Not All It’s Cracked Up To Be…

I would be lying if I said that this isn’t the definitive time to be alive with Type-1 Diabetes. Treatment options, medications and education that definitely weren’t there even 50 years ago are a Godsend and reinforce the possibility that the lifespan of someone with condition is much more assured than it used to be.

Prior to the creation of insulin, the average person with type-1 Diabetes would typically die after 7 to 10 days, usually due to complications such as ketoacidosis. But despite all the benefits and available resources (which are not necessarily available to everyone, FYI), there are still significant difficulties that come with living with T1D. If I had a dollar for every person who told me how lucky I am to have an insulin pump, I could likely retire.

And while they’re quite right about how lucky I am, most non-Diabetics don’t realize the amount of work and effort required in order to maintain our health, despite all these benefits. Because I’ll tell you right now, even the best technology is NOT all it’s cracked up to be!

Let’s take the overnight odyssey I suffered last Monday as an example. Last Monday was a pretty typical day for me; work and errands in the morning, time with my son in the afternoon and some television and R&R during the evening before bed. I used Monday as a rest day, since I foolishly did a marine workout on Sunday evening that pretty much slaughtered my legs.

We had dinner, and as is often the case I miscalculated and boluses too much for the amount of food I ate. The end result was a low, which I treated but overcompensated. What followed was to be a night of sweats, nausea and lack of sleep…

Here’s the logbook entries for the end of Monday night, as taken from my Freestyle Libre. My family and I had dinner around 5 p.m., which would explain why my slightly elevated blood sugars started to go down within the next hour. At 6:38, I realized my blood was starting to drop. I retreated to me basement office, where I indulged in a handful of fast-acting carbs.

Usually, it works like a charm so I gave it time and thought nothing further of it. About forty minutes later, I checked my levels again, only to realize that I was sitting at 3.8! It had tapered off, sure, but it was still too low to safely sit at. So I suspended my pump and wolfed down more fast-acting carbs, uncertain of how much insulin beyond what was required I may have coursing through my system.

At 9 p.m. we were getting ready to crash for the night, so I checked my levels again and realized that I overcompensated and was now at 14.2, with the indicator arrow telling me that I was still climbing. I bolused accordingly and hit the sack, confident that my pump would bring my levels under control. I mean, why wouldn’t it? That’s what it’s for, right? Unfortunately, as convenient and effective as my pump may be, it’s still a mindless machine and requires direct human intervention to function. Adding to the fact that it’s prone to malfunction like any other piece of technology, it can make proper balance of blood sugars rather challenging.

Less than an hour later, I hadn’t fallen asleep yet so I checked again. I had continued to climb to 15.2, but the indicator arrow showed that I was levelling off and I still had a lot of insulin on board, so I went to sleep confident that it would be fine. It would NOT be fine… I woke up just before midnight, feeling flush and nauseous and checked my blood sugars again. I was sitting at 14.2, which was odd considering how much I’d bolused. Concerned I may overdo it and slip in the other direction, I nevertheless instructed my pump to bolus in order to correct. The pump indicated I still had too much insulin in my system and did not provide any further. Fair enough, machine! Take the wheel, I’m going back to sleep!

I tossed and turned for a few hours and may have slipped in and out, but I didn’t really get much sleep. I was awoken by the violent spasming of my pump and checked the alert, which indicated the worst message a pump user can see: “NO DELIVERY”. What the hell? I resumed my pump’s normal function and checked my blood, to see that I was still sitting in the high 14’s. I requested a bolus to correct. The pump began to comply.

Then, 2 units into the bolus, the pump vibrated once more and still provided the message “NO DELIVERY”. I wasn’t due to change out my set until the day after, and I still had a LOT of insulin in the pump. I made several attempts to get the pump to comply. After three attempts at trying to get insulin into my system, I finally surrendered and took a manual injection, the old fashioned way.

I performed a “FILL CANNULA” to see if insulin would drip freely from the infusion set, which it did. I reset the pump to continue with its normal basal rate and tried to get back to sleep. I tossed and turned, washed some Netflix on my iPad and got up for the dreaded Diabetic cycle of drink, pee and repeat. I may have snoozed off and on from sheer exhaustion, but I awoke at 8 a.m. and found my blood sugar to be sitting at 19.8! In the interest of preventing further complications and despite the waste of insulin and pump resources, I completely changed out my pump assembly and started a new infusion set.

I spent the next 8 hours (yes, you read that right) working on getting my blood sugars back down to a normal level. I was exhausted, parched and felt like absolute shit. I did a workout on Monday evening despite my fatigue, in order to help get myself balanced. The big problem is that I have no idea what caused the pump to stop delivering insulin, whether is may have been a bad site or bent cannula… who knows?

This simply goes to show that no matter the advancements, no technology is perfect and no two days for a T1D are ever the same. The challenges, issues and complications continue to pile up, even when one does everything as properly as they can. I’m hoping that my new pump system will help lessen and alleviate some of the issues, but until a cure is found, Diabetes is still a full time job. ☯

Stick To Your Guns, And Don’t Be Afraid To Pull The Trigger

Having been diagnosed as Type-1 Diabetic at quite a young age (4 years old, to be precise), I’ve had just about every type of doctor imaginable. I’ve had the detached cynics, who see their patients but are just trying to scrape past the retirement line. I’ve had the eternal optimists, who seem to go out of their way to have you call them by first name and focus on being a friend more than a doctor. I’ve also seen the medical dominatrix types, who basically make you feel like shit and a failure if your last A1C isn’t absolutely spot on. So from a patient standpoint, I’ve pretty much seen it all, Diabetes or not.

There has been a silent tipping of the scales taking place over the past twenty years. It’s been subtle and if you haven’t been paying attention, it’s snuck up on you without notice. I don’t need to tell anybody that waiting to see a medical professional can be excruciatingly frustrating. Increased wait times, doctor availability and sometimes feeling as though you’re being ignored and rushed out the door can all lead to bad experiences and scare you off from going to a doctor, even when you need one.

This tipping of the scale basically involves the internet. I’ve never hidden the fact that the internet and I share a rather love/hate relationship. I admit that I absolutely love the internet for the purposes of education and research, but I loath the effect that social media and the unnecessary propagation of disinformation has damaged our society. But I would be lying if I said that the internet hasn’t been a thorn in the side of most medical professionals. Most doctors absolutely hate “Dr. Google”. And why is that? Wouldn’t it make sense that a doctor would want to get all the help they can to ensure the best diagnosis? Apparently not. And there are reasons behind that.

First of all, unless you ARE a trained diagnostician, you can do more harm than good by going online to seek out the cause of your symptoms. Especially if your symptoms are vague. For example, having frequent headaches does not necessarily mean you’re having migraines. Online symptom checkers can be a real pain in the ass for doctors, especially if you arrive and “challenge” your doctor with a half dozen possible diagnoses that you’ve found online.

According to an article posted on Forbes.com by Robert Glatter, MD, a study was performed four years ago that compared the results of online symptom checking when compared to visiting an actual doctor. He wrote, “When doctors in the study were armed with patients’ medical history and symptoms, and then compared the information entered into a symptom checker, doctors arrived at the correct diagnosis 72% of the time, as opposed to 34% for the apps.”

I don’t know about you, but 72% accuracy doesn’t make me feel all that comfortable when confronted with a possible illness that could be treated by way of medications or other treatments. But it’s a hell of an improvement over the 32% that you would get from using an app. The article goes on to say, “And 84% of the time, doctors provided the correct diagnosis in their top three choices, compared with only 51% for the symptom checkers.”

Here’s the online article, if you wanna give it a read. It’s pretty interesting: (https://www.forbes.com/sites/robertglatter/2016/10/13/doctors-beat-online-symptom-checkers-new-study-finds/#246af81e2d44)

The take-home lesson here is if you want to go on a reputable, peer-reviewed medical site such as WebMD or the Mayo Clinic to look something up, such as Diabetes… What is it? What causes it? Can it be prevented? Etc… That’s fine! The problem is if you go online to find out why your legs might be turning blue and assume you have deep vein thrombosis, when all you did was fail to properly wash your new jeans before wearing them for the first time. This is where doctors and health professionals get pissed and frustrated.

The other side of the coin is no brighter. Because of people’s tendencies to look symptoms up on the internet before consulting their doctor, many medical professionals have started shirking or ignoring what their patients may bring up upon arrival. Don’t even get me started on a doctor’s reaction if you utter the words, “I looked up” or “I read online that…” That’s a surefire way to start a verbal battle of wills. Most medical clinics have extended wait times and many medical professionals have even started limiting the number of things that a patient can bring up during any one visit.

In some respects, it’s rather hard to blame them. The average doctor spends well over a decade of study and training to actually BECOME a doctor. So if you walk in and presume to have diagnosed your problem already by spending two minutes on Google, it only makes sense that they may be offended and dismiss your thoughts.

The best approach would be to ask your doctor questions. Don’t necessarily bring up your online search, but feel free to ask your doctor if what you found is possible and why he or she believes that it’s not. This keeps you involved in the diagnosis process and doesn’t make the doctor feel offended or as though you’re trying to tell them their job. If you feel as though your concerns are being ignored, then say so. And be certain to exercise your right to a second opinion if you aren’t comfortable with what’s being done to help you.

When I was a kid, I literally never waited more than 15 minutes to see my doctor. Once in, I’d be greeted with a handshake and we’d talk about how my Diabetes was doing, how I was managing with my current medications and what life and family issues may be affecting all of it. Nowadays, seeing my personal physician includes well over an hour’s wait, followed by a five minute visit that usually doesn’t even involve reviewing my most recent blood results or Diabetic issues. Times have changed.

As the world continues to turn, we all have a tendency to turn towards the World Wide Web for answers. After all, we have the world’s knowledge at our fingertips. And although all the information required to become a doctor may be available on the internet, it doesn’t mean you have the skills or knowledge to use it. As far as doctors go, they could probably stand to lighten up a touch and be willing to listen more. Because as time passes, the growing trend of doctors using online resources is increasing, as well. Food for thought… ☯

The Whole World’s Goin’ Crazy…🎶

Sometimes I try to avoid being mainstream as much as possible. It’s not that I’m anti-social, per se. I’m more of what I call “socially independent”. Be that as it may, my wife and I don’t have cable. We don’t subscribe to the news or social media and we tend to be somewhat disconnected from mainstream issues that surround us. My wife is pretty good at keeping me in the loop by following certain discussion groups. Otherwise, I learn everything as I go along through pure research. This usually involves subjects related to this blog: Diabetes, Buddhism, Martial Arts and Health & Fitness.

Despite everything I’ve just explained, it’s time for me to jump on the proverbial band-wagon and talk about the latest pandemic that seems to be on everyone’s mind and involves absolutely every aspect of current society. I’m talking about the Coronavirus Disease 2019, better known as COVID-19.

So what the hell is this nasty bug? According to a page on Diabetes.ca, “Coronavirus (COVID-19) is a respiratory infection that causes patients to develop mild to severe symptoms including a cough, fever, and difficulty breathing. Symptoms may take up to 14 days to appear after exposure to COVID-19.” Because it so closely resembles generic symptoms that a person can get with the common cold, some people who have been infected may not even recognize that they’ve been exposed until they’ve exposed a bunch of other people through their work, schools and public places.

Why is this so important? Well, I don’t think I need to bring up the ridiculous issues surrounding the selling out of toilet paper or hand sanitizer from practically every available outlet in Canada and the U.S. Most people of common sense are of the opinion that you should be able to find plenty of alternatives to wipe your backside, so why aren’t more people focusing on food and medications in order to get through their quarantines? We went grocery shopping this morning and I noted that the shelves in the paper aisles were essentially empty. But I digress…

According to the Government of Canada Website (https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19.html), there 324 confirmed cases of COVID-19 in Canada as of 9 a.m. this morning with another 17 probable cases that have yet to be confirmed. It’s not an “out there” problem; it’s very much real and present in Canada.

For folks with Type-1 Diabetes, COVID-19 poses a particular threat. According to that same post by Diabetes.ca, “Since Diabetes is a chronic disease, questions and concerns about the impact of COVID-19 is understandable. People living with Diabetes, especially those with poor glycemic control have an increased risk for infections. It is for that reason that vaccinations are recommended when available.” (https://www.diabetes.ca/media-room/news/novel-coronavirus-(covid-19)-and-diabetes–what-you-should-know)

There is currently no vaccine for COVID-19, but this is why it’s SO important for people with Diabetes to eat well, exercise and check their blood sugars often throughout the day. The better control you maintain on your condition, the better the chance that you’ll keep your system strong. I may sound like a broken record with how many times I’ve repeated this holy trifecta, but it seriously eliminates and/or reduces so many issues and complications associated with Diabetes. And COVID-19 is no exception. No, it doesn’t mean you won’t get infected if exposed, it may simply help to prevent it.

You can check the CDC website, Government of Canada website and Diabetes.ca, but the general guidelines for prevention of the infection are pretty standardized:

  • Wash your hands often, with hot water and soap. This should be done before and after eating, after any visit to the washroom and if you’ve shaken hands or had contact with members of the general public;
  • Don’t travel abroad. Let me say that again: DON’T TRAVEL ABROAD!!! This whole mess might have been better contained had people listened from the beginning and didn’t travel internationally. Preventing the spread of the virus is quite a bit more important than making your yearly trip to fuckin’ Cancun or travelling to another country to film a movie. It’s simply not worth the risk;
  • Sneeze or cough into your elbow (which people should have been doing prior to this anyway) and try to avoid touching your face any more than necessary;
  • Be prepared. Make certain you have an adequate supply of insulin and medications to get you through a 14-day quarantine if necessary, and enough food and supplies for the household in general. This doesn’t mean buying out the toilet paper aisle or panic-shopping, but buying a little extra in order to be prepared is not a bad thing (whether there’s a pandemic or not).

Since being sick affects someone with Diabetes, be sure to contact your medical practitioner if you become ill and symptoms become aggravated or worse over the course of a week. If you believe you’ve been exposed to COVID-19, the Government of Canada website has guidelines to follow and you should phone your doctor BEFORE going into any offices in order to obtain pertinent instructions.

Far be it from me to make light of the situation, but hopefully people will shake off the panic in the short days to come. So far, COVID-19 has not been shown to be lethal to strong, healthy individuals. We just need to nip this thing in the bud. Considering that since the turn of the century, we’ve had to deal with SARS, H1N1, outbreaks of ebola and cholera as well as the resurgence of polio (thanks to anti-vaxxers), this too shall pass!

As long as the proper preventative steps are taken and protocols are followed, this WILL pass in time. And then everyone can get back to buying their bathroom tissue at a normal rate, twelve rolls at a time. ☯

Summer Bod, Bring It On!

One of the biggest struggles for folks with Type-1 Diabetes is weight loss. People who don’t have Diabetes have qa rough go of it as it is, but when you throw Diabetes in the mix, it becomes all the more difficult.

One of the reasons behind this is insulin therapy. Believe it or not, constant insulin injections may lead to weight gain. According to an article posted by MedicalNewsToday.com, “Eating more calories than the body needs will lead to excess glucose levels. If the cells do not remove glucose from the blood, the body will store it in the tissues as fat. When a person takes insulin as a therapy for Diabetes, their body may absorb too much glucose from food, resulting in weight gain.” (https://www.medicalnewstoday.com/articles/325328#link-between-insulin-and-weight)

Realistically speaking, there are a number of things that can be done to help trim you down for the coming summer months. First and foremost, we need to agree that weight loss requires a combination of exercise AND diet. If all you do is binge on every fad diet that floats by, you may see some immediate results but it likely won’t stick. If you work out consistently but eat like a living trash can, you’ll still start chugging out.

Before you blow the dust off of your cut-off jean shorts, try doing some of the following:

  1. Exercise 3 to 5 Times A Week: This one should be pretty obvious, since I mentioned it earlier. But physical activity is important, whether you have Diabetes or not. A workout doesn’t have to be an all-encompassing activity that takes hours. Even 20 or 30 minutes of activity that leads to an increased heart rate will be beneficial;
  2. Quit Snacking: Most people have a compulsion to snack. When you’re sitting at home, watching a show or a movie, we generally tend to want something to munch on. Although one can find some healthier alternatives to snack on (granted, you won’t catch me eating celery sticks while watching Avengers: Endgame), limiting or eliminating snacks is even more ideal. Salty or high-sodium snacks may cause you to retain water and/or gain weight;
  3. Drink Plenty of Fluids: Many times, we eat out of habit and not necessarily out of hunger. Dehydration can be another problem, as it can cause a person to feel the same sensation as hunger. Stay away from sodas and sugared juices and stick to water and herbal tea; and
  4. Embrace Your Technology: I use a water drinking app (My Water), a fitness app (Runkeeper) and a workout designer app (Seconds Pro). These things can be helpful in helping to keep you on track. Runkeeper has GPS tracking that allows you to measure your time, distance and average speed, all while tapping into your music playlist. Seconds Pro allows you to design your own circuit, HIIT, Tabada and interval workouts. You can program it to use the music on your phone and set whatever times and periods are required. All three of these are free of charge, with the option of upgrading to pro versions that have additional features (I’ve upgraded My Water and Seconds Pro).

Keep in mind that eating well and also meal planning are much easier than it probably sounds. Frozen vegetables have proven to be just as healthy and beneficial as fresh ones, and can be way easier as they won’t spoil. Black coffee is also a big plus, since it contains zero calories and can give you the caffeine boost required for that workout.

No matter what route you take or what methods you use, the biggest thing is to give it time. If you expect to see results within a week or two, you’ll be greatly disappointed. In fact, IF you see results in as shirt a time as a week, you should probably consult a medical practitioner. Every individual person is different and what works for one person may not work for you. ☯

Presenting, The Medtronic 670G

As I mentioned in an earlier post, I received an important package via FedEx on Monday: my Medtronic 670G insulin pump kit. For any non-Diabetics who may not be in the know, an insulin pump is a prescribed, electronic device that holds insulin and delivers it automatically based on your requirements and how many carbohydrates you consume.

There are a number of different brands, models and types, depending on what you’re looking for. Some are pretty straightforward and simply delivers the insulin based on simple calculation. Others have an additional feature called CGM, or Continuous Glucose Monitoring. This allows the user to have their pump track their blood sugar trends on a minute-to-minute basis and the pump makes adjustments accordingly.

My package of supplies, like opening gifts at Christmas!

There are many benefits to this new pump system. The included CGM system checks interstitial blood sugars every five minutes and makes adjustments accordingly. According to new math, that’s 288 time a day! Even with the FreeStyle Libre, I still can’t test that frequently. This allows for better overall control and time in range. The pump has the ability to automatically deliver insulin if your blood sugars are starting to rise, and can halt the delivery of insulin should they begin to drop.

The pump is said to be waterproof up to 12 feet of depth, although the manufacturers still recommend removing it before swimming. The pump uses fast-acting insulin (in my case, Humalog) and eliminates the need for long-acting insulin, acting much more like the pancreas would.

My old MiniMed on the left compared to my new 670G on the right.

Although it’s hard to tell from the photo, the new pump is all shiny and it feels like opening up a new smart phone. There’s a backlit LED screen and a belt clip that attaches directly to the pump as opposed to simply clipping onto the body of the pump.

I have a lot of “homework” to do before I can begin reaping the benefits of this device. There are a number of manuals to read through, some online videos and learning to complete and then I have two sessions with a certified pump trainer before going on automatic mode and letting the pump take control. However, considering this pump has been out for a number of years in the U.S., it’s well known for helping you to maintain an increased amount of time “in range”. I’m looking forward to taking full advantage of this system in the weeks to come. ☯

You’re Not An Exhaust Pipe, Quit Venting!

There is suffering in the world. More than we often choose to acknowledge or discuss, but some of this suffering comes at a personal cost and in our personal lives. Because of this, we are usually want to complain. After all, most people feel it’s easier to complain or “vent” then it is to spread positivity.

Depending on what school of thought you adhere to, venting can be beneficial. It allows you to get things “off your chest”, which in turn is meant to make you feel better. Normally, this can be a good practice as long as it doesn’t become your modus operandi. If you make complaining your normal habit, it can also have a number of detrimental effects on you and the people you’re complaining to.

First and foremost, long term complaining can lead to quite a few physiological problems. Increased stress, increased cortisol levels, lack of sleep and weight gain can all be long-term effects of constant complaining. Not to mention that if you’re a constant source of negative, verbal diarrhea, you’ll start to notice your friends, acquaintances and family start to avoid you or make excuses not to be in touch with you. Couple that with the psychological effects of constant negativity, and you’ve got yourself some real problems.

I was reading an article posted by Inc.com that covers the topic of complaining too much. I was entertained by what Dr. Jeffrey Lohr, a psychologist who studied venting, mentioned in the article, “People don’t break wind in elevators more than they have to. Venting anger is… similar to emotional farting in an closed area. It sounds like a good idea, but it’s dead wrong.” Funny and entertaining, but he makes a good point.

The article goes on to explain that our brains are wired in such a way that the more we express negative thoughts, the easier it becomes to do so. More than that, it becomes habit. Further to that, it has the same effect on people who are around you while you vent. Here’s the article: https://www.inc.com/jessica-stillman/complaining-rewires-your-brain-for-negativity-science-says.html

I’m still of the firm belief that the occasional venting is important. Sometimes, you just need to get things off your chest. The important thing to remember is that the recipient of your venting should understand what’s happening and why. And even if they’re a trusted family, spouse or friend, it shouldn’t be a constant thing. Otherwise, you could find yourself becoming the subject of THEIR venting as opposed to the recipient of yours. ☯

Fido Needs His Insulin

Anyone who has done even a minute amount of research into the history of Diabetes is aware that insulin was first discovered in 1921. What some, if not most people are not aware, is that it was first used on a dog called Marjorie in that same year. Marjorie had been diagnosed with Diabetes and had her pancreas removed. It was found that she could survive by receiving daily insulin injections. This discovery led to it being administered to the first human recipient in January of 1922. The rest is history.

Not Marjorie. Just a happy pooch!

There are many animals that can contract Diabetes. For the most part, the reason behind their getting it is similar if not identical to how humans get it. These animals include, but are not limited to dogs, cats, apes, pigs, horses, the occasional cow and some rodents.

For the more “popular” household pets, such as dogs or cats, a diagnoses of Diabetes can mean many of the same effects and complications as a human who has Diabetes. Organ and vision problems, obesity and circulatory issues are prominent in pets with Diabetes. For this reason, it’s important to maintain a good exercise regiment for your pets and feed them a veterinary-approved food that will help control their weight and blood glucose levels.

Administering insulin to your pet can be difficult and even intimidating. But once you’ve gained the knack for it, your pet will certainly be appreciative (Unless it’s a cat! They’ll make your life a living hell for the audacity of giving them an injection) Your pet’s vet should be prescribing the insulin that will best suit your pet and provide instruction on its proper administration. That being said, there are tons of instructional videos online that will show you how.

The interesting challenge when dealing with Diabetes in pets, is that they are mostly unable to explain what symptoms they may be feeling or what may be ailing them. This is why it’s important to learn and recognize some of the physical signs that things may not be going well for your pet and how to deal with them.

For most households, their pet is part of the family. So while the treatment of Diabetes and the administering of insulin in pets may seem daunting, one needs to consider that you would do no less for one of your children. Educate yourself, obtain the necessary medications and learn how to provide for your pet. Even though they may not be able to express it verbally, you can believe that they’ll be grateful. 🐶