Archive for 2010

Post Move

Two weeks ago we moved house. We moved north from NSW to Queensland. While I know I hate it here (we’re back in a big city area), and the reasons for the move are many and varied, we’re here now, and I have to make the best of it.

We’ve had constant rain for the last two weeks. Our basement was inches from flooding last night and it was a huge scramble to get what we could to higher ground.

With so much increased and unplanned activity over the last couple of weeks, unpacking, walking up and down stairs, trying out the pool and spa, the diabetes thing has a life of its own.

It’s so strange that the busier you are, the less time you seem to have to test, test and test, which is something you have to pay even closer attention to with increased activity. I’ve caught lows and sometimes overcorrected with the first thing on hand, while workmen stood at my door or needed instructions. Stress on top of stress!

While I generally don’t have much of a set routine, house moving can throw any routine, totally out of whack. My hypo food was depleted after the first couple of days and I learned my lesson when I didn’t have anything in the car. I now keep at least a box of juice, even though the summer temperatures make you think you’re drinking warm… er… well… no we won’t go there! It’s disgusting to treat a hypo with warm juice.

I don’t yet have a medical team – not even a family doctor. I did go to one local doctor to ‘interview’ him. He was ok-ish but I think need to look further afield. There were a few things he said about Type 1 and my other health conditions that had me wondering whether he and I will get along.

I have enough scripts for now and there’s nothing urgent, but I do need to get this sorted. Bad time of year to be doing all this with the holiday season and the many public holidays we have in Australia this time of year.

I need some yearly checkups – eye specialist, a new endo (my old one was a gem and he’ll be hard to replace), a new DE and so on. I don’t yet know anyone in this area, let alone anyone with T1, so recommendations aren’t happening. I’m sure it’ll all fall into place in time. It’s a bit of a worry at the moment.

In terms of stress, moving house is right up there. When you’re moving to a completely new area, where you don’t know anyone and have no medical team in place, it can definitely add to the stress.

While I’m usually pretty good with testing and making sure my numbers don’t go haywire, I have to say all of this has gone a bit to hell in a hand basket these last two weeks.

Stress? Don’t care as much? Out of my comfort zone? Too many variables with a new lifestyle? Too much to do?

I don’t know yet. When I know, I’ll let you know.

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Taking Control of Your Diabetes (TCOYD)

For a while now, I’ve been reading about a not-for-profit organisation called Taking Control of Your Diabetes (TCOYD).

George (aka Ninjabetic) of the B.A.D. Blog and Kerrie of as well as many other D-bloggers and forum posters, in one way or another, sing the praises of TCOYD’s activities in the diabetes world.

While based in California, TCOYD has events all over the USA as well as a comprehensive online presence.

Dr Steven V. Edelman, MD, the founder and Director of TCOYD, and having penned the Taking Control of Your Diabetes book, heads a multi-disciplined team of people devoted to educating, empowering and motivating people with diabetes to take control and live well with diabetes. .

With some amazing qualifications, awards and publications to his credit, not to mention having T1D himself, Dr Edelman formed TCOYD in 1995. Since then, through various avenues, it has reached thousands of people living with all kinds of diabetes in an effort to improve their lives by helping them to take control of their diabetes.

In my experience, encouraging people to take better care of their diabetes, even in a non-judgemental way, doesn’t always get results. People will take charge when they are ready. If you’re ready right now, what resources are available?

Get connected to the various online communities (for example TuDiabetes), read diabetes blogs and head on over to TCOYD.

Having said that, don’t believe everything you read on the internet unless you’ve checked out the writer’s credentials. Whether it be a doctor, diabetes educator or a PWD (person with diabetes), if it doesn’t sound right, maybe it isn’t. On the other hand, there is so much good information out there, it’s worth doing some research. Get to know the TCOYD website! You can be sure that what Dr Edelman and the team at TCOYD say, is worth listening to. The more you know, the better D-management decisions you can make.

While some of you know that I prefer low and lower-carb for managing my diabetes (via an 90/10 rule, which I’ll tell you about soon), it seems to me that nothing is right or wrong if you are getting the blood sugars you and your medical team want, while avoiding those damaging blood glucose spikes along with those devastating lows.

Be aware that an A1c in range isn’t necessarily good enough – it could quite easily consist of lots of highs balanced out by lots of lows, which doesn’t augur well for now and for the future. Aside from this, if your current and long-term health is not at risk from what you are doing, you’re likely on the right track (I stress that this is my opinion only, without a medical degree). Yet, with over 33 years of diabetes under my belt, I can tell you that I’m still learning and tweaking the way I manage things day-to-day. When I had a thorough look at the TCOYD website, I was quite impressed.

In several videos, which are available on the TCOYD website, Dr Edelman discusses issues and the latest research with leading industry experts. These videos are well worth watching with 4 seasons of topics, whether you are Type 1 or Type 2 or anything in between.

From medications to dieticians, to foot care, to exercise and beyond, TCOYD’s mission is to educate so you can take control of your diabetes. If you want to TCOYD, or tweak what you already do, or you want to learn more, I recommend the website as a good source of info.

If you’re based in San Diego or can travel there, TCOYD is hosting a Mini-Series in 2011 that you can attend. From the TCOYD website… “A team of medical professionals will once again volunteer their time to provide a series of evening lectures held on certain Wednesday nights throughout the year.”

Check out the Extreme Diabetes Makeover episodes, which assist people who have diabetes (any kind), and who want to manage their Diabetes better. Inspirational! (Update: Amy Tenderich of Diabetes Mine has written more about the makeover programs here.)

Here’s the USA schedule for 2011:

2011 TCOYD/CME Program Schedule

February 12 • Santa Rosa, California • TCOYD and CME
March 5 • Honolulu, Hawaii • TCOYD and CME
March 6 • Kona, Hawaii • TCOYD
April 2 • Tuscon, Arizona • TCOYD and CME
May 21 • Albuquerque, New Mexico • TCOYD and CME
June 11 • Albany, New York • TCOYD and CME
June TBD • Oceanside, California • TCOYD Latino Conference
June TBD • San Ysidro, California • TCOYD Latino Conference
September 10 • Amarillo, Texas • TCOYD and CME
October 1 • Tampa, Florida • TCOYD and CME
November 12  • San Diego, California • TCOYD and CME
November TBD • Oceanside, California • TCOYD Latino Conference
Date TBD • Native American Conference • TCOYD

I only wish such programs were available in Australia!

(This post was written with permission from TCOYD.)

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Dr Bernstein – Anti Insulin Pump

Dr Bernstein of low-carb for diabetes fame is anti insulin pumps. Actually, what he says is that he ‘doesn’t recommend’ pumps. He states his reasons in many interviews. Just one example from here:

Many of the female patients seemed to have wings on their sides where the pump tubing was inserted and they got lipohypertrophy. But that was the least of it. None of them had normal blood sugars. Of the new patients who came in using pumps, there was only one whom I was able to get near normal blood sugars. It was because he was still in his honeymoon period. After a year on the pump, his blood sugar started getting unpredictable. And why is that? I believe it is because of the scar tissue that forms where you have a foreign body inserted for days at a time.

First, from Wikipedia:

Lipohypertrophy[1] is a medical term that refers to a lump under the skin caused by accumulation of extra fat at the site of many subcutaneous injections of insulin. It may be unsightly, mildly painful, and may change the timing or completeness of insulin action. It is a common, minor, chronic complication of diabetes mellitus.

Here’s my response, directly to Dr Bernstein:

Much as I’m a low and lower-carb fan and I respect the logic behind your low-carb theories, I’m very pro-pump.

That stated, I read many blogs and forums and I don’t know anyone whose A1C hasn’t improved, or their diabetes has become more unstable on a pump – provided they’ve had the right education and continue to tweak their insulin until it’s right for them. Lack of proper pump education can be the cause, as can many other factors (eg insulin allergy) that can be investigated and dealt with. True, I don’t know everyone in the diabetes world, but the majority of what I read and hear doesn’t bear out your statement.

Scar tissue? Sure if you keep putting the inset in the same place and leaving it there longer than is recommended.

On the other hand, I can show you the huge, deep, very-slowly-fading bruise I still have 18 MONTHS after stopping Levemir! I was told to inject NovoRapid on one side and Levemir on the other. For now I’ve lost that area on my belly for my pump cannula because it’s as unreliable as I could ever imagine! All my pump occlusions have occurred in that area. I dare say there’s also some lipohypertrophy in that area.

One can get lipohypertrophy on injections too!

The body has plenty of areas to insert a pump cannula before there’s no place left because of hard, fatty deposits, if indeed you get them at all. If you really run out, you’ve been pumping for an awfully long time. In addition, the possibility of  lipohypertrophy is reduced if you change your site within the recommended time. Some seem more prone to these fatty deposits than others.

And really, do you think, Dr Bernstein, that in 10 or 15 years time, we will still be using the same insulin pump technology?  Surely not with current advances! But maybe we will. Who knows?

I don’t see a whole lot of people scrambling to get off insulin pumps because their blood sugars haven’t improved and stay improved. Sure, people do go back to MDI or take a break, but mostly for other reasons, as far as I can tell.

My own experience of moving from MDI to an insulin pump saw a 3 % point decrease in A1C by the first test after! It was the very best thing I’ve ever done for my health. My A1c is still improving as I tweak what I do with my pump ! How does that in anyway reflect unstable blood sugars or ones that don’t approach normal?

Actually, your idea of normal seems a tad narrow. Research shows when the damage from diabetes happens, and it’s certainly still within the higher range of blood sugar recommendations for people with diabetes, but above what you recommend. So, neither recommendation is necessarily right.

In this age of people being interested and involved with food, cooking, lifestyle programs, good restaurants, farmers markets, recipes, entertaining and so on, some of us simply can’t always do the 30 grams of carbs a day you recommend. Some of us also don’t want to. Some of us do mostly low-carb and everything in between. But we’re still achieving good A1Cs and we’re avoiding those damaging blood glucose spikes.

I’m not saying low-carb and injections don’t work, but for me, some days I do want to have an occasional piece of cake or pizza, or a slice of that new sourdough bread that everyone’s raving about, and my pump allows me to do that with extended boluses and calculations that I was so sick of doing in my head when on MDI and often getting nowhere even on low-carb.

Pumps are also great for people with gastroparesis, particularly with the ability to do extended boluses. Yes, I know you can achieve similar with longer acting insulin injections. Why bother?

I don’t want to continually draw attention to myself in restaurants with friends by having a 15 minute conversation with a server about what he or she can and can’t bring me to eat. I don’t want to live my life like that and I don’t want my friends to be subjected to that conversation ad nauseum. I just want to order the lowest carb thing I can find on the menu and if that ends up being way over a particular carb allowance, so be it. I yank out my pump, enter an extended bolus and I’m done. No bringing out shots or insulin pens and being looked at like I’m a drug addict. Not that I ever much cared about that, but it’s an issue for many from what I hear.

Sometimes my friends want to dine where almost everything on the menu is carb-laiden, or I’m invited someplace where there’s little that is low-carb. Do I have to stay home? How would I manage that with injections? Pull out a syringe every half an hour? Or maybe I just shouldn’t eat? Yes, people do manage on injections, but I say I have better and far easier control with a pump AND I have the quality of life I want. I can and do participate in social meals as a nearly normal person. That’s priceless!

I have another autoimmune disease that sometimes plays havoc with my blood sugars. Do I really have to manage that with injection boluses or an increase of a 12-24 hour  basal when I can’t predict when it will stop? With a pump, I have minute-by-minute control of basals. I increase for a couple of hours at a time, test every hour or two, to see what’s happening and I’m done.

In conclusion, I would much rather have 10 years of far better A1Cs than I had on shots, and be more easily able to sometimes live outside the low-carb regime than not. And I would much rather and more easily achieve that with an insulin pump than with injections. If someday I have to go back to injections, because of lipohypertrophy or because my BGs have become unstable because of a pump, then I’ve still had 10 or 15 years of doing much less collateral damage from diabetes in a far more convenient way.

Again, I’m not saying your “normal” blood sugars can’t be achieved with diet and insulin injections, but why bother when most insulin pump users will probably tell you it’s so much easier with a pump?

If you think that all pump users have unstable blood sugars or that their A1Cs are not more normal than they were on MDI, you’ve been hanging around in the wrong places!

With the greatest of respect for what you’ve done to help people better control their blood sugars (me included), I’ll wear my pump and have better A1cs until the last place I can wear it is on my big toe! I dare say that most people using a pump would agree.

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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.