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!

The Australian Government’s Institute of Health and Welfare (AIHW) published figures from 2008, which they claim to be estimates.

Here’s what the AIHW say:

In 2007–08, an estimated 898,800 Australians had been diagnosed with diabetes (excluding gestational diabetes) at some time in their lives.
87,100 had been diagnosed with Type 1 diabetes.
787,500 had been diagnosed with Type 2 diabetes.
(http://www.aihw.gov.au/publication-detail/?id=10737419311)

The Garvan Institute, one of the more well-known private research bodies in Australia say:

Type 1 diabetes affects over 140 000 children and adults in Australia…
(http://www.garvan.org.au/pdfs/factsheets/foundation_2007/type1_diabetes_07.pdf)

JDRF in Australia say:

Using data from 2006 the Australian Institute of Health and Welfare (AIHW) estimated that there were 122,300 Australians living with type 1 diabetes, with over 2,000 new cases diagnosed every year.

Australia has one of the highest numbers of new cases annually per capita in the world: Australia is in the top-ten countries worldwide for incidence of type 1 diabetes in children under 15…

The rates of diabetes per Australian state also varies. Interestingly, Tasmania, our coldest state has the highest incidence. The Northern Territory, our hottest state, has the least. Queensland, also a relatively hot state, comes in after Victoria (colder). So, no conclusions can be drawn about climate.

(All JDRF references from: http://www.jdrf.org.au/s/media/documents/australiantype1diabetesresearchagenda_web.pdf)

Seems a bit odd that from 2006 and 122,300 cases of Type 1 (JDRF quoting AIHW, 2006), it’s also 140,000 people in 2006 (Garvan Institute) and to 87,100  cases in 2008 (AIHW). The Better Health Channel, Victoria, probably has it right: “estimates vary”.
(http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Diabetes_Type_1_or_juvenile_diabetes)

If you need insulin in this country, you have to register with the NDSS – the National Diabetes Services Scheme. You also have to specify what kind of diabetes you have. I don’t understand why the numbers vary so much!

I’m not even going to begin to write about the difference in estimates of Type 2 diabetes in Australia!

What we do know is that about 10% of people diagnosed with diabetes in Australia, have Type 1, although JDRF say it’s 13%. That doesn’t seem to vary much with numbers elsewhere in the western world.

The government via NDSS subsidises insulin pump consumables – insulin cartridges (box of 10 is AU$9.60) and infusion sets (box of 10 is AU$14.50). It also subsidises test strips and insulin. Syringes are free as are insulin pen needles. The subsidies vary but the most any eligible person (all Australian residents with diabetes) will pay for 100 test strips is AU$14.70 (exchange rates close to USD) and the least is AU$1.20, or even free. Criteria is varied and includes anyone with a Health Care Card (usually low-income people, pensioners etc) to veterans. If you have reached what we call the Safety Net for out-of-pocket costs (approved items only), test strips are free.

More info about Medicare Safety Net:
http://www.medicareaustralia.gov.au/public/services/msn/index.jsp#N10059

More info about PBS Safety Net:
http://www.medicareaustralia.gov.au/public/services/scripts/pbs.jsp#N100D3

Now here’s what interests me from JDRF:

The high use of hospital care by people with type 1 diabetes is a major contributor to cost burden, with hospitalisation accounting for nearly half the direct health care costs incurred by people with the disease. In a recent survey of people with type 1 diabetes, more than a third of respondents indicated they had been admitted to hospital emergency departments in the year prior to survey. 

Improving resources for managing diabetes in Australia would go a very long way to reducing the cost of hospital admissions. How? One way is by more easily allowing into Australia the various types of insulin pumps and Continuous Glucose Monitors (CGM) that are already available in the USA and Europe, for years… ones that are already being used and have proven to improve diabetes management, AND making them more affordable!

We don’t have many choices in Australia. Animas, Medtronic and Accu-Check sell and support insulin pumps here. Medtronic has CGMs here, hellishly expensive too and not covered by insurance – not the CGMS and not the sensors at $70 each. Insulin pumps are covered only by private health insurance, which most people here don’t have, and there is a scheme for kids of low-income earners to be subsidised to buy an insulin pump. Half of $7,500 for a low income earner is still out of reach for most.

The Dexcom 7+ CGM, the one I’m always complaining isn’t here yet, still isn’t here, despite it already being approved for sale in Australia quite a while ago. Likewise the Omnipod, a tubeless insulin pump, also isn’t here yet (at the time of writing). Likewise various other options that are available in the USA and Europe.

I guess one factor is that we are a country of only 22.2 million people (2010 estimate), a long way from anywhere, and a huge country where distance is an issue. The cost of setting up operations here for say 100,000 people with Type 1 Diabetes (not to mention all the people with Type 2 who would benefit from this technology), not all of whom could afford an insulin pump, is prohibitive. Big Pharma (and this includes diabetes technology manufacturers) has to make profit, right? Pity!

It’s always a fun thing to do, so I encourage you to get the word out to everyone you know with diabetes, and to encourage people to participate.

Here’s how…

From: www.bigbluetest.org

In 2011, with each Big Blue Test, Roche Diabetes Care will make a donation to support humanitarian diabetes programs. When you do 14 to 20 minutes of exercise and share your blood sugar readings before and after getting active, YOU help yourself and you help us get life-saving supplies to OTHER people with diabetes in need.

After playing with it for 24 hours, I totally love it! I’ve been having some fun with Siri tonight, asking her (it’s a ‘her’ in Australia) to do all sorts of things.

Siri is an ‘assistant’ of sorts. You speak to your iPhone and tell her what you want. A note? Call someone? A reminder? Some info? An internet search? Someone’s address? Dictation instead of typing? And a whole lot more! You speak in normal language.

Here’s an interesting list of things you can ask Siri.

Some iPhone 4S screen photos of my interactions with Siri…

Carb Counting with Siri

Information is provided via Wolfram Alpha, and other sources.

HbA1C information request

A fictitious note was fun to make. I can’t measure my A1c (no home testing kits in Australia), and I doubt it will ever be 4.6, but that’s what I told Siri to write and she got it right first time!

Siri take a note (totally fictitious of course!)

The note is time-stamped and synced with iCloud. It’s then downloaded to all my Mac computers and devices, so if I’m in the doctors office, for example, with my iPad and not my phone, the note will be there too.

Siri is still learning my voice, my accent and certain words that I will regularly use. I was surprised she got “HbA1C”.

So far, I’ve dictated several SMSs, an eMail and a Facebook reply and the words she got wrong were far less than expected. Sometimes she git everything right!. It gets better every time I use it. She knows what I mean when I say, “Remind me to call my daughter tomorrow afternoon,” and will set a reminder for me. I only had to say daughter and a name one time and Siri asked if I wanted to always associate that contact as my daughter. Cute and amazing!

I can think of so many uses for this technology. Can’t tell you how many times I’ve been driving and needed to write something down, or I think of something and I’m fumbling around for a pen and notepad so I won’t forget. The carb counting is easy and fantastic – no more flipping through books or scrolling through hundreds of food items on an app! I even asked it for nutritional info for a BigMac and the answer was there in seconds.

You can ask Siri to do calculations. Let’s say your insulin to carb ratio is 1:8. You’ve asked for a carb count for that BigMac. Siri comes back with 45 grams. Then you ask Siri, “What’s 45 divided by 8?” She answers with 5.625. Round it and you’ve got how many units of insulin to take!

Siri functionality still has some limitations in Australia – there’s no map interaction, traffic or business lookups (only USA), but apparently that’s coming in 2012. I totally love this technology!

So, you’re plodding along in your life and suddenly a steamroller comes along and tries to flatten you. That’s what happened to me last month. I’ve come to the conclusion that sometimes generosity and caring translates to a huge sign on my forehead that says something like: Born yesterday! Want something? Apply here!

That very long story, for the purpose of this piece, is not worth telling. The result is…

So, three weeks ago, I separated from my husband of 4 years, and have evicted my overseas guest who was here for 8 weeks. I don’t actually feel a whole lot better… yet. Sure, I’ve saved my self-respect (or whatever that was supposed to do for me), but in the world of diabetes, living alone in a new location with no new friends yet, doesn’t augur well with me.

If I had time to get out there, it would be easier, but although the work is starting to come in now after eight months of marketing for new clients, I’ve got bills stacked high. My time is spent trying to make ends meet on one income, in a place and a mortgage meant for two, and I have little energy for much more after that.

My daughter lives in this area and I talk to her and see her often, but she works 6 days a week and has a life with a live-in boyfiriend and all their friends. I also have some clients I’m friendly with (but don’t socialise with). In reality, no one else is responsible for me or for how I deal with diabetes.

When I had other people in my house, I could reasonably rely on them to pick me up off the floor, should I have ever ended up there. I never did literally, but I do have trouble when I go low, and there was much security in knowing others were around.

Daytime isn’t a problem. I test often, but sometimes I’m caught up in stuff and can leave it an extra hour or so to test. I’m a bit hypo unaware, often not feeling anything but my eyes going strange starting when I’m well below the threshold. Not so good, but I’ve always caught it, even though by the time I do catch it, I can’t often remember what I’m meant to do. Test? Wait for a migraine? (My beginning symptoms are similar.) Put my glasses on? What IS that with my eyes? What does it mean?

It’s a strange kind of funny that every time this happens, you’d think I’d know what to do, but the thought process goes into a kind of slow motion, sometimes illogical deduction. Lack of glucose to the brain no doubt.

While I have never minded living on my own, it was always in places I knew others, and since 1989, my daughter was at home until she was a late teen, She’s smart, resourceful and has lots of common sense. She knew what to do when something was wrong. Since she was 6, I always had husbands or others living in my house. Not so now. I’m in the kind of place it’s very difficult to rent rooms for various reasons.

My late friend, who died in February 2010, always knew I was heading for a low, well before I realised it. He was a kind of hypo-dog human! I sure miss him. No one else has ever come close to the kind of instincts he had about me and about my blood glucose.

I do have a dog, a very sweet Border Collie, but she’s the furthest thing you can imagine from being a hypo dog you can possibly imagine! She prefers to have glaring contests with the local frill-necked lizards, on the other side of the open fence.

Living alone, sleeping is more of a worry. Not sure how to solve that. I could get one of those medical alert buttons (at a cost for monitoring or one that dials numbers), but what can I do with it while I’m asleep? I sleep like a log, and that’s a worry too.

So, no really late night snacks unless they’re very low carb. Making sure my blood glucose is stable for a couple of hours before bed. Not going to bed at anything under 5.5 (99 mg/dl), in fact sometimes if I do find myself much lower than that before bed, I’ll take a 4 gram glucose tab.

Making sure my basal rates are just right on my pump means regular night basal testing, especially while the seasons are changing (summer is different to winter for me).

I’m not sure there are any more precautions I can take, but there’s still risk. I think everyone who is insulin dependent, worries about the risks. Yes, you can live with a house full of family and still no one could know you’re in trouble when you’re asleep, but those risks multiply when you live alone.

I may not particularly want to face the day sometimes, but these days I tend to be very thankful I’ve woken up in the morning.

Tonight was the start of Rosh Hashanah.

The same dilemma faces me every year. Food has special significance in Judaism – traditional food at traditional times of the year. Symbolic food for a sweet year is eaten on Rosh Hashanah. Sweet Challah – a yeast-risen, eggy bread that is usually eaten on Friday nights, and made sweeter for Rosh Hashanah. Apples are also traditional. Both are dipped in honey, and plenty of it!

The nightmare for someone with diabetes continues with, for Europeans, something called gefilte fish. Yup, sweet fish mixture (don’t ask) with chren, horseradish mixed with beetroot. Don’t ask! I love it but I guess it’s like Australian Vegemite – an acquired taste. You either grow up with it and love it, or learn to like it if you’re living in someone else’s tradition, or you turn your nose up at it. The non-European Jewish people – some  from the Middle East, Africa and some Mediterranean countries don’t have gefilte fish in their traditional food and often don’t like it. Thanks… if you’re sitting next to me, I’ll have yours too!

Course number three will have a side of tzimmes, a sweet carrot dish. And there are more dishes – sweet, sweet, sweet. How else can we expect to have a sweet year unless we stuff ourselves with traditional sweet foods? That’s tradition for you!

Every year, I look at the apple, the challah, the honey and all the other dishes, swearing I will only take a tiny bite. But, you know… I want to have a really sweet year.

The problem is the massive carb guestimate that goes along with eating that kind of food.

While you’re in a fascinating conversation with someone else at the table, you are barely aware that you’re reaching for another piece of challah because this year, it’s especially yummy, or that someone has put a plate of freshly cut fruit in front of you and it’s just there, staring at you, saying: eat me, eat me. Fresh rockmelon, honeydew melon and watermelon. One small bite, right? Wrong! Honey cake (yes, honey is THE star of the show) and more fruit. So that’s 4 courses (at least) times sweet.

Um… what was that? Maybe 50 grams of carb… maybe 150… maybe some carb number out of my reach. None of the food comes with a carb count. After years of enjoying the food and madly blousing under the table, you get pretty good at guessing, but you can never be sure. Just 10 grams of carb out – nearly one teaspoon of sugar, which could easily be contained in a single bite of some of what I was eating – can be the difference between ‘in-range’ and oh hell I need more insulin. Believe me when I tell you, it’s seriously good food, firstly because it’s good food, but secondly, it’s food you’ve had at this time of year, every year of your life, so it has a history in a deeply rooted tradition. Maybe like a traditional Christmas lunch, which I’ve never had. The older you get the more past times and places you are reminded of, and the more entrenched that tradition becomes – least it does for me.

Insulin pump, thank you! I could never have managed this without you! (And never did!) I’ve had you now for 2.5 years, and still thanking my lucky stars! Combo bolus for a few hours, and add straight boluses here and there as you realise you’ve nearly lost count of the carbs. Manageable, although I suspect I had an entire week of carbs in one sitting. And I’m well aware that it will do my waistline no good at all! Insulin makes me fat – it loves me that much!

Every year, when I get home and pull out my meter, I make bets with myself – how high am I going to be after all that food I wasn’t going to eat, and how off was my carb guesstimate. In times past, I would also be doing some of the cooking for the crowd, so I would make some lower carb dishes as well. This year I wasn’t in the kitchen for the first time in 12 years. Eat or starve!

All things considered, I was a little high by the time I got home, but a 9 mmol/L (162 mg/dl) wasn’t so bad. Yesterday my endo said he advises people not to correct under 10 (180)… not that I’d follow his advice. That wouldn’t work for me. I’ll correct if I’m in the 7s or 8s (126-180). I feel better if I’m around 5.5-6.2 (99 – 112). I seriously expected to be way higher, so I’m pretty happy I almost nailed it. Just one more little bolus before bed.

Wishing all who celebrate this special time of year: Shanah tova u’metuka - a good sweet year.

How high do you go before you correct? At certain times of the year (e.g. Christmas or some other special occasion), do you have food you don’t usually eat? Clearly I do! And I’m not one tiny bit sorry!

On what planet?

The more ‘normal’ your A1C is, the more you had to do to get it there and keep it there. It’s a 24/7 thing when both the stuff that sustains you and the medication that fixes you, can kill you. Hmmm… a lose-lose situation.

When the stresses of daily life make your blood glucose soar around a number you don’t want… when an unexpected walk though a shopping centre has you rummaging for your meter and some glucose… when a simple social situation where there’s food, turns you into a mathematical genius… when the endless rounds of doctor visits, endos, eye doctors, foot doctors, pharmacy visits and any number of allied health visits and more, has you calculating how much per hour your time is really worth… when you’re tossing up between paying for medical insurance and paying the mortgage… when you wake up every morning, thankful you’ve woken up at all, but have to start managing diabetes all over again…

Just a few points of a very long list of D-life intrusions. How is that normal? Not remotely so. And where is the cure “within five years” I was promised more than 30 years ago? On the horizon? Yeah, right, that horizon keeps being a horizon for now, no matter how fast you run towards it.

Unless you eat the same, do the same, take the same every single day, day in and day out (and even then, there’s unpredictability), and if that’s normal for you (it isn’t for me), it’s still not normal.

After a few relentless years of diabetes, and if you’re interested enough, you end up with a PhD in D-Management. It’s life-long learning as you figure out what works for you, and watching as new things are discovered, new studies done, new technology – none of it perfect, but each step makes a difference.

Food, activity, stress, insulin – a small mix in a much greater mix of how this disease works.

And there’s survivor guilt of sorts too, when you hear about so many people dying or not living well because they can’t afford insulin. Nowhere is this more prevalent than in third world countries.

But this isn’t really a grumble… ok, it is of sorts because ‘normal’ doesn’t factor much into living with diabetes. Normal would be forgetting you have diabetes, eating anything you want, not taking insulin or other medication, not testing a gazillion times a day and generally not having a problem doing that. It’s like having a baby – your awareness is on your baby all the time, no matter what else you are doing. Babies grow up, diabetes doesn’t, although it can get easier to manage over time, the more you learn and the more determined you are.

Factor out life stresses, depression and other things that get in the way, diabetes IS manageable, but living with it is not a normal life.

There are few things you can’t do with diabetes – piloting a commercial plane, for one. Yet there is so much on-the-job discrimination for some… like you wouldn’t believe! No way, in this post, am I going into the other discrimination and misinformation out there that impacts on our lives. If you are determined and you can manage your diabetes, there’s no reason you can’t do almost anything you want. Being spontaneous is a little more difficult sometimes, but still do-able. If you grab your supplies in an always-prepared bag and go, you could almost call that spontaneous!

For me, this is a testament to how well many of us handle diabetes, despite so many obstacles, the huge education curve and the day-to-day vigilance. We do what’s required of us on a 24/7 basis, not only to stay alive from day to day, but to stay as healthy as possible for the long term. This is not only a mostly silent disease, all too silently it can wreak havoc with other medical complications if not well-managed 100% of the time.

And parents of kids with diabetes – I’ve said it before and I’ll say it again – what an amazing job you do! Out of love, you take on this disease as if it was your own, losing sleep, worrying, doing what’s required – trying to manage something even more unpredictable in kids than it is in adults.

Having diabetes is not in any way a ‘normal’ life, but it’s an often invisible disease and one that can be lived as a semblance of normal.