I’m in Australia and almost every piece of technology I have is Apple-based. I do run Windows via Parallels Desktop for a couple of business applications, but it’s a royal pain for a lot of reasons.

When I first got my Animas 2020 Insulin Pump, I religiously uploaded the data via Parallels Desktop and the Animas program for Windows. Sadly, the Mac version of the upload program that is available in the USA for the Animas Ping isn’t available in Australia for the 2020. No matter, I had a way to upload with Windows.

Eventually it became a chore and I ended up not doing it for the past year or so. I think I did it once in 2011, and no one looked at it anyway.

There’s a website: www.diasend.com, which I heard about ages ago that also takes uploads from my pump, but for some reason I didn’t pursue it. I can’t remember if it wasn’t available back then for Mac or for Australia or for what reason I didn’t do it.

Today I received a letter from AMSL, the Animas people in Australia. The letter said that it was introducing the Diasend website and upload program for Australia and that I could make use of it,  on a PC or Mac. I wondered how easy it would be…

Went to the www.diasend.com website. Registered. The system didn’t however have my blood glucose meter, so I just chose the closest one, and that seemed ok.

I then downloaded and installed the Diasend Uploader App for Mac. That was very easy, and requires a restart.

After installing the app, I grabbed my IR dongle – the one that usually connects my pump to the Windows program to upload the data. I wondered if I would have to go get an extra program for the dongle, which had to be installed on the Windows side. Nope!

Plugged it into the Mac, put my pump on suspend and positioned it over the dongle. Then I clicked ‘Confirm” on the Diasend Uploader App and away it went.

It was THAT easy!

Then I logged into my account at www.diasend.com and saw everything it had uploaded. Amazing! Really good reports, trends and more!

I can download reports in PDF and take them to my Endo, or the clinic can register and can see my data anytime I update it.

The list of compatible devices is here. Currently it includes the Animas 2020, Animas Ping and Omnipod insulin pumps in the clinic uploader and the Animas pumps for the personal uploader.

I’m SERIOUSLY impressed!

By now, we all know about Paula Deen, her diagnosis of diabetes and her bedding-in with the Victoza people to promote it.

Here’s my take, and please don’t take anything as fact. I’m not a doctor. Go do some research by reading reliably conducted studies or look on Blood Sugar 101. The science is out there! Apologies if this rave is all over the place. I’m typing thoughts, not writing an essay. Sit back, relax, and read. It’s a monster post!

PS: I’ve just measured my blood glucose and it’s 3.2 (61 mg/dl), so I’ve written most of this in a hypo (which I sometimes don’t feel). I have no time to write it again nicely, so apologies!  This whole Paula Deen thing has motivated me to write about her and a bunch of other things that have been on my mind lately!

Riva Greenberg posted an article on Huffington Post, as have many others who’ve commented and posted. Many have implied  that high-fat, high-carb, excessive-calorie diets causes obesity (yes), and obesity causes diabetes (no). Last I looked, this isn’t the case at all. Don’t believe me?

Here’s the quote from Riva’s post: No matter what Deen’s real reason was for keeping her diagnosis mum, I applaud that she’s now using her popularity to help inspire the millions of Americans who eat as she ate: an unhealthy high-fat, high-carb, excessive-calorie diet.

High-fat, high-carb, excessive calories never CAUSES diabetes, which is not actually what Riva said, but she did imply there’s a connection to diabetes, which is correct, but not for the reasons some people who’ve commented believe. Read on to find out why this kind of eating is not the “cause” of diabetes…

What you may know as insulin resistance or fat resistance, I’m going to call ‘cell-resistance’. It sounds better to me and has a more blameless and politically correct quality. Cell-resistance is the body’s inability to synthesise glucose from food properly with a normal amount of insulin produced from the beta-cells in the pancreas, so insulin production has to increase to cope. It’s the cornerstone of T2 diabetes.

I’ll state it again… Type 2 diabetes (T2) is not caused by obesity, which is a symptom, not a cause. Yes, obesity is a symptom!

T2 starts way before most people are diagnosed, and results from people starting to have cell-resistance (from a host of reasons including genetics) and consequently needing increased insulin production to cope with glucose in the bloodstream. This often starts when fasting blood glucose and weight is still fine and normal. Hence no diagnosis at this point, because early on in the process of  T2 diabetes, by the time you’ve spent 9 hours fasting, your increased insulin has cleared the glucose from your dinner the night before, with plenty of time to spare. A normal fasting glucose test is meaningless early on and doesn’t mean the T2 diabetes process hasn’t already started. Blood glucose is probably normal after meals too at that stage, because insulin production has increased.

But all that insulin production… not only do people get hungry, they also can start putting on weight easily because the glucose is not getting to muscles efficiently. The cells are literally resisting! If glucose can’t get to those cells properly, where does it go? It turns into fat. If it didn’t, people in this kind of process wouldn’t be putting on weight so quickly! Exercise will probably start to tire your muscles much more easily too. Weight loss becomes a chore, and sometimes exercise does too! Don’t blame the people, blame the process!

Meanwhile those ‘healthy whole grains” (no such thing as a ‘healthy’ wholegrain for some people headed to diabetes, read on for why), and all the other high-carbs like rice, simple sugars, fruit/fructose and so on, will tend put on weight incredibly easily, because they need more insulin and because the glucose is not going where it should be going. Meanwhile, you still don’t have a diabetes diagnosis at this stage.

Conversely, if you have decreasing insulin production, you will lose weight (less glucose is metabolised), as often happens in the Type 1 (T1) process, or later in the T2 process, when the beta cells are exhausted.

No truer words have ever been spoken, especially in terms of diabetes: The hardest part about a diet is not watching what you eat, but watching what others eat… especially when they eat twice as much as you and stay normal weight! They probably don’t have the beginnings of T2.

As an aside, if your blood glucose is at diagnosis level, how many years has it been increasing to get to that level? Very early detection would go a long way to what is now termed as “prevention” but is really a delay in onset if you’re prone to T2!

You did not gain weight and then get diabetes. It was already there, but undiagnosed along the way because of current diagnostic criteria! But you sure piled on the weight much more easily than someone else whose food synthesis mechanisms are ‘normal’. Cell-resistance can start at any weight, but usually gets worse the more weight you gain! Yet… some, like people with PCOS (Polycystic Ovary Syndrome), who are prone to cell-resistance, are often normal weight. Go figure! They may be watching their diet, be more active, or the process of weight gain isn’t as pronounced as it is in some others with T2. I don’t know enough about PCOS to know for sure.

Someone in their early twenties and very close to me, already has impaired glucose metabolism (goes high at 1 hour after meals) and she weighs 48kg! Nothing can be diagnosed at this stage because it’s not “bad” enough, apparently. We also don’t know what this may turn into – T2 or slow onset T1 (like me), a thyroid problem, or what? But all that is for another post. If it’s T2, it’s an example of the start of something, when someone is thin and has been tested at random times by someone who is diabetes-aware, me! No doctor would test a thin 22 year old unless she presented with typical diabetes symptoms (she has some), and even then… a fasting blood glucose would show nothing at this stage.

Insulin is hunger-promoting. Aside from the overproduction of insulin, as people gain weight they also can get hungry from leptin resistance and other things too. Again, the glucose from carbs for people on their way to T2, is not being used efficiently and more of it is stored as fat instead, according to what I’ve read.

If you eat low-fat, what do you think usually increases in your diet to appease the hunger, if you’re not truly dieting and ravenously hungry all the time? Carbs! It’s a rotten, horrid, soul-destroying cycle for anyone who has experienced it, so please don’t be so quick to judge!

So maybe you want to lose some weight and you follow what most doctors prescribe, a low-fat, “healthy” wholegrain diet, and over a while, you might have lost some weight, but you could’ve had plenty of glucose spikes that do damage. Your beta-cells have to work really hard to cope with the carbs. At some point they will fail to produce enough insulin. Common sense tells me that this is not the way to go.

Being a healthy weight can prolong that honeymoon to diagnosis of T2 (if you’re overweight), let alone the other health benefits. But folks, have a heart and check the science! There’s a mechanism that happens in people prone to T2 that does not happen in others. (That’s the short version.)  And full-onselt T2 can be delayed in many people!

Because the bonus of losing excess weight is that you might well prolong the onset of diagnosable diabetes, it’s is exactly why people are confusing the real cause of T2 with a lifestyle issue. Being overweight makes T2 diabetes diagnosable sooner, IF you’re going to get it at all. Don’t get me wrong… being overweight will likely bring on an earlier diagnosis, but the road to being overweight starts years earlier. Why being overweight gets a diabetes diagnosis in some and not others, has to do with genes and other factors, including the possibility that some people can produce any amount of insulin to cope, will keep being hungry and gain weight but will never be diagnosed with diabetes. Jury’s out on that one, I think.

This is really important in the scheme of things - there are plenty of obese and morbidly obese who will NEVER get diabetes. I’ll bet you know some already! After this, I hope you’ll stop telling them that their obesity will cause diabetes. It certainly might not!

So, moving along… maybe you don’t change your diet, but along comes more cell-resistance as you gain weight (horrid cycle). Slowly your blood glucose creeps up because the already increased insulin from your beta cells can’t cope – it’s not only having to cope with cell-resistance and residual circulating glucose, but also with your high-carb meals. Your doctor says you don’t have diabetes because fasting blood glucose is still normal at this stage. He doesn’t know you’re already on your way, and neither do you. But you struggle to lose weight, and you’re hungry, especially in the evenings after a bigger meal (more insulin, more hunger).

So after a while, there comes a point that is different for everyone – wham, you’ve got Type 2 diabetes. That’s when your glucose metabolism is maxed out and it ends up in your pee and hangs around in your blood. And, what’s worse, you get a slap in the face – you’re told that being overweight “caused” your diabetes.

There are plenty of normal weight people with T2 diabetes, so there goes the theory of obesity being the cause. It simply isn’t. Yes, excess weight will probably hasten any impending diabetes diagnosis, but is not the cause. The cell-resistance that switches on years before is the cause and no one knows exactly what the trigger is other than certain genes.

You might well ask why overweight kids are getting T2. I suspect it’s because these days they are way more sedentary (doesn’t help cell-resistance), they are eating high-carb foods with high fructose corn syrup, and having sugary drinks and tons of supposedly healthy fruit juice, all of which will make them gain weight easily (Lustig: Sugar-The Bitter Truth). They probably would have got T2 much later in life if they had a different lifestyle. But the genes have to be there first!  Plenty of overweight kids who do not have diabetes, and may never get it! Plenty of normal weight kids who won’t see diabetes until they are much older, if at all.

There’s probably also an exponential factor too – more people with more ‘diabetes’ genes are having children who in turn have children, so this defective mechanism is getting passed on more and more, with increasingly high-carb, nutritionally-empty diets that promote hunger, insulin production and weight gain in susceptible kids (just like adults), which in turn offers an earlier than usual diagnosis.

But hey, politics, Big Pharma and high carb diets go hand in hand, and so comes the “you can live a normal life” and “you have to have 40-60 grams of carbs at each meal” (so you’ll need medication sooner) and so on. It’s just not so. Some of it is probably left-over and ingrained from the days there were only longer-acting insulins with one-dose-fits-all, peeing on sticks to guess your blood glucose, and what’s known as ‘feeding the insulin’. It somehow spilled over into treatment of T2. It’s also a lack of education for people who are put on rigid medication or insulin doses for diabetes and have to eat that much carb to cover the insulin, plus long-held beliefs from flawed studies that say lowering fat intake prevents certain diseases like heart disease and diabetes. (Read some books and articles by Gary Taubes for more info.)

A ‘diabetes friendly’ recipe should rarely contain grains, fruit or or any high-carb ingredient. Each to his own though. Eat to your blood glucose meter! If you are T2 (or in fact have any kind of diabetes) and what you’re eating makes you high 1,2 or 3 hours later (more for pizza etc) then surely common sense says don’t eat it unless you’ve got meds to cover it properly, at the time you’re eating it (not 4 hours later when your blood glucose is high). Blood glucose spikes cause long-term damage! But why take medications that wear out your beta-cells by promoting insulin production, when a lower carb diet may mean you don’t have to? Metformin is one big exception to diabetes medications. It doesn’t promote insulin production. It’s not only protective in so many ways, it will help make your cells be less resistant. In some people it also helps weight loss and hunger issues.

You’re only testing your blood glucose at 2 hours? Why? Studies have shown that the spikes at 1 hour are most predictive for long-term complications associated with diabetes. In your early days of diabetes, even while you’re not yet fully diagnosed, or you have a family history so you want to test your blood glucose, it’s this one hour measurement that will often best tell you that you have an impaired insulin response (if other tests are normal), and you’re possibly headed for Type 2 and complications. Buy a glucose meter if you think you’re on your way to T2 and manage your food intake by cutting carbs if you’re seeing numbers that are not truly normal.

Just so you know that I practice exactly what I’m talking about, I have my pump set to alarm at one hour after I give a bolus (despite recommendations to set at two hours). I check, make any corrections, and get reminded in another hour. When I’m done maybe 3 hours later and my blood glucose is where I want it, I turn the alarm off until next time I check, eat, correct or whatever. And no, I’m not Miss Perfect!

You also may be one of the lucky ones who will never get diabetes no matter how much weight you pile on!

I don’t care what Paula Deen says or does, that’s her business and surely most can see she’s just a smart businesswoman who will make money from her current situation. If you eat high-carb, stay hungry so you eat more and your blood glucose spirals, sooner rather than later you may need the Victoza she’s promoting! It’s a win/win for her, but she’ll get a lot of flack from some people for being so public about claiming a recipe is ‘diabetes friendly’, when, for many people, it’s not. Let me explain…

Here’s the problem… EVERYONE with Type 2 diabetes is different and at different stages of their condition. To simplify that with an example… some can eat fruit without a blood glucose spike, some can’t. Some can eat fruit early on but after a few years, it spikes their blood glucose unacceptably. Some can eat a sandwich or pasta without extra medication, some can’t. Some can exercise more efficiently than others, which lessens the cell-resistance. Lowering fat intake never did much to lower after-meal blood glucose. Lowering carbs does.

T2 can take a long time to show up in some, but shows quickly in others. In some it shows up sooner than in the person down the road who weighs more and is also on the road to T2. Some on higher carb diets may need medication sooner than if they were on lower carb. I can’t really make definitive one-size-fits-all statements because everyone is different and at different stages of T2, with differently impaired mechanisms. It would also take several pages of scientific references to back up what I’m saying. Yeah, like you really want to read all that too!

What I can say is that you have to do what you have to do to keep your blood glucose in a normal range, which may be different from what someone else has to do. The only way to curb that insulin production and the hunger/eat/gain weight cycle, is to lower your carbs, unless of course you want to spend 5 hours a day exercising!

There are certainly many reasons to lose weight if you are overweight, obese or morbidly obese. From a diabetes point of view, the more fat you have, the more insulin resistant you can be, and that’s much worse if you are racing along a track to diabetes. The less fat your body has, especially early on, the less insulin it needs to deal with cell-resistance and the carbs you eat. Many people report their blood glucose numbers coming down with weight loss. Depends on how far into T2 you are.

So, I don’t care about Paula Deen and how she wants to make money. What I do care about is that both the causes and the “official” diet for Type 2 diabetes are so misunderstood. It’s so endemic in the press, the public, and surprisingly, in quite a lot of the medical profession. Because of that, people are being given information that isn’t optimal. Diet for diabetes is so often counter-productively promoted with low-fat/high-carb recommendations when it should be the exact opposite, especially in T2s who do not yet inject insulin, or in those who need to take more tablets to cope with those high carb meals.

Eaten carbs turn into glucose. Carbs are metabolised by insulin (and a bunch of other mechanisms). If you are headed to T2, you will be producing a ton more insulin to get those carbs metabolised, and less efficiently, so you’ll gain weigh very easily. I can’t emphasise this enough (or maybe I have?).

If I cut carbs, then I would increase protein and fat if I’m hungry. About 50% of protein will turn to glucose in your body and about 10% of fat, so please don’t tell me you HAVE to have carbs because your body needs glucose – it’s already getting glucose from protein and fat, and from non-root vegetables. Both protein and fat help to delay hunger, but do not spike blood glucose nearly as much or as quickly as carb foods will, which is one of the reasons a lower-carb diet is so ideal. I’m  not saying that a low-fat diet doesn’t work for weight loss. It does, and has been proven to repeatedly, but often you’re also cutting out all the junk too which is full of carbs. But low-fat by itself does diabetes no favours because your blood glucose will still eventually spike with higher carbs, no matter how ‘healthy’ they’re supposed to be.

Try eating the equivalent amount of fat to the carbs in two slices of bread, so your glucose load is the same. It’s a huge amount of fat!

How about these numbers: 1 cup of butter is 184.1 grams of fat, which when eaten, gets converted to approximately 18.4 grams of glucose (at a slow rate) so call it 18 grams of carbs. Or one cup of olive oil is 216 grams of fat, so call it 21.6 grams of carb. Compare to 2 slices of normal off-the-shelf, pre-sliced bread, no toppings. That’s around 24-30 grams of carb. So, you’d have to eat about 1.5 cups of butter or just over a cup of olive oil. Could you do that? I sure couldn’t!

Weight loss in anyone’s book is good, but the ‘how’ is important too.

As for Paula Deen… she already has enough people out there to criticise her, but some are already doing it for entirely the wrong reasons, saying it’s because her recipes are so high-fat etc. Had she not had diabetes brewing for many years, and had she not had the genes and other factors, she might have been able to cook and eat as she has been, gained a gazillion more pounds, and never got diagnosed as T2! She did not get diabetes because she ate ‘unhealthy’ meals, but maybe it was diagnosed sooner with easy weight gain because her propensity for cell-resistance had begun years ago. It’s a slowish process.

If you want to blame her at all, then blame her genes and a mechanism that became flawed long before T2 was diagnosed, which helped her be hungry and put on weight far too easily!  

Let me also say that people with Type 1 diabetes have an autoimmune disease that destroys the beta cells which produce insulin. It’s an entirely different disease process to Type 2, and the cause has nothing to do with obesity or eating sugar or any other myth, but results in high blood glucose. (Apologies to all T1s because this is way too simplified an explanation of the differences.)

There’s nothing to say that people with Type 1 can’t become cell-resistant as they get older – they sometimes do.

It’s also as much of a struggle sometimes for people with Type 1 to take the right amount of insulin, and to also lose weight, as it is for Type 2s to lose that weight. For the Type 1s, we have insulin 24/7 – that can be hunger and fat-promoting too. The artificial process is not yet like the natural way of producing insulin, so often the weight gain is much faster. For T2s, they’re producing that insulin naturally, and then tons more because of cell-resistance.

This from a fifty-something long-time T1 who has just as many weight issues with having to take insulin 24/7. The only way it works better for me is to reduce my carb intake and not worry at all about the fat!

Lower carbs, less insulin (whether external or internal), less hunger, less weight gain, less blood glucose spikes. Kinda makes sense, doesn’t it?

Show me a T2 whose blood glucose is under good control, who is managing weight (so less strain on natural insulin production), who cooks lower carb dishes that are truly ‘diabetes friendly’ (<20g CHO/meal, which would suit everyone)… and maybe I’ll listen. Right now, that’s not Paula Deen, who, from what I’ve read, has already made a supposedly diabetes-friendly recipe, that definitely isn’t friendly for many people with diabetes. She will sell lots of Victoza if people don’t come to understand that cutting carbs can help in so many ways.

But please be clear, having excess weight didn’t cause her diabetes. Her diabetes probably caused her to gain weight far too easily, starting years before her diagnosis. Huge difference!

A couple of days ago I answered someone on a group/forum who reported waking and getting up with the pump swinging at her knees, and then the cannula promptly got ripped out. Hey, I wrote, that never happens to me. Sure I’ve had the pump swinging a couple of times, but the cannula stays where it should!

I wake up this morning and wouldn’t you know it! Well, not exactly… it wasn’t the pump swinging at my knees, it was the cannula, which I’d somehow ripped out. In my just-woken stupor, it did make me laugh. Must have done it only in the last hour or two before waking because my BG wasn’t bad.

I must also allow myself to be fully conscious before attempting a site change. That was funny in itself! Apart from the ‘which way is up’ thing I get before I’m really awake, my pump got an error message right after the rewind and I was instructed to call Animas support, with an additional message to take the battery out. Still not awake properly (takes me a while), I couldn’t figure out which one to do first. After staring at the screen for ages, eventually I realised I should call first. If I took the battery out, I wouldn’t remember what the error message was. It turned out to be nothing, but seriously Mr Pump, you really HAD to do this when I’m not quite awake yet?

So, from a ripped out cannula, that of course I never get, to a very stern message…

Note to self: never say never.

Do you behave strangely when you have a hypo? Here’s another one… oh no, I never get really strange, I wrote to someone the other day. My eyes just go funny when I’m down near 3.2 (57). What? People need ages to get over a hypo? I never do! I’m sensible and just treat with some glucose and be on my way. Sure, I feel for those who take ages to get over a hypo, but that never happens to me.

So, last evening, I drive to the local supermarket. I’m 4.1 (73 mg/dl) at this point, and I figure I’m fine. It’s not a hypo yet. I’ve not recently bolused. I can get to the supermarket (2 mins drive) where my favourite cafe is open and have a fantastic excuse for an iced decaf late and I’d put a spoonful of sugar in it. That would solve a multitude of impending problems, including cooling down (it’s summer here). The owner (and fantastic barista, I might add) is always very chatty and we talk about lots of things. So I’m standing at the counter, wondering why it’s so difficult for me to get the words out to order the stupid drink, and wondering why I feel so odd and not fully comprehending what he’s saying. Plus I was trying to explain why sugar, when I usually have a sugar-free sweetener. “Trying to explain” is what I’d call it.

Then I go into the supermarket, sure that I’ve avoided any kind of hypo (the iced decaf is history by then) and wonder why it’s all so difficult – walk up one end to get this, another end to get that. Like trying to walk fast through water… no, through oil. Finally, I’m at the checkout and feel like I’m about to faint or have a panic attack. Self-talk… don’t be stupid, you’re fine, slow down your breathing, yada, yada, yada, and I’m getting annoyed that the person in front of me still had three things left to scan and it was taking several eons for her to pay! Bizarre time-warp. Two minutes seemed like two hours! With my few items finally scanned, and my debit card in hand, I step up to pay and only vaguely remember my pin to enter at the EFTPOS terminal. Why is the universe being so difficult? Or is it me bordering on being a certifiable bitch?

So I drive home, tested… BG fine but still feeling really odd, now with a headache. Of course Miss Logic here figured it out… ah, it’s the middle of summer, it’s really hot here (over 30C), I’m probably dehydrated. But I’ve just had something to drink, so it can’t be that. No big deal, I’m home… just more drink water, get back in front of the fan, turn the TV on, have some dinner, relax and chill. Eventually I forget about it and I’m feeling OK.

Hours later, I realise that with that thoroughly annoying 20% error allowed in BG meters, I was probably much lower that I thought. The hypo I thought I’d averted, was probably gathering steam while I drove (what was I thinking?), ordered a drink and went through the supermarket. How dumb is that? And the ages that it took me to feel better was another one of those things that I thought never happens to me, but apparently it can… usually right after I say it doesn’t.

Note to self: never say never.

I’ve said it before that diabetes is as much a science to treat as an art form. It’s not always predictable. Oh, it probably would be if you had a dozen probes implanted that would tell you what internal chemistry is askew that day, or that you’re totally stressed when you don’t think you are, or that you have an infection brewing that never turns into anything, or any of a gazillion other reasons. Sometimes you can actually figure out what happened. All that logic, including diabetes management, sometimes goes to hell in a hand basket when you have a hypo, or you can’t do instant internal measurements to find out what’s really going on.

I do think, however, that on the days my carb intake is low, diabetes is so much easier to manage, and those sometimes unpredictable BG swings are minimised, because they’re mostly not from lack of, or too much insulin. It works for me, and that’s what matters. I learn so much from the Diabetes Online Community! When I think I know way more than I knew a year ago, something else pops up to teach me. Just a couple of days ago, I somehow surfed my way to Dr Jack Kruse’s website and subjected my brain to many articles on leptin resistance. When I think I’ll never learn any more, I always do!

Note to self: never say never.

Just when I realise that I’ve occasionally been a tad judgemental about someone else, or even been way too judgemental about myself (see above), and I’m chastising myself, swearing I’ll never do that again, I probably will.

Note to self: never say never.