The courage to treat oneself

Do you fear crashing so much that you aren't doing what needs to be done?

Lately, I've been struggling with a lot of high blood sugars.  It took me a long time to realize what was going on: I was failing to adjust my insulin doses as I should, because I was afraid of crashing.

Finally, when my sugars routinely climbed into the 300s and even the 400s and higher, I realized I was going to have to do something about it.  The first thing I started doing was checking my blood sugar more often.  While that did help, it only did so much: I was still correcting to bring down my highs far too frequently.

So at last, faced with no other option if I wanted to regain my health, I started tinkering with my dose.  I started by raising my long-acting insulin, Lantus, by a unit every day.  That helped, but it seemed like perhaps more was needed.  I raised the dose another unit, for a total of two more units than I used to take.  Then I started crashing.

It wasn't the horrible, no good, very bad experience that I'd dreaded for so long.  The next day, I cut back down to one extra unit a day, and continued checking my blood sugar more often.  That seemed to do the trick.

I may need to cut it back down that unit, back to my original dose, sometime soon.  Sometimes I find that I have to raise my dose for only a short time before I knock it back down again.  Perhaps it's stress, or an illness, or a change in exercise or diet that causes me to temporarily need more insulin. 

In any case, I have to remember not to be afraid to change my dose as needed.  Sometimes I think that failing to change it, and letting my sugars go on getting higher and higher, actually exacerbates the problem until I do something to bring my sugars back under control.  Then my body seems to normalize, and I can go back to my old dose.

I know those with type 2 diabetes have to go about things a little differently, as they can't change pill dosages without their doctor's involvement.  But if you have to tinker with insulin dosages on your own, do you ever find that fear of crashing is stopping you from doing what would most likely make you feel better in the long run?

Diabetic care: Deciding what is necessary vs. unnecessary

Overtreated by Shannon Brownlee

There is a lot of care to manage when you are a diabetic.  You have to see your doctor or endocrinologist regularly and get your A1c test (to show your average blood sugar over the last couple months).  You have to get your eyes checked once a year for problems in the retina.  Your doctor also wants to keep tabs on your weight, blood pressure, the condition of your feet, and labs such as cholesterol to ensure you are in good health and to minimize the risk of various complications of diabetes, such as the risk of going blind or having a heart attack.

But how much of this care is really necessary?

I read an eye-opening book recently about the state of our health care here in the United States: Overtreated by Shannon Brownlee.  Not only are we wrong when we think our health care is the best in the world, we are massively overpaying for health care that gives us not one iota better health than the care other developed countries offer -- and can actually at times put us at more risk.

The issue is that doctors and the pharmaceutical companies are constantly subjecting us to unnecessary, expensive and often risky medical procedures and medicines, while ignoring the need for other care that can actually make a difference (such as counseling diabetics on how to improve their health via diet and exercise).  Doctors and hospitals order unnecessary tests and prescribe unnecessary medicine because they get paid more for doing so or because they have connections to the drug companies, and patients often demand these things because of the many advertising campaigns that (successfully) attempt to intervene in the traditional doctor-patient relationship.

While many things about diabetes care are completely necessary, the book makes me think about things that are often overlooked by many doctors, such as ensuring that diabetics know the importance of diet and exercise.  And it also makes me wonder about things such as the increasingly stricter expectations for cholesterol (which leads to more and more people being on statins, despite recent studies indicating that they may not actually reduce the risk of heart attack).  As the book points out, most medical studies are funded by the drug companies -- and of course, they have incentive to find in favor of their products.  In fact, the book cites more than one instance of the drug companies withholding information about dangerous side effects.

So how do you know what parts of your care are necessary or unnecessary?  One of the messages of the book is how important it is to have a primary care doctor whom you can trust.  I'd say to start there, but also to question everything -- why do you need this test or drug, how likely is it to help, and what are the risks and side effects?  Use common sense, and don't be too quick to jump on the bandwagon whenever your doctor recommends a new drug, test, or procedure.

Review of the iBGStar meter and app

Free, helpful iPhone app for diabetics

Through my doctor's office, which participates in a lot of studies on upcoming medicines and devices, I have known for a while that there was a blood glucose meter for the iPhone in the works.  The meter was to sync with the iPhone to help you keep track of and chart your test results.

I have an iPhone, so I was excited to find out at my last visit to my endocrinologist that the meter, called the iBGStar, is now available to the public.  The meter is tiny, smaller than any other meter I've ever had, and plugs into the iPhone via the port in the bottom of the phone.  (I've heard the iPhone 5, when it comes out, won't have the same sort of port, so I don't know what that means for the meter -- will they come out with a new meter for the iPhone 5?)  You can check your blood sugar with the meter connected OR disconnected -- if it's not connected to the phone, the next time you plug it in, it will download all the test results since the last time it synced.I personally have been plugging it into my phone quite a bit, mainly due to another feature that I love: the ability to keep track of insulin dosages, carb intakes, exercise, etc. in the app.  The app, which is free in the App Store under the iBGStar name (and, as far as I can tell, can be used even if you don't have the meter -- you'd just have to manually input your blood sugar readings), automatically syncs with the meter to download readings or allow you to check your blood sugar with the meter plugged in.  But in addition, you can add to any "card" -- which is how the app stores your readings -- an insulin dose, carb intake, and notes such as exercise, skipped or missed doses, whether you have your period, etc.  You can also add cards with this information without any glucose reading, in case you have a snack and don't check your blood sugar first.  This is extremely useful if you can't remember when your last dose was, or how much long-acting insulin you took last time, etc.

The app also does a great job of tracking and charting your blood sugar readings.  You may remember a review I wrote a while back on this topic, looking for an iPhone app that allowed me to see a graph of my test results over the long term -- harder to find than you might think.  The iBGStar app (which is free!) gives you several different ways to track your data: a trend graph (which is what I like best, since it gives me an at-a-glance visual so I can see how I'm going), a logbook, and statistics that show what your average blood sugars are before and after each meal and before bed.  Of course, to make use of these features, it really helps if you test often, but I've found that having such a cool "toy" at my disposal is encouraging me to test more often than I used to!

I highly recommend this meter for diabetics who want to be in better control of their sugars.  At the very least, if you have an iPhone you should download and try out the app, which is the best I've seen so far for showing me the "big picture," so to speak, with my blood sugars!

Ten years as a diabetic

Remembering Memorial Day weekend, 2002

Memorial Day weekend memorializes, for me, something more than it does for the rest of the United States: Ten years ago, I was diagnosed with type 1 diabetes.  I'd seen the doctor the Wednesday before Memorial Day weekend, and the next evening, she called me to tell me to go to the emergency room right away.  I did, and ended up spending the next four nights in the hospital -- my entire holiday weekend.

Perhaps it's no surprise, then, that this weekend makes me think about diabetes, hospitals and a monumental life-changing event.

What's really amazing to me, when I think about it, is how much a part of my identity being diabetic has become.  I remember, when I was in the hospital, crying in the hospital bed and saying, "Why did this have to happen to me?"  I thought it was so unfair.  But now I simply cannot imagine my life without diabetes, cannot even remember what it was like before I had to check my blood sugar and take insulin and visit the doctor every three months.  If I think about it, though, that's not surprising, considering I've been diabetic for nearly a third of my life, and the majority of my adult life -- I had just turned 22 when I was diagnosed.

In some ways, diabetes has made my life harder.  Not so much with my health, as I feel like I have it under pretty good control, but with other things: health insurance, for example.  I don't worry about it anymore, since health care reform prohibited health insurance companies from turning people down or charging them more for pre-existing conditions, but I used to really worry about getting health insurance -- unless I was on a group plan through work or my husband's job, I couldn't just go out and buy health insurance like other people could.

But for the most part, I don't regret having diabetes.  Sure, I have to pay better attention to my health and be sure to take good care of myself, but hey, more people should do that, diabetic or not!  And after ten years, most of it is pretty automatic, anyway.

How long have you been diabetic?  How much a part of your life and your identity do you feel it has become?

 

Where does insulin come from?

Recently, a friend and I were talking about where injectable insulin comes from.  She thought it came from sheep, but I was pretty sure that animal insulin wasn't used for diabetics anymore.  I looked it up, and sure enough, the modern insulin that is now used to treat diabetes is synthetic.

Here is a link that talks a little bit about how it is made:

How is Synthetic Insulin Made?

The description of how insulin is made is pretty technical, and I don't have enough of an understanding of the process to go into it here, but I encourage you to check out the article.  To summarize, though, what it basically says is that synthetic insulin is made using DNA that scientists alter in the lab to turn it into what they want.  Pretty amazing, isn't it?

Synthetic insulin has been a blessing for diabetics.  First of all, animal insulin could cause some allergic reactions -- the danger of getting sick was probably part of why people would take as little insulin as possible, and restrict their diet to suit it.  In addition, I suspect animal insulin was a little more variable in how long it took to work and what effect it had.

Synthetic insulin, on the other hand, has given scientists the opportunity to program the way the insulin behaves.  The result is a variety of different insulins that work very differently.  Diabetics can use short-acting insulin when they eat or to correct a high blood sugar, and take long-acting insulin to control their blood sugar levels the rest of the time.

It did surprise me to read that synthetic insulin was first developed in 1978.  I had no idea it was so long ago!  Think how far we've come since then -- when you consider how much more difficult it was to control diabetes 20 or 30 years ago, I am thankful that I was diagnosed during a time when medical technology was so advanced!

 

Curtailing obesity has to start with our kids

The Institute of Medicine has issued a report making recommendations on how to end the obesity epidemic.

A new report by the Institute of Medicine indicates that it will require more than one approach to curb the rising incidence of obesity in America.  The report focused mainly on how to end obesity in our young people, presumably because habits formed in youth stick with us for the rest of our lives.  It also talked about how the obesity epidemic is causing rises in other medical problems, such as heart disease and -- drum roll, folks -- type 2 diabetes.

One of the main points of the report is that schools need to be a major part of the push to reduce obesity in our country.  They need to ensure that kids are active for at least an hour every day, and they need to provide kids with nutrition education (and presumably more nutritious lunches in the cafeteria).  There is already some of that going on in schools, but not enough, obviously.

Other recommendations deal with other parts of life.  For instance, the report calls for fast-food restaurants to willingly provide nutritious, reasonably-priced kids meals so that families that eat a lot of fast food have some healthier, more appealing options for the kids.  If you thought rather cynically, "Yeah, like that will ever happen," I did too -- I don't think fast-food restaurants will ever make these changes (at least not any significant changes) without a ton of pressure and/or government regulations, and as long as people are still eating unhealthy foods, there won't be enough pressure to make them change.

Essentially, the report is calling for a major overhaul of all the various facets of our society.  The idea is to foster healthy ways of thinking about food and exercise in all parts of society.  It won't be easy, and it won't happen overnight, but I would say -- for this report to even happen -- that the process has already begun.  Many people nationwide are becoming more interested in eating better, and are avoiding unhealthy foods and restaurants in favor of more wholesome, organic choices.  I think the movement has a long ways to go before it produces the changes in our society that this report is calling for, but I actually believe that if our society has the presence of mind to call for these changes, then we are already on our way to making them!

 

Glucose Tracker Apps for your iPhone

Technology to help you manage your diabetes

When I went into the doctor's to see my endocrinologist on Friday, I was shocked to find that my A1c had climbed from its usual 6.9-7.1 range to 7.7.  It hasn't been that high since I was diagnosed!  I knew I hadn't been very good about monitoring my blood sugars lately, but I didn't think it had been that high.

Luckily my doctor is pretty understanding.  He says most diabetics go through periods where they need to take a "vacation" from keeping tabs on their diabetes as closely.  That's what the quarterly doctor's visits are for, really -- to keep you in check and reset your habits when needed.

So I came home very energized and ready to take better care of myself.  I have an app on my iPhone for tracking blood sugar, insulin doses, carb intake, and exercise -- I haven't used it in ages, but I decided to start using it again.  Unfortunately, although there are some things I like about the app, there are other areas where I feel it is lacking.  It's been a long time since I downloaded the app, though, so I figured there must be more options out there now -- and sure enough, there are, so I downloaded a couple to try in comparison.

Glucose Buddy - This is the original app that I've been using for a few years.  It's a comprehensive diabetes tracker, by which I mean that it doesn't only track blood sugar -- you can also record how many grams of carbs you eat, how much insulin you take, and when you exercise.  It was free when I downloaded it, way back when, but there are several upgrades (none of which I have) that you have to pay for.

Unfortunately, the app has a serious weakness, in that there is no way to view this information comprehensively.  I really wanted an app that would show me a line graph of my blood sugar throughout the day, preferrably with a mark to show where I ate, took insulin, or exercised.  Glucose Buddy only shows a graph of average, high, and low blood sugars from day to day, with a bar to indicate carb intake.

Blood Sugar Tracker - I really wanted to like this free, simple app.  It is by far the easiest app I've found to enter your blood sugar into -- when you open the app, it goes right to the main page, where you can type in your blood sugar and save the log within seconds.  You can also view and email your log history, and see a graph of your average daily blood sugar over a week, two weeks, three months, six months, or a year.

The app is supposed to allow you to set your target blood sugar range, so that you can see how many of your values fall into that range, but it won't work for me -- every time I tap the "More" tab to set it up, the app crashes.  That, to me, is the most significant flaw.  It's also worth noting that the app doesn't offer the one-day graph of actual blood sugars, the sort of graph that I most want, and also that it doesn't track anything other than blood sugar.

Blood Pal - At just 99 cents, this app wasn't very expensive, and so far I like its features quite a bit.  It allows you to view line graphs of one day, one week, one month, and one year's worth of blood glucose logs.  It also has a handy bar graph, using the same time period choices, that shows you how many of your blood sugar logs fall into four different ranges: below 79.1, 79.2 to 138.6, 138.7 to 199.8, and over 199.9.  This enables you to see, at a glance, how many of your blood sugars fall into the low, normal, slightly high, and really high categories.

Unfortunately, it's not a perfect app.  My biggest complaint is the system for adding a log -- unlike Blood Sugar Tracker, once the app opens you have to tap the "add log" button (a plus sign), but more importantly, you have to use a scroll wheel to select your blood sugar, rather than typing it in.  The wheel is always set at your last blood sugar, so if you were crashing last time you checked and now you are over 300 (or vice versa), it can take a lot of swiping to get to the right value.  Also, I do wish I could enter in other things, such as carb intake and exercise.

I'll probably end up using the Blood Pal app, and supplement with the Glucose Buddy when I find I need to track the additional stuff -- unless I can find one single app that does the job of both!  Have you found any smartphone apps that help you to manage your diabetes better?

Flashbacks to my diagnosis with diabetes

When my mother-in-law went into the hospital, I started thinking about my own hospitalization and my diagnosis of diabetes 10 years ago.

A few days ago, my mother-in-law passed out at work and hit her head hard enough to give herself a very bad concussion.  She was hospitalized, of course, and in addition to treating the concussion, the doctors started immediately trying to figure out why she passed out in the first place.

Visiting her in the hospital, I was reminded of when I was hospitalized for dangerously high blood sugar, almost exactly 10 years ago.  Over Memorial Day weekend in 2002, I found myself in the hospital, being treated for type 1 diabetes -- a condition that we'd had no idea I'd had until I went into the doctor a couple of days before, complaining of rapid weight loss.  (I was under 100 pounds by the time I finally made the appointment.)  There was no history of diabetes in my family, and so we'd never suspected that might be what was wrong with me.

When I visited my doctor, she took enough blood to supply a blood bank, and ordered just about every lab she could think of.  Thirty six hours later, she called and told me to go to the emergency room right away: I was diabetic.  Partially thanks to a can of soda that morning, my blood sugar had been over 700 the morning of my appointment.  (It was at the slightly less death-defying level of 480 when I was admitted to the emergency room.)

I spent four nights in the hospital--pretty much my entire holiday weekend.  It was something of a fiasco. Because of a lack of space and staffing, I was put into a room in the surgery ward, which was virtually empty in anticipation of the holiday.  I felt somewhat like I was being looked after by a team of trained monkeys, because no one in that ward -- and, apparently, in the entire hospital over a holiday weekend -- specialized in diabetes.  They couldn't get my blood sugar down to save my life (har, har, har).

After three days of being given insulin and then fed immediately afterward (a perfect example of the right hand not knowing what the left hand is doing), I finally saw an endocrinologist, and from then on they got my blood sugar under control pretty quickly.  I was released and sent home to begin a life-long process of learning about my diabetes.

Here I am, a decade later, and doing well -- but my mother-in-law's hospitalization reminded me so much of those four awful nights in the hospital 10 years ago.  The diagnosis is rather different -- she has emphysema and pneumonia, it turns out, a result of a lifetime of smoking a pack (and sometimes two) a day -- and the hospital is newer and nicer than the one I was in, but I can tell that she feels just as trapped, as I remember feeling!

What about you?  What's the story of how you were diagnosed?

Continuous glucose monitors

Protection against high and low blood sugars

This picture was actually taken a few years ago, when I was doing a study at my doctor's office comparing a couple of different kinds of continuous glucose monitors (CGMs).  For the study, we compared the Navigator and the Dexcom, so participants had to wear both at the same time.

Now I'm doing another study (I love doing studies) that is completely unrelated, but requires me to wear a Dexcom for a couple of weeks out of the month.  Because they don't want me changing anything, they have blinded the CGM so that I can't see the readings.  They will give me the printouts at the end of the study, though, so that I can use them to tweak my insulin doses if needed.

My impression a few years ago, when the technology was still fairly new, was that the CGM was rarely 100 percent accurate -- but then, as any diabetic knows who has tested their blood sugar two or three times in as many minutes, regular meters are rarely 100 percent accurate either.  What I found the CGM most useful for was recognizing trends and catching lows (or highs, for that matter) before they happened.  Whether it was spot-on or not, the CGM showed you if your blood sugar was rising or falling, so that you could use your regular meter to verify the trend, and fix it before it became a problem.

The biggest thing I'll be looking for when I get to see the downloads from the Dexcom for this study is my overnight trends.  I don't really have any other way of knowing whether I am crashing overnight and just not waking up for it, so I will be glad to see what the CGM has to say about that.

For diabetics who have never worn a CGM, I highly recommend one if you can get your insurance company to pay for it!  They are incredibly helpful for determining whether your dose is correct, and for protecting against crashing overnight or when you are exercising!

 

A frustrating conversation with my general practitioner's office

Why I see an Endocrinologist for my diabetes

Yesterday my general practitioner called me.  Since I had missed a call from them several weeks ago and forgotten to call back, I decided I had better answer this one. That was a decision I later regretted.

 

It became apparent shortly into the conversation that the sole purpose of the call was to try to get me in for a diabetes wellness exam.  Now, were I not seeing a specialist four times a year -- if I were, say, one of those diabetics who completely neglects their health -- I would completely understand their concerns.  But I told the woman on the other end, repeatedly, that I see an endocrinologist every three months.

She started out by asking when the last time was that I was in for a diabetes wellness exam (as if she didn't have my records right there in front of her, I'll bet).  I explained that I go to a well known diabetes specialist in town four times a year.  Then she said that they were trying to get all their diabetic patients to come into the office for a diabetes wellness exam once a year, and tried to tell me I should schedule an appointment.  I explained again that I already see someone for my diabetes, and it would not make sense to see a second doctor, especially when it was only going to be a cursory appointment.

 

From there, she peppered me with questions about when my last appointment at the diabetes clinic was, who my doctor there is, when my last blood draw was, when my last dental exam was, my last eye exam, etc.  And periodically she repeatedly revisited the subject of me coming in for an exam.  It was almost like she didn't believe me that I was being seen by another doctor -- or perhaps like my general practitioner's clientele has fallen, and they were trying to drum up business by coercing patients to come in for exams.

Every time I thought I'd gotten rid of the woman and answered something to her satisfaction, she would come up with another question.  Her very last attempt was the question, "Do you follow a diabetic diet?"  I couldn't help but laugh, because this kind of thing is exactly why I am not going to see a general practitioner about my diabetes.

As a type 1 diabetic, I don't follow a "diabetic diet" -- I carb count, and determine by shots of short-acting insulin according to what I am eating.  The fact that the woman from my general practitioner's office asked about whether I follow a diabetic diet makes me think she probably thought I was type 2 (or doesn't know the difference -- and there is a very big one, trust me), or doesn't know that there are better ways to treat type 1 these days, or both.  I explained that I don't follow a diabetic diet, that I take 1 unit per 15 grams of carbs (though I doubt she understood what I meant), and that's between me and my endocrinologist.

The thing is, general practitioners don't always have the special knowledge to offer the best care for patients with something like diabetes.  My endocrinologist went to school specifically for this sort of thing, and sees diabetes patients all day long.  And the clinic is part of the local university hospital, so all the doctors there are up-to-date on the latest treatment information for diabetets. There IS a difference in care that you can get from a specialist versus your general practitioner, and I highly recommend making the switch if you haven't already!

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