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Too Much of a Good Thing?

May 30th, 2010 by James

Controlling one’s blood sugars is paramount in maintaining health and keeping any complications at bay. However, low blood sugar due to too much insulin is a constant threat. Due to my late diagnosis in life I really experienced the slow transition for my body from perfectly normal blood sugars to ones that were either too high or too low.

During the first few months when I would go down to 70 mg/dL I would start to sweat and really feel the adrenaline being released as my body tried to bring my glucose levels back up. As time has gone on in these past few years that has become slowly less noticeable to me. Now I can sometimes hit 50 mg/dL without noticing. I do notice when I move around more easily as it is more difficult to balance, but if I’m just sitting doing work or writing it can be hard to notice, especially if I’m completely focused on something else.

During the time directly after my diagnosis it was also hard for me to go very high at all, a good thing, due to the fact that once I got above 140 mg/dL or any higher I would get horrible headaches and would either go for a quick jog or inject a bit of insulin to bring my blood sugar back into the normal range. Today, I can easily hit 200 mg/dL or even higher without a headache or any easily noticeable reaction on my body’s part.

So how do you deal with the natural responses being diminished? I check often. In fact I check before every meal, two hours after every meal (sometimes in between too if I’m feeling off), and then before and after any running or workout. This means I am pricking my finger up to twelve times per day sometimes. This also means that I inject insulin at least four times per day, and often more if I need to compensate for any highs.

So is there an ideal number of times to check per day? I don’t think so. There is a definite need to find a balance, but it is a balance that you must find based on your own routines, habits, and desires for what activities you want to participate in. I’ll be addressing some of the problems with such tight control in my upcoming posts.

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Priorities

May 5th, 2010 by James

One of the largest challenges in life is finding that necessary balance between all the different aspects of life: work, play, education, hobbies, health, etc. Living with Type 1 Diabetes complicates this balancing act by requiring constant attention, and heavily weighting the commitment required for maintaining the health portion of one’s life.

As much as it is true that when living with Type 1 Diabetes you can still do whatever you want to do, it is crucial that you also take the time to deal with all the daily responsibilities to maintain the best health possible. For me this has meant taking a break from writing recently to focus not only on my training for rugby but also my education and work.

Now that I’ve set a good baseline for both and gotten into a good rhythm I’ll be returning to writing here at Zen Diabetes regularly. I’ll be focusing not only on the topics of living day to day with diabetes, but also my own personal experiences in training for a demanding sport and maintaining blood sugar control and consistency along the way.

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The Art of Injecting Insulin

Feb 20th, 2010 by James

A minimum of four injections per day adds up quickly. I’m already nearly at number 4,500 by my count. When I first started injecting insulin I was afraid. I had never cried when I had gotten shots when younger, but the thought of taking a hard metal tube and piercing my own skin with it was far from desirable. At this point however it is such a common occurrence that I think barely anything of it when I take insulin during the day.

Today it seems like more of a dance to me. Pulling the insulin pen out of my pocket, unzipping the needle pouch and pulling out a pen needle while simultaneously pulling off paper seal from the back. Then screwing the needle onto the pen with ease, before picking an injection point, dialing the pen to the desired amount, sticking the needle in, pressing down the button to release the insulin and pulling it back out.

While it used to be a stressful event that continually taxed me, the routine nature of it makes it almost calming. With everything else going on in the world and the constant pressures from all sides, having something basic and necessary to survive to fall back on is nice at times. Yes, there are many routines. Eating is obviously another one that is a similar necessity. However, the uniqueness of having to inject makes that routine special somehow, and being able to take pride in doing it correctly makes it that much more so.

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Living Longer

Feb 15th, 2010 by James

I’m a big fan of open media and communication and the resulting surge in online educational material over the past few years. The materials available range from full length documentaries and classes to short speeches and there are definitely some gems in the vast number of videos out there.

One such gem  that I recently came across was this TED talk: “Living to 100: The 9 Wise Habits.” The brief twenty minute talk examines the different cultures in the world that consistently outlive everyone else and tries to narrow down exactly what they are doing so differently to help extend their longevity.

One of the main points that is highlighted in the talk is the importance of doing consistent low impact exercise, including everything from talking walks to beating that cake batter by hand rather than using a machine. It is also pointed out that a healthy diet is necessary, specifically one that includes a slant towards vegetables and little to no alcohol. In the social field, it is key to connect with others and have a sense of belonging within the community. Interestingly, along these lines the fact that those with healthy friends tend to be healthier is pointed out also. It seems like a silly point to make, but the numbers speak for themselves.

Two points that I found particularly powerful were having the right outlook and keeping a strong sense of purpose. In respect to the right outlook, it is explained that it is important to downshift (similar to the zen idea of living in the moment), taking time to relax and remove oneself from the stress of our otherwise overly hectic lives. Also, it is stated that those with a sense of purpose live longer, thus the idea of setting long term goals and consistently moving towards them.

Interestingly this just serves to reinforce the information that we already know about living more healthfully. And ultimately since there is no difference between what a person with Type 1 Diabetes has to do and anyone else, aside from a quick injection here or there, the same rules go for us as well.

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Hacking Away

Feb 12th, 2010 by James

As helpful as consistency can be when it comes to managing Type 1 Diabetes, it is all too easy, as it is with much in life, to fall into a basic cycle and become lackadaisical as a result. This becomes an issue especially when it comes to blood sugar control.

When I was first diagnosed with Type 1 Diabetes I was taught that if I felt the symptoms of low blood sugar (loss of balance, confusion, sweating, etc.) to check my blood sugar and if I was low to eat 15 grams of carbs. Then, after a 15 minute wait I was told to check again, and if I was back up in the normal range great, but if not to eat another 15 grams of carbs.

I followed this pattern religiously for a while, but as time went on, and I was forced into new situations and had to find novel ways to treat the low blood sugars I strayed more and more. Often when low I would find myself eating a brownie or drinking a full cup of juice, both of which contain many more than 15 grams of carbs, probably around 60 grams for the brownie and 26-35 grams depending on the type of juice. A primary symptom of low blood sugar is increased hunger as your body craves anything that can be broken down into glucose and used for energy. Therefore it is easy when low to make that rash decision and reach for the easy way out, not really thinking about how many carbs are in what you are eating. This of course is not in any way helped by the extra anxiety that is brought about by the release of adrenaline and other hormones in your body’s attempt to raise your blood sugar.

Doing this obviously solves the problem, blood sugar is raised, but a resulting problem arises out of the fact that in doing this it is easy to completely overshoot normal blood sugar levels and then be high. And once high, it is easy to over compensate with insulin and end up low again, only repeating the cycle.

When confronted with consistent cycles, it can all seem so hackneyed and meaningless. Thus I am always drawn back to the key idea of living in the moment and taking full account of my actions. With a little self restraint and realizations of the resulting consequences it is not easy, but easier, to eat only those 15 grams of carbs and not rubber band between the two extremes of high and low blood sugar.

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Extra Perks

Feb 1st, 2010 by James

As I was reminded of when I recently read this post there is a lot of information that we, as those with type 1 diabetes, get special access to. For example the ability to know that a workout actually did something as Sam pointed out in that post.

One of the most interesting things for me is knowing that I’m getting sick before I start to feel any symptoms. I can tell that I am getting sick due to the lower than normal blood sugar levels from doing the same everyday activities I do all the time. There are naturally a ton of different possibilities for what could have caused those lowered blood sugars in a single instance, but after seeing a day’s worth of them, it becomes pretty clear that something is going on. I’m not sure if it is due to the liver processing more toxins and thus releasing less glucose, or more parts of the body working harder to rid themselves of the sickness, or any of the other possibilities that exist, but after a while it becomes a clear pattern and highlights that something is going on.

Reacting to this information can be difficult, not knowing the exact cause, or in the case of a cold, not knowing what if anything will help. However, it is nice to get some advanced warning and maybe be able to drink a bit of extra orange juice in the morning, or eat a bit of extra fruit or vegetables in order to try and boost my immune system. Yes, it complicates things all that much more, but isn’t it nice to know that you really did work hard on that exam, walking out with a blood sugar level of 70 after starting an hour earlier over 120? It is the brain after all that uses the most energy in the body, so it must have been working hard to drop blood sugar levels that much.

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Stress

Jan 28th, 2010 by James

Stress is often highlighted as one of the key contributing factors to poor blood sugar control. In fact is it one of the most common topics that is written about in relation to diabetes. Even the ADA has dedicated a full page to it.

Stress can affect blood sugar levels directly through the release of stress hormones, but due to lack of sleep and inattention to good eating and exercise habits, stress can also lead to other problems. The ADA (in the article linked above) gives some good tips on stress reduction and management, such as starting a new exercise program as well as different coping mechanisms. However, when it comes down to it, with diabetes one of the best ways to handle stress is with consistency.

Back in the days of NPH those with type 1 diabetes had to follow strict eating schedules and stay within certain amounts of carbs for each meal. Today, with shorter acting synthetic insulins it really is possible to eat whatever one wants as long as carbs are correctly counted and the right amount of insulin is injected. The caveat is of course to be cognizant of the two hour time period required for today’s shorter acting insulins to wear off in order to prevent any insulin stacking, and thus resulting low blood sugars.

This blessing of greater freedom when it comes to eating and schedules also carries with it the added possibility of worse control due to the added variables. One such variable is the time of day, since insulin sensitivity is generally heightened as the day goes on (thus the common need for extra insulin or a lower carb:insulin ratio for breakfast). In order to counter this and other factors, and thus reduce stress, it can really help to keep at least some consistent items each day, even if all that means is running or going for a walk at a specific time each day.

For as large a part as stress can play in blood sugar control and diabetes, there really is no need for it to. Even a few small changes can have a huge impact towards reducing stress and resultantly increasing control.

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Exercise and Diabetes

Jan 27th, 2010 by James

As important as exercise is to everyone, and as helpful as it can be in maintaining more constant blood sugar levels, it can also bring about a lot of difficulties as well. As a rugby player at the collegiate level, and generally pretty active person outside of that, I am often put in new situations that I do not know how to approach from a diabetes standpoint.

Is doing this going to drop my bloodsugar? Or will it release adrenaline and therefore possibly spike it? How many carbs should I eat, or how much insulin should I take, in order to be safe and not go too low or too high?

So how do I approach these situations? I try to learn from experience and as much as possible find a similar activity that may be comparable that I have done before. However, when faced with something completely novel I try to hedge my bets and check my blood sugar before, as much as possible during, and then after.

When starting a new exercise program it is key to try to maintain some consistency when it comes to not only the exercise routine, but also eating habits and insulin use beforehand. By knowing how much I eat before and what (if any) insulin is in my system at the time, it is much easier to isolate the effect of the exercise upon blood sugar levels and therefore better plan for future exercises that are similar.

If you really think about it, this is not too different from what anyone else has to do when starting a new exercise plan: figure out what their limits are, plan ahead, and stick to a regular schedule. There are certainly a few complicating factors, but nothing that cannot be handled with a little practice and extra vigilance.

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Learning From Disease

Jan 20th, 2010 by James

Although sometimes difficult to quantify, for as much hardship as comes from disease there is an equal amount of good that comes out of it, often from unexpected avenues. I’ve spoken before about the importance of teaching others about one’s condition (See Type 1 vs. Type 2 and Finding a Balance With Others), but with disease there is a lot of unconscious learning that goes on as well, as the simple result of the different approaches we must all take to life.

In the past we, as humans in general, have made some egregious mistakes when it comes to the substances we have used for our clothes (mercury in hats), insect repellents (DEET), building materials (asbestos), etc. Either due to humans’ general resiliency or other factors, in nearly every case it often takes years for anyone to realize what is going wrong and for any action to be taken towards reducing the usage of the materials. Interestingly, it is often through disease that we learn just how fragile the human body can be and the different mistakes we are making.

Take for example building materials. Everyone today knows that asbestos is bad. But very little is said about the toxic gases emitted from paint, or those from the glues in carpets, or even more common: the glues in fiberboard and plywood. All release toxic gases (the most common gas from glues is formaldehyde), not to mention other gases that are destroying the environment, yet until recently little attention has been paid to these facts. However, those with certain allergies as well as those with more serious diseases such as cystic fibrosis have to pay close attention to such things when deciding where to live and what to do.

One family that I was recently informed about is in the process of building a house and they have a young son with cystic fibrosis. Not only can they not have granite due to the radon emissions, but they have to go item by item to make sure that whatever materials they use are safe and do not emit anything that could in the slightest way be harmful to their son’s health. For example, instead of using traditional fiberboard containing formaldahyde based glues, they are using new products made with non-toxic glues (such as wheatboard. Note: I’m in no way affiliated with that company, it is just the first example I came across).

When it comes to diabetes instead of bringing a new focus to building materials, the disease lends itself perfectly to addressing eating issues within the world. The dietary requirements are really all the same for anyone with or without type 1 or type 2 diabetes, there is just more stress put on eating healthfully for those with diabetes. Those with diabetes do not always eat the ways suggested, but if everyone got to that level we would certainly be in a better place as a society.

Thus it seems that disease can bring about key realizations about being healthy in today’s society. Granted harmful building materials are still years away from being completely phased out, and a large majority of society could undoubtedly eat better, but what has started and been spurred on by realizations made through disease will ultimately lead to a more healthful society.

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The Necessity of Immediate Feedback

Jan 17th, 2010 by James

Information is such an integrated part of our lives these days that it is easy to overlook. Over the past week I have heard from both economists and environmentalists about the importance of immediate information to feed back into the system and make corrections.

On the economic side of things this comes from a need to regulate debt and quickly see what is going on. In listening to stories of debt and the recession over the past couple of weeks one of the most common things that people say is that the reason for such bad debt in most cases is that there is no immediate feedback for the consumer. You can simply buy something and not have to pay for it for at least a month, and in some cases longer than that with 0.0% APR cards and other offers. The instant gratification of buying something when tied with no short -term cost, ultimately leads to overspending for a lot of people.

This same concept can be applied to diabetes management. It is all too easy to eat the cookies, and have the immediate reward of a tasty snack, but completely overlook the resulting blood sugar spike that will undoubtedly occur, much less the increased A1C further down the road.

The same can also be said for the environmental sector. At my college we currently only have energy meters in a few locations on campus, and those can only be read once per month. Therefore, if anything breaks, or energy use goes way up, no one finds out about it for on average two weeks. As one energy consultant put it this week in a class of mine: “You cannot drive the bus by always looking out of the back.” Instead of looking out the back and seeing where we have been and dealing with problems after the fact, there is a need for current information so that problems can be dealt with head on as they arise. As a result of that need, the campus is now installing digital energy meters around campus to measure energy use in real time and allow for maintenance and efficiency improvements across the board.

Just as there is a need for current information when it comes to energy usage, we have the same need when it comes to diabetes. Sure, it can be easy to check blood sugars only a couple of times per day and make corrections many hours after a heightened blood sugar level, but by checking regularly and soon after meals and other events that can affect blood sugar levels, we can actually drive the bus, rather than passively watching out the back window.

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