Going to the Summit

unnamedGuess what? I was chosen to attend the DiabetesMine Innovation Summit in November! I entered the Patient Voices Contest in March and was selected. I think this is the third time I’ve won something in my life after tickets to a Springfield Indians (hockey) game and a catered lunch for ten at Qdoba. The latter two prizes were both for calling in and answering a question on the radio!

Anyway, this one is the most exciting and pertinent to my life – personally and professionally – with diabetes. I am going to learn about diabetes technology and discuss ideas and possibilities beyond my wildest imagination. I admit, I’m not the biggest technology geek on the planet. I do have a few ideas for diabetes innovation, though.

I’d love to hear from others, too! What ideas would you like to see shared and discussed at the Innovation Summit of 2015?


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40 years of diabetes

Start-your-mammograms-at-40-years-of-ageSo it’s been a while since I’ve blogged. But it’s also been a while that I’ve had diabetes!! In fact, Saturday, June 20th, marked 40 years since I was diagnosed and hospitalized. Last year my dad gave me a file folder full of mementos from my early diabetes days, and in there are the log sheets where the nurses (and then I) recorded my urine glucose and “acetone” results while I was in the hospital.

The first day I had 3+ glucose and large ketones (acetone); the second day I had 4+ glucose and large ketones (and received my first dose of NPH insulin). By the third day the ketones were down to moderate and then small, but the glucose was still up there. On day four the glucose started fluctuating and the ketones were gone.

Other fun items in the folder include a pamphlet titled “you and diabetes: an informative booklet for patients taking oral medication” (I was diagnosed with type 1 and taking insulin – go figure); a 2200 “calorie controlled diet” pamphlet with lists of A and B vegetables and all the exchanges; and bonus! a recipe for lemon gelatin (1 tsp unflavored gelatin, 2 tbsp cold water, 1 tbsp lemon juice, and 1/2 cup water), which “may be used in any amount.” Sounds amazing!!

There’s a copy of the Meal Planning with Exchange Lists copyright 1950 and a hand-typed Guidelines for Healthy Living with Diabetes written by my diabetes educator. And a (fun) Fact Sheet on Diabetes from the ADA, which included stats on death, decreased life expectancy, blindness, kidney disease, gangrene, amputation, heart disease, unsuccessful pregnancy, birth defects, and economic toll. I’m sure that was uplifting for my parents!

So 40 years later it’s interesting to think about where we’ve come (or not). For 40 years we’ve been “about five years away” from a cure. Yet in those 40 years we’ve seen the advent of insulin pumps and blood glucose monitoring. We have all sorts of insulin analogs, insulin pens, and diabetes-related technology. We certainly know a lot more about diabetes and how to manage it successfully.

I am a word-nerd, and reading through the pamphlets and information in that folder I was somewhat disappointed to see that our language hasn’t really changed much. We still use words like “rules” and “control” and “diabetic,” although possibly not as much or as often. And hopefully we are thinking about it more and aware of the difference that our words make.

My hope is that I won’t have diabetes for another 40 years. But I am realistic, so if I do, my bigger hope is that those who are either new to diabetes or even celebrating 40 years with it, won’t know those words in the context of diabetes. I hope they will only know a few inconveniences, but otherwise good health and happy lives.

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Get Fit, Don’t Sit

ADA-Dont-Sit-Get-Fit-Stickers-Image-File Tomorrow is the American Diabetes Association’s first National Get Fit Don’t Sit Day. The motivation for this event was a report published in January of this year that said we are sitting too much!

I, for one, am guilty as charged. I work from home, at my computer. I sit for long periods of time. Luckily, I have a dog who has to be walked, and whenever I’m on a phone call I walk around the house, but otherwise I sit. And “sitting for hours every day creates serious health risks.” Although the risk is lower for those who exercise, it’s still not great.

They say we can stretch, walk, or in some way move our bodies – every 90 minutes – to solve the problem or at least decrease our risk.

I apologize for being a little late with this information – there is a toolkit available from ADA to help with ideas for getting fit. But at the very least we can be creative and figure out ways to move more tomorrow. And then keep it up going forward.

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What’s Your Diabetes Gap?

I recently read an inspirational article about The Gap. The author says that everyone has gaps in their life, which he defines as “the difference between what you say you want in your life versus the results you’re actually producing.” And seriously, who can’t relate to that on some level (or many)?

What’s your diabetes gap? Does it have to do with food? Or exercise? Or daily management tasks? Or complaining? Overtreating lows? Fear? Or is your gap completely unrelated to diabetes?

Todd says that we tend to fill our gaps with blame, justification, rationalization, and excuses. Yikes! But he goes on to say that we can close the gap with four things: effort, courage, love and presence. Ok, maybe not easy, but doable, right?

I discussed many of my gaps in my book, and I am still working on some of them (and I’m sure there are new ones). One of the most important gaps I have pretty much closed in my diabetes life is giving myself a break when I don’t meet my goals or expectations in diabetes care. By doing that I am able to keep getting back up and starting again and being successful more of the time.

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Diabetes Innovation Opportunity

diabetesmineCheck this out! DiabetesMine is hosting their 2015 Patient Voices Contest. You could be the lucky winner of a scholarship to attend the Diabetes Innovations Summit at Stanford University in November.

What a fabulous opportunity – why not give it a try?

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Diabetes Alert Day

MF1639Today is Diabetes Alert Day. But any day is a good day to lower your risk for diabetes (if you don’t already have it) and to take good care of your diabetes (if you do have it).

The American Diabetes Association has lots of resources available for people at risk for and living with diabetes. And they’ve been around for 75 years!

My favorites include

Plus tons and tons of other resources for just about any diabetes-related topic you can think of. Check them out!

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High Fat Low Glucose

54f954bed9fda_-_shamrock-shake-mcdonalds-del-blogLately I’ve talked to and read about people who’ve eaten fast food and then experienced low blood glucose. This can be confusing and/or frustrating, but it actually makes sense.

Fat takes longer to break down in our bodies and doesn’t turn into glucose the same way carbohydrate does. Most items in a fast food restaurant are high in fat (burgers, fries, milkshakes, etc.). Even the foods that have a lot of carb still have a lot of fat, which slows down the effect of the carb on blood glucose.

So if we take our insulin for all the carb, but don’t take into consideration all the fat, we can end up low pretty soon after eating. The timing of the food and insulin hitting the blood stream doesn’t match up; the insulin hits at its usual time (Humalog, Novolog and Apidra start working in about 15 minutes and peak in about 90 minutes) but the food hits much later (while carbohyrate, on its own, starts working in about 20 minutes, the fat slows that way down and the timing will vary up to hours).

It takes practice and observation, but luckily there are ways to deal with this. Those of us who use injections (syringe & vial or insulin pens) can take a little bit of insulin up front and the rest after the meal. Or we can take all of it after the meal if we are low beforehand. Those of us who use insulin pumps can take advantage of the extended, square wave, or dual wave bolus (which delivers the meal bolus over time or some right away and the rest over time).

Next time you find yourself at a fast food place, a little extra planning could prevent an unwanted and unnecessary low blood glucose afterward.

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Low Blood Glucose

Question_mark_(black_on_white)Has this ever happened to you? You feel symptoms of a low blood glucose (hypoglycemia), you check, and it’s actually not low? This can happen if you are nervous/excited and are experiencing the affects of adrenaline, which can be the same as low symptoms. This can happen if your blood glucose is dropping quickly. Perhaps when you check it isn’t low yet, but will be shortly. It can also happen if your blood glucose has been running consistently high and now it is lower than it has been (even if it isn’t technically “low”).

I think of that last scenario as your body’s way of saying, “Hey, we were used to all that glucose and now there’s not as much – what’s going on??” And I talk to a lot of people who have experienced this.

Health care professionals usually define low blood glucose (BG) as any number below 70 mg/dL (3.9 mmol/L). That means we don’t usually worry about the dangers of low blood glucose until we reach 70 or below.

But if you feel low at a higher number, you’re not crazy. I read about a blogger who had this experience while in the endocrinologist’s office. This person felt low, checked their BG and found it was in the 170s. The endocrinologist proceeded to roll his/her eyes at the person who felt low but was not (according to the BG).

Dear health care professionals: if you didn’t learn this in school, please take note – NEVER roll your eyes at a patient!

Dear people with diabetes who feel low when the number says they aren’t: don’t worry about it. The way you feel is legit and it could be any number of things going on (see above).

I have found that I tend to feel low when my blood glucose is either rising or falling through the 180 mg/dL range. I honestly don’t know why that is, but my personal suspicion is that it has to do with the renal threshold. The renal threshold is when the blood glucose level surpasses 180 and the kidneys start spilling glucose into the urine. Maybe someone will study this one day (and maybe they already have) and I’ll get an answer, but in the meantime I try to check before treating when I feel low – just in case I’m in the 170s or 180s like the person I read about!

One other thing…if you are feeling symptoms of low blood glucose when your BG is not actually low, keep working on managing your diabetes and bringing your average down and eventually you will feel low when you are closer to or below 70.


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Needle Length for Insulin Injection

syringes 002Once upon a time we only had long insulin needles. Of course they weren’t called long; they were simply called needles. But over the past several years the needles for injecting insulin (by syringe or pen) have gotten shorter and finer.

I remember counseling patients who were bigger to use longer needles and patients who were smaller to use shorter ones (if they wanted to). Then one day I was at a conference exhibit and saw a demonstration on skin thickness, which basically showed that shorter needles work for anyone.

Now even I use “short” needles, but I admit I haven’t gone to the shortest ones yet. The options start with 12.7 mm and move down to 8 mm, then 6 mm, 5 mm, and now even 4 mm (in other countries there may be other options).

Back in the day we used to teach people to pinch up their skin (fatty tissue, we called it). It turns out this was necessary in order to avoid injecting into muscle, which can lead to unpredictable insulin action times (usually too fast). We even told people who were extremely thin to inject at a 45-degree angle.

But now we have short needles (and shorter ones), so we no longer need to pinch the skin. In fact, pinching the skin with super short needles could lead to injecting into the dermis (skin) and not the subcutaneous tissue (fat). That would also affect the ability of insulin to do its job properly.

Here are some other interesting tidbits about needle length: men probably would benefit from needle lengths shorter than 8 mm; there tends to be more bruising with longer needles; and studies have shown absolutely no difference in blood glucose levels between the various length needles.

So enjoy your short needles!

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Timing of Insulin

DSCN2322Back in the days of Regular insulin, taking injections at least 30 minutes before a meal was important because it took quite a while for the insulin start working. Nowadays most people use rapid-acting insulin (Humalog, Novolog, or Apidra), which we think of as starting to work in 10 to 15 minutes. But how many people actually take it 10 to 15 minutes before eating? When we first had rapid-acting insulin available one of its claims to fame was that it started working rapidly and we could take it right before the first bite of a meal, or even right after eating.

What we know now is that taking rapid-acting insulin 10 to 15 minutes prior to eating really can lower the A1C. Of course, that requires some planning and knowing how much we’re going to eat. It still makes sense to wait when someone who does not know what or how much they are going to eat, or when eating away from home. It’s always safer to know the food is ready and available before injecting rapid-acting insulin.

Some guidelines for when to take rapid-acting insulin are as follows: if the blood glucose is below 100 take insulin right before eating a meal, if the blood glucose level is in the 100s wait ten minutes, and if the blood glucose is in the 200s wait 20 minutes.

As far as long-acting insulin goes, Lantus can be given any time during the day/evening as long as it is consistent from day to day. For those who take Lantus or Levemir twice a day, taking it consistently about 12 hours apart is a good plan, although personally I take Lantus at 7 am and 10 pm and that works well for me. The point is to be consistent so your background insulin coverage is consistent. I once worked with a teen-ager who could only remember to take her Lantus if she took it at noon – and that’s fine!

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