The Aquarium Story

After spending the first part of the summer teaching a class, I was more than ready to take a vacation starting in mid-July. The plan was to spend four days visiting Chicago and my brother, who lives in the greater Chicagoland area. Then we would head to central Illinois to visit my husband’s family for a couple of days, and then head for home. We were supposed to leave on Monday the 22nd and return on Monday the 29th.

The morning of the 22nd, I got up early to finish packing and then woke up both girls. Morning blood sugar check for my daughter was low (in the 60s). She ate a package of fruit chewies, and we were off to do last minute errands, including picking up breakfast at McDonalds. Once we arrived back home, the girls started eating breakfast, while I finished packing the van.

At some point, I noticed my younger daughter (the one with diabetes) hadn’t touched her breakfast because she had a stomachache. I had her sip a little of her Diet Coke, and then go lie down for a little while. This didn’t help and she ended up getting sick about 20 minutes later.

Now I’m wondering if this is an isolated thing, or if we are starting a sick day. The answer came about 30 minutes later – it was a sick day, and our vacation was postponed. All of us were disappointed to delay our vacation, but I managed to rearrange our trip for later in the week. She ended up getting sick three times, but was feeling better by early afternoon. Her diabetes behaved; blood sugars stayed up OK and no ketones. She did run hot and cold without much of a fever and didn’t eat much throughout the day. But, as sick days go, it wasn’t too bad.

Later that night, we were eating dinner when we heard a loud noise, kind of like a popping sound, coming from somewhere in the house. We couldn’t find the source of the sound, and put it out of our mind. Until later that night, that is, when my husband went to feed the fish in his 55-gallon aquarium. When he lifted the lid, he noticed something didn’t look right; the frame for the lid was partially in the water. This same frame also held the aquarium lights, so he quickly removed them while I unplugged everything in the cabinet below.

With the lid, light, and frame gone, the source of the loud noise became clear; the center support connecting the front and back of the aquarium, and holding up the frame with lid and light, had snapped on the front right side. As my husband was troubleshooting the problem, we both looked at the side of the aquarium and saw that the front was BOWED! Not just a little bowed, but REALLY BOWED! Just as I was trying to get the words out “Oh no, the front is bowed, what do we do?!”, my husband said “The front is bowed, we have to get the water out now!” So, over the next two hours, we (mostly my husband) managed to siphon out the water before any leaks occurred. We also found the fish a new home that night, and they all made it through the transition to a new aquarium.

Without our daughter getting sick and postponing our vacation, we would have been gone that night. Obviously we don’t know how long the aquarium would have held together, but chances are good that our cat sitter would have found a HUGE mess the next day. Needless to say, 55-gallons is a lot of water.

So, to recap, daughter getting sick and having to postpone vacation – bad. Saving our house from an unmitigated disaster – good.

Amy

So Far, So Good

I just returned from my three-month diabetes and hypertension check-up. Everything seems to be going well. My A1C has leveled off at 5.7 (the past three numbers were 5.7, 5.6, and 5.7) and my blood pressure and heart rate are at normal levels. We are going to maintain current medications and levels and check again in six months.

My only remaining frustration is with my weight. The good news is that I am maintaining the 30 pounds I lost after my T2D diagnosis a year ago in March. The bad news is that my current weight is still solidly in the “overweight” BMI category.  So, I will be thinking about ways to alter my diet and adding a consistent exercise program.  Have you found an at-home exercise program that really works for you? Any ideas would be greatly appreciated.

Amy

Your Diabeteses May Vary

Your Diabetes May Vary (YDMV) is a familiar refrain from the members of the diabetes online community.  While we can learn from each others’ experiences, any differences in treatment, diet, exercise, stress, etc. will affect different people differently.  What works for one person will not necessary work in the same way, or at all, for someone else.

I was thinking about this phrase last week when reading Gary Scheiner’s blog post “Meet the Diabeteses.” As Gary points out, the calling card of every type of diabetes is the inability of the body to keep blood sugar levels in the normal range.  The causes of these high blood sugars differentiate the different types of diabetes or as Gary called them, diabeteses.

But even within a given type of diabetes, researchers and doctors don’t really know what caused it to occur.  Yes, for T1D, we know the immune system has attacked the beta cells in the pancreas.  But, why? What was the trigger and why are some people susceptible while others are not? It would stand to reason there are multiple genes involved with T1D and multiple triggers for the development of the disease.

So, why doesn’t the same reasoning apply for Type 2? We are constantly bombarded with the message that T2D is caused by poor diet, obesity, and lack of exercise. Therefore, if people would eat better, lose weight and get moving, T2D is preventable. Really? 100% preventable? We really understand enough about the causes of T2D to make this kind of blanket statement?

Joslin Diabetes Center posted a link today to Twitter about the difference between Type 1 and Type 2. I was very surprised and disappointed to see some of their descriptions of Type 2, especially the unequivocal answer as to whether or not Type 2 is preventable (yes) and reversible (yes, with diet and exercise).  I don’t know if my T2D was preventable or not; no one does.   But I certainly do know my T2D is NOT in any way, shape, or form reversible. No matter what I do for the rest of my life, I have T2D. I might have a normal A1C level, but I will always have T2D.

People are very quick to lay blame on people with T2D for their condition. But, not everyone who has T2D developed it for the same reason. Again, it would stand to reason that multiple genes are involved with T2D and multiple triggers exist for the development of the disease. Researchers and doctors simply don’t know enough about the causes of T2D or any types of diabetes to make these kinds of statements.  So, why did Joslin Diabetes Center, of all places, decide to perpetuate this misinformation?

Amy

P.S. I really liked reading Gary’s blog post (and books).  I especially liked that he made up the same word (diabeteses) as I did about a month ago during DSMA Wednesday night chat time.  Here’s my tweet in response to the question about whether we have a nickname for diabetes:

 

Control vs. Manage

As a parent of a child with Type 1 diabetes, I have been asked by people if my daughter’s diabetes is “under control.”  Until recently, I answered this question with information about her A1C and the A1C targets for her age.  Luckily, I haven’t run into people who question us about her diabetes based on individual blood sugar numbers.  But, after reading several different blog posts from adults with Type 1 or other parents of children with Type 1, I think I understand the problem with the “control” question.

First, look at the definition of the word control.  Here’s the definition most applicable to the “control” question.

  • to exercise restraining or directing influence over

This does not at all describe diabetes for a person with Type 1.  There are too many factors affecting blood sugar for anyone with Type 1 to actually “exercise direct influence” over their blood sugar levels.  Sometimes, you do everything “right,” and you end up with blood sugars in the 50s or 300s.

Instead, it’s more appropriate to say that people with Type 1 diabetes “manage” their condition.  Here’s the definition of manage:

  • to work upon or try to alter for a purpose

This is a much better description of diabetes for a person with Type 1.  People with Type 1 work 24/7/365 to keep blood sugars in the normal range for as much of the day as possible.  With current treatment methods, it’s not possible for people with Type 1 to “control” their blood sugars; to always have them in the normal range.

So, why are people with Type 1 diabetes asked if they have their diabetes “under control?”  I think this is another example of people confusing Type 1 with Type 2 diabetes.  In thinking about the differences between my diabetes and my daughter’s, I can actually “control” my blood sugars.  No, I can’t make a particular number come up every time I test my blood sugar.  However, by my actions, I can keep my blood sugars in the normal range.  I don’t have low blood sugars, and as long as I eat within my carb limits, I don’t have high blood sugars either.  Not all people with Type 2 diabetes can control their blood sugars through their actions, but public perception is that diabetes can be controlled as long as people eat right (whatever that is), exercise, and take their medications.

So, how should people with Type 1 or parents of children with Type 1 answer the “control” question? Should we try to educate people or should we just answer yes?

Amy

Lantus – Big Tall Bottle

I was looking at several other diabetes blogs the other day, and I came upon an article Scott K. Johnson wrote last November about the “scariest diabetes mistake” you can make: injecting fast acting insulin when you meant to inject long lasting insulin.  You can read his article here.

His article prompted me to share our method for avoiding the “scariest diabetes mistake.” In our house, we use Novolog (fast acting or bolus insulin) and Lantus (long lasting or basal insulin).  When my daughter was first diagnosed, I used the “L” in Lantus to remember it was the long lasting basal insulin. Here is a picture of the two bottles side by side.

bottles

We inject Lantus right before bed, usually around 9 o’clock.  On MDI, the amount of basal insulin injected is usually around 50% of the total amount of daily insulin.  In other words, we are injecting A LOT of insulin all at once.

Pretty early on, we realized the potential for the “scariest diabetes mistake” you can make, so my husband came up with a system to make sure we are injecting Lantus instead of Novolog.  When I prepare the Lantus injection, I call out “Lantus, big tall bottle.”  My husband then says “Big, tall bottle, says Lantus?”  This forces me to stop, focus, and make absolutely sure I have the correct bottle of insulin before preceding.

It’s a simple system, but it works for us.

Amy

 

Metformin

When I was first diagnosed with diabetes, my doctor wasn’t convinced I had Type 2.  I definitely fit the pattern for someone with Type 2, but given the quick increase in my A1C levels, he wanted to make sure I was still making insulin before starting me on any medications. It was clear I needed something besides diet and exercise to help control my blood sugars, especially my fasting levels.  Even on a diet of few carbs, I was still waking up with blood sugars between 140 and 170.

Once he verified I had Type 2, he prescribed 500 mg of metformin twice a day.  About a month later, he then raised the dose to 1000 mg twice a day; the dose I’m currently taking.  My fasting blood sugars now range from 100 to 110, with an occasional number below 100 or above 110.  I would really love to be under 100 on a consistent basis, but given my levels a year ago, I’ll take waking up at 105 any day.

So, how does metformin work? Doctors think metformin acts on the liver to reduce the amount of glucose released during fasting. Normally, the liver releases some of its stored glucose in response to low insulin levels in the blood during fasting to keep blood sugar levels from dropping too low. To the liver, low insulin means low blood glucose.  The liver doesn’t respond based on glucose, it responds based on insulin. Except, in many people with Type 2 diabetes, the liver is resistant to insulin; it doesn’t sense when insulin levels are high.  It responds as if there are low insulin levels, and releases glucose, exactly the opposite of what the body needs at the time.

Like all medications, metformin has side effects. The main ones are digestive: upset stomach, loose stools or diarrhea, etc. To help with these side effects, they recommend taking metformin with food. At first, I would take the pill and then sit down and eat my breakfast or dinner. After suffering through a couple of weeks of the above side effects, I started googling information about metformin. Most people reported needing to take metformin at the end of a meal to ward off these unpleasant side effects. For the most part, this has worked for me.

Metformin has been on the market for many years and has a good record of safety and effectiveness for treating Type 2 diabetes.  Except under special circumstances, it doesn’t cause low blood sugars, and is associated with weight loss, instead of weight gain like other Type 2 medications.

In addition to cutting the amount of carbs in my diet, taking metformin seems to help me live within my insulin budget.  Do you take metformin to treat your Type 2 diabetes? Does it work for you?

Amy

Carb Limits

After I was diagnosed with Type 2 diabetes last year, I spent at least two months figuring out how to keep within my insulin budget.  Mostly, this meant trying to determine how many carbs I could eat at each meal so that my blood sugar would be no higher than 140 two hours after eating.

At first, I went down to the carb limits I was given when I had gestational diabetes: 15 for breakfast, 30 – 45 for lunch and dinner, and 15 for snacks.  These limits didn’t work; my blood sugars were still too high, especially at breakfast and lunch.  So I started cutting.  Based on a lot of blood sugar testing, I figured out it works best when I eat 5-10 carbs right when I get up in the morning, followed by a breakfast with no more than 15 carbs at least an hour later.  For lunch, I can usually eat around 25 carbs and for dinner, between 30 – 40.  I usually eat a small snack of no more than 15 carbs at mid morning and another one at mid afternoon.

Now that I have established my carb limits, I generally test each meal once a week to make sure they still work.  Occasionally, I do go outside these limits.  When this happens, I try to get some exercise after I eat to keep my blood sugars from going too high.  Most of the time I’m successful, but not always.  I feel it when my blood sugar is high, so it’s good motivation for staying within my carb limits.

Do you have carb limits for your meals and snacks?  How did you determine them and have they changed over time?

Amy