Diabetes Blog Week 2014: A Poem

Diabetes Blog Week 2014 The prompt: Write a poem, rhyme, ballad, haiku, or any other form of poetry about diabetes. (Thanks, Tu Diabetes, for the topic.)

Since yesterday would have been Edward Lear’s birthday, how about a limerick?

The guest – we’ll call her Amalia –
Stood chatting amongst the regalia.
On hearing a squeal
She dared not reveal
The pump in between her mammalia.

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Diabetes Blog Week 2014: Changing the World

Diabetes Blog Week 2014

The prompt: Today’s topic is Change the World.  (Thanks, Kim of Texting my Pancreas for the topic.)

I ran my first 5k yesterday, thinking it might be an interesting challenge.

I’ve never been much of a runner. So I downloaded a couch-to-5k runner app and started training the next day. I registered for a local race (Denver’s Adelante! 5k). Then I recruited a few running pals to run with once a week. The other days I ran on my own. In time, I looked forward to the trainings as a way to spend time with people I don’t see often enough or just zone out and listen to music.

With 7 weeks of training under my belt, I was feeling reasonably prepared on the day of the race. I ate an apple, drank some water, and stashed a juice box in my jacket pocket, just in case. My family came with me to cheer me on (it being Mothers’ Day, what choice had they?). I ran most of the way. And since I wasn’t running for any particular time, I was happy to complete the course in 36:12.

Of course, the numbers I care more about are the ones on my meter. And I was less happy with those yesterday. Given that I’d been testing and adjusting for weeks to determine a sensible strategy for the run, I was surprised and vexed by my body’s response. Here’s what the day looked like in diabetes terms:

7:15 Test: 89mg/DL
8:15 Test: 81mg/DL
Eat apple (skip bolus) Preventively, to avoid mid-race low.
8:45 Decrease basal rate by 20% Again, preventively.
9:00 Run (mostly) for 36 min.
9:55 Test: 176mg/DL Woah…
Check site (it’s fine).
Bolus 2.5 units Hope that’s not too aggressive.
Hydrate.
10:10 Test: 172mg/DL Really?
Ponder test strip inaccuracy.
Verify recent changes to pump settings.
Second-guess skipping the apple bolus.
Second-guess the 20% basal decrease.
10:20 Test: 164mg/DL Still?
Bolus 1 more unit.
Head home.
Change site.
Spot a few air bubbles in line. Maybe?
Open new vial of insulin. It’s time anyway.
Continue to bolus against a stubborn high for most of the day. Sheesh.

It’s difficult to convey the squirrely nature of diabetes to people who don’t live with it every day. The best-laid plans often deliver uncertain results. And yet, my first 5k was rewarding and fun. Diabetes didn’t spoil it. I may not know for sure what was going on yesterday, but I know I’ll apply what I learned to my next 5k. In general, this is how I try to approach to diabetes.

So, what do I advocate for? Continuous improvement.

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Thanks, D.O.C.

By all accounts, participatory medicine is a growing movement. And The Pew Internet and American Life Project, which studies such trends, reports that people with chronic conditions (e.g., diabetes) are more likely than our peers to consume and share health information. The Diabetes Online Community (DOC) doesn’t replace my professional care, but I increasingly rely on its vast network of diabetes patient-experts for general support and practical advice.

I&D marks its first anniversary this January. Looking back on a year of blogging, it’s clear to me that being part of the DOC has engaged me in new ways. I participated in Diabetes Blog Week, World Diabetes Postcard Exchange, and the Big Blue Test. I learned practical tips from fellow bloggers (e.g., the best sticky tape for securing a port; how to keep insulin cool in hot weather). I found new blogs to read like Karmel Allison’s Where Is My Robot Pancreas and Kim Vlasnik’s Texting My Pancreas.

Even when the DOC doesn’t have the answers, it’s reassuring just knowing that others are asking the same questions.

We don’t usually exchange Christmas presents, but I got you one anyway – this clip from a favorite episode of The West Wing (No. 32, Noel.) Enjoy!

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Uh-oh, Spaghetti-o

Pasta doesn’t do my blood sugar any favors, so I don’t eat a lot of it. At roughly 55g of carbohydrate per serving, I’d rather eat this:

bagelor a generous slice of this:

chez_panisse_pizza

But the rest of my family loves pasta, so I was happy when a friend turned me onto Dreamfields pasta. dreamfieldsIt tastes exactly like regular boxed pasta, but contains only 5g of “digestible carbohydrates.” It’s a pretty amazing feeling to eat a bowl of pasta, dose for only 5-10g of carbs, do a post-meal BS check and find that I am perfectly in range.

There is one important caveat: over-cooking, re-heating, or letting Dreamfields pasta sit in cooking liquid/sauce breaks it down and raises the digestible carbs. So, on the rare occasions I make a pre-sauced pasta dish, I use “regular” pasta. To offset the ginormous carb hit, I also flip the typical pasta-to-vegetable ratio so the bowl is filled mostly with vegetables and accented with pasta.

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Diabetes Awareness Month

logoJust in time for the holidays, November is National Diabetes Month. Who cares? You might. According to the National Diabetes Education Program:

  • Approx. 26 million Americans have diabetes.
  • An additional 79 million adults in the US have prediabetes.
  • The total direct medical cost of diagnosed diabetes in 2012 was $176 billion.

Two diabetes awareness campaigns caught my attention this year:

  1. Lee Ann Thill created the World Diabetes Day Postcard Exchange to “promote healing through creativity, connection and activism.” Participants in the Exchange send and receive handmade postcards that incorporate the blue circle (the international symbol of diabetes) in their design. Great idea – I’m mailing my cards today.
  2. The Big Blue Test is designed to help people notice the impact of small changes. Through November 14, for every 10 Big Blue Test results that are logged, Diabetes Hands Foundation grants $5 to support people with diabetes.
    You don’t have to have diabetes to participate, and the benefits of exercise are yours to keep. Here’s what to do:

1) Test your blood sugar (if you have diabetes)
2) Move your body (at least 14-20 mins)
3) Test again (if you have diabetes)
4) Share your results on bigbluetest.org

I’ve been logging my big-blue data since the start of the campaign. Each time, my blood glucose has dropped 20-30 points following 60 minutes of moderate-to-vigorous exercise. Plus, I use 15% less basal insulin for the ensuing 4 hours.
That’s some solid motivation right there.

 

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Carb Cheat Sheet for Halloween Candy

I’m not super-tempted by Halloween candy. (Lucky for me, our neighbors don’t hand out Cadbury milk chocolate.) Still, I keep a carb cheat sheet handy, just in case.

Curious about the carbohydrate count of your favorite Halloween treat? Take a look:

Carbohydrate Content of Popular Halloween Treats

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Statin? Not so much.

When my endocrinologist suggested earlier this month that I go on a statin to lower my LDL (damn you, diabetes!), I didn’t love the idea. I agreed to think about it, but in truth, I began at once exploring alternatives. To begin with, I wanted to understand if my lipid numbers were in fact problematic.

Should I even worry about my cholesterol levels?
According to the American Diabetes Association (ADA), people with diabetes should meet the following targets:

  • LDL (aka “bad”) Cholesterol: < 100 mg/dl
  • HDL (aka “good”) Cholesterol: > 40 mg/dl (men) and > 50 mg/dl (women)
  • Triglycerides: < 150 mg/dl

The role of cholesterol in our bodies seems poorly understood. For years I believed in the protective benefit of HDL – the idea that a high HDL would offset a high-ish LDL. But this 2012 New York Times article points out that view may be outdated.
(So a high HDL isn’t necessarily helping me avert heart disease?) I was further encouraged by another briefly popular notion that what mattered more than the individual numbers was the ratio of HDL to total serum cholesterol. The American Heart Association (AHA) has stated that a ratio of <3.5:1 is ideal. And yet, the AHA has not incorporated the metric into their clinical practice guidelines. (So much for my own reassuring ratio of 3.55:1.)

Therefore, barring other measurements, I am resigned to the fact that the individual cholesterol numbers matter at this moment in time. Which leads to the question of treatment:

Should I lower my LDL with a statin?
Again, according to the ADA, yes. The ADA maintains that:
Statin therapy should be added to lifestyle therapy, regardless of baseline lipid levels, for diabetic patients without CVD (cardiovascular disease) who are over the age of 40 years and have one or more other CVD risk factors (family history of CVD, hypertension, smoking, dyslipidemia, or albuminuria.

There’s no question that statins lower cholesterol, but for whom, to what degree, and with what effect remain unclear. Statins’ success in secondary prevention –  helping people (particularly men) avert a second heart attack or stroke – is well documented. But their effectiveness for primary prevention (initial heart attack/stroke) is less clear. It turns out that cholesterol levels may be less predictive of cardiovascular disease (CVD) than previously thought. (This 2012 Journal of American Medicine piece suggests the controversy).

Even if the indication were more certain, the benefits would have to outweigh the potential side effects linked to statin use (see the FDA’s current consumer advisory on statins), notable among them: muscle pain, cognitive interference, and – wait for it – elevated blood sugar.

On the NIH’s National Heart, Lung and Blood Institute website, I found a simple (now outdated) risk assessment calculator* where you can plug in different cholesterol numbers and see how they affect your 10-year risk of heart attack.
(I calculated mine based on my recent lab work: 1% risk. Not very statin-worthy.)
* 11/12/2013 update: new cholesterol treatment guidelines were published today. Per these new recommendations, anyone between the ages of 40 and 75 who has Type 1 or Type 2 diabetes should be on a statin (period). However, I used the brand new calculator (which now includes stroke risk) to gauge my 10-year risk of heart attack or stroke. .04%. So, thanks, I guess, for the new guidelines, but I’ll still pass on the statin for now.

Despite my skepticism, I don’t want to give my newish endocrinologist the impression that I ignore her advice. There seems to be no harm in trying to lower my LDL naturally.

My plan to reduce my LDL without a statin
Reputable web sites assure me that diet and exercise may help lower my LDL by 20-30%. The added bonus for me is that I’ll get more fit in the process. Excellent! So:

Exercise:

  • I upped my gym visits to 5-7 days/week.
  • I found my long-lost pedometer and am logging at least 7500 steps/day.

Diet:

  • Oatmeal or soup (why not?) for breakfast.
  • Meat and dairy are now occasional indulgences.

On the upside, I figure I’m just leveraging diabetes to make myself healthier.
(Take that, diabetes!)

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