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Lyfestories: Jon Tijerina– Outsmarting His Diabetes

3 years ago, my persistent nerdiness brought me from Texas out to sunny California to study at Stanford School of Medicine. I was surprised to find incredible research and developments not only at the medical school, but in the overwhelmingly supportive and innovative diabetic community!

After years of feeling like I had to go it alone, in and out of diabetic burn-out and meal-time anxiety, I finally found the encouragement and positivity I needed to refresh my mindset and management.

Diabetes has been part of my life for as long as I can remember. I’ve seen the full gamut of treatments, from my grandmother explaining that her “medicines” came from cows, to my father’s diagnosis and all the finger-pricking, pill-swallowing, and (eventual) groan-inducing injections that followed. There had to be a better way.

13 years ago, I was diagnosed with Type 1 Diabetes after a family trip to Guatemala (which I mostly spoiled with my constant trips to the bathroom and incessant napping). Thinking I had to resign myself to pinching together the little fat I had to inject the rest of my life, I was all-in when offered the chance for an insulin pump and CGM in college.

The technologies weren’t exactly a silver bullet (big shout out to CGM alarms for sleep loss), but they instantly made running collegiate track and maintaining my glucose during times of stress (i.e. college finals) more manageable.

I never expected that 5 years after going on a pump system, I would be “jailbreaking” my own insulin pump to receive instructions from an incredible (but NOT FDA-approved) app called Loop. But here we are!

After a lot of research, a lot of discussion with my endocrinologist, and a lotttt of CGM sharing with my mom (mistake), girlfriend and basically anyone who would be ok with getting annoying alarms for me, I decided to download this software that allows an algorithm on your phone to send temp basals to your insulin pump…. all by itself… every 5 minutes!

The Loop system takes your CGM readings, insulin-on-board, and carbohydrates-eaten into account when making its calculations and can even predict when you’ve miscalculated your carb intake and make an automatic correction! This functions similarly to the FDA-approved Medtronic 670G hybrid closed-loop system (the only FDA-approved closed-loop to date) that has recently become available, although it allows you to choose which CGM you prefer and is highly configurable. Again, Loop is NOT FDA-approved (see below for disclaimer).

3 weeks after beginning my journey with this closed-loop system, I have to reiterate nothing is a silver bullet for diabetes management. The system requires some computer and programming competency, and like any computer program can have malfunctions. Electronics and connectivity come with their own troubleshooting, but I couldn’t be happier with how this system has drastically reduced my mental workload (and the sleep!).

After a lifetime being surrounded by diabetes management, I feel incredibly lucky to be riding the next wave in treatment. A huge and profound thank you to the diabetes community for coming together around issues in our treatment, and solving the problems we know need to be addressed now!

*The opinions expressed in this blog do not reflect professional treatment recommendations, the opinions of Stanford University, Stanford School of Medicine, or Stanford Hospital and Clinics. Any changes to diabetes management regimes should be discussed with the patient’s endocrinologist or primary care doctor. Any persons adopting a non-FDA-approved system of treatment do so at their own risk and should proceed with appropriate caution.

Jonathan Tijerina is a 3rd year medical student and research coordinator at Stanford School of Medicine. He teaches the med school course, Diabetes 101 for Healthcare Providers, and started the Bay Area Running Group for diabetic teens learning to manage their glucose on long running ventures. IG: Jonathan_David_Tijerina

 

Real Talk with Dave: You Don’t Know What It’s Like To Feel So Low

 

            Each day, we are each given a choice as Diabetics. A choice to take the best care of our health or the choice to be laid back and not as careful. Diabetes is hard work and sometimes, we go through a burnout phase where we may be care free of our Diabetes and not put as much focus on it as usual. However, each day, whether we work hard at our T1D or not, we each face lows, highs, sick moments, and feelings that are indescribable. The main focus I’d like to discuss is primarily on lows.

Lows are the absolute worst feeling a Diabetic can get. Low in terms of blood sugar, energy, focus, strength, and mental capacity. Lows take so much out of us. They make us feel like we’re dying in a sense, and yes that sounds a bit dramatic, but that is the honest description that a Diabetic will say it feels like, just ask any person with Type 1 Diabetes. I often say that lows “hurt” and that could mean a variety of things. My body, my muscles, my bones, my mind, or even my emotions. Lows have a way of playing with the person who it decides to attack.

As a Diabetic of 9 years, I have learned several different ways to cope with and manage lows in all sorts of settings, as each low is unique and different, yet all have some similar symptoms. Throughout the years, I have tried to explain to people who don’t have Diabetes what it’s really like to have a low blood sugar. Though many people just don’t understand, some do try and empathize with me and see how horrible they can be. As much of a description I may give, I always mention though that a non-Diabetic will truly never know what it feels like to have a low, as much as I try and describe it. The pain, the fear, and the shock it has on the person is something I wish nobody had to face.

Some lows are better than others. Low blood sugars in the 60mg/dL-70mg/dL range are not so bad, but anything below 50mg/dL, that’s where things can get scary. Severe lows contain symptoms such as shakiness, sweating, fast heart beat, fear, panic, nausea, lethargy, etc., just to name a few, but, as mentioned, each low is different and each Diabetic can feel their own unique symptoms. I think most of us know the cause of a low blood sugar, but for those who don’t know, intense exercise, too much insulin, and not enough consumption of carbohydrates/sugars are the main ways low blood sugars come to be.

The reason I am writing about lows are to mainly spread awareness on this issue. I can remember countless times in which I simply avoided doing certain activities or sat in fear during a certain situation (such as classes, work, travel, etc.) as I was constantly worrying about going low. High blood sugars are different in the sense in which you may feel very sick still, but you have a larger and somewhat safer timeframe to treat the blood sugar before it gets too serious. Yes, I have had Diabetes for 9 years, but I almost feel as though I will never fully get over my constant fear of lows. Lots of people have shared over time that they are very afraid to go to bed each night as they are worried they’ll go low and not be able to wake up from that low and that is exactly why I am writing on this specific topic, to share what us Diabetics truly go through on a daily basis.

Diabetics are fearless and I think it’s safe to say that we put up with so much and have gone through so much over the years of being Diabetic. We face so many scary and life altering challenges every moment of every day, most of which goes unnoticed, that is why we must continue to spread awareness, seek support from as many people as possible, and create a safe environment in which if emergencies do arise, we will at least feel as though we are in good hands.

Diabetes is tough, but we are strong. Diabetes is scary, but we are brave. Diabetes is a big deal, but we are so much bigger than this disease.

Live well,

Dave

 

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