of them are incredibly dedicated. How often do I wish my mum was still with us and how amazed she would have been at Marley’s diabetes gadgets and gizmos!
While I consider one child a lot of work, my mother had four, two of which were twins, and it was the 60s, with no TV, washing machines, spin dryers or microwaves. Phew, doesn’t bear thinking about!
And yes to other T1D parents out there, I know three years is not long and Marley, Richie and I undoubtedly have more hurdles to overcome.
I like to think that if the saying “it takes a hero to deal with diabetes and diabetes only chooses heroes’’ is true, it doesn’t do any harm for us parents to occasionally think of ourselves as super-heroes!
This story was written by Helen Black, mother to Marley, 4 years old. Helen will be writing for Path to a Cure over the coming months, with case studies and first-person accounts of her own experiences as a mother to a young child with type 1 diabetes.
Wednesday 22 August 2012
Washing It Away: A 3-Year-Old's Take on Diabetes | A Sweet Life
Last week while I was giving my 3-year-old son, Adam, a bath, he took his green plastic cup and began to pour water onto my hands. Several times he refilled the cup and poured. Then he said, “I’m washing the diabetes.”
I had one of those moments when I had to fight hard to hold back my tears and yet I was laughing, too. A classic bittersweet moment.
Diabetes conversations are a regular thing in our home, so and I knew Adam was aware of diabetes. I just didn’t know what it meant to him or how he interpreted it. For the most part, I do my diabetes care in private. It’s not that I’m trying to hide diabetes from my children. It’s more of a feeling that I want to protect them from it. I don’t want them to think about it all of the time. I don’t want them to worry. Of course, there are times when I have to check my blood sugar in front of my children, and when I do, I don’t make a big deal about it.
Adam and I are having a lot of quality one-on-one time now, since his nursery school is on vacation and the big boys are in day camp. Getting any work done is impossible, so rather than having Adam write a guest blog for me, I decided to interview him about diabetes. I think you’ll agree with me, his answers are pretty spot on. (And, yes, Adam does call his father Mikey.)
Who has diabetes? Mikey and Mama
What is diabetes? Not good.
What do you do when you have diabetes? You have to check them. Then you get something and eat it.
Do you know what that is (pointing at Mike’s pump)? That’s diabetes.
What does it do? It makes dots on Mikey.
What does Mikey eat? Dinner, but not granola.
What does Mama eat? Broccoli and cauliflower
What does Mikey eat for dessert? Dinner
What does Mikey do on his fingers? Dots
What does Mama do on her fingers? Dots
Oh bless!
Tuesday 21 August 2012
Jamie’s story of his life with T1D
Jamie has decided to share his story of T1D diagnosis at a difficult time in his life with the JDRF community.
I’ve had type 1 diabetes for two and a half years.
At the time of my diagnosis at the age of 17, I was homeless, with severe depression and anxiety. I was staying with a friend, and constantly anxious about having to leave and how that might affect my T1D. I remember thinking that I’d have to stay at a community house, and how scared I was of doing a needle in front of people.
My best friend really helped with my anxiety when he told me it didn’t bother him that I had to do needles in front of him. This brought my self esteem up enough to feel confident doing my needles in front of people, and to accept my T1D.
Two and a half years after my diagnosis, and my life has completely changed. I found my estranged father over the internet late last year, and I started living with him. He also has type 1 diabetes, and has taught me a lot about management and eating healthy and well-balanced meals. I’m on my way to my dream job. I feel secure with my T1D – it has helped me through every day, and I regard it as a friend.
Do you have any encouraging words for Jamie? Leave them in the comments below!
Pump therapy in Australia: Where we get a tick and where we need to try harder | Diabetes Australia – Vic's Blog
A new report was released today by the Australian Institute of Health and Welfare. Insulin Pump Use in Australia provides a snapshot of pump use and how it has changed in the past few years. You can read the press release for selected highlights. For more info and to bore your friends senseless, read the whole report.
This is an important report because not only does it show how we are tracking with the use of this technology, it also gives insight into barriers to taking up this therapy.
Right now, about 10 per cent of people with type 1 diabetes are using an insulin pump. That’s an increase of over 30 per cent since 2004, which was when the NDSS pump consumables subsidy was introduced. Also, more people are starting to use a pump within two years of diagnosis. It will be interesting to see the impact of that over the next 10 or so years.
You all know that I am a huge pump advocate. I was one of the early adopters of this technology, and have now been pumping for eleven-and-a-half years. I couldn’t imagine not having access to this therapy, but the reality is that for a considerable number of people pump therapy remains out of reach. And really, that’s not okay.
Access is a buzz word in healthcare and how it refers to pump therapy is twofold. Of course it refers to cost, but it also is relevant when we are talking about workforce. There are simply not enough health professionals out there to keep up with demand. This is evident in waiting lists, health professionals’ refusals to put people on pumps and the lack of follow-up. The report states that:
In spite of recommendations for contact with a health professional every 3-6 months, 10 per cent of insulin pump users had not had contact with a professional in over 6 months.
The increased initial and ongoing costs associated with insulin pump use are reflected in the socioeconomic profile of users. About 70 per cent of pump users live in areas classified into the middle to high socioeconomic status groups.
An insulin pump costs between $4000 and $9000 (ongoing costs not included). For those with private health insurance, this cost should be covered. According to yesterday’s report, about 80 per cent of pump users received a rebate for the purchase of their pump from their private health insurer.
A small number were able to access the highly inefficient pump subsidy program administered by JDRF. This grant is only for those under 18 years and is means tested. Up to 80 per cent of the pump cost can be subsidised, provided the individual meets the criteria. I have always been critical of this program. Why is it only available to children and adolescents? Surely needs extend far beyond age? Women planning pregnancy are encouraged to aim for optimal BGL levels, which may be easier to achieve using a pump; those experiencing impaired hypo awareness may find an insulin pump assists with regaining hypo symptoms; those who have experienced severe hypos may find that the use of a pump with CGMS can reduce the severity of their hypos.
Ongoing costs are also a factor for some people. The report states that the ongoing cost of using a pump is about $29 a month, compared with about $7 per month for those on MDI. This cost is difficult for some to manage, with 32 per cent of survey recipients stating that pump consumables were too expensive. In fact, this cost was cited as the biggest issue when it comes to pump therapy.
Remoteness also refers to geography, with 70 per cent of users living in major cities. This surely reflects the difficulties faced by people in regional and remote areas when it comes to finding suitably qualified health professionals. With most pump clinics being located in major metro teaching hospitals, there is an added degree of difficulty for people living outside these areas when it comes to accessing pump information and therapy.
It’s not good enough. When did having access to medical technology become a luxury?
We pride ourselves on having a health system that is accessible to all and I am the first person to be grateful and thankful for our public health system, Medicare and, for those of us living the diabetes dream, the NDSS. I have followed closely the ‘Obama-Care’ debate that is going on in the US and have spoken with many people with diabetes living over there and I know that things here could be worse. Much, much worse.
But that doesn’t mean that we don’t need to address the short-comings of which there are many. This report highlights where pump therapy is on the Australian diabetes healthcare landscape. But it also shows where we could be doing better.
Renza Scibilia is the Manager of Type 1 Diabetes and Community Programs at DA–Vic. She has lived with type 1 diabetes since 1998. The opinions and thoughts expressed in her occasional blogs are her own.
Renza blogs regularly at Diabetogenic about real life with type 1 diabetes and you can also follow her on Twitter @RenzaS
Thinking of taking the pump plunge? We’ve got lots of information on our website.
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For those with diabetes its an emotional journey.
You are diagnosed, meet with a number of health professional, given a range of often overwhelming information and left to get on with it.
If you are like me, you will then be booked in for a number of infrequent ongoing medical appointments to discuss your progress. These appointments will often mean long wait in hospital or doctors surgery waiting rooms, where you will be finally met by a Doctor,
The Doctor will then quickly walk through a range of typical health checks
- check your blood pressure and weight
- review your pathology blood test results
- review your blood glucose levels and recommend improvements
This process will repeated over and over for many years to come.
But what if you want more?
Where do you turn to for further information to help your diabetes management on an ongoing basis without the large waits and constant criticisms?
Monday 20 August 2012
Brenden Hills: Living with diabetes | thetelegraph.com.au
Picture: Thinkstock Source: The Sunday Telegraph
The number 62 never had much of a bearing on my life.
I was born in the 1980s and I'd never lived anywhere with a number higher than 29 on the letterbox.
But 62 changed my life on January 14, 2010, at Neutral Bay Medical Centre. It was my blood sugar level. A normal level is five.
"Have you been vomiting?" the doctor asked. Nope.
"Well, it's not far away, so I suggest you get yourself to the emergency room as fast as you can because I've never seen a blood sugar level this high.
"I think you've got type one diabetes."
And that was it. I did.
At least I'd entered the world of incurable disease with a higher score than anyone else.
Most people get diagnosed when their level hits 20, the doctor said.
Rugby league star Brett Stewart could only manage in the 30s.
There was no explanation for how it happened.
Diabetes wasn't in my family. A great-aunt I'd never met had it, but no one else.
There was some mystery thing inside my body which decided it was time to kill off the important parts of my pancreas and, as a result, my ability to produce insulin naturally.
Insulin? I'd never heard of it.
It's a hormone produced by the pancreas which pushes sugar from your blood into the rest of your body. My pancreas had just packed it in. We'd only just met.
I was now signed up for a lifetime of strict diet and exercise.
At 29 I had to become accountable for everything I ate and drank.
No more boozy nights with the boys topped off with a race to see who could get through 20 chicken nuggets the fastest at 4am.
No more competitive eating at the all-you-can-eat pizza bar.
On the plus side, I'd probably never again be thrown down the stairs of the Bull and Bush Hotel by a bouncer after singing into a microphone I wasn't authorised to.
A run or a surf would now have to be preceded by a complex mathematical equation.
Once on the early-morning bus to work I could feel the sugar level slide and struggled to open a value pack of Skittles that exploded when I pulled too hard in my dopey state.
They ended up scattered all over the bus, but still I gathered a few off the floor and the person next to me and ate some.
Beer became low-carb and flavourless. But at least I have developed a taste for top-shelf spirits, taken neat.
These are tough realities for a man with a fondness for chicken schnitzel and a schooner.
The other downside was my new life as a pin cushion.
When your pancreas stops working, you have to perform its role by injecting insulin.
That means five injections a day. Minimum. Two in the morning, one at lunch and two more at night.
As a diabetic, routine is king. You have to structure your main meals to occur at roughly the same time every day and accompany them with an injection of insulin timed just right to shift the sugar.
The problem is there's a lot of guess work.
Too much insulin and your level goes low, meaning you're at risk of passing out, or death.
Too high for too long and you run the risk of all sorts of medical blowback.
And for some reason it gives you a shorter fuse than Hulk Hogan.
So, you've got to park it in the middle, on the edge of that five-cent piece.
It's weird at first.
I felt like a junkie, jabbing myself with needles five times a day.
It's confronting for others to watch. I still refer to it as "shooting up". At least it goes in the stomach and I don't have to look for a vein.
Before diagnosis, I ate whatever I wanted.
Now I lock my survival lollies in a safe to keep my wife's lack of willpower from killing me.
Workmates love the endless supply of snakes on my desk, but they're always careful to leave me enough to live.
But with your pancreas on the blink the Mars bars or pasta you've been eating push up your sugar level.
When it hits 15 or higher you get thirsty. Really thirsty.
Every drop of water tastes as good as if I'd run the London Marathon with a hangover on a 42C day in a ski suit.
When the levels are wrong water isn't enough.
I turned to sports drinks, which are refreshing but are more sugary than Froot Loops. In the weeks leading up to diagnosis I was so thirsty I must have drunk 50 of them. They pushed my blood sugar level sky high.
Once you are diagnosed with a level that high it's quite a process to bring it down.
For me it took two days hooked up to a drip on a bed that had been wheeled into a Royal North Shore Hospital storeroom due to a lack of space in the rest of the hospital.
Once the adjustment is made, it's about coming to terms with it and just doing it.
So says Manly Sea Eagles fullback Stewart, who is a great ambassador.
That Stewart can maintain a steady blood sugar level through 80 minutes of rugby league shows you can live to your full potential.
"After a while you just figure out what works for you because everyone responds to it differently," he told me. "You just have to plan for everything and eat accordingly."
Wonder how many carbs are in that pic? ha ha
Sunday 19 August 2012
Leading My Own Life with Diabetes - Diabetes Daily Voices
Each day with diabetes brings about challenges, new and old, that continue to make us feel like we were recently diagnosed. We learn, relearn, and continue to count our carbs, check our blood sugar, take our insulin and still end up with a blood sugar that makes us ask, “What the heck?”
The day came for me to complete my 13 mile run in preparation for my first marathon and I did everything right. Or, so I thought at the time. The night before the run I had a balanced meal, made sure to stay hydrated by drinking a ridiculous amount of water, set a temporary basal to kick-in at 4:30a.m. for a 7:30a.m. run by using the “patterns” function on my pump, and went to bed the night before with an ideal blood sugar.
Everything was going well…until I woke up! First thing, I check blood sugar. 294 mg/dL.
“What the heck?”
I was hoping to jump out of bed being excited for my big run, but I practically had to be pushed out of bed because I was so tired from the high. I had a little over an hour until I was going to start my run and I had some decisions to make.
- I need to lower my blood sugar to around 150 mg/dL without causing it to go much lower during my workout.
- I need to eat some carbs to give me energy for the run without increasing my blood sugar.
- I need some coffee, because I have a 16 month old! More of a necessity than a decision!
But more than anything else, I need to prepare myself mentally for the longest run of my life. I have been training for months now to get to this point and regardless of how my diabetes is trying to interrupt my plans, I am going to do this run!
I have come to realize that living with diabetes is similar to training for a marathon, only one has a finish line and the other does not. The daily training of diabetes/running continue to make us more disciplined, better prepared, and stronger mentally and physically. But every once in a while we have a day where we just cannot seem to get things going.
You start chasing a high blood sugar and the next thing you know you are eating glucose tabs for a low; much like a runner struggling to get to the top of a hill and then using the momentum of the downhill to propel them to pick up the pace. Unfortunately, the temporary burst of energy from your blood sugar dropping, or running downhill will eventually lead to fatigue because of the erratic levels.
So, when I woke up with a blood sugar of 294 and my diabetes telling me to give some insulin, go back to bed, and complete my run tomorrow, I needed some motivation. Being a music junkie I turned on my iPod to one of my favorite songs, from the band Rise Against, called “Paper Wings,” and headed for the door. I kept singing the line, “Is this the life that you lead or the life that’s led for you? Will you take the road that’s been laid out before you? Will we cross paths somewhere else tonight?”
My Answer: I lead this life with diabetes and although diabetes tests me with different challenges each day in an attempt to take the “reins,” I am not going to take the road that has been laid out before me. We (diabetes and me) will cross paths somewhere else tonight, tomorrow, and the next night, and I am prepared more than ever for your next challenge!
I finished the 13 mile run with a blood sugar of 133 mg/dL!Related:
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Saturday 18 August 2012
dLife | If Luke Skywalker Had Diabetes
There's probably a good reason why iconic film characters don't tend to have diabetes. I was curious to see how diabetes might play out in a classic scene from a classic film. Stay tuned for more to come. Here's the first installment. It comes from Star Wars Episode IV: A New Hope.
The scene:
After landing on Yavin IV, the Death Star plans are analyzed by the Rebel Alliance and a weakness is discovered that could potentially destroy the deadly space station. Teenage moisture farmer and Jedi-in-training Luke Skywalker, recently diagnosed with type 1 diabetes, is called upon to destroy the evil Death Star and save the Rebel base from total obliteration.
Luke's X-wing speeds down the trench; three TIE fighters, still in perfect unbroken formation, tail close behind.
Biggs looks around at the TIE fighters. He is worried.
BIGGS: Hurry, Luke, they're coming in much faster this time. I can't hold them!
The three TIE fighters move ever closer, closing in on Luke and Biggs.
LUKE: R2, try and increase the power!
Stealthily, the TIE formation creeps closer.
Vader adjusts his control stick.
Luke looks into his targeting device. He moves it away for a moment and ponders its use. He looks back into the computer targeter. He begins to sweat, feeling disoriented and shaky.
BIGGS: (over headset) Hurry up, Luke!
LUKE: Hang on Biggs! I think I'm low.
BIGGS: (sighing) Are you freaking kidding me? Now???
Vader and his wingmen race through the Death Star trench. Biggs moves in to cover for Luke, but Vader gains on him.
Biggs sees the TIE fighter aiming at him.
BIGGS: Luke, Hurry!!!
LUKE: Hang on, Biggs. (fumbling) Stupid test strip!
BIGGS: Luke, please!!!!
LUKE: (over headset) I knew it! 42. Forty frickin' two. This makes no sense at all!
R2: Beep boop beeeeeeeeeeep!
LUKE: (checking insulin pump) R2? Is that you or me?
R2: Beep boop beeeeeeeeeeep!
LUKE: (irritated) Yes, I ate, R2! I had poached icefish and a glass of bantha milk just before we left the base!
BIGGS: Luke!!!
Vader squeezes the fire button on his controls.
Biggs' cockpit explodes around him, lighting him in red. Biggs' ship bursts into a million flaming bits and scatters across the surface.
Inside the War Room, Princess Leia and the others stare at the computer board. Leia returns her general's worried and doubtful glances with solid, grim determination. C-3PO seems nervous.
LEIA: Luke! Can you hear me? It's Leia. Is it possible you over-bolused for the icefish?
Three TIE fighters charge away down the trench toward Luke.
LUKE: (irritated) No! I didn't bolus at all for the icefish! When are you going to understand that icefish has no carbs? It's a free food. We talk about free foods all the time. It's not such a difficult concept!
Vader's finger's curls around the control stick.
LUKE: And not only that, I barely bolused for the bantha milk. I figured the adrenaline of the mission would send my sugar soaring. Ugh! I hate this disease!
Luke lines up the yellow cross-hair lines of the targeting device's screen. He looks into the targeting device and feeling weak, he starts to close his eyes, losing consciousness.
BEN KENOBI'S VOICE: Use the snack, Luke.
Luke looks up at the voice. His fighter streaks through the trench.
Vader follows Luke's X-wing down the trench.
BEN'S VOICE: Luke, trust me. Use the snack.
Luke's hand reaches for a bowl of stackleberry nuts on the control panel and pops a handful of the sugary treats into his mouth. Within minutes Luke regains his strength.
BASE VOICE: (over speaker) Luke, you switched off your targeting computer. What's wrong?
LUKE: (over speaker) Nothing. I'm all right.
The three TIE fighters move in on Luke. As Vader's center fighter unleashes a volley of laserfire, one of the TIE ships at his side is hit and explodes into flame. The two remaining ships continue to move in. Vader's ship spins out of control, heading for deep space.
The Millennium Falcon arrives just in time. Han Solo and Chewbacca grin from ear to ear.
HAN: (into mic) You're all clear, kid. How's your blood sugar?
LUKE: It's OK, I think.
HAN: Now let's blow this thing and go home!
Luke fires his laser torpedoes into the exhaust port and into the main reactor. The Death Star explodes, bursting into a supernova.
Luke is at ease and his eyes are closed.
BEN'S VOICE: Remember, the Snack should be with you … always.
HAN: Great shot, kid. That was one in a million.
HAN: Hey kid?
LUKE: Yeah, Han.
HAN: Do me one favor. No more intergalactic combat until you outgrow that diabetes, OK?
LUKE: (fake laughter) Deal!
HAN: (laughing)
LUKE: (muttering under breath) Idiot!
(Portion of script taken from Journal of the Whills by George Lucas)
Coming soon to Blogabetes:
Willy Wonka & the Chocolate Factory with Charlie Bucket, diagnosed with type 1 diabetes at age 3.
CHARLIE BUCKET: (upon entering Willy Wonka's glorious candy-filled factory) Are you !%#$@ kidding me?
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Drinking Alcohol Safely With Diabetes - Diabetes Daily Voices
Alcohol. Yep, some people with diabetes drink it. I do, on occasion. Some argue that drinking alcohol with diabetes isn’t the healthiest choice, but I could say the same thing about diet soda.
Whatever your stance on it is, it is something that should be handled with care, especially when you are dealing with diabetes.
As anyone with diabetes (or someone who loves a PWD) knows, it is a balancing act. Between food, exercise, hormones and the like, we are constantly chasing that elusive 100 mg/dl on the meter. Alcohol can really throw your blood sugars into a tailspin. Let’s not even start on carbohydrates in your drink. Your liver and its functions are a very big player in how you manage diabetes while drinking. Instead of helping to regulate your blood sugar, your liver is busy metabolizing the alcohol, which can result in some scary lows. Be prepared with glucose tabs and make sure to check regularly if you are having a drink.
What to Drink?
I like to stick to drinks that don’t have carbohydrates in them: a good red wine, vodka and club soda or Fresca, or an occasional martini are predictable for me. Plus, I don’t have to take any insulin with them which makes it easier. If I am having a beer or something fruity like rum punch, I make sure to limit how much I am having. I once had an endocrinologist tell me that after every 3 drinks make your fourth one with carbs. I don’t know how good that advice was, I don’t follow it… But I do stick to what I know, I test very often, and I make sure to eat something while I am drinking.
Bedtime Cautions
Yes, you should be cautious before bed even when not drinking but you need to be even more on track of what your blood sugar is when you are. I cannot stress enough to test right before bed (and before you brush your teeth) to make sure you are in a healthy range. I usually have a little snack like bread and cheese or something with fat, carbs and protein to make sure that I stay safe.
If you don’t live alone make sure that your spouse/roommate/partner, etc. knows what your blood sugar level is and that you have had a drink (or two). If they really love you they will keep their eyes out for you so you are ok.
The Day After
Since the effects of drinking alcohol can last for 24 hours after (not just a hangover but diabetes wise) it’s important to make sure you test a lot the next day. From your liver working to process the alcohol, it is not unlikely you will be low. Again, test a lot, wear a CGM if you can, and keep on top of it. Eat something a little carby if you like- I am a big fan of a bowl of Pho- and take it easy. Don’t plan on any big workouts. I have been there and had to sit out of many runs and yoga classes eating glucose tabs because I was constantly low. That is no fun either.
I find that an occasional drink can be a fun way to relax with friends or to enjoy with a meal. I make sure to make diabetes my top priority with drinking so that I can remain healthy and in control. Do you drink alcohol with diabetes or do you find it doesn’t fit in with your lifestyle? I want to hear all about both sides! If you do drink, what do you find works best for you? Any tips you can share to safely drink with diabetes?
Photo Credit: Anders Adermark
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And guess what Im another one that loves a glass of wine or three