Archive for 2009

TAG – Total Available Glucose

Today I was reading a blog post by Amy Tenderich over at Diabetes Mine called, Betting Our Lives on Guesses.

I made a comment as follows:

Lately I’ve been studying TAG (Total Available Glucose) of not only carbs, but protein and fat too. It’s a much better and more accurate way of bolusing for T1 than just counting carbs. I have a pump, so I do extended boluses for all but small meals and snacks. That seems to work better too.

The one thing that also drives me crazy is the inaccuracy of meters. Thank heavens we have them, but really, by now they could be much more accurate. The other one is that I wonder sometimes how some manufacturers get to their carb counts on food packs. I’m sure sometimes they’re just guessing.

TAG is a system that takes into account not only the carbs in foods but also the available glucose of protein (about 58%) and fats (about 10%) and working out boluses on that.

Not that boluses are inaccurate only because you’re not doing TAG. There’s so much more to take into account: fighting an infection, inflammation, pain, stress, weather, hormones and a whole lot more. It makes looking after diabetes, once thought of as a science, more of an art-form at times.

There’s a great discussion over at TuDiabetes. It started off about doing combo/extended boluses on a pump and evolved into a discussion about TAG. Read more about the posts in “Dual Wave Bolus”

Even if you don’t have an insulin pump, it’s well worth the read.

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Stress, Weather and Basal Rates

For about 3 weeks, I’ve been so unexpectedly busy that on this fine but very hot Sunday morning, I finally get the opportunity to take stock of how my diabetes has been during that time.

I do know how much and how easily my BGLs go up with stress – any kind of stress… the kind of stress that you wouldn’t ordinarily call stress. Day to day living is a stress of sorts. Having to be somewhere on time is stress. Trying to get a job done on time, even when you have plenty of time, is stress. Being in a crowded room with the din of everyone talking, is stress. Unless you’re in a meditative state 24/7, it’s all stress of sorts. While I may be more sensitive than some, daily living does have an effect on everyone. Managing diabetes is sometimes more an art form than a science.

Put stress together with the really hot weather we have here (in Australia) over late spring and summer, and it’s time for me to take a good look at my basal rates. Weather definitely has an effect on insulin needs too.

I know my current basal rates are not serving me the best way they could at the moment.

Who’d have thought in just 3 weeks, what was once a nearly-perfect basal program, is now quite off at some times of the day?

The problem is that being as busy as I’ve been, I’ve hardly had time to notice. Yes, I’ve noticed the numbers being off, but I’ve also had a much more varied diet (read: mostly more carbs than usual) and I’m very aware of my BGLs going up some 4-6 hours after a meal that is only a tad more than would be considered ‘light’, let alone a heavier meal – that one is a disaster! Mostly after dinner, the struggle with BGLs going up consistently, so long after dinner, is something I’m not yet sure how to handle.

Despite using extended boluses over several hours, I’m thinking I have to extend any bolus I do quite a bit longer. It doesn’t matter what time I eat, it still happens around the same time later. If I skip dinner (rare), it doesn’t happen, or if I have a very light meal, it also doesn’t happen. It’s called gastroparesis – delayed stomach emptying. Many people who’ve had diabetes for a long time have it. And it’s a bitch to handle, whether you’re on a pump or on MDI.

Sometime in the next few days I have to formulate a plan to test all the basals I have right now.

Remember that on injections (MDI), you do possibly 2 injections a day and it’s pot luck whether the relatively flat-line of Levemir or Lantus can come close to what the human body really needs. This is one of the reasons a pump is so great. You can adjust your basals any way you want and have as many as you need.

If you’ve never seen basal rates for a pump, this is what mine looks like at the moment. The time indicates what time that rate starts, and it continues until the next time listed. The number next to the time is the units-per-hour of insulin. I have 6 different basal rates at the moment. After I reassess it could go to 4 or 8 or whatever I need with the rates I need for that time of day. I used to go very low around 4-6am so the reduced basal rate at that hour is great! Also remember that you’re adjusting the rate for a peak around 1-2 hours later.

Basal Rates
12:00a 1.100
01:30a 0.925
02:30a 0.750
09:00a 1.075
03:00p 0.900
07:30p 1.125


I’m fast coming to the conclusion that unless you’re a total creature of habit – go to sleep the same time, wake up the same time, eat the same things at the same time, do exactly the same thing every day, on time – then the daily, and sometimes inexplicable fluctuations in blood glucose needs quite a bit more managing. Even creatures of habit have fluctuations, but certainly not as much as if the criteria changes drastically from day-to-day. I’m definitely not a creature of habit and I wouldn’t change that for anything. You live with some things, you change others to manage diabetes. Some things are not negotiable!

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World Diabetes Day: Opinion

November 14th is World Diabetes Day. The theme for 2009 – 2013 is Education and Prevention. This is goes for both Type 1 and Type 2. While we still don’t know the trigger for Type 1, research on prevention is just as important as it is for Type 2.

November 14th is the birthday of Fredrick Banting, who along with Charles Best, is credited with the discovery of insulin in 1921. Imagine if you can, how people with Type 1 diabetes coped without insulin. They didn’t. It’s a painful death without insulin with 100% mortality. Now, some 88 years later, there are still people in the world who have no access to insulin. Thanks to global organisations like Insulin for Life, some insulin does get to people who would otherwise not be able to obtain it. It’s mostly economics. No, we are not all equal – certainly not in the realm of being able to afford what is now a simple, abundantly available medication.

Which country do you think has the highest rates of Type 2 diabetes? You’d be wrong if you thought the USA. From what I’ve read, it’s India!

Which countries do you think have the highest rates of Type 1 diabetes? You’d be wrong if you thought the USA. It’s Sardinia and Finland.

Which areas of the world have the lowest incidence of Type 1 diabetes? Zunyi, China, and Caracas, Venezuela.

Do you know the differences between Type 1 & Type 2 Diabetes? Can you name at least 3 other forms of diabetes?

Education!

I was not all that shocked to read what Kate from the T1DN, after attending the conference in Montreal in October 09, wrote in her report:

A central area in the conference was the Global Village where all the world’s diabetes association (the equivalent of Diabetes Australia in every country) had displays and staff there to chat with you about what they were doing. Through the Congress I tried to do the rounds of these stands and find out about anything that other countries were doing to support adults with Type 1 diabetes. I have to say I was shocked and amazed at how many times this conversation ended up with me explaining that Type 1 really is very different to Type 2 and the supports and services people with Type 1 need are also different. That Type 1 occurred in large numbers in adults was also not well understood – when I asked about Type 1 I was often informed about children and had to push and prompt. This appeared to be news to many of the associations I chatted with including several with high prevalence of Type 1 – Canada and Denmark, for example.

Even in this day and age, I also come across so many medical professionals who seem to know a lot of rubbish and unproven information about Type 2, and know even less about Type 1. They also know next to nothing about other forms of Type 1 Diabetes of adulthood. Why? Where is the education for professionals?

If the International Diabetes Federation (IDF) wants education to be the focus of its World Diabetes Day, they really need to start with doctors, nurses, Certified/Credentialed Diabetes Educators, pharmacists and the people who work for the various diabetes organisations world-wide! Educating these people is paramount and is the first line to the rest of the education the IDF wants.

But how is the right kind of education going to happen when so many professionals can’t get it right. Being mis-diagnosed for 30 years, as I was, isn’t confidence inspiring. Neither is being given totally wrong information on how to manage diabetes, from people who should have known better… and still probably don’t.

The IDF states (here) that

Prevention of Type 2: Lifestyle changes aimed at weight control and increased physical activity are important objectives in the prevention of type 2 diabetes. The benefits of reducing body weight and increasing physical activity are not confined to type 2 diabetes; they also play a role in reducing heart disease, high blood pressure, etc.

Wrong! Plenty of thin Type 2s. Emerging evidence that people don’t necessarily eat their way to diabetes. Plenty of obese and morbidly obese people don’t have and will never get diabetes. If in doubt, this article is a must read! As Jenny writes:

While people with diabetes often are seriously overweight, there is accumulating evidence that their overweight is a symptom, not the cause of the process that leads to Type 2 Diabetes.
Even so, it is likely that you’ve been told that you caused your diabetes by letting yourself get fat and that this toxic myth is damaging your health.

Blaming you for your condition causes guilt and hopelessness. Even worse, the belief that people with diabetes have brought their disease on themselves inclines doctors to assume that since you did nothing to prevent your disease, you won’t make the effort to control it–a belief that may lead to your getting extremely poor care.  READ MORE

If the professionals can’t get it right, what hope is there for the media which influences a vast number of people who, when we’re around them, can make our lives with diabetes so much more unpleasant than it already is?

The food police (“Should you be eating that?”) – yes, I’m Type 1, I have insulin and theoretically, I can eat whatever I want.

The totally misinformed (“Oh you have Diabetes, just lose some weight”) – no, there’s no cure for Type 1, plenty of thin Type 2s, plenty of Type 2s who need insulin and have already lost weight, plenty of Type 2s who do exercise, eat like birds and can’t shift the weight.

And please, folks, going low fat will do a whole lot less for diabetes than reducing carbs in your diet.

Learn about fructose without fibre and high fructose corn syrup and what they do to your body and your insulin response! See prior posts on this issue – here and here.

Yes education is always the key, but how can so many people (who should know better) get it so wrong for so long?

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Animas Insulin Pump

I've had an Animas Insulin Pump since June 2009. I absolutely love my pump and I love the wonderful people at Animas (AMSL Australia).

If you are even remotely thinking of getting an insulin pump, please feel free to contact me and ask me why I love mine and what a huge difference it's made to my life.

There are also lots of posts here to give you similar information.