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Optimizing Diet and Exercise as Tools for Managing T1D: Thoughts from an Entrepreneurial Certified Diabetes Educator

Colette finished her Master’s degree in Clinical Nutrition to become a Registered Dietician and a Certified Diabetes Educator. She is also a board-certified Sports Dietician, inspired by her former career in professional bodybuilding.

I have been living with Type 1 diabetes since 1984, signifying 35 years with the disease. I have watched some of my dreams come true including the Dexcom G6, a better basal insulin (Tresiba) and a noninvasive way to take insulin, Afrezza.  I understand the physiologic benefit to being on an insulin pump, especially those that DIY close loop their pumps and have basal modulation to help keep blood sugars in range, even if you don’t quite get the carb counting correct.

My issue with wearing all these devices comes with being a professional athlete.  Although I don’t compete anymore, I still try to live my life around a bodybuilding lifestyle, which means going to the gym five to six times per week.  I never liked being attached to a pump and having to find that perfect spot to put your infusion site.  I wear a weight belt when I train, which rules out my entire midsection, leaving only my right and left glute and outer thighs.  That didn’t work too well for me and I developed severe lipohypertrophy. Now, Afrezza and Tresiba offer me more freedom with much less worry around low blood sugar due to its fast in / fast out absorption.

While waiting for advances in T1D management, I have found that the best advice is to minimize the amount of insulin you need to inject before each meal and maximize your insulin sensitivity so that you don’t require that much basal insulin.  It is also crucial to keep in mind that the more carbs you eat, the more basal insulin you will need.  Insulin is NOT predictable, especially the injected, rapid-acting insulins.  In order to perfectly time them, you really need to inject 20-30 minutes before you eat in order to match up the peak of the food with the peak of the insulin.  To manage this difficulty more effectively, try to have your blood sugar < 100 mg/dl before eating.  That way, you have less insulin resistance.  It is also important to differentiate between the two sources of glucose when a person with diabetes eats – liver glucose and food glucose.  The best approach is NOT a keto diet because it is too difficult to sustain long term and, quite frankly, who wants to eat all that fat!  A true keto diet is comprised of 70% fat. We need more antioxidants and micronutrients than what can fit in the remaining 30%.  My T1D management diet philosophy includes high protein, moderate healthy fats and high fiber carbs such as legumes, vegetables, bean pastas, low carb wraps, spaghetti squash/acorn squash/butternut squash, and artichokes. Keeping the fiber high offsets how quickly carbohydrates turn to sugar, thereby giving insulin time to work and suppress the liver from producing glucose. It also allows for more variety in one’s diet and the one thing that the ketogenic diet lacks: fiber.  I have been following this diet throughout my competition years and continue to do so now.  This is not a fad diet, but instead a way of life and approaching food choices.  Understanding the unpredictability of insulin, we can infer that the more we need to take it, the more unpredictable it becomes. Optimizing diet as a tool is simple: eat the foods that require less insulin to ensure greater predictability and better blood sugar control.

Exercise is also another key component to my success. Similar to making dietary changes, this also was not without struggle.  Given that I love to weight train, high volume, high intensity weight training sessions involving my legs and back would often raise my blood sugar > 100 mg/dl.  I would have to take insulin on an empty stomach before my workout in order to keep in normal range. Interestingly, it is typically the stroll in the park when your blood sugar drops because it is non-stressful and does not promote the secretion of adrenaline and cortisol.  Don’t be surprised if you need insulin to workout, as it was common practice for myself for quite some time.

My last suggestion is to not be afraid of the lows.  My patients would rather be low than high. Although all too often our doctors want us to stay high where there are less short-term consequences, I stand by this statement. If you are wearing a CGM and more aware of your trends and predictability, incidences doctors worry about like insulin shock and passing out should not be happening.  If you ate something and think you might have taken too much insulin, be prepared with 1-2 glucose tabs.  You often don’t need that much when taking smaller amounts of insulin at each meal, especially if also following a low carb lifestyle. Even if you took one extra unit, we aren’t talking about a severe low.  It is also always important to choose a straight glucose source rather than food. If you take a glucose tab, it won’t cause that same reaction as food, resulting in more predictable rebound sugar and less weight gain.

The reality is we can’t just stop taking our insulin, but we can help it work better and be more user-friendly. Minimalizing the amount of insulin you take is one step towards better management.

To summarize, Type 1 diabetes is an autoimmune disorder, meaning there is no cure at this point in time. However, through efficient application of dietary practices and the implementation of a fitness routine, you can create a maintainable lifestyle that will ultimately make your diabetes more manageable.

#RealT1DLyfe Sara’s Story: Type 1 Diabetes, Food and Eating Disorders

Being diagnosed with Type 1 diabetes is far from the best news I’ve ever received. However, I had the best support from family, friends and healthcare professionals. Thanks to this support system from day one, I felt confident that I could maintain a positive mindset, even though I knew there would be many tough periods ahead.

I have always tried to look and act “perfect” on the outside by not making a fool of myself and not creating unnecessary conflicts so that I would be accepted and respected. All of these behaviors striving for “perfection” have in some way affected the history of my T1D.

For better or worse, I have always placed significant value on my appearance. I have always strived for something that is ultimately superficial and should not really matter in the scheme of things. The combined stress of how I saw myself in the mirror and my perfect blood sugar curves eventually turned into a minor disaster.

Sara Moback thin

I learned quite quickly when I was diagnosed with T1D how food affected my blood sugar. I learned how many units of insulin I needed to maintain a relatively stable blood sugar. Together, the time and effort I dedicated towards food while I began to think more about how my body looked, as well as other important happenings in my private life, led to an awful disease – anorexia nervosa in 2016. This part of my life was probably the worst. I do not really know where my strength came from, but I eventually managed to contact a clinic that helped me, and this was the beginning of a journey to a healthier life.

I made significant progress once I started working with my body instead of against it. Before, the nutrition of what I was eating was not important to me. The most important thing at that time was for any food I consumed to not affect my blood sugar.  Now, I realize how much of an impact my T1D had on the way I considered food and my overall diet.

Receiving a diagnosis of Type 1 diabetes was traumatic because it meant I couldn’t live life as I knew it. It is difficult to change habits and ways of life – even the small, everyday habits. The additional diagnosis of anorexia made this even more difficult. After a long time spent in treatment, I had overcome most of the difficulties I encountered with my disease. I had a tough time when it came to relationships, jobs and figuring out what life meant to me.

Today, I have come a long way in my recovery. However, food is an integral part of my life and I will never be able to get rid of the thoughts of what my next meal will look like. It is a feeling that a person with T1D can never truly get rid of. Some days I feel strong because I do not struggle with my thoughts surrounding food and T1D at all. While other days, I feel the heavy burden of T1D, although I don’t always show it.

If people around us knew the extend of how hard we work to keep our bodies and souls alive, they would be shocked. Although many still do not and most likely will never fully understand, the most important thing is that you are aware of the choices that make you feel good.

Sara Moback full length

 

#RealT1DLyfe Chris’s Story: Type 1 Diabetes and Suicide

As anyone with Type 1 diabetes knows, life can be an absolute roller coaster. I would like to take you on a personal journey of mine going into the darkest of hours, but coming out in the brightest of days. Back in June of 1988, my diagnosis marked not the first or second, but fifth Type 1 diabetes diagnosis for my family. Already having lost an uncle to Type 1 in the same year, my diagnosis likely hit my family harder than I will ever know. However, growing up having two family members who passed from T1D complications weighed heavy on my mind. It didn’t help that at a young age, I heard a doctor tell my mother, “if he sees 30, feel lucky.” Growing up, T1D never completely stopped me from doing things, but often had a way of interfering. Going to play soccer as a kid, I had a coach say I couldn’t play because he didn’t want a kid dying on his field. Name calling, being told I wasn’t good enough, and the like made me angry in the moment, but ultimately sat deeper within my subconscious for twenty years into adulthood, slowly taking its toll.

Getting out on my own is where my life took a darker turn. Around 2011, I fell into a deep depression and I almost didn’t make my way out. My blood sugars were rarely where I needed them to be. It was also a constant roller coaster at work. Eat then work, forget to bolus, go high, then crash, and repeat. Although I was consistently out of range, my reasonable a1c kept my doctor at bay, all while hiding the fact I was miserable mentally. Relationships were impossible to maintain with my depression and blood sugars as they were and I began to isolate myself alone with my thoughts. The thoughts escalated from “your diabetes has destroyed your life” to “your life isn’t worth living with diabetes.” Mind you, at this point in time I already had one beautiful son. I pushed the thoughts back as much as I could for his sake. However, in doing so it enabled my thoughts to escalate even further. I was telling myself that my son would be better off without a father. I started looking up those who completed suicide and how they did it. However, even with everything I was feeling, I couldn’t leave my family with the thought that I would do so on purpose. After having crashed my blood sugars numerous times over the years to counteract extreme highs, I decided insulin was my best option.

On a Saturday morning, I woke up in tears and decided that was the day. I got up and took a fatal dose of short acting and went about my morning routine with the idea that at some point, I would have an insulin reaction and go unresponsive. For whatever reason, by an act of God, the insulin took hours to work. Later that day, when I was on line to have lunch, the last thing I remember was reaching for a plate. I woke up surrounded by EMTs in my manager’s office. Lucky for me, the guys I worked with knew me and my diabetes very well. Upon coming to, one of the EMTs said it was the first time he had a patient so low it wouldn’t read on his meter. We still don’t know how low I truly was when they got there. I finally got to the point I could stand on my own and was feeling okay physically. However, my mental state was still in shambles. Per policy at my work, I had to be sent home. I begged with my manager to let me stay. I said “I’ll just sit in the back, no one will know I‘m there.” I couldn’t go home in the state of mind I was in. But none the less, I was on my way home. The short 5 minute drive was nerve racking, tears falling, thinking “should I try again” and “I can’t be alone” and “I don’t want to live.” My best friend was sitting on the couch as I walked into my apartment and he immediately looked up at me, knowing something wasn’t right. He put his arms around me, like any brother should, and gave me a much-needed embrace–the kind of hug that lets you know someone loves you. We ended up going for a long walk where I explained what I did. He was the only one who knew what I did for years. During our walk he said, “I know the greatness you have ahead of you, you just have to be here to find it.” His words have sat with me for years.

With my two children and the Betes Bros, I have a family that pushes me to succeed. Brothers who reach out for my support as well as check on me. The men and women who have come into my life have filled my cup and continue to make life even better. If you are struggling, that is okay. As someone who almost experienced an end to my life, if I had the support then that I do now, I probably wouldn’t have gone that far. If you’re ever in a place like that in your life, talk to someone. Seeking a professional counselor doesn’t make you weak, it actually makes you stronger. Reach out to a friend who may be struggling that you haven’t talked to in a while, let them know you’re there. A simple text, note, message saying, “I’m here if you need me” can literally save a life.

#RealT1DLyfe Chris Pickering Family

Get real with T1D! #RealLyfe

For additional resources on Depression and Diabetes, check out this article from our friends at Diabetes Daily!

Inside the Patient Entrepreneur’s Mind: John Wilcox

Managing a chronic illness is challenging, whether it is your own or a loved one’s. Starting and running a business also poses unique challenges. If you struggle with a chronic illness, have started a business, or want to start a business, this blog series can help guide you. “Inside the Patient Entrepreneur’s Mind” offers key insights into chronic disease and mission-driven entrepreneurship by some of the most innovative patient entrepreneurs in the world. 

John Wilcox is the CEO & Co-Founder of Diatech Diabetic Technologies, Inc. 

As a patient entrepreneur, can you describe your personal experience with diabetes from diagnosis through your current daily management and how this experience drove you to innovate the space? 

In 2005, I was diagnosed on my ninth birthday. I figured the only way to come out on top was to make it a positive experience. Growing up, I really identified with the disease and now use it as an opportunity to empathize with others with chronic disease. I wanted to go to medical school, and still might, but this opportunity came up in college to develop intellectual property—what is SmartFusion today.

I took on the business full-time post college graduation of May 2019. My diagnosis gives me a leg up on how to develop technology to help diabetes patients. As a collective community, we can appreciate when someone with a disease can relate to us and effectively create change. My condition is something that I can share and allows me to connect to people and understand how other people are struggling—it is one of the best gifts that I could ever ask for. I don’t know what I would do with my career without this diagnosis because it has turned into a passion to help others and a lesson on how to make the best of situations.

What makes SmartFusion unique and how does it meet an unmet need of the diabetes community?

SmartFusion is a new infusion set that can more accurately tell you if insulin delivery is actually getting into your body. SmartFusion is unique in the fact that it helps patients understand if they are getting insulin.  Insulin pumps on the market right now are not really meeting the standard of being able to tell patient users if their insulin delivery is effectively working. We noticed the issue of infusion set insulin delivery failures where pumps can have issues with insulin delivery efficacy.

Personally, I have had issues going into DKA because of insulin mis-delivery.  I went to an endocrinologist in college who blamed me for poor A1C control rather than it being a technology/pump failure. I want to provide technology that can deliver alerts before hyperglycemia because it happened to me and it is very dangerous. Fixing this unmet need of pump reliability can take one thing off the list of what patients and caregivers go through regarding issues with diabetes care.

Are there any other unmet needs of the diabetes community that you think take priority in working to address? How are patient entrepreneurs well-suited to meet these needs? 

In the future, I would love to focus on software for pumps. There has been great work on hardware that is safe and effective for patients with diabetes but a real gamechanger could be software that pairs any type of CGM with any type of pump. The diabetes “hacker” community is already pairing their own CGMs with pumps but are not following standards of the industry.

Additionally, there is a lot that needs to be addressed in education, especially how to learn to effectively use diabetes technology for parents of children with the disease.

Where do you draw your inspiration and motivation from to keep forging ahead as an entrepreneur in the healthcare industry?

 My inspiration and motivation comes from talking to people who have the condition. I want to make sure the diabetes community is affected and impacted in a positive way. Stories from patients about issues with diabetes care like insulin mis-delivery keep me up at night.

Lastly, what do you do for fun to manage the stress of running a business as both a person with t1d and an entrepreneur? Do you have any similar advice on work-life-disease management balance to others out there thinking of starting a business to meet an unmet need of a chronic disease patient community?

I love to run whenever I can and I find it a very clearing activity. My goal is to John Wilcox 5k racerun the Boston marathon for the JDRF. In terms of advice for other patient entrepreneurs, we have a disease that can help connect us to other people that have the same chronic illness. However, each patient story is unique so taking the time to recognize that is important. For example, my parents helped me get appropriate care at a young age by providing insurance coverage. How dare I compare my journey to patients I meet now, who are in their twenties, who are still without coverage to get insulin. In a nutshell, know that your story is unique and craft a connection to fellow patients based on that fact.

 

 

New Workout App for People With Diabetes – And Christel is an Instructor!

Have you ever dreamt of working out with a trainer who understands diabetes, who might even live with diabetes, and who gets what it takes to get through a workout without wonky blood sugars?

Well, that trainer could be me!

Today, my 12-week fitness program “STRONGER”, that I developed for GlucoseZone, is available in the GlucoseZone app. I’d like to personally invite you to come train with me. To join me for a program that will push you to be a stronger version of yourself.

Sign up HERE and use the “STRONGER” code to get 30% off your monthly subscription

The beauty of joining GlucoseZone is that you’ll get access to not only my program but to 6 other exercise programs, as well as live workouts, all developed specifically for people living with diabetes. You can do all of the workouts in your own home or bring it to the gym.

Regardless of your fitness level, you can find qualified instructors to take you through the workouts that are right for you, and always with your diabetes in mind.

One of the reasons why I’m so excited about working with GlucoseZone is that it’s the first-ever clinically validated digital exercise therapeutic for people living with diabetes, and it’s endorsed by the American Diabetes Association.

Stronger Getting Started

Sign up HERE and use the “STRONGER” code to get 30% off the monthly retail (You’ll only pay $9.09 per month) when you sign up for the GlucoseZone app.

 

Connect with Christel on Facebook: @DiabetesStrong; Instagram: @diabetesstrong_ig.

Wearing a Diabetes Medical ID On-The-Go!

Medical ID Bracelets

Living life on-the-go can be fun and busy, however, doing so with a chronic illness requires a few extra steps and planning along the way.

 

Hi, my name is David and I have been living with Type 1 Diabetes for 10 years now. I was diagnosed at the age of 11 and let me tell you… I have been through a lot. In living with this disease, I have been able to experience so much and learn from my mistakes. In doing so, I have come to realize that as a diabetic, I am one of those who should wear a medical ID and why it’s important for all life’s experiences.

For years on end, I never wore a medical ID bracelet. I could never find a bracelet that I simply liked or wanted to wear daily. When I became a part of the Diabetic Online Community (DOC) back in 2014, I was exposed to several different people who shared the same struggle. I also saw a variety of amazing brands and companies who understand this struggle and have found ways to make ID bracelets, dog tags, necklaces, and more so much nicer and pleasing to the eye and the patient. I own several different medical ID bracelets, I think when one finds their style with Diabetes, it’s always nice to have options and create your own look, which is why owning multiple forms of emergency ID that go with different looks is a great idea!

I have mentioned several times on my Instagram, @type1livabetic, that when wearing my personalized Paracord bracelet from American Medical ID, I felt so very safe. I felt as though if anything Diabetes related could go wrong, I would be prepared. On my engraved bracelet, my name, condition, and emergency contact information were all located on a small piece of metal, attached to the Paracord bracelet. At a recent trip to Disneyland with a large group of people who also had Type 1 Diabetes that could vouch for me if there were to be an emergency, I still encountered times in which I was alone at the park (walking to and from my car, walking to meet the attendees, or simply stepping to the side to grab a snack), rest assured, I was confident with my Diabetes at the time.

So why is it so important to wear a form of medical alert jewelry for Diabetes? Well, not to get too dark or technical, however, the fact remains that we do have Type 1 Diabetes that does come with some symptoms and consequences. If our blood sugar drops significantly low, we could pass out and become unconscious or go into a coma. Same with high blood sugar, if we are severely high and go into DKA, we could in fact experience some symptoms that could limit our ability to function, which can prevent us from acting in the moment to get help. Say you were in public, alone, and you experienced one of these symptoms, if you were wearing a medical ID, someone nearby would mostly likely come to check for various hints or signs on you if something doesn’t look entirely right and search for an alert jewelry in particular sites on the body: wrists, around the neck, tattoos, etc.

In being diagnosed with any chronic disease and being told you have to take extra care of yourself can be a lot, however, allowing yourself some relief by wearing a form of ID can truly reduce a lot of the stress surrounded by various diseases. One should never leave the house without some form of ID as you never know when these emergencies could happen.

American Medical ID Healthy Packing List

The CDC includes having a form of medical identification such as alert bracelets, necklaces, or wallet cards as part of a healthy travel packing list.

I believe that some may also feel safe in knowing that they have a medical ID card in their wallet as well, for added peace of mind. One should also wear a form of ID at home, just in case. For those who live alone, I understand that it may feel as though you are not in need of wearing an ID at home as you will be alone, but that could just be the very tool that can keep you alive, say you have an emergency, it could be that neighbor walking by and seeing something isn’t right that could barge in and save your life and being able to identify you have a particular medical condition that needs attention.

We each have our own busy lives that takes up so much time and mental focus away from our health, which is why wearing medical alert jewelry can protect us as we are on the move, daily. School, work, the playground, a coffeeshop, wherever you may be, ID is necessary. No matter how old the patient is, whether a child, teen, adult, or elder, wearing a medical ID all the time can protect us from the dangers of our diseases and more.

 

Live well,

David

To End The Weekend In A Perfect Way

The human body is an incredible thing. Yes, it can fall apart and let you down, but it also holds amazing minds that dream up things like insulin and glucose pills that can save someone’s life and help you work around the parts of your body that can’t keep up anymore.

Weight isn’t everything — health is. I grew up battling an eating disorder and now that my focus is on health, and not weight, I feel much more connected to my body. It’s like meeting an old friend I haven’t talked to in a long time (and we have a lot to catch up on). Having to count, track and balance every bit of food or drink that goes in my body is definitely a trigger for me, but I’m getting to know what food makes my body healthy now.

It’s okay to be sad and let go.

There is no perfect health zone. There will be days when I can’t “beat” diabetes no matter what and there will be days when I need to treat myself and not focus on only eating things I know I can control well. Life needs little moments like that to stay sane and right now, the only path to staying happy I can see is one that embraces ups and downs and doesn’t try to turn them into a perfect straight road.

Last and most importantly: LIFE CHANGES. It is important to remember. Life looks and will not look the same even though we have a disease that will need the same type of treatment.

THE MORNING SUGAR: A Window into your Type One Management

I lie in bed with one eye open, ears still ringing from my poorly selected, overplayed alarm tone. I sit half hunched over my glucose monitor attempting the first blood-drop-to-test-strip co-ordination of the day. Its 05h30, I have fasted for 6 to 8 hours, it’s time to dive into diabetes. My test strip sucks up the drop of blood and counts down to my first glucose reading of the day:

BEEP: 4.6mmol/l (84)

OR

BEEP: 9.6mmol/l (173)

OR

BEEP 16.6mmol/l (299)

The good, the average and the ugly.
These are the 3 general ranges of readings that might greet me at the first finger prick of the day. It’s only one of the many sugar readings that lie ahead, but it is a special one to pay attention to, as your morning glucose reading can provide important insight into your diabetes control.

A fasted reading has a myriad of information which you can choose to ignore, or preferably dissect and investigate for optimum diabetes control. I believe it is vital to ask myself why? Why is my blood glucose this level and what were my preceding actions?

I will take you through my 3 ranges and my general approach to morning sugar readings and how I personally troubleshoot these readings. We each tackle diabetes differently, but hopefully the following brings some insight into your morning sugars or encourages you think critically of those interesting rise and shine numbers!

The “Gem”
My personal values are 3.8-5.6mmol/l

Oh this is a sweet, gem of a reading. It’s the real “roll out of bed on the right side” number.
Perfectly in range, it is still important to acknowledge the formula that achieved this number. We could all do with a little positive reinforcement and mindfully recognize and enjoy our diabetes successes! I always ask myself, “What did I do well?”

This sugar reading generally informs me that I have correctly dosed my long acting insulin as it did not bring me into the clutch of hypoglycaemia when fasting during my sleep. It was also sufficient to meet the cascade of morning hormones such as cortisol and hyperglycaemia it brings along with it. This sugar happily greets me when I don’t snack after dinner and I eat around 3 hours before bed-time. This plan allows for an honest, stable blood sugar reading before bed where my injected insulin has already peaked in activity, and I can expect predictable glucose readings as I sleep.

The “Meh”
My personal values are 6-9mmol/l

It’s a sugar range that is higher than I would like for a fasting blood glucose level, but it’s not remotely the end of the world. To solve this morning glucose and to prevent it creeping higher, I have my insulin dosage for my breakfast plus a dash more insulin to correct. I wait 20-30 minutes for my insulin to start working and bring my glucose down before having my breakfast. I ask my “why?” and make a mental note of how I could improve and act accordingly. If went to bed with a great blood glucose level and I woke up high, it could be various things:

1. Insufficient long-acting insulin: The Dawn phenomenon

When I have my continuous glucose monitor (CGM), the Dexcom, attached, this will be displayed as a nice steady graph with readings in glucose range for the first 2/3rds of sleep, only to find in the few hours before waking my blood glucose slowly and steadily increases. This is due to the get-up-and-go hormones that pump through your body to prepare you for waking and tackling the day. These sneaky buggers include growth hormones, cortisol, glucagon and epinephrine and they increase your insulin resistance, causing blood sugar to rise.

2. Too much insulin: The Somogyi effect

This is an interesting stress response of your body, a rebound effect of low blood glucose while sleeping. If you have too much insulin, long acting or short acting, and you experience a low while sleeping your body mounts a survival response and encourages your body to release sugar back into your blood via adrenaline and cortisol. This low may not be rapid or severe enough to cause a seizure, but sufficient to mount a physiological survival response from your body.

3. Not enough short-acting insulin

This is usually prompted by snacking before bed and eating late. My stomach is still full and has not emptied. My blood sugar will be in range when I get to sleep, but as my tummy works to digest my food, sugar trickles into my blood which I thought I had sufficiently covered by my short-acting. This especially occurs if I eat meals that have a carbohydrate, protein and high fat content. It has even been dubbed “The Pizza Effect”, where fats and protein delay the absorption of carbohydrates from a meal. The most challenging part is that you don’t know when the carbohydrates are going to be dumped into your bloodstream as sugar. It could be more than 5 hours until you feel the true effect of your meal. This could also be a reason for a really high morning blood glucose reading, the one where you would rather turn over and head back to sleep, which brings me to my final morning range, which I like to call the “Lie in Bed for a Few Minutes in Denial”.

The “Lie in Bed for a Few Minutes in Denial”
My personal values are anything double digit

The “Man, I messed up” feels. I most likely did not give myself enough insulin for the previous night’s meal, or I ate complete rubbish, did a massive carbohydrate count guestimate (that’s right folks- guess and estimate can really be combined into one perfect word), it could be “the pizza effect”, or I forgot my long acting insulin.

The alternative explanation is that I woke up with low in the middle of the night and quite passionately, dove into my bedside glucose stash, bathed myself in sugar before falling back asleep in a pile a sweet wrappers. (Yes, I have awoken with gummy sweets melted into my back and bed sheet).

If my sugars are really bad in the morning, there is usually a pretty grand, blatantly obvious reason as to why they are absolutely deranged. I find myself glancing in the mirror, at my poor, hard-done-by face to ask myself why? My expression smirks, “Oh girl, you know why. You know.”

This is where the power of the mind can transform your day. You can switch to victim. You can choose guilt and actively bring yourself down. You can choose to let a number on a plastic monitor define your day or you can free yourself from mental binds, for you are capable, you are strong and you are going to tackle the day.

My go-to plan of action:

1. Massive bottle of water with loads of top ups
2. Small simple, low sugar breakfast (I find waiting for my sugars to come down before eating leaves me more frantic and stressed)
3. More water
4. Add Insulin
Tip: Don’t give yourself 70000 units because you are panicking and desperately want your sugar to go down as quickly as possible (TRACY SANDERS I am talking to you girl). A resultant severe hypoglycaemia does not make it easier to improve the day.
5. Forgive yourself, give thanks to your body for all the other goodness it brings to you and power forward.

Transform your WHY’s into WISE, pay attention to each nugget of information your body and glucometer communicates to you. By building up an understanding of your sugars, you build a stronger relationship with your body and mind. Work closely with your support network, endocrinologist and diabetes educator to make the correct adjustments to suite your body, always ask questions and challenge your knowledge and experience of type one.

Real Talk with Dave: The Lifesavers of Type 1 Diabetes

Over time, there have been several breakthroughs in medical technology that have made living with Type 1 Diabetes almost a breeze! From Insulin Pumps to Continuous Glucose Monitors (CGMs), these devices have made the battle of blood sugar regulation so much more bearable and practical in living life on the go. We’ve all seen them and most of us even own these devices, but I’m pretty sure we can all agree that they have made living with Type 1 way less stressful. Going to school, work, and even on vacations just got a whole lot easier!

When the idea first comes to a newly diagnosed patient about getting an Insulin Pump, for example, it may seem scary to have a device attached to them 24/7, but give it a week or two and most of the time, people sure fall in love with them. I can’t express how much I love wearing a Pump and Dexcom sensor, they have made my crazy schedule as a student so much more manageable than before when I used to take Insulin injections before every meal and having to rely on finger sticks alone, not knowing which direction my blood sugars were actually going in. They have definitely given me peace of mind in which I no longer have to worry about going low or high in class, at work, or even as I’m driving around town, as I am always in the know of what is going on with my blood sugars thanks to my CGM. If I go out to eat with friends, for example, it has become very convenient to quickly enter in how many carbs I’m eating into my Pump and I let the insulin drip in me as I enjoy quality time with some very special people.

There is always the fear of a Pump site ripping out or having it scrubbed off in the shower, but no need to worry, these sites we wear are just like bandaids (that give Insulin and monitor blood sugars!), so if they do come off, the pain is usually little and is very easy to re-apply a new site! I can remember countless times in which I have had sites come loose in the pool or shower, ripped off for no apparent reason, and even once I was playing with my dog and he accidentally knocked my Dexcom right off my arm (no worries, Comet!), but it just takes a few little incidences like these to help prepare us for the worst. Now a days, there are so many different medical tapes and glues that can help keep our sites on for the 3-7 days of wearing them. There are now a variety of companies, such as @PumpPeelz and @GrifGrips, who are aware of the struggles of keeping our sites on, that they have created fun patches with some really cool designs, allowing us Diabetics to show our style and decorate Diabetes!

In all seriousness, however, Diabetes is a full time job that requires around-the-clock care and attention, so having these so called “lifesavers” is so convenient and helpful to us in the long run as they assist us in living our best life with T1D. They can be the very devices we need to help us in an emergency of knowing what our blood sugars are and giving ourselves Insulin if needed. Diabetes is tough, but with these incredible medical breakthroughs that we’ve all been blessed with, the game of Type 1 Diabetes has been changed for the better and has allowed us to keep on fighting! Not only have they helped us, the Diabetics, but they have also helped parents, teachers, roommates, etc. as they too are given the peace of mind that we are just fine, as T1D can be a mess sometimes, thankfully though, we have these devices to help us all out!

So go ahead, live your best life and don’t look back, unless you forgot your Insulin Pump or CGM, then you should definitely look back and go get them!

Live well,

Dave

The Problem With Diabetes Education in Brazil

I’m here to talk about the Diabetes educational problems in Brazil. We have a lot!

For starters, if you have the money or good contacts, you are safe because you’re going to have the best doctors ever and they’ll tell you everything new that comes up about Diabetes treatment. But, if you don’t, I’m sorry to say but you are completely alone in this journey.

 

We know that there are more poor people than rich people in every country, and here in Brazil, it’s the same. Those who depend on a public health system tend to have a hard time to get good treatment, or getting updated on new thing happening around the world. We also don’t have enough qualified doctors in the public health system. Sometimes a cardiologist will even treat you and diagnose you with Diabetes!

We also don’t have enough qualified doctors in the public health system. Sometimes a cardiologist will even treat you and diagnose you with Diabetes!

I also need to talk about the horrible insulins that are given here. We still use NPH and regular insulin (old insulins). We’ve recently won the right to receive on SUS (public health system) better insulins, but who knows when they’ll start the distribution. As the public health system doctors don’t know much about Diabetes, they cannot give the support that Type 1 diabetics really need, and I frequently see T1Ds being diagnosed by mistake as T2D. This is very serious.

 

Did you know only 10% of T1Ds in Brazil have an hb1ac below 7? And those who live with an hv1ac higher than 7 think that Diabetes is a monster and that it is ok to have complications! Did they ever read about the DCCT study? I don’t think so.

I don’t even need to talk about knowledge in insulin pumps, right? Only 4% of diabetics in Brazil use this type of treatment here. Most of them don’t even know that it exists!

 

If we want better treatments we need to search on the web, or ask the best (usually most expensive) doctors for information. For example, here in Brazil we can ask for a better insulin and even for an insulin pump with CGM in a lawsuit against the government. We just need to prove that we can’t afford it. And we receive all the supplies monthly. Not everyone knows about this, but they SHOULD.

 

My work at Biabética is to give this kind of information to those who don’t have it. I talk about new treatments, what to eat in case of a hypoglycemia, what to do if an infusion site is bent, etc. I share my life with diabetes and my knowledge (everything my doctor taught me) with love. My goal is to get at least 50% of the population diagnosed with T1D in Brazil to use an insulin pump.

 

I hope things get better for us, Brazilians, soon!

Real Talk With Dave: Surviving Summer and Type 1, with all the Highs and Lows

Summer time is a fun time when we all kick back and relax. Some go to the beach, chill by the pool, or go on a tropical vacation. Though as a Diabetic, there is one thing that interrupts you having the time of your life in the summertime, and that is this (not so) little thing called Diabetes. Type 1 Diabetes should not stop you from having a blast this summer and neither should it restrict the types of activities you do and places you go. Though there are some things to look out for so you can have the best summer ever, no matter what!

First? Insulin. Being the number one thing that you actually need as a Diabetic, it has to be cared for like no other. If your Insulin is sitting around in the blazing sun, it will go bad and will no longer be safe or effective for use, so always keep your Insulin in a cool setting such as a refrigerator or in a cooling pack. Same goes for your blood glucometer and insulin pump, as if they get too hot, they will not work until they cool down a bit. I would highly recommend having a backup blood sugar meter and a set of syringes, along with a vial of insulin, just in case your pump and meter overheat. When I was first diagnosed with Type 1, I remember how during the hot summer months, my blood glucometer would overheat, so I would stick it in the fridge to cool down faster, as funny as that may have seemed.

Always keep your Insulin in a cool setting such as a refrigerator or in a cooling pack

I have had days when I was out all day by the pool and left my pump on the side of the pool, which apparently made the insulin cartridge become warm, so when I went to take my insulin I found my blood sugars going high due to the insulin going bad in the heat. It’s all a learning process in which you have to go through some tough experiences (like your blood sugar going high or your meter breaking down) to learn how to plan for the worst.

As for blood sugar regulation, when the weather outside is blazing hot, that tends to make your blood sugar go high and stay that way until you cool down. My advice, based on personal experiences, is to stay cool and in the shade as much as possible. Always keep an eye out on your blood sugars as the day goes by just to make sure they are in range. Most importantly, drink plenty of water. I cannot stress enough how helpful water is on a hot summer day. If you do tend to go higher in the summertime, as everybody reacts differently, try these tips and tricks to avoid annoying Diabetic issues and spend more time out by the pool or chilling at the beach!

Going on a tropical getaway can also be fun and exciting, but remember to have a checklist of all the Diabetic supplies you’ll need to avoid any problems. It wouldn’t hurt to take extra supplies as well, just in case. Once, a few years back, my family and I took an amazing trip to Hawaii and I remember being so excited! However, the beginning of that trip was not fun at all as I had forgotten my Insulin back at home in California. Luckily, I had just changed my pump site the night before our flight and filled the vial of Insulin, which lasted me three days so I wasn’t completely out of Insulin.

It was a very stressful situation though. I was feeling like I failed myself and ruined the trip. Thanks to my amazing parents, who did everything they could to get me my insulin, there was a new order ready for pickup at the pharmacy in Hawaii as soon as we landed. Once I was reunited with some fresh Insulin, I truly was in paradise! Like I said, we need experiences like this to go through and learn from so that we can know how to handle practically any situation life may throw at us. Since that trip, I learned to NEVER forget my insulin at home and to always put that as number one on my list for all my Diabetic travel supplies.

So remember to stay cool, stay hydrated, and stay prepared to take on this hot summer! Enjoy it to the fullest and do what you love! Swim, surf, travel, you name it, because even with T1D, you can do literally anything you put your mind to!

Live well,

Dave

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