I have an Uchi makeup bag with a couple of zippered compartments with exactly the right slots. In it I keep a blood glucose testing kit (an Accu-Chek Nano, my favourite meter), a syringe (I can get insulin from the reservoir in my pump if I have a problem, or get myself home), some jelly beans or glucose tablets and some migraine meds, just in case. On longer outings, or if I’m going to be stuck somewhere, into the bag goes some insulin, plus an infusion set, reservoir and some SkinPrep for a full pump site change in case it gets yanked out, there’s an occlusion or some other problem.

I always test before I drive. We have driving guidelines in Australia: “Above 5 (90) to drive.” Guidelines only, not law, but to be heeded nevertheless. We also have guidelines about not driving after a severe hypo that requires intervention by others. I’m used to testing before I drive. It’s a habit.

My handbag ends up heavy. I also carry my giant wallet, a notebook and fountain pen, a hand fan, tissues, lipstick, mobile phone, and sometimes a real book or my iPad with iBooks on it, and more. Sometimes it feels like I’m carrying bricks!

It also helps if I use my testing kit, while I’m out. Today I learned that one the hard way too.

I tested about 10 minutes before I went out. My BG was in range. I grabbed my keys and bag and drove to the local shops. I went to the greengrocer. Dropped in to the doctors surgery, got an appointment, waited only 10 minutes and was in with the doc for about 10 mins. Went to the pharmacy, maybe another 10 mins. Didn’t think I’d walked all that much. Not like taking the dog for a walk. All up, I’d been out around 40 minutes – maybe 55 minutes since I’d tested.

Drove home and tested because by that time, my pump was beeping at me to test – I have reminders set for an hour after I enter a BG reading and/or bolus. Works for me.

Quite a surprise when I saw my BG was 3.1 (56)!

I even tested again, just to make sure, and I had absolutely no idea how long I’d been like that! Certainly not when I left home, but clearly I drove home on that. Oops! I had a fleeting thought that 40 minutes out wasn’t going to make much difference. How wrong I was!

So now I’ve learned another thing the hard way – test on the way out AND on the way back if you’re going to be longer than 15 or 20 minutes. I drove home on a 3.1 and had no idea! I was in no danger and drove perfectly normally for the 5 minute drive home, but it’s still a really bad idea to drive when you’re low. I felt absolutely nothing until I started tearing open a packet of jelly beans and my hands were shaking slightly. I didn’t have my usual ‘eyes go funny’ thing, which I usually have when I hit 3.2 (58). No sign whatsoever!

Lesson learned.

She was having brunch with friends and one of them remarked that Kelly would have to take extra insulin for the fruit she’d ordered, and suggested that Kelly order a side with less carbs. The bit that made me roar laughing was when Kelly thought in her head… Maybe you could ask for an extra side of Stupid with your oatmeal!.

The real crux of the issue is as Kelly says: “SO why should I, or anyone else for that matter equate taking more insulin to cover a certain meal or food item with being bad?? If I didn’t have diabetes my pancreas would automatically secrete insulin to cover a pineapple or a cupcake, or a pineapple cupcake for that matter, so why is that considered OK?”

The full post is here:
YES, I Do Need To Take More Insulin To Eat That – SO WHAT

We know two things (amongst others): (1) blood glucose spikes contribute to long-term complications, and (2) those spikes can translate into a not-so-great HbA1C, which equally heralds long-term complications, and short term – feeling like… um… crap.

There are recommendations for how high blood glucose should go after a meal, and recommendations of what your HbA1C (3 month average blood glucose) should be. These don’t necessarily equate with the evidence. In both cases, the recommendations are likely a little too high, but if you’re not at least at the recommended levels, it’s up to you if you want to improve things – your body, your choice.

It’s certainly not up to a friend to make comments of any kind, well meaning or not. Every last one of us with diabetes is responsible for our own diabetes management. We have quite enough to deal with, without the so-called well-meaning offers of clueless advice from others. Whether we have to take more or less insulin for one food or another, as Kelly says, so what?

Here’s the rub though… what one person does to get a great HbA1C and few spikes after meals, won’t be exactly the same as what another person does.

Some people can get away with eating more carbs and not having big spikes (or lows for that matter). Others can’t. Yet others make decisions not to worry about things that some do worry about. We’re all different. I’m one of those who can’t do too many carbs. It’s not always an insulin management issue for me (although for many people this is exactly the issue), but mostly an insulin quantity issue because insulin loves to create fat on me. It may not for others.

The kind of inanely stupid comments made by many people to those with diabetes, are completely unnecessary and entirely uncalled for, for the very reasons Kelly says.

People without diabetes have working beta cells that match endogenous insulin to food, automatically. People with diabetes on insulin do exactly the same – matching insulin to food, but with exogenous insulin, injected or via an insulin pump. The result is intended to mimic what the insulin producing beta cells do, but essentially it’s a crude version of the real thing. The artificial process, at this stage of medical and technical advancement, is far inferior to how endogenous insulin works, but it keeps us alive in the best way currently possible. 100 years ago, we wouldn’t have survived without that external insulin. In the scheme of things, we’re doing great.

No matter what kind of diabetes, it’s firstly an insulin problem, but more importantly it’s a problem of carbohydrate/glucose metabolism.

We all react differently to different foods. We all take differing amounts of insulin, at different times of the day. The same meal for two people could require completely different amounts of insulin. It’s not a one-size-fits-all.

If someone with diabetes tells me they can’t control their blood glucose, and wants advice, I’ll gladly relate my experiences if that’s what they want to hear. I’m by no means perfect, but my HbA1c is well within the recommended range, so some of how I got there might be helpful to consider and discuss with their medical team. Invariably I find out that their carb consumption is quite high, and/or some basic rules of management aren’t being followed. For all the reasons that people like Bernstein say, high carb consumption just doesn’t work for quite a few people with diabetes, yet it works fine for others. (And I’m not specifically talking about a few pieces of fruit.) Congratulations if it works ok for you and you don’t have after-meal spikes and a decent HbA1C etc, etc.

What I’m saying is that if you have a decent HbA1C, no paramedic-requiring lows and you’re doing just fine with only one or two mild lows a week and very few spikes, then your doctor will probably say that’s great!

If you’re not one of those people, and you are struggling, then if it were me, I’d be removing all the carbs I could from my diet and starting from scratch. That means finding what each food I want to eat does to my blood glucose by checking at 1, 2, 3 and 4 hours after eating it (more if it’s a fatty meal), and deciding whether it is a food I can eat, or one I’m having trouble with and probably want to either manage differently or leave out completely.

It never ceases to amaze me what foods some people with diabetes can eat without major blood glucose highs. Likewise, what I can eat that others have trouble with.

Diabetes management is rigid for some and not for others. Also a personal choice. Theoretically, if you have insulin to cover it, you can eat anything. It doesn’t always work that way in practice.

Kelly can clearly manage fruit (even if she couldn’t, it’s still her choice to eat or not eat it). Generally, I can’t do fruit unless it’s only around 10 grams of carb or less, I eat some protein with it, and I bolus insulin early enough. Just Kelly’s metabolism versus mine. Nothing to do with good/bad, right/wrong… just different.

Fructose, even as part of whole fruit with its own fibre, goes into my bloodstream faster than a speeding bullet. For me, fruit is great, especially fruit juice, for treating lows. It’s not at all my low treatment preference – pure glucose is, but that whole fructose issue is another matter entirely, which I’ve blogged about before.

The crux of this post? Whether you have diabetes or not, if you are not directly involved in the other person’s medical care (a medical person, a parent or caregiver etc), it’s not up to you to judge, attempt to help, or in any way comment on what an adult does or doesn’t do in their management of diabetes, unless they specifically ask you. Ok, yes there are times some encouragement may be appropriate when people end up in diabetes burnout or when complications set in that could be halted with better management – even then you’d have to tread very carefully, despite good intentions, and it’s not what I’m talking about here.

Too many people without diabetes think they have some valuable advice for someone who has diabetes. It’s usually not valuable, and more often than not, not even science-based.

Unsolicited advice (often completely incorrect) and judgements are never welcome!

While diabetes management has many generally accepted principles, there’s quite a bit of leeway within those principles for individual preferences and methods of management. Quite a few roads lead to Rome.

You can ask me any question you like, but if that turns into judgement or unsolicited advice, like most of us with diabetes, I will likely tell you how unwanted, insensitive, incorrect and judgemental your comments are. At the very least, like Kelly, I will think it.

If we want to eat something that you don’t think we should, it’s time to change your thinking, not ours!

Please, please watch what you say!

Nothing would stop the itching – not cortisone cream, not Telfast, not Phenergan, or any other lotion and potion I threw at it. All my skin was crawling! It’s now 6 days later, and the itching is starting to subside slightly, but not enough for me. I still feel like I could punch a hole through a door. I’m thoroughly sick of sitting on my hands during the day, and scratching myself to bits when I can finally get to sleep! Pinetarsol has helped a bit – a dastardly concoction of pine tar, which makes you stink! Many years ago, I made a concoction out herbs, tea and creams and it worked a treat for bites. I thought I’d never forget the recipe. Hmmm… I did! It was magic stuff and I planned to market it and somehow got sidetracked.

I’m happy to report that despite open sores, the cortisone cream had almost zero effect of my blood glucose, whereas injections in to various joints in the past, definitely has made me go sky high.

Earlier in the week, while still scratching myself silly, I saw my endo for my 6 monthly visit. I got my A1c, which had to be adjusted for high haemoglobin. He adjusted it, from 6.7% to 6.5%, which is strange because last time he adjusted my A1c from 6.9% and said I was 6.2 or 6.3%. Haemoglobin the same. Odder than odd, don’t you think?

I set to work to find a formula. With all the calculators and converters out there, you have to be careful which one you choose, according to whether you’re calculating from mean plasma glucose or whole blood glucose. In any case ,after much checking, calculating to formulas and putting numbers in converters, I’ll take the most conservative one at 6.4%, although I’d love the 5.7% that one calculator gave me.

My endo’s offsider, who did my physical exam, found my neurophathy has completely resolved! That’s taken a few years, but I’m pleased to report success. He also apparently found a heart murmur. That was less-than-interesting to hear. I realised then that in more than one year in a new place, not a single doctor has listened to my heart and probably not for the 2 years prior either. Makes you wonder. Hello? I have T1, diabetes and am over 50.

More tests coming up, no doubt to find out that the murmur is a result of misdiagnosis and uncontrolled blood glucose for far too many years. Times like these I still get cranky at the misdiagnosis.

On the other hand, cranky won’t get me anywhere.

I was reminded last week of some wonderful philosophies, this time in a different guise: The Four Agreements and The Fifth Agreement (Don Miguel Ruiz), both of which I now have as audiobooks read by the mellifluous and very soothing voice of Peter Coyote. I know the material, which tends to waffle on a bit, so dear Peter has put me to sleep several times this week. It’s very difficult when listening, to remember that they are not Peter’s words. He’s most definitely the best voice-over guy in the business.

These are all things I learned way back in the early 1980s, in the days of Insight and est, in the 70s with New Age philosophies, and in the 90s when other gurus were taking these ideas and making them their own. Even back in the 70s, it had all been said before. Think of Florence Scovel Shinn back in the 1920s, who wrote what was the 1920s version of The Secret, plus others way before her, with roots in ancient Kabbalah, which has ideas similar to Buddhism. If anyone has read The Jew in the Lotus, you’ll know what I’m talking about.

Whatever ways you learn, not all of it sticks, all the time. When your life goes off the rails, which mine has over the last year or two, having thrown myself into an environment I don’t much like, with unbelievable stress, it’s good to be reminded.

I’m excited to be going on a meditation afternoon up into the hinterland, sometime after Easter, and then, a while after that, a 4 day daily retreat with a Tibetan Lama. Details are sketchy, but I’m happy it’s on my horizon.

So, what has all this to do with a diabetes blog? Absolutely nothing except that there’s much more to me than just diabetes, and it’s good for me to digress sometimes.

So that brings me to the Chaharshanbe Suri celebration held on Tuesday night. It’s an ancient Persian custom dating back to Zoroastrian times. It’s a festival held before the Persian New Year (Nowrooz), also called the Festival of Fire. It was held at a local venue with mostly Iranians, but some Afghanis, and then me, related to the Persian community by marriage only. Lots of dancing, Persian food and jumping over fire to ward off evil spirits. I went last year as well and loved it equally.

I’ve been scratching between writing this, dipping my various rashes and bites in Pinetarsol, then all sorts of creams, and generally feeling annoyed that likely the only way to give me some relief is to knock me out. No time for that, but it’s definitely been a busy itchy week!

A week ago, I got my latest HbA1C. It was 6.7%, but this isn’t adjusted for high haemoglobin, which I have. My last, a tad higher,  was adjusted down to 6.4 or 6.5, which I’m ok with. This one will be adjusted too. Does anyone know the formula to adjust? My lovely family doctor says there is one somewhere.

I would like to do a little better, but the risk of more than just a couple of hypos a week is always there, which my endo is always warning me about… which I ignore just a little. I can get lower without more hypos, the secret being to eat low carb and then you blood glucose stays pretty level. Not so easy because I’ve been dealing with some pesky raised blood glucose in the mornings, and it’s taking some time to adjust my insulin (doing it slowly). Stress? Dawn Phenomenon?

What blood glucose target do you aim for? I aim for 5.5 mmoL/l (99 mg/dl) during the day and 5.7 at night.

The 5.5 or 99 seems to be the magic number for adults. Gosh, if I could stay at 5.5 24/7, wouldn’t that be nice? Unrealistic… probably even impossible! Even in people without diabetes, the blood glucose fluctuates.

There’s a group on Facebook called: The 5.5 and 99 Club where you post photos of your meter when you get a 5.5. Of course, none of us sit there all day testing every 5 minutes, and I often miss the exact number as I fly through it going up or down with my blood glucose.

Here are some of the photos I’ve posted recently.

Oh, you think you’re not creative? Think again!

Everyone is creative in some way. From how you stack a dishwasher, how you hang the washing, how you organise a cupboard, how you doodle on a notepad (check out some Zendoodle pix), how you play music, sew, write anything expressive, sing, dance, cook, put speaking words together… it’s all creative! And it’s all different to the way someone else does the same things.

Sure, there are people who are gifted artists, but that doesn’t mean you’re not creative. Someone watching you ride a bike down the road might think that picture is art in motion. Almost anything you do could be considered an expression of you and therefore art.

From the video: You don’t need to be an artist to do the kind of art we’re talking about for healing. Anybody doing anything that feels good to do that is getting something in you out, I think the beauty here is this is all very accessible to virtually everybody.

I think it’s so much more than just the artwork in the video. It’s all the things and more that I wrote about. It’s about getting what’s inside of you, out. Doesn’t matter how that happens (long as you don’t hurt yourself or anyone else), because the medicine is in the expression.

Could I do it?

A cake I haven’t had in years, after 3 weeks of doing really low carb (and barely losing an ounce, I might add)… hmmm… it sure looked tempting. I was brought up on Austrian-German-Hungarian cooking, so the taste is like home. This kind of cuisine, and especially the cake, is rare in these parts (unless it’s my kitchen – without the cake or too many carbs though), so being the opportunist that I am, I was considering it.

We were at a multicultural dance event – the first half was about the artists/performers, Flamenco, Middle-Eastern and Gypsy. The second half was about us, the audience, getting up and dancing to the sounds of the Middle-East – belly dancing, Persian dancing and even Kurdish halparke!

Cake and dancing. Kinda goes together, doesn’t it? Ah… what the hey… I ordered it. Carb guestimated both courses, then gave myself half the insulin. Savoured every mouthful of both the goulash and the cake.

I danced to a few songs (kinda Persian style), and it’s now just after midnight and my blood glucose has been sitting around 4.9 mmol/L (88 mg/dl) for the last couple of hours. Nice one!

So, here’s the lesson… if you wanna have cake, you gotta dance!

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!

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!

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.

I could tell you everything that happened in 2011 that made it an annus horibilis and that I’ll be glad to be rid of it, but it’s done and dusted. Little I can do except learn and try not to repeat those things that led to where I am now and what I have to do in 2012 to fix the result of 2011. A bit cryptic but that’s how I’m going to leave it.

Instead, I’m going to list all the things I want for me and for the diabetes world in 2012.

• A cure for diabetes – that goes without saying!
• Dexcom 7+ to arrive in Australia and be affordable and insurance funded.
• Animas pump with integrated CGMS to land in Australia with insurance coverage.
• More government or charity programs for people who want pumps but can’t afford them.
• Wider testing for the 20% of misdiagnosed Type 2s, who really have LADA/Type 1 and would benefit from more appropriate treatment.
• Normal Blood Glucose limits for T2 diagnosis to be more realistic – current diagnostic criteria is that blood glucose has to be =>11 mmol/L (198 mg/dl). How many years are those people sitting in the 8s, 9s & 10s (144, 162, 180) before diagnosis? Possibly years after damage from blood glucose spikes has begun?
• Wider acceptance of low and lower carb eating for diabetes. I have, thus far, completely failed to understand the recommendation for high carb meals for people who can’t control their diabetes, when this is the very food that causes blood glucose to rise, more than any other food. “Healthy whole gains” aren’t the least bit healthy if they raise your blood glucose to unacceptable levels.
• Better education and support for the newly diagnosed. A 10 minute family doctor appointment simply doesn’t cut it. A dietician and diabetes educator who follow outmoded ideas that do more harm than good, don’t cut it either. Leaving people in isolated areas waiting months for an appointment with an endo, also isn’t acceptable. People who aren’t internet savvy are also at a huge disadvantage. All of this needs approving.
• An understanding that about 50% of protein and 10% of fat is metabolised into glucose and appropriate insulin needs to be factored in.
• Awareness that there are many people on the planet who can’t afford insulin and many who have died and will die without it. In 2012, I would like more support for and a spirit of giving to those organisations who assist people all over the world, who can’t afford insulin and other diabetes supplies. In the words of Tom Karlya, “I would like someone to give Ron Raab’s Insulin for Life every dime the man needs.” Well said! I have been an volunteer with Insulin for Life since 2003 and I know the great work they do. They need funds to offset freight costs to get supplies to where they are needed.
• When recipes are called “diabetes friendly” and all I can see is that they are low fat, and high in carbs, I want the ‘diabetes friendly’ term to be banned!
• A wish that the medical community would fully understand the distinction between all the different types of diabetes, and more importantly, that it and the media stop the blame game about what causes T2 diabetes because more and more they are being proven wrong. (Read: You did not eat your way to diabetes.)
• Stop the “you can live a normal life with diabetes’ nonsense. You can’t! Yes, you can DO almost anything you want in life, but not without dealing with a disease that needs to be monitored and treated 24 hours a day, 7 days a week, no time off, no holidays, no respite. That’s hardly normal!
• That ordinary people realise people with Type 1 diabetes and some with Type 2, need to eat and need to have insulin. The very things that keep us alive can also kill us.
• That technology is developed and made available to all those amazing carers of kids with diabetes so they can sleep through the night, not have to get up every few hours to monitor blood glucose, and not have to worry that their kids could have dangerous highs or lows through the night, let alone the juggling that goes on during the day with active kids. My hat is off to all those carers who take on their kids’  diabetes as if it were their own. They mostly don’t get any respite either.
• Some similar monitoring for teens and adults who manage their own diabetes so that we can sleep peacefully too. No more possibility of ‘dead in bed’. We’ve lost too many people in the diabetes community this way.
• That more restaurants would have some lower carb options for people who choose to eat that way. The penchant for sugar-laiden, high carb Asian-fusion food in this country drives me crazy! I can easily walk along an entire strip of restaurants where I live, and not find a single lower-carb thing on a menu that I’d prefer to eat. For that matter let’s include better menu choices for gluten-free for those who need it. I’m starting to see restaurant menu items that are labelled GF (gluten-free) or LF (lactose-free) and I congratulate those few restaurant owners, but how about LC (low carb)?
• More availability of sugar and fructose-free drinks without all the harmful chemicals. I’m thoroughly sick of drinking water or paying upwards of Au$2.40 for a bottle of it when in a restaurant, with no other choice than Diet Coke laden with caffeine and chemicals.
• The banning of high-fructose corn syrup (HFC). Luckily in Australia, not much is manufactured here with HFC.
• Painless blood glucose testing – not 8 times out of 10, but 10 out of 10, painless, accurate and non-invasive.
• Better blood glucose meter accuracy. The allowed 20% margin of accuracy just isn’t good enough. If my meter reads 4.5 mmol/L (81 mg/dl), I could really be 3.6 mmol/L  (65) or 5.4 mmol/L (97). At 3.6, I need to treat a low, especially because I often can’t feel symptoms of being low until I’m much lower. At 4.5 I might have to watch for a low. At 5.4, I can go merrily on my way. With so much technology now available in such small packages, I can’t believe a more accurate meter isn’t possible. Let’s hope one arrives on the market in 2012, and gets to Australia before 2025!
• Better flavours in glucose tabs for treating lows, and that they’re available at any of my local pharmacies (which they mostly aren’t)! Half the time I can’t get them anywhere! Or I have to pay around US$9 for one of those awful glucose treatment tubes. Crazy! And no, I don’t want to treat with fruit juice or carry packets of sugar that end up all over my bag. I want pure , measured glucose.
• Technology like the iPhone’s Siri to be incorporated in a pump. “I’m going to eat one cup of salad with balsamic dressing, one medium steak and half a cup of steamed broccoli. How much insulin do I need?” It will know everything it needs to in order to make that calculation. No more fumbling with buttons or looking for items in a food database that you can only scroll through 4 or 5 at a time when what you want to eat starts with “W”.
• An instant treatment for anyone at risk of developing almost any type of diabetes so it doesn’t develop at all. Whether that’s the discovery of the trigger for Type 1 so that the autoimmune reaction can be stopped in its tracks, or the discovery of how to identify Type 2 risk very early in life, and a treatment to stop that too.

Sounds like I’m having a grumble. I suppose I am. Most all of these are issues I’ve written about here on my blog at one time or another.

I’m sure I could make the list longer, but I’m sitting here with 1 unit of insulin left in my pump and it’s only minutes before the alarm goes off, so I have to go do a site change.

I haven’t seen all that much progress in diabetes treatment in the 2.5 years I’ve been on an insulin pump, but I’ve definitely seen some awesome technology developed in the last 33 years. Let’s hope that continues a little faster! If a cure isn’t on the horizon, then at least some improvements in treatment would be very welcome!

What do you wish for in the diabetes world?

I wish everyone a very Happy New Year, and fabulous 2012!