Monday Morning Musings…

1427584_81613555I took a little blogging break last week. It wasn’t intentional; I had other things cooking on the burners and gave them the time that was due to them. In the end, it all goes in the same pot, but it was strange to not write. (And that’s the extent of my chef metaphors.)

And now I sit with a large amount of caffeine, thinking about the good things that are happening in the diabetes world. In no particular order…

The Power of Community

According to an unofficial total (but from a source I trust), the Spare a Rose, Save a Child campaign raised…drumroll, please… $26,519. That’s a lot of insulin. That’s a lot of love. That’s a lot of lives that will be saved because the Diabetes Online Community raised their voices as one. I am in awe of the power of this community. For those who shared the message, thank you. For those who donated, thank you. (And it’s not too late to give a rose… )

StripSafely

Just because we’re not shaking the gates in person doesn’t mean that we aren’t working on ensuring blood glucose meter accuracy isn’t on our minds. Larry Ellingson has a guest blog post over at StripSafely.com, asking us all to join him in calling for congressional oversight of meter accuracy. I had the pleasure of meeting Larry at the DTS meeting in September, and I’m glad he believes as we do: whatever it takes to make sure we stay healthy and safe.

Think meter accuracy is not important? Larry gives another statistic that scares me (and it should scare you, too!):

 A second survey confirmed that 27 percent of patients with type 1 diabetes had experienced health problems due to inaccurate blood glucose meter readings.

The FDA can only do so much at this point. It’s up to us to rally together to bring Congress the news: we need their help. Bennet and I will be putting together some points that you can use when talking with your representatives soon.

It’s an i-port Advance

Medtronic announced the i-port Advance, an “all-in-one” injection port. For those who take multiple daily injections, it basically takes the place of injecting into different places… and into the injection port. You insert the i-port Advance and for the next 72 hours, you inject into the port.

Injection ports aren’t new. I remember using an injection port years ago. (I don’t remember why. It was probably a sample or two to see if I liked it, but obviously I didn’t care for it, because I didn’t use it for long.) If you have needle phobia, it’s a great way to ease the fear of having to inject more than once a day. If you micro dose fast acting insulin for optimum control, this may be a great way to avoid seven or eight injections each day.

There was a study done in 2008 about the impact of insulin injections on daily life and the results didn’t surprise me much. The study showed that out of 500 subjects, 29% of them stated that injecting insulin was the hardest part of their diabetes care. Fourteen percent of the subjects said that insulin injections have a negative impact on their life. So… obviously there’s a need to help alleviates some of the negativity. The i-port Advance is one way to do so.

The Future of Glucagon

For anyone carrying around that red hard case in the bottom of a bag or a purse or next to your bed, you will nod your head when I say this: Glucagon is a pain in the ass. (Sometimes literally.)

The Glucagon Emergency Kit has been around for quite a while, but unless you’re with someone who knows how to use it, it’s useless. If you pass out, the last thing a stranger will do is rifle through your bag looking for something to help you. Even if you’ve shown a friend or a work colleague how to use it, when push comes to shove (or push comes to drop on the floor), it may be too complicated.

True story: I would give a little primer about my glucagon emergency kit to my staff. New team member = pull it out and go through the motions. I would end every discussion about glucagon with this: “Call 911 first. Then attempt to inject me.” Then the discussion would be who would draw the short straw to do this. I trusted my team, but knew that glucagon was a last resort.

These days, I’m hopeful that glucagon will be available in an easier delivery mechanism – and perhaps even not by injection! Mike Hoskins over at DiabetesMine has a great article about Next-Gen Emergency Glucagon, in which he discusses the big issue: stability of glucagon. (Currently, once mixed, it’s good for 24 hours. After that, pfftt.) But even more exciting? This:

Assessment of Intranasal Glucagon in Children and Adolescents With Type 1 Diabetes – Yes. It’s a clinical trial that currently is recruiting kids for an intranasal dose… Could this be more awesome? Nope. I am hoping that this is what’s in store for all of us. I’d be much happier giving a primer about: Hold this up to my nose and squirt. Wouldn’t you?

By the way, there’s also a trial for adults: Effectiveness and Safety of Intranasal Glucagon for Treatment of Hypoglycemia in Adults. You can get a little more info here: Evaluate the Immunogenicity of a Novel Glucagon Formulation. The company behind this is AMG Medical, Inc. out of Canada. I’m eager to see the outcome of these trials!

So, as I sit here this morning, I’m buzzing with excitement (or is it caffeine) with hope for the future. What are you excited about?

 

How Do I Love Thee? Let Me Count The…Insulin Units.

roseI don’t believe that professions of love should be relegated to just one day.  I also don’t believe that children (or anyone) should die from Type 1 diabetes.

Do you agree? (At least about the diabetes issue.)

The DOC (Diabetes Online Community) agrees and we want to raise awareness (and donations), so that the International Diabetes Foundation’s program, Life of a Child, can give children with diabetes the true profession of love: life through insulin.

Life of a Child began over a decade ago and gives donor funds directly to diabetes centers around the world, allowing those centers to help children with clinical care. Over 12,000 children in 43 countries are given the gift of life through this essential program. But that’s not enough.

Lack of access to insulin remains the most common cause of death in a child with diabetes (Gale, 2006). The estimated life expectancy of a child who has just developed diabetes could be less than a year in some areas (Beran et al, 2005). Many die undiagnosed, others through lack of insulin or lack of expert care. In some countries, expert care is available but resources are limited and so early and serious complications frequently lead to death in young adulthood. – IDF

From as far away as the Solomon Islands to as close as Haiti and the Dominican Republic, children with diabetes need help. It’s atrocious to think that some children lose their lives because diabetes care is more than an entire family makes in a year.

Please consider donating the cost of a single rose ($5) to the Spare A Rose, Save A Child community effort. (Or more…) Your sweetheart still receives flowers and the knowledge that you both helped to save a life.

Spare A Rose, Save A Child
Click on this link, which will take you to the donation page of Spare A Rose, Save A Child.

Now, I know you’re asking… “So, I donated the money I would have spent on a rose (or a dozen roses, because you are totally amazing), but now what do I give my beloved?”

You give them a spiffy certificate – and you have your choice of two!

Card 1Card 2

A dozen roses doesn’t prove I love you… or Roses Are Red, My Face Just Smiled…

Both are adorable.

The goal this year is to raise $10,000. That’s a lot of roses. That’s a lot of love. That’s a lot of life.

Show your love to those you love and donate.

(And P.S.? Even if you can’t donate, would you share this with your friends on social media or email? It’s hard to love you more than I already do, but I can try, right? Thank you.)

DAM: Diabetes & Hypoglycemia

243484_7519Ever overhear a conversation that included:

“Sorry I’m so cranky today. You know I’m hypoglycemic and my blood sugar must be a little low. Let’s go get a latte and a scone…”?

It’s usually followed by a hair flip and an application of shiny lip gloss.

That, my friends, is not hypoglycemia.*

People with diabetes know that insulin is not a cure. It’s what our bodies uses to bring glucose where it’s needed. (Remember the hot guy and the beautiful woman? That.) Too little insulin and we get sick. Too much insulin and we get sick. The very thing that keeps us alive can kill us. Not a pleasant thought, but one that needs to be understood when talking about hypoglycemia.

What is Hypoglycemia?

As simply as I can state it, it’s the lack of glucose in the blood. The brain (another really important organ to have) needs glucose to function, so if there isn’t enough of it floating around, the brain doesn’t work well. For people with diabetes, it’s easy to diagnose hypoglycemia – a blood glucose check does it. (Ahh… if only it were that simple, right?) Many medical professionals recommend the ingestion of some form of glucose when the blood glucose reading falls below 70 mg/dl, although some people with diabetes treat under 80 mg/dl.

What happens when blood sugars go lower than normal?

The body is an amazing machine. (Are you tired of me telling you this yet?) People with diabetes, despite having broken pancreases, still have other functioning bits. (Yes, bits is a medical term.) When there’s too much insulin and not enough glucose, two things happen.

  • The brain has a quiet freak out. (Technically, it’s called neuroglyceopenia.)
  • The body has a quiet freak out, releasing “counter-regulatory” hormones: adrenaline, glucagon, and epinephrine.

Symptoms are different for everyone – and they can change over time, but here are some of the more common ones:

  • Impaired judgment. (This is my downfall. While I may feel my blood sugar dropping, I have thoughts that include: “It’ll go back up by itself,” or “I’ll take care of it in a few minutes.” A few minutes is often the difference between a mild – easily treatable – hypoglycemic reaction and a moderate one.)
  • Difficulty speaking. 
  • Inability to control emotions. (I’m giddy girl going down. I think everything is hysterically funny and I often talk about my sock status. “Look! I’m not wearing socks!” Unfortunately, when I drop below 50 mg/dl, things aren’t funny anymore and I get angry, frustrated, and begin to get emotional. Academy Award winning performance.)
  • Sweating, shaking, pounding heartbeat (Thanks, hormones!), clamminess.
  • Vision issues, including blurriness or “tunnel vision”. (If I’m tunneling, as I call it, I’m in dire straits. It’s happened a few times and those few times called for glucagon or syrup administered on the sides of my mouth.)
  • Sleepiness. (I’ve caught myself tilting my head back and closing my eyes, thinking that I’ll just take a quick nap and I’ll feel better or rolling over in bed at night.)
  • Not being able to focus on anything. That’s how John can tell before I can that something is not right. He’s my human CGM, because he’ll ask me to check my blood sugar if he recognizes that I’m not “right”.
  • (A personal few symptoms that I have: my lips and the area around my mouth get numb and my hearing changes. When my hypo is horrible, I also can’t stop jerking my limbs and shaking uncontrollably because my body is trying to physically squeeze any glucose it can out of my muscles.)

I’m not a medical professional, so I can only tell you my own personal experiences with hypoglycemia. My “mild” lows are ones that I catch above 60 mg/dl. I usually bounce back quickly and the rest of my day isn’t impacted. “Moderate” hypoglycemia for me  hits around 50 mg/dl and if I can treat it immediately before it gets worse, while it will make me sluggish and one step behind for the rest of the day, I’m not down for the count. “Nasty” hypoglycemia for me is 40 mg/dl and under and it wipes me out for about 24 hours.

How Do You Treat Hypoglycemia?

How the experts say you should treat it:

Simple carbohydrates. Glucose. Rule of thumb is 15 grams of carbs, wait 15 minutes, then test. If you’re still below 70 mg/dl, then consume another 15g of glucose and wait another 15 minutes.

How I treat a mild low:

Glucose tabs. (I love Cherry Glucolift). Or juice. I wait 15 minutes, test, and then go on from there.

How I treat a low below 50 mg/dl:

Eat everything sweet that I can get my hands on because my brain is in full blown freak out mode. Wait what seems like 15 minutes (In reality, it’s about 45 seconds.) and then eat some more. Once I’m back above 70 mg/dl, I deal with the aftermath.

And when it’s low, low, low… this is how it happens. (It’s an oldie, but a goodie.)

Glucagon

Things can get dicey. If a person with diabetes can’t swallow anything, passes out, or is so ill that they can’t keep anything down and blood glucose is dropping to dangerous levels, it’s time to call in the big guns: external glucagon. Available by prescription, it’s a kit that uses a syringe to inject glucagon inter muscularly (IM) to force the liver to release sugar. (Again, that’s the non-medical explanation.)

I’ve had glucagon injected twice in thirty years and both times, I was conscious and consented for it to be done. My blood glucose levels were dangerously low and I was so nauseous that I knew I wouldn’t be able to ingest anything in time.

It’s not simple to use. Wish it was. You need to inject water into a vial of powder, shake it up, draw the liquid out, blah blah blah. The instructions and more information can be found here.

People can be freaked out when you talk about using it in the case of an emergency. I give a quick tutorial to coworkers and close friends and family (and refreshers) and let them know where I keep the kit in my purse. But I always tell them this: “Please make sure you call 911 immediately after you inject the glucagon. Please.” I hate the aftereffects of a glucagon injection (wicked nausea and gastrointestinal stress), but I hate the alternative more.

The Scary Thing I Don’t Want To Mention, But Will Because It’s Important

You can die from hypoglycemia.

The brain needs glucose to function. I don’t have to draw a picture for you. No glucose = no brain function.

I’d like to talk about it more, but I can’t. Not because I can’t find research or statistics, but because I…can’t.

It happens. It’s horrible. And it’s no one’s fault. We do everything we can and people with diabetes still die from insulin; the same drug that keeps us alive.

What Can You Do To Prevent Hypoglycemia?

I didn’t want to leave this post on a total downer, so here things you can do to prevent hypoglycemia:

Monitor:

  • What you eat
  • What you drink
  • What your blood glucose levels are
  • How much you exercise
  • How much insulin/medication you take

Wait… this sounds like… what most people with diabetes already do?

Yes. It’s because this disease is sometimes often unpredictable.

I  wear a CGM, check my blood glucose levels often, stay vigilant… and it still happens.

So, latte and scone lady?  You don’t know hypoglycemia. You don’t know cranky. And you certainly don’t know my sock status.

“Look! I’m not wearing any socks!”

* Yo, before you all get your pitchforks, there are individuals who do not have diabetes, but are clinically diagnosed with hypoglycemia. I know that. I’m talking about those individuals who think that because they don’t eat properly (a latte and three bites of lettuce is not lunch) and self-diagnose hypoglycemia are…well, you got to eat something besides lip gloss. Work on that, will ya? 

DAM: Diabetes and Sick Day Rules

1209598_63761593I thought this might be a good post for today, seeing as our entire house is under a red level threat: snot alert. The Kid developed a runny, then stuffy nose and John and I knew we were next. We were not disappointed.

I have a tough time being sick. As a person with diabetes, I’ve been labeled “sick” while feeling perfectly healthy. When I begin to feel under the weather, I always have to ask myself: “Is this diabetes or is it something else?” If I am actually just sick, my diabetes takes an extra beating, so I have to be extra careful and follow the rules.

I’m talking Sick Day Rules. This is the plan that you use, developed by your medical team, to deal with your diabetes while you are dealing with illness.

A cold is not just a cold. A fever is not just a fever. A bout with a gastrointestinal bug is not… well, you get the gist. People with diabetes and their family members go into high gear, even when we feel like we can’t get out of bed, because diabetes doesn’t stop and rest.

What’s the big deal about being sick with diabetes?

As I’ve said before, our bodies are amazing machines, doing lots of things behind the scenes that we don’t consciously control. When we get sick, the fighting commences against whatever ails us, which often involves an increase of hormones making our blood sugars harder to control and rise with normal insulin doses.

If you don’t follow the sick day rules (and sometimes it should be called sick week rules), you can end up in the emergency room, dehydrated with high ketones and blood sugars. If you don’t have a sick day rules sheet, you should talk with your medical team about it and plan ahead. You can look at some great samples here:

U Mass Memorial’s Sick Day Rules for Type 1 Diabetes

Clinical Diabetes’ Sick Day Guidelines

University of Wisconsin-Madison Sick Day Guidelines for Patients with Type 1 Diabetes

I’m not eating. Why do I have to take insulin?

Your body is fighting, remember? The hormones are waging war against the invaders and your blood sugars rise with the hormones. Even if you are puking your guts up, you still need insulin. I know, it sounds crazy, but insulin must be taken, and sometimes, in larger quantities than when you feel fine and dandy.

(You didn’t think that your body would miraculously start making insulin because you’re sick? Nah. Didn’t think so.)

K-K-K-Ketones.

As if being sick didn’t suck enough, people with diabetes have to be super-vigilant about ketones. Your body, while amazing, also fails miserably when separating being sick from being “ketone sick” – it feels the same. Nausea? Shortness of breath? Vomiting? You can be sick – or have ketones – or both. So, the only way to know for sure is… check ketones by peeing on a stick (one that measures ketones, not one you found in your backyard) or by using a blood monitor that measures ketones and glucose levels.

If you’ve got ketones, follow your medical team’s guidelines. For me, depending on my ketone level, it’s more insulin and more liquids and more frequent testing. If it’s not coming down, I’m required to call for further instructions. I’m not failing if I have to call; I’m sick and I need help.

Help When You’re Sick With Diabetes

Some people have an emergency preparedness kit with water and matches and extra batteries. Do you have a sick day preparedness kit? If nothing else, have a list to give someone to pick up items at a pharmacy or grocery store if you don’t keep this stuff handy (but you should!). My list includes:

  • Sugar-free cough drops/throat soothers (I love Ricola.)
  • Sugar-free cough/cold medicine (ask for recommendations from your medical team)
  • Pedialyte – I know. Why Pedialyte? It’s got sugar in it. Yep. And electrolytes. If I’m puking, I’ll need both to absorb quickly. You can also get Pedialyte pops. If you have ketones, your body still needs carbs ingested to help clear out the ketones. I’ll talk ketones later this month. It’s fascinating.
  • Fever medication/Pain reliever
  • Tissues for your tender nose! (You can never have enough and when you run out? Ow!)
  • Prescription anti-emetics (If you can hold it down long enough to absorb it, you’ll thank yourself later. There are dissolving tablets of Zofran available. I adore these.)
  • Popsicles (sugar-free and regular)
  • Broth/clear soup/tea/soda
  • Bananas, toast, crackers and pudding
  • Glucagon, in case things go south fast (And while it may not happen, the whole point is to be prepared.)

You must check glucose levels and ketone levels more frequently. You must stay hydrated. You must keep carbohydrates in your system. And if you don’t normally write all the tests and dosages down (::raising my hand::), then start in case you need to call your medical team.

Calling Your Medical Team When You’re Sick with Diabetes

There are times when you must call your medical team. Fever doesn’t go down? Food doesn’t stay down? Blood sugars won’t stay down? Ketones refuse to come down? It’s a downer, but making a call can save your life. The medical team may give you extra advice or advise you to go to the ER. You may need reassurance and it’s perfectly OK to ask for that help.

The best thing that you can do for yourself is to have your sick day rules ready before you need to use them. At your next appointment with your medical team, get it in writing. Then share it with a friend or family member in case you’re too sick to get out of bed. 

You’ll save yourself a lot of hassle. It may not do anything to shorten the duration of the cold or fever or puke-a-palooza, but at least you’ll have your diabetes covered.

Fortunately, this cold is mild. I’ve raised my basal a little bit and no ketones, so I’m holding steady. I know that this won’t be the last time I fall prey to whatever bug is out there, but I’m going to play by the rules, even when my body doesn’t.

Remember: I am not a medical professional. Do not think that what I’m giving you is medical advice for even a second. I do not play a doctor on TV or on the Internet. 

DAM: What Is Diabetes?

20131101-133252.jpg

Like Maria von Trapp sang in the movie: “Let’s start at the very beginning/ it’s a very good place to start.” She wasn’t talking about diabetes, but work with me on this. Before we discuss what diabetes is, we need to learn some basic anatomy.

Our bodies are amazing, intricate machines. Our hearts pump blood throughout miles of tiny vessels, lungs fill and empty without us even thinking, a bite of food starts a series of events that boggle the mind. Hey! Let’s follow that bite of food and see where it goes, shall we? (We won’t follow it all of the way. Promise.)

It’s Party Time

Before food even hits your tongue, the brain is working to prepare your digestive system. It’s the equivalent of an announcer booming: “Start your engines!” The autonomic nervous systems revs up and gets ready for that, what one can only hope will be, delicious morsel to be ingested. (And your pancreas is already putting on its dancing shoes, releasing insulin if you don’t have diabetes. It likes to party.)

The salivary glands are the early partygoers of your digestive system, hitting the floor for the first wave of breaking down food into smaller and smaller bits. Amylase, an enzyme, begins to rip apart starches into simpler forms. (Polysaccharides down to disaccharides, if you want to go all technical on me.)

That bite of food, which doesn’t resemble what you put in your mouth, goes down through your esophagus to your stomach, where it hits an acidic pool party in full swing. Chemical reactions break down that food even further as the stomach churns and spits out chemicals and enzymes and acids. (If you’ve washed down that bite with a beer, the alcohol makes an early exit right there, absorbed through the stomach membrane and into your bloodstream.)

That food is now called chyme and is a slurry of nutrients and small molecules when it enters the small intestines, going from a pool party to a mosh pit, mixing with additional liquids: bile, intestinal juice, and pancreatic juice. Some of the food is absorbed and shipped off to the liver through the blood and the rest party on in the large intestine.

If there’s sugar to be had, the small intestine screams: “Winner, winner, chicken dinner!” (Although chicken is a protein, not a carb.) Think of sugar as a beautiful woman. She never leaves a party alone. Insulin is the hot guy who offers her a ride home. Home in this case is the cells throughout the body, where the sugar is either immediately used as energy or stored as fat. (Not all sugar stays pretty. Some stick around and start a cat collection.)

Wait. What About Diabetes?

It’s all about the hot guy, insulin. Insulin is a hormone that is supposed to be produced by the pancreas. I say “supposed”, because sometimes the beta cells that produce insulin decide to take a permanent vacation. (I’m hoping it’s somewhere warm and tropical and that they brought sunscreen.) In Type 1 diabetes, it’s a mass exodus, leaving all those beautiful sugar cells to dance around slowly in the blood, looking for partners. In Type 2 diabetes, there may be some insulin hanging around, but it’s not enough to clear the room. (Or the insulin is an awkward shy guy who needs help holding hands with sugar.)

In Type 1 diabetes, without insulin bringing the sugar home, they just hang out in the blood vessels. No insulin means no way for the body to get energy, so it uses the fat stores (Siyonara, cats!) to eek out energy. When the body uses those fat stores, it “burns” or coverts the fat into usable energy, leaving toxic waste behind in the form of ketonic acid. Too much ketonic acid and diabetic ketoacidosis can occur… and that can be deadly. (That’s a story for another day.)

In Type 2 diabetes, insulin may still be made, but not enough to keep blood sugars in the proper range.

Type 1 diabetics must take insulin from an external source (subcutaneously), which may involve injections or infusions using an insulin pump. No insulin = party is permanently shut down. Type 2 diabetics may use insulin or oral medications to help sensitize the body to use the insulin it produces.

So, Insulin Is The Cure, Right?

Au contraire, mon frère. (Which is French for… nice guess, thanks for playing, but no.)

Insulin is not a cure. The pancreas is broken and no amount of duct tape will fix it. Insulin is an essential hormone for the body, so when it’s not made by the pancreas, it’s got to come from somewhere. A cure for diabetes doesn’t exist. Treatment does. Careful dosing of insulin and other diabetes medications, monitoring of blood glucose levels, careful food intake, exercise and much more goes into the balancing act that 26 million Americans face.

And that concludes today’s post.

Party on, Garth.