Category Archives: Diabetes Management Tips

Don’t Underestimate the Power of Housework

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I buy a quart of juice each week and the kids get a few drops of it in their cup of water so that it’s flavored.  We went to a local university to enjoy the nice fall weather recently and when I realized that I forgot to buy glucose tablets, I just packed that unopened quart of juice in the car for any emergencies.

Earlier that same day, my parents let me know they were stopping by.  I took a look around me and knew  I’d have to speed clean in order to make the house presentable.  So I whipped the kitchen, living room, and guest bathroom into shape in 30 minutes.  This is something that would have normally taken me 2 hours.

I was sweating after it all and almost out of breathe (not sure what that says about me).

And a little after that is when we went out to walk.  And that’s when I was thankful for that entire quart of juice I packed in the car.  I needed every last drop totaling 96 grams of carbs.  Two hours later I was 83 and in desperate need to pee.

I think this was a great reminder for me.  When I ponder choosing between a workout and cleaning the house, why not combine the two?  One and the same if you move quickly and deliberately.

What about you?  Do you get lows during or after housework?

Spending on our Diabetes Supplies

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Here’s my story-I used to get very caught up with how I was going to afford my diabetes medications and supplies.  I would make a yearly budget list of things I wanted to spend money on and I would include all my diabetes stuff on that list.  Then throughout the year I’d make choices from that list as money came in.  I ended up putting off my diabetes related purchases until the last moment or until I was broke and had to ask my parents for a loan.

This was no dignified way to live.  I felt upset every time I did spend money on my diabetes thinking, “This is so unfair, with what I spend on my diabetes, I could have gone to Europe for a month by now!”  And perhaps that’s the truth.  BUT…didn’t I have a high value placed on my health?  Didn’t I realize diabetes wasn’t going to go away and that if I was healthy, I was able to do more things?

I began realizing that my diabetes related purchases needed to be on a list of things that I must spend money on.  And in fact, those purchases needed to be at the top of the list because health really should be my priority.

I was bitter for years because I was giving up small vacations, clothes, cds, and other things I wanted to buy because that extra money was going to my diabetes.  I didn’t like feeling this way so I started working on changing the way I thought.

I realized I was choosing to be miserable, yet healthy when I could choose to be content and healthy.  So I decided to continue prioritizing my diabetes but I also began working towards a goal of getting a new job and making more money.  In the meantime, I’d try to take pleasure in the simple things like friends and family and focus on what I DID have.

Eventually I got to where I’m at now.  Paying for my insulin and strips is just like paying the monthly rent.  I don’t even think about it.  I need it.  I’m grateful to be able to pay for it.  And instead of being upset about it, I’m spending that energy on much better things.

In the end, it’s all worked out better than I ever dreamed.  Some people cannot afford their diabetes supplies.  Some don’t have the choice.  For those of us who do, let’s make it in favor of our health and the rest will fall into place.

Travelling with Diabetes

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I’ve been travelling more than I’m used to lately and suddenly I’m really interested in what items to pack for my diabetes.  On a plane the other day I suddenly had the thought, “What if I use up all my sugar for lows and need more?”  Now typically on a large plane, there are sodas and juice but on the plane to my hometown there is no such thing because it’s a small bumpy ride home.

So…I want to ask those of you who have diabetes and travel from time to time or frequently, what do you pack in your carry on?  Do you travel with glucagon?  Do you bring tons of back up glucose tabs?  What do you do with your back up or extra insulin that you bring if there is no fridge in the hotel room?  Does that affect it’s function later?  Do you eat differently when you are travelling?

So many questions!

Healthy Lifestyle Habits and Their Impact on Diabetes Management

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From watching message boards and facebook, I’ve come to understand that more people than I imagined don’t believe that healthy lifestyle habits can improve their diabetes management or are an essential part of their management.  They believe that adhering to the strict rules of carb counting and insulin dosing is all they need to do.  And when their diabetes management isn’t where they’d like, they blame diabetes.  And yeah, yeah diabetes is ultimately the cause of all our blood sugar woes.  But focusing on that is NOT going to ever help.

So I’d like to offer some opinions on lifestyle habits and how they impact diabetes management.

First, I’ll say that my diabetes management was extremely challenged while I ate a typical American diet.  I have never had an issue with carb counting or portion sizing.  My challenge was facing the ups and downs that broke the rules about insulin and carbs.  When I changed my diet to omit most processed foods, most of the time, I realized my blood sugars didn’t swing up and down nearly as much.

Same happened when I began to exercise daily.  Easier diabetes management.  Insulin is much more powerful when we exercise regularly.  When I don’t, I cannot maintain tight control.

These discoveries were so huge for me that I can’t imagine someone not knowing the potential of healthy lifestyle habits on their diabetes.

No matter who you are, the positive impact you stand to gain from changing things about how you eat and move during the day is huge!  I can eat carefully and exercise daily and use 12 units of my long acting insulin a day.  If I eat like I see most people eating and if I don’t exercise regularly, I literally need 25-30 units of my long acting a day.  That’s a HUGE difference.  That difference impacts weight gain, hormone balances in the body, moods, metabolism, thyroid function, cholesterol, and more.  That’s why I take it seriously.

Now, I didn’t make these changes overnight and don’t expect others to either.  But it helped me to be slowly convinced that trying to make small, gradual changes over time were totally worthwhile.  And that’s what I’m trying to do in this post for anyone who isn’t convinced.  I benefited from reading stuff like this long ago and I hope somehow this helps someone else.

I write it over and over again because I believe it through personal experience.  And yes, we all have unique experiences but I’m not saying eat what I eat or exercise how I exercise.  Those details are up to you.  However, if what you’re doing isn’t working, try something else.  And just because it worked for you once doesn’t mean it works for you.  Something has to work consistently in order to “work”.

If you love and respect yourself, and I hope you do, you owe it to yourself to adopt the habits that will nourish your body and mind for the long term, rather than going for instant gratification.

On Meter Accuracy and What to Do in the Meantime…

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While I do give my time and energy when it comes to petitioning for better meter accuracy, I also have adopted a few personal safeguards.  These safeguards are like self imposed regulations that I don’t know how to live without.  I used to live without them but there were a lot of close calls.  And sometimes I forego them and scary things happen.

Meters being a good bit off (up to 20% off is it?) is an important issue to tackle, indeed.  But since it’s the reality of our current situation, we might ask ourselves in case we haven’t already, “What can I do about it?”  I’ll share what I do in case in inspires anyone to answer this question for themselves:

It’s been my experience that the further away from 100 my blood sugar is, the less accurate my meter may be.  Well how about that?  My meter and I mutually agree as to what my “target” is.  Just kidding.  Sort of…

Since low blood sugar comes with clearer symptoms for me and is an immediate emergency situation, I don’t question my meter when it says I’m low.  Though, if I don’t feel low at all, I will try jump in jacks and if I have energy for those I will retest because something strange is going on.  Perhaps leftover fruit juice on my fingertips from the apple I had earlier.

When my blood sugar is within my target range I relax, cheer, do a dance, etc.  But I try to have faith in my meter and assume it’s right on.

When my blood sugar is over 250, I retest.  It hurts me to retest because strips are like gold but I do it because this could happen:

Years ago, I tested 350-something.  When my blood sugar is that high, it’s hard for me to bring down so I usually push it down with a larger than usual bit of insulin.  Well, I gave insulin and then stopped.  I thought about how I didn’t feel 350 high.  So I tested again and saw I was 260.  I tested yet again and was 249.  “OK” I thought, “Now I’ve got a heck of a lot of insulin coming my way”.  Sure enough in 40 minutes I was 98 and dropping fast and still had over an hour of active insulin coming.  Nowadays the times that has happened have been handled differently.  I start to eat after 15 minutes to deflect the steep drop.

But better yet, it really doesn’t happen too often because I test twice.  If the second test is really far off from the first, I test a third time and go with the majority rule.  I would never ever test, see a high number, give insulin, and go to sleep.  Our meters are not built to support that level of responsibility.  Not with our lives.  That is a shame, yes, but that’s where our brain comes in handy.  What can we do to help ourselves against this?

Something a lot of my friends do is to eat low or moderate carb.  They have many reasons for eating low or lowish carb but one of the reasons for many of them is that this way, there is usually not a lot of insulin circulating at any given time.  And the food they eat is going to minimize the likelihood for being high enough to see super large discrepancies in their test results.  This works well for me.  In particular, what works well for me is to be careful with processed food.  I find that avoiding it makes my blood sugars more stable and my life easier because I don’t have super high highs.  And then my meter isn’t as big an issue for me as it could be.

But they should totally work on meter accuracy.  Or at the very least give everyone more strip allowance.

Please.

My Biggest Worry about Pumps

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“Ketones” by Ana Morales

 

I’m all about people using pumps if they like them (or don’t like them but find they manage their diabetes well with them).  It’s a wonderful device and I’m happy technology like that exists for us.  I used a pump for 7 years, which is plenty of time to experience just what pumping is all about.

So I want to talk about something I noticed during my pumping years and after them.

It occurred to me recently that my numbers rarely go high enough to induce DKA.  I can count on one hand the occasions in the past 5 years where my blood sugar has gone over 350 and it hasn’t been over 400 in 6 years.  I’ve been off the pump for 6 years and find I can’t go back, yet.  One of the most dangerous things in my mind is DKA and very high blood sugars.  I experienced super high blood sugars enough as a teenager to know I never want to go through that again.

When I was on the pump, it was a regular monthly occurrence to have a 400+ blood sugar reading and it was almost always due to a pump or tubing or pump site malfunction.  I knew that my being human provided sufficient variability and error to my diabetes management and I began to seriously resent the pump for adding to that risk simply because I didn’t have the energy to keep up with it’s extra requirements.

What I mean is people who don’t endure these pump issues have very good discipline when it comes to changing their pump site and checking their tubing and changing the site when they suspect they need to.  However, I know that many of us don’t do this.  I completely understand why-it’s hard to keep up this kind of diligence, especially if it means inserting a painfully long needle more times than we’d like.

Those who use pumps should probably be in a very good place when it comes to their motivation to do all that is necessary to successfully use the pump.  I was not one of these people because I resented wearing the pump and as a result, kept my site in too long sometimes and suffered the consequences.  Of course, sometimes, we can do everything right and something wrong can still happen with the pump though the likelihood is very much decreased if we keep up the right routine.

I love using syringes because I get piece of mind each time I give insulin, knowing I don’t have extra variables to contend with (there are SO many as is).  And mostly because I never have a high blood sugar surprise that is a result of my not receiving any basal insulin for a mysterious amount of time.  The danger of very high blood sugar isn’t just that, it’s also the lows that can result from giving insulin over and over again in an effort to push that really high and resistant blood sugar down.

Obviously there is more involved in keeping blood sugars stable.

Reducing my carbs and using shots has made my blood sugars so much more stable, with little extra effort involved.  And to me that’s practically miraculous in terms of gains to my quality of life and health.  So while I don’t mean to say that people shouldn’t use a pump I just think we should each be honest with ourselves about how it works for us.  I realized I was no longer a good candidate and got off the pump and there is nothing wrong with that.  And there is a good possibility that one day I’ll get back on a pump.  They are making wonderful improvements to pumps each year and I’m becoming a more responsible and disciplined person each year.

Very well meaning people tell me all the time, “but don’t you miss being able to sleep in and eat when you want?”  News flash my friends, there are now long acting insulin such as Lantus which serve as a basal insulin.  The NPH and R insulin of the past are just that.

I guess what I’m saying is, are you having a lot of extremely high numbers due to pump issues? If so, work to reduce them with your healthcare team and if you know in your heart that you aren’t keeping up with site changes and all the pump requires, think about your options.  Whatever you do, do it in favor of your health.  Everything else will surely fall into place.

Classification of Carbs

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I really believe carb counting alone is insufficient when it comes to my diabetes management.  At least the simple way it’s taught.  It’s just my opinion and I’ll explain why:

I’ve found that for ME, there are adjustments I make for different types of carbs.  These are adjustments beyond just subtracting grams of fiber.  A carb is not a carb.  They vary spectacularly and learning their differences helps me keep my blood sugars in range and helps me decide which carbs to avoid.

I classify my carbs:

-Refined grains

-Sugar/sucrose/plain fructose (no fiber)

-HFCS (High Fructose Corn Syrup)

-Chocolate, ice cream, and other high fat desserts

-Poultry/Meat/Seafood

-Fruits and vegetables

Refined Grains

When I eat anything with processed grains like white rice sushi or pizza or cookies, cake, or crackers, I have to watch out for a post meal blood sugar skyrocket.  It doesn’t happen right away which is why it’s often confusing to dose for these kinds of foods.  For example, last time you had pizza you were high afterwards so this time around you give more insulin, only to get low in the middle-towards the end of your meal.

I find that about 30 minutes after eating anything with refined or processed grains, I have to give another dose of insulin.  An insulin pump option on a dual or square wave bolus works well for a lot of people, but from what I gather, people with and without pumps have a hard time keeping blood sugars in range with processed grains.

Sugar

Eating something like candy made from glucose or sugar or drinking plain 100% juice or sugar sweetened beverage is a bit different.  I find that if I’m going to consume this within a reasonably fast amount time (as opposed to snacking over a period of 30 minutes) then I count carbs and using my 1:15 scale, I give just that amount of insulin.  Then I wait 15 minutes for the insulin to start working (more if I’m not in range).  I find that the insulin cancels out the sugar carbs pretty well and there is no shocking aftermath.

High Fructose Corn Syrup (HFCS)

This one is interesting.  At least for me (remember, this is just what happens in MY body).  I find that candy or beverages made with HFCS works like when I eat refined grains.  But that makes sense to me when I think about corn being a grain!  It’s easy to forget because people serve it to kids and say “eat your veggies”.

High fat desserts

This gets it’s own category because of the large amount of fat (and because they’re my favorite!)  I try to stick with dark chocolate for a low dose of sugar.  I also make sure to buy desserts that do not have HFCS in it as a sweetener.  I try to get the gourmet kind with minimal ingredients and then I count carbs and give insulin in the middle of eating since the fat content really slows down the absorption of most of these foods.  If there is a lot of sugar I give insulin prior to eating as usual.  I’m referring to a dessert like high fat truffles, mostly.

Poultry/Meat/Seafood

I count carbs and then add a tiny extra amount of insulin to my carb count depending on how much I eat.  I don’t have to do this unless I’m really filling up on this protein source.  I love how these foods fill me up and do very little to my blood sugars.

Vegetables and Fruits

I’m a fan of these, especially in terms of carbs.  As you are well aware, the high antioxidant, vitamin, mineral, fiber, and water content of these foods makes them wonderful for our health.  I definitely don’t need as much insulin for these foods.  I count the carbs and then omit for fiber content.  Fruit is something I stick to consuming in it’s natural state and in small quantities.  The sugar in fruit is fructose and too much overloads the liver, causing fatty liver problems.  Oh and it definitely affects blood sugars.  My favorite are cherries, they are very low glycemic.  Have you tried them for a low?  It takes so many!

I know I didn’t talk about legumes or nuts.  I don’t eat legumes anymore.  I think I ate too many as a kid.  I treat legumes like vegetables and I treat nuts like meat.

With any food:  If I eat a lot, I need to give a little extra insulin for the full stomach effect that Dr. Bernstein has talked about in his books.

I adjust for a few other things.  I’ve mentioned them before but here we go again:

BM status.  Eww, I know.  But being backed up might make a person anticipate a need for more insulin.  The opposite of that issue= less insulin.  So watch out for major lows if you get food poisoning!

Stress.  If I’m stressed, I have to give a little bit extra insulin to combat the stress hormones and their affects on my blood sugars.

Exercise.  Different types of exercise require different diabetes management approaches.  Read Ginger Vieira’s book for that info and so much more-even worksheets for getting all these changes right!

PMS.  Days before I start, I need to up my basal insulin.

Sleep.  If I stay up late (past midnight), I have to give some extra insulin (unless I’m active).

Sedentary.  If I’m being sedentary more than two days in a row due to sickness or diabetes burnout or whatever, I definitely have to up my basal insulin substantially (by 30-40%).

Too much artificial sweeteners.  Certain artificial sweeteners in high doses do contain carbs (it’s a small amount per serving so they’re legally allowed to round down to 0) so if you’re binging on diet coke, check your blood sugar and stay alert to a sneaky increase.

That’s all I can think of.  It’s just an example of how you want to be aware of how your body reacts to different types of food and activity.  You can see why I stick with meat/poultry/seafood, vegetables, and fruits.  Much better blood sugar stability and less variability for me.  But when I do splurge, at least being aware of how those foods act differently help me manage them for those occasions.

I write all this out because you can have tighter blood sugar management.  It helps to learn yourself and the foods you’re eating.  Again, get Ginger’s book or ebook and discover how to improve your blood sugars.  I highly recommend it.

Sanofi iBGStar® Blood Glucose Monitoring System in the U.S!

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Do you live in the U.S. and want to check your blood sugar with your iPhone or iPod Touch?

Now you can.

Today, Sanofi launched the iBGStar Blood Glucose Monitoring System in the U.S.  It’s a glucose meter than connects directly to your iPhone or iPod touch.  You can get the iBGStar at Apple Retail Stores and at all Walgreens stores nationwide, online at Apple.com, Walgreens.com, and through Diabetic Care Services.  Check with your insurance about test strips being covered by your insurance.

From the press release:

About iBGStar®
When iBGStar® is directly connected to an iPhone® or iPod touch® and used with the iBGStar® Diabetes Manager App, blood glucose results are presented on the Multi-Touch display quickly after monitoring.

iBGStar® can also be used independently to measure blood glucose levels; results can be synchronized later to an iPhone® or iPod touch®. iBGStar® and BGStar® Blood Glucose Test Strips, which are used with iBGStar®, are available at all Walgreens stores nationwide and online at Walgreens.com and through Diabetic Care Services. These test strips may be covered under certain health insurance plans so individuals should check directly with their provider.

The iBGStar® Diabetes Manager App has a range of features and multiple views for analyzing glucose patterns on-the-go. Visual graphs and statistics can help people record and track their readings, carbohydrate intake, insulin doses (if taking insulin) and more. Color-coded scorecards show individual monitoring results for easy identification of high or low blood glucose levels. A ‘share’ function allows specific data to be sent via e-mail to caregivers and/or healthcare teams. The iBGStar® Diabetes Manager App is available for free from the App Store on iPhone® and iPod touch® or at www.itunes.com/appstore.

How did the iBGStar come to be?

Sanofi’s Laura Kolodjeski wrote a really interesting blog post talking about the players that made this possible  I’m impressed with the insight of these people and grateful that they looked at our lives and found a way to integrate our daily tasks of making phone calls and checking email with our daily task of testing our blood sugar.

Are the strips covered?

I just called my insurance company and they had to call a pharmacist who had to look up this device online and then report back that they can’t give me pricing info on the strips, yet.  I’m to check back in a month.  I will be checking back and if my strips are covered…what a wonderful thing that will be!

 

Real Age Diabetes Tool at Diabetes Care Club

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I work a bit at Diabetes Care Club, writing blog posts and helping out on the forums.  While logging on the other day I noticed they entered into an exclusive partnership with Real Age to create a diabetes specific real age evaluator.  I thought this was cool because I’ve taken the Real Age Test before but was a bit bummed out by how it wasn’t able to capture information based on my diabetes management and therefore not really give me a more accurate or personalized assessment.

My Real Age Diabetes score is 26-which is pretty encouraging considering I’m about to turn 29 in a couple weeks.  That’s the fun game aspect of the Real Age test but it’s not what I consider the most important aspect.  The test asks questions on every element of health imaginable and then, depending on your answers, gives you information and recommendations.

I found this test to be a helpful tool to me because it pointed out my weaknesses in my overall health.  For example, I realized that I’m eating and exercising pretty well most of the time but maybe I’m not as socially active as I’d like to be or I’m not testing as often as I’d like.  Also, the test reminded me about all the annual diabetes wellness check ups I should be having such as a visit to the eye doctor and podiatrist.

We don’t necessarily need help pointing out what we’re doing right.  We need help to pinpoint what we need to improve upon and taking the Real Age Diabetes assessment helps to organize your strengths and weaknesses in an easy to view and understand way.  And yes, it is kind of fun to work to lower one’s “real age”, I’m not going to lie.

Something I want to mention:  The regular Real Age test gave me a score of 24 and the Diabetes one a score of 26.  I think that’s interesting to note because it shows how diabetes does make a difference-not that we didn’t know that!  But it shows that creating a diabetes focused Real Age test was really worthwhile.  The truth hurts but it’s also empowering.  Let’s try to focus on the empowering part and on the part we CAN influence.

Take the test here! (you will have to register and sign in first)

Check Anywhere and Anytime You Need To

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Sometimes I hesitate to check my blood sugar because it seems inconvenient based on my location or what I’m doing.  But really, a high or low blood sugar that’s not caught in time is the real inconvenience.  So check, test, and measure your blood sugar when you need to.  It’s A-Okay.

Oh and generally, the same can be said for diaper changes ;)

 

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I hope you had a great Easter!

I’ll be in DC for a few days with WEGO Health for the DTC Conference, will post again on Friday! XOXO